Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the brazupa study

CNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOStudies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. Methods: This study presents cross sectional, Baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. Results: Patients with ulcer had longer disease duration (17.2 +/- 9.9 vs. 13.2 +/- 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 +/- 2.03 vs. 8.35 +/- 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. Conclusions: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population825CNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOCNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOsem informaçã

Playoffs or Just League: A Debate in Brazilian Football

After several consecutive seasons in the league, the Campeonato Brasileiro may return to the playoffs format. The Brazilian Football Confederation (CBF) and some Brazilian clubs commented that this format will provide higher competitive balance and increase the interest of Brazilian football fans. Therefore, the objective of this paper is to assess the competitiveness and the interest of Brazilian fans in the last twenty-four seasons: Playoffs (1991-2002) and League (2003-2014). The competitiveness is evaluated by Herfindahl Index of Competitive Balance (HICB) and C4 Index of Competitive Balance and the interest measured by the average attendance to the stadiums. The results show that Brazilian League has become more balanced since 2003 season and football fans are more interested in the tournament with league format. The main conclusion is that the change to the playoffs would not improve the competitiveness and the interest of fans. Moreover some problems of the Brazilian football market are commented and some solutions proposed to improve it