Programas de suplementação alimentar: análise crítica

A critical analysis of the Supplementary Feeding Programs which have been undertaken around the world is presented. Although only a few programs have been rigorously evaluated it seems that in relation to their main objectives, most of them have not proved to be successful. Some suggestions for improvement are put forward and the particular case of the Brazilian programs is assessed in detail.Foi feita análise crítica dos Programas de Suplementação Alimentar no Brasil e em vários outros países do mundo. Embora poucos programas tenham sido rigorosamente avaliados, observa-se que em relação aos seus principais objetivos a maioria deles não tem se mostrado satisfatória. Algumas medidas são sugeridas para melhorá-los, dando-se ênfase especial aos programas no Brasil

Symmetric chain decomposition for cyclic quotients of Boolean algebras and relation to cyclic crystals

The quotient of a Boolean algebra by a cyclic group is proven to have a symmetric chain decomposition. This generalizes earlier work of Griggs, Killian and Savage on the case of prime order, giving an explicit construction for any order, prime or composite. The combinatorial map specifying how to proceed downward in a symmetric chain is shown to be a natural cyclic analogue of the $\mathfrak{sl}_2$ lowering operator in the theory of crystal bases.Comment: minor revisions; to appear in IMR

Cost and affordability of healthy food in rural South Australia

The unaffordability of healthy food, or ‘food stress’ in low SES groups is a concern, especially when this group carries the greatest burden of diet-related disease. Findings suggest that there is a need to consider both rural location and SES when developing policy responses to decrease the cost and increase the affordability of healthy foods in rural and remote areas

Estadio de maduración de terceros molares inferiores en radiografías panorámicas digitales de pacientes del servicio de radiología del C.C.O. de la Universidad de Talca el año 2010

63 p.Introducción: Se reportan dos métodos frecuentemente utilizados en la adolescencia, para la evaluación de la edad cronológica. El primero es el examen morfológico observando las características del esqueleto y el segundo es el examen radiológico de los dientes tomando como referencia el desarrollo de los terceros molares. El tercer molar ofrece una ventaja única sobre otros dientes porque su desarrollo tiende a continuar por un largo período y hasta una edad más avanzada, cuando el resto de las piezas dentarias ya han terminado su formación. Sin embargo, hay factores genéticos, ambientales y hormonales que pueden alterar la relación que existe entre la formación de las piezas dentarias y su erupción con respecto a la edad cronológica. Demirjian y col., en 1973, desarrolló un método para estimar edad cronológica y su relación con la edad dental, lo cuál ha sido comprobado en numerosos estudios. Objetivo General: Determinar los estadios de maduración de los terceros molares inferiores del lado derecho e izquierdo y su distribución respecto a edad cronológica y género, en pacientes de 9 a 20 años. Materiales y Método: Se realizo un estudio tipo transversal. Se recopilaron 738 radiografías digitales panorámicas de pacientes ente 9 y 20 años de edad, atendidos en el Servicio de Radiología del C.C.O de la Universidad de Talca el año 2010. Se evaluó el estado de maduración de ambos terceros molares inferiores, utilizando la metodología propuesta por Demirjian. El análisis de los resultados se realizó con el programa SPSS versión 14.0. Resultados: El estadio de maduración A, se obtuvo a los 9 años, el estadio de maduración D, a los 13 años y el estadio de maduración H a los 18 años, encontrándose diferencias significativas entre hombres y mujeres, en dónde los primeros presentan un desarrollo que precede a las mujeres. En relación a diferencias de maduración entre tercer molar del lado derecho e izquierdo fue de 1 a 3 meses, con ventaja la ventaja para el tercer molar inferior derecho. Conclusiones: El inicio de la calcificación coronaria se encontró a los 9 años, el término de la formación coronaria a los 13 años y el término de la formación radicular, a los 18 años. Los hombres aventajan en maduración a las mujeres y en ausencia de un tercer molar inferior, podemos utilizar el contralateral para estimar edad cronológica. PALABRAS CLAVES: Tercer molar inferior, Demirjian, radiografías panorámicas

A single polyploidization event at the origin of the tetraploid genome of Coffea arabica is responsible for the extremely low genetic variation in wild and cultivated germplasm

The genome of the allotetraploid species Coffea arabica L. was sequenced to assemble independently the two component subgenomes (putatively deriving from C. canephora and C. eugenioides) and to perform a genome-wide analysis of the genetic diversity in cultivated coffee germplasm and in wild populations growing in the center of origin of the species. We assembled a total length of 1.536 Gbp, 444 Mb and 527 Mb of which were assigned to the canephora and eugenioides subgenomes, respectively, and predicted 46,562 gene models, 21,254 and 22,888 of which were assigned to the canephora and to the eugeniodes subgenome, respectively. Through a genome-wide SNP genotyping of 736 C. arabica accessions, we analyzed the genetic diversity in the species and its relationship with geographic distribution and historical records. We observed a weak population structure due to low-frequency derived alleles and highly negative values of Taijma's D, suggesting a recent and severe bottleneck, most likely resulting from a single event of polyploidization, not only for the cultivated germplasm but also for the entire species. This conclusion is strongly supported by forward simulations of mutation accumulation. However, PCA revealed a cline of genetic diversity reflecting a west-to-east geographical distribution from the center of origin in East Africa to the Arabian Peninsula. The extremely low levels of variation observed in the species, as a consequence of the polyploidization event, make the exploitation of diversity within the species for breeding purposes less interesting than in most crop species and stress the need for introgression of new variability from the diploid progenitors

Leitsymptom Hämatemesis

Eine 62-jährige Patientin wurde notfallmäßig bei Hämatemesis, arterieller Hypotonie, Anämie und hämodynamischer Instabilität auf unsere Intensivstation aufgenommen. Bekannt war eine AL-Amyloidose mit kardialer Beteiligung und Omentuminfiltration. Im Rahmen dieser erhielt die Patientin 6 Tage vor dem Ereignis den zweiten Zyklus Chemotherapie mit Daratumumab und Cyclophosphamid, Bortezomib und Dexamethason. In der Medikation fanden sich Acetylsalicylsäure (ASS) und Apixaban bei Zustand nach akuter Beinischämie links. In der Notaufnahme trat eine weitere akute Hämatemesisepisode mit einem konsekutiven Hämoglobinabfall auf. Zur hämodynamischen Stabilisierung und zur notfallmäßigen endoskopischen Untersuchung und Blutstillung erfolgte die Verlegung auf unsere Intensivstation

Protocolo para ensaio clínico randomizado : psicoeducação por telefone e apoio para cuidadoras informais femininas de pacientes com demência

OBJECTIVE: The burden felt by informal caregivers of patients with dementia is a source of physical, emotional, and financial problems. Face-to-face interventions for caregivers have accessibility limitations that may prevent them from receiving adequate care. Telehealth tools can be a solution to this problem. We will compare a telephone psychoeducational and support intervention protocol to usual care for informal female caregivers of patients with dementia treated at Brazilian specialized outpatient clinics. METHODS: In this single-blind randomized clinical trial, the intervention group will receive one weekly call for 8 weeks that addresses issues such as disease education, communication with the patient, and problematic behaviors. The control group will receive printed material on problematic behaviors in dementia. The primary outcome will be the difference in caregiver burden between baseline and 8 weeks, which will be assessed by blinded investigators through the Zarit Burden Interview scale. Caregiver burden at 16 weeks after baseline, depression, anxiety, and quality of life at 8 and 16 weeks are secondary outcomes. CONCLUSIONS: We expect the intervention to reduce caregiver burden. These results could lead to public health programs for improving dementia care in lower-middle-income countries. Ethics and dissemination: This trial was approved by an independent ethics committee. The results will be published in an international peer-reviewed medical journal. Trial registration number: NCT03260608.OBJETIVO: A sobrecarga sentida por cuidadores informais de pacientes com demência é uma fonte de problemas físicos, emocionais e financeiros. As intervenções face a face para cuidadores apresentam limitações de acessibilidade que podem impedilos de receber cuidados adequados. As ferramentas de telessaúde podem ser uma solução para esse problema. Comparamos um protocolo de intervenção psicoeducacional e de apoio por telefone ao tratamento usual para cuidadoras informais de pacientes com demência tratados em ambulatórios especializados. METODOLOGIA: Será realizado um ensaio clínico randomizado simples-cego. Durante 8 semanas, o grupo de intervenção receberá uma ligação semanal abordando questões como educação sobre a doença, comunicação com o paciente e comportamentos problemáticos. O grupo controle receberá material impresso sobre comportamentos problemáticos na demência. O resultado primário será a diferença na sobrecarga da cuidadora entre o ponto de partida e oito semanas, que será avaliada por pesquisadores cegos com a escala Zarit Burden Interview. Sobrecarga da cuidadora em dezesseis semanas após o início do estudo, depressão, ansiedade e qualidade de vida após oito e dezesseis semanas são resultados secundários. CONCLUSÕES: Esperamos que a intervenção reduza a sobrecarga da cuidadora. Esses resultados podem levar a programas de saúde pública para melhorar o tratamento da demência em países de renda médiabaixa. Ética e divulgação: Este estudo foi aprovado por um comitê de ética independente. Os resultados serão publicados em uma revista médica internacional revisada por pares. Número de registro do teste: NCT03260608

The intrafamilial transmission of rheumatoid arthritis--II : An interview measure of rheumatoid arthritis

Our conclusion is that we have a very usable instrument in the 4-point RA measure, and that if our assumptions are correct, the associations to be presented in subsequent papers are just as true as if the respondents had been examined by a physician equipped with X-ray and laboratory facilities. In some senses this is an affirmation of the medical dictum that the history is by all odds the most important part of a medical evaluation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/32905/1/0000285.pd

Autophagy and ATP-induced anti-apoptosis in antigen presenting cells (APC) follows the cytokine storm in patients after major trauma

Severe trauma and the systemic inflammatory response syndrome (SIRS) occur as a result of a cytokine storm which is in part due to ATP released from damaged tissue. This pathology also leads to increased numbers of immature antigen presenting cells (APC) sharing properties of dendritic cells (DC) or macrophages (MΦ). The occurrence of immature APC appears to coincide with the reactivation of herpes virus infections such as Epstein Barr virus (EBV). The aim of this study was the comparative analysis of the ultrastructural and functional characteristics of such immature APC. In addition, we investigated EBV infection/ reactivation and whether immature APC might be targets for natural killers (NK). Significant macroautophagy, mitochondrial degradation and multivesicular body formation together with the identification of herpes virus particles were morphological findings associated with immature APC. Exogenous stressors such as ATP further increased morphological signs of autophagy, including LC3 expression. Functional tests using fluorescent bacteria proved impaired phagolysosome fusion. However, immature APC were susceptible to NK-92-mediated cytolysis. We found evidence for EBV latency state II infection by detecting EBV-specific LMP1 and EBNA2 in immature APC and in whole blood of these patients. In summary, trauma-induced cytokine storms may induce maturation arrest of APC, promote ATP-induced autophagy, support EBV persistence and impair the degradation of phagocytozed bacteria through inefficient phagolysosome fusion. The susceptibility to NK-mediated cytolysis supports the hypothesis that NK function is likely to contribute to immune reconstitution after major trauma by regulating immature APC, and ATP-induced autophagy and survival