Qualidade de vida de pacientes submetidos à cirurgia bariátrica: estudo transversal

Purpose: Analyze factors that influenced the quality of life (QoL) of patients after bariatric surgery. Methods: A cross-sectional study was carried out, involving 307 adult bariatric surgery patients between 2012 and 2014. Data was obtained from the electronic patient records and telephone interviews. To assess the QoL, the World Health Organization Quality of Life-Bref (WHOQOL-bref) was used. A simple linear regression model was constructed, adjusted by sociodemographic variables, with p<0.05. Results: The domains with the worst scores were the physical (mean=58.45; SD±10.42) and environmental (mean=65.19; SD±11.36). The best domains were the social (mean=76.51; SD±15.71) and psychological (mean=68.70; SD±15.71). In the linear regression model, it was observed that time since the surgery was inversely associated with the physical health domain. For each month post-bariatric surgery, the patient’s average score dropped by 2.66 points, adjusted by sex and age. Conclusions: Time since the surgery could be an important determinant of the physical domain score of quality of life. Identifying the quality of life after bariatric surgery and influential factors is fundamental to prepare these patients for the changes deriving from the weight loss.Objetivo: Analizar los factores que influyeron en la calidad de vida (CV) de los pacientes después de la cirugía bariátrica. Métodos: Se llevó a cabo un estudio transversal en el que participaron 307 pacientes adultos con cirugía bariátrica entre 2012 y 2014. Se han obtenido los datos de los registros electrónicos de los pacientes y de sus entrevistas telefónicas. Después se construyó un modelo de regresión lineal simple, ajustado por variables sociodemográficas, con p <0.05. Para evaluar la CV, se utilizó la Calidad de Vida Breve de la Organización Mundial de la Salud (WHOQOL-bref). Resultados: Los dominios con las peores puntuaciones fueron el físico (media = 58,45; SD ± 10,42) y ambiental (media = 65,19; SD ± 11,36). Los mejores dominios fueron el social (media = 76.51; SD ± 15.71) y psicológico (media = 68.70; SD ± 15.71). En el modelo de regresión lineal, se observó que el tiempo desde la cirugía se asoció inversamente con el dominio de la salud física. Por cada mes posterior a la cirugía bariátrica, el puntaje promedio del paciente se redujo en 2.66 puntos, ajustado por sexo y edad. Conclusión: El tiempo transcurrido desde la cirugía puede ser un determinante importante de la puntuación del dominio físico de la calidad de vida. Identificar la calidad de vida después de la cirugía bariátrica y los factores influyentes es fundamental para preparar a estos pacientes para los cambios derivados de la pérdida de peso.Objetivo: Analisar os fatores que influenciaram a qualidade de vida (QV) dos pacientes após a cirurgia bariátrica. Método: Realizado um estudo transversal envolvendo 307 pacientes adultos submetidos à cirurgia bariátrica, no período de 2012 a 2014. Os dados foram obtidos por meio de prontuário eletrônico e entrevistas telefônicas. Para avaliar a QV, foi utilizada a World Health Organization Quality of Life-bref (WHOQOL-bref). Um modelo de regressão linear simples foi construído, ajustado por variáveis sociodemográficas, com p <0,05.Resultados: Os domínios com os piores escores foram físico (média = 58,45; DP ± 10,42) e ambiental (média = 65,19; DP ± 11,36). Os melhores domínios foram o social (média = 76,51; DP ± 15,71) e o psicológico (média = 68,70; DP ± 15,71). No modelo de regressão linear, observou-se que o tempo desde a cirurgia foi inversamente associado ao domínio saúde física. Para cada mês pós-cirurgia bariátrica, a pontuação média do paciente caiu em 2,66 pontos, ajustada por sexo e idade. Conclusão: O tempo desde a cirurgia pode ser um importante determinante do escore do domínio físico de QV. Identificar a QV após a cirurgia bariátrica e fatores que a influenciam é fundamental para preparar esses pacientes para as mudanças decorrentes da perda de peso

How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men?

BACKGROUND: Falls affect approximately one third of community-dwelling older adults each year and have serious health and social consequences. Fear of falling (FOF) (lack of confidence in maintaining balance during normal activities) affects many older adults, irrespective of whether they have actually experienced falls. Both falls and fear of falls may result in restrictions of physical activity, which in turn have health consequences. To date the relation between (i) falls and (ii) fear of falling with physical activity have not been investigated using objectively measured activity data which permits examination of different intensities of activity and sedentary behaviour. METHODS: Cross-sectional study of 1680 men aged 71-92 years recruited from primary care practices who were part of an on-going population-based cohort. Men reported falls history in previous 12 months, FOF, health status and demographic characteristics. Men wore a GT3x accelerometer over the hip for 7 days. RESULTS: Among the 12% of men who had recurrent falls, daily activity levels were lower than among non-fallers; 942 (95% CI 503, 1381) fewer steps/day, 12(95% CI 2, 22) minutes less in light activity, 10(95% CI 5, 15) minutes less in moderate to vigorous PA [MVPA] and 22(95% CI 9, 35) minutes more in sedentary behaviour. 16% (n = 254) of men reported FOF, of whom 52% (n = 133) had fallen in the past year. Physical activity deficits were even greater in the men who reported that they were fearful of falling than in men who had fallen. Men who were fearful of falling took 1766(95% CI 1391, 2142) fewer steps/day than men who were not fearful, and spent 27(95% CI 18, 36) minutes less in light PA, 18(95% CI 13, 22) minutes less in MVPA, and 45(95% CI 34, 56) minutes more in sedentary behaviour. The significant differences in activity levels between (i) fallers and non-fallers and (ii) men who were fearful of falling or not fearful, were mediated by similar variables; lower exercise self-efficacy, fewer excursions from home and more mobility difficulties. CONCLUSIONS: Falls and in particular fear of falling are important barriers to older people gaining health benefits of walking and MVPA. Future studies should assess the longitudinal associations between falls and physical activity

Spatial extremes of wildfire sizes: Bayesian hieralquical models for extremes

In Portugal, due to the combination of climatological and ecological factors, large wildfires are a constant threat and due to their economic impact, a big policy issue. In order to organize efficient fire fighting capacity and resource management, correct quantification of the risk of large wildfires are needed. In this paper, we quantify the regional risk of large wildfire sizes, by fitting a Generalized Pareto distribution to excesses over a suitably chosen high threshold. Spatio-temporal variations are introduced into the model through model parameters with suitably chosen link functions. The inference on these models are carried using Bayesian Hierarchical Models and Markov chain Monte Carlo methods

Comparative transcriptomic analysis reveals similarities and dissimilarities in saccharomyces cerevisiae wine strains response to nitrogen availability

Nitrogen levels in grape-juices are of major importance in winemaking ensuring adequate yeast growth and fermentation performance. Here we used a comparative transcriptome analysis to uncover wine yeasts responses to nitrogen availability during fermentation. Gene expression was assessed in three genetically and phenotypically divergent commercial wine strains (CEG, VL1 and QA23), under low (67 mg/L) and high nitrogen (670 mg/L) regimes, at three time points during fermentation (12h, 24h and 96h). Two-way ANOVA analysis of each fermentation condition led to the identification of genes whose expression was dependent on strain, fermentation stage and on the interaction of both factors. The high fermenter yeast strain QA23 was more clearly distinct from the other two strains, by differential expression of genes involved in flocculation, mitochondrial functions, energy generation and protein folding and stabilization. For all strains, higher transcriptional variability due to fermentation stage was seen in the high nitrogen fermentations. A positive correlation between maximum fermentation rate and the expression of genes involved in stress response was observed. The finding of common genes correlated with both fermentation activity and nitrogen up-take underlies the role of nitrogen on yeast fermentative fitness. The comparative analysis of genes differentially expressed between both fermentation conditions at 12h, where the main difference was the level of nitrogen available, showed the highest variability amongst strains revealing strain-specific responses. Nevertheless, we were able to identify a small set of genes whose expression profiles can quantitatively assess the common response of the yeast strains to varying nitrogen conditions. The use of three contrasting yeast strains in gene expression analysis prompts the identification of more reliable, accurate and reproducible biomarkers that will facilitate the diagnosis of deficiency of this nutrient in the grape-musts and the development of strategies to optimize yeast performance in industrial fermentations

Transgenic expression of the dicotyledonous pattern recognition receptor EFR in rice leads to ligand-dependent activation of defense responses

Plant plasma membrane localized pattern recognition receptors (PRRs) detect extracellular pathogen-associated molecules. PRRs such as Arabidopsis EFR and rice XA21 are taxonomically restricted and are absent from most plant genomes. Here we show that rice plants expressing EFR or the chimeric receptor EFR::XA21, containing the EFR ectodomain and the XA21 intracellular domain, sense both Escherichia coli- and Xanthomonas oryzae pv. oryzae (Xoo)-derived elf18 peptides at sub-nanomolar concentrations. Treatment of EFR and EFR::XA21 rice leaf tissue with elf18 leads to MAP kinase activation, reactive oxygen production and defense gene expression. Although expression of EFR does not lead to robust enhanced resistance to fully virulent Xoo isolates, it does lead to quantitatively enhanced resistance to weakly virulent Xoo isolates. EFR interacts with OsSERK2 and the XA21 binding protein 24 (XB24), two key components of the rice XA21-mediated immune response. Rice-EFR plants silenced for OsSERK2, or overexpressing rice XB24 are compromised in elf18-induced reactive oxygen production and defense gene expression indicating that these proteins are also important for EFR-mediated signaling in transgenic rice. Taken together, our results demonstrate the potential feasibility of enhancing disease resistance in rice and possibly other monocotyledonous crop species by expression of dicotyledonous PRRs. Our results also suggest that Arabidopsis EFR utilizes at least a subset of the known endogenous rice XA21 signaling components

Feasibility of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity in community-living older people: a process evaluation

BACKGROUND: Fear of falling and associated avoidance of activity are common among older people and may have negative consequences in terms of functional decline, quality of life and institutionalisation. We evaluated the effects of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity among older persons. This intervention showed favourable effects on fear of falling, avoidance of activity, daily activity, and several secondary outcomes. The aim of the present study is to assess the feasibility of this cognitive behavioural group intervention for participants and facilitators. METHODS: The intervention consisted of eight weekly group sessions lasting two hours each and a booster session after six months. Self-administered questionnaires, registration forms and interviews were used to collect data from participants (n = 168) and facilitators (n = 6) on the extent to which the intervention was performed according to protocol, participant attendance, participant adherence, and participants' and facilitators' opinion of the intervention. Quantitative data from the questionnaires and registration forms were analysed by means of descriptive statistics. Qualitative data were categorised based on matching contents of the answers. RESULTS: Facilitators reported no major protocol deviations. Twenty-six percent of the participants withdrew before the start of the programme. Of the persons who started the programme, 84% actually completed it. The participants reported their adherence as good, but facilitators had a less favourable opinion of this. The majority of participants still reported substantial benefits from the programme after six and twelve months of follow-up (71% and 61% respectively). Both participants and facilitators provided suggestions for improvement of the intervention. CONCLUSION: Results of this study show that the current cognitive behavioural group intervention is feasible for both participants and facilitators and fits in well with regular care. Minor refinement of the intervention, however, is warranted to further improve intervention effectiveness and efficiency. Based on these positive findings, we recommend implementing a refined version of this effective and feasible intervention in regular care. TRIAL REGISTRATION: ISRCTN43792817