Controle glicêmico em pacientes diabéticos atendidos em centros de atenção primária à saúde

OBJECTIVE: To identify factors associated to poor glycemic control among diabetic patients seen at primary health care centers. METHODS: A cross-sectional study was carried out in a sample of 372 diabetic patients attending 32 primary health care centers in southern Brazil. Data on three hierarchical levels of health unit infrastructure, medical care and patient characteristics were collected. RESULTS: The frequency of poor glycemic control was 50.5%. Multivariate analysis (multilevel method) showed that patients with body mass indexes below 27 kg/m², patients on oral hypoglycemic agents or insulin, and patients diagnosed as diabetic over five years prior to the interview were more likely to present poor glycemic control when compared to their counterparts. CONCLUSIONS: Given the hierarchical data structuring, all associations found suggest that factors associated to hyperglycemia are related to patient-level characteristics.OBJETIVO: Identificar fatores associados à falta de controle glicêmico em pacientes diabéticos atendidos em centros de atenção primária à saúde. MÉTODOS: Estudo transversal em amostra de 372 pacientes diabéticos atendidos nos 32 centros de atenção primária de uma cidade do sul do Brasil. Foram coletados dados ordenados em três níveis hierárquicos: estrutura das unidades de saúde, características do processo do cuidado médico e pacientes diabéticos. RESULTADOS: A freqüência de falta de controle glicêmico foi de 50,5%. A análise multivariada (método multinível) mostrou que pacientes com Índice de Massa Corporal abaixo de 27 kg/m², em tratamento medicamentoso e com mais de cinco anos de diagnóstico de diabetes, tiveram maior probabilidade de apresentar hiperglicemia quando comparados a seus pares. CONCLUSÕES: Considerando a estrutura hierárquica dos dados, todas as associações encontradas sugerem que os fatores associados à hiperglicemia são relacionados a características dos pacientes

Avaliação do impacto de um programa de suplementação alimentar para crianças desnutridas no Brasil

Um estudo prospectivo, controlado foi realizado no Nordeste do Brasil para avaliar a efetividade de um programa de suplementação alimentar (Programa do Leite) sobre crescimento infantil e composição corporal. Ao ingressar no programa, crianças de dez municípios com as maiores taxas de cobertura do programa (intervenção) foram comparadas a crianças não-beneficiárias de dez municípios com as menores taxas de cobertura (controle). Um total de 219 crianças de 6-18 meses de idade foram arroladas. Ao entrar no estudo, ambos os grupos eram comparáveis quanto a sexo, idade e estado nutricional. Houve freqüentes falhas na entrega do suplemento, não foi fornecido leite para os familiares menores de cinco anos, a redistribuição intradomiciliar do leite foi alta e a adesão materna ao recomendado, baixa. Análises ajustadas por modelos multiníveis mostraram variações em peso, comprimento, escore Z peso-idade, comprimento-idade e água corporal (método deutério), em seis meses, respectivamente de 1,53kg; 6,34cm; 0,33; 0,05 e 1,11%, entre as suplementadas; contra 1,54kg; 6,57cm; 0,26; 0,07 e 4,10% entre as controles, sem diferença estatisticamente significativa entre os grupos. Conclui-se que o programa não foi efetivo para compensar deficiências nutricionais no nordeste brasileiro.To assess the effectiveness on child growth and body composition of a supplementary feeding program (Milk Supplement Program), a prospective, controlled study was conducted in Northeast Brazil. When entering the Program, children from 10 municipalities with the highest coverage rates in the Program (intervention group) were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates (control group). A total of 219 children aged 6-18 months were enrolled. At entry, both groups were comparable in terms of age, sex, and nutritional status. There were frequent gaps in delivery of the supplement, no extra milk was provided to siblings less than 5 years of age, intra-household redistribution of milk was high, and maternal compliance with recommendations was low. Adjusted analyses by multilevel modelling showed average changes in weight, length, weight-age and length-age Z-scores, and % body water (deuterium method), at 6 months, of 1.53kg, 6.34cm, 0.33, 0.05, and 1.11% respectively among supplemented children as compared to 1.54kg, 6.5cm, 0.26, 0.07, and 4.10% among controls, with no statistically significant difference between groups. Thus, the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil

The granite‑hosted Variscan gold deposit from Santo António mine in the Iberian Massif (Penedono, NW Portugal): constraints from mineral chemistry, fuid inclusions, sulfur and noble gases isotopes

The study area is located in the Central Iberian Zone, a major tectonic unit of the Iberian Massif (Variscan belt). In this region the basement is composed of Cambrian-Ordovician sedimentary and minor volcanic rocks that underwent deformation and metamorphism during the Carboniferous. These metamorphic rocks host ca. 331–308 Ma granitic plutons emplaced during the D2 extensional and D3–D4 contractional deformation phases. The gold-bearing quartz veins from the Santo António mine (Penedono region) occur in granite formed at 310.1 ± 1.1 Ma and post-dated the peak of metamorphism. Gold–silver alloy is included in quartz, but mainly occurs in spaces between grains or micro-fractures within arsenopyrite of all three generations and less in pyrite. Late sulphides and sulphosalts were deposited along fractures mainly in arsenopyrite, and locally surrounding the gold–silver alloy grains. Ferberite, scheelite and stolzite replace arsenopyrite. The abundant aqueous carbonic fluids and the occurrence of a low-salinity fluid and their minimum possible entrapment temperature of 360–380 °C suggest that this gold-forming event began during the waning stages of the Variscan orogeny. The mean δ34S values of arsenopyrite and pyrite are − 4.7‰ and − 3.8‰, respectively. He–Ar–Ne isotopic data suggest a crustal origin. The ascent of the granite magma has provided the heat for remobilization of gold, other metals and metalloids from the metamorphic rocks. This gold-arsenopyrite deposit has thus similar characteristics as other selected gold-arsenopyrite deposits from the Iberian Massif, but it contains tungstates.El área de estudio está ubicada en la Zona Centroibérica, una importante unidad tectónica del Macizo Ibérico (cinturón varisco). En esta región el basamento está compuesto por rocas sedimentarias y volcánicas del Cámbrico-Ordovícico tectonizadas y metamorfzadas durante el Carbonífero. Estas rocas metamórfcas sirven como caja de los plutones graníticos datados en torno a 331–308 Ma y que fueron emplazados durante la fase de deformación extensional D2 y las fases de deformación contraccional D3 y D4. Las venas de cuarzo ricas en oro de la mina de Santo António (región de Penedono) que aparecen en un granito datado a los 310.1 ± 1.1 Ma son posteriores al pico metamórfco regional. La aleación de oro y plata se incluye en el cuarzo, pero se produce principalmente en los espacios entre granos o micro-fracturas dentro de arsenopirita de las tres generaciones y menos en pirita. Los sulfuros y sulfuros tardíos se depositaron a lo largo de las fracturas principalmente en arsenopirita, y alrededor de los granos de aleación de oro y plata. Ferberita, scheelita y la estolzita sustituyen a la arsenopirita. Los abundantes líquidos acuosos carbónicos y la presencia de un fuido de baja salinidad y su posible temperatura de atrapamiento mínima en torno de 360-380 ºC sugieren que este evento de formación de oro comenzó durante las etapas fnales de la orogenia varisca. Los valores medios de S de arsenopirita y pirita son − 4.7 ‰ y − 3.8 ‰, respectivamente. Los datos isotópicos de He–Ar–Ne sugieren que en el origen de los fuidos mineralizados participa la corteza continental. El ascenso del magma granítico ha provisto el calor para la movilización del oro, otros metales y metaloides desde las rocas metamórfcas. Este depósito de oroarsenopirita tiene así características similares a otros yaciamientos con arsenopirita y oro del Macizo Ibérico, pero sin embargo contienen tungstates.This research was financially supported by Fundação para a Ciência e Tecnologia through the projects GOLDGranites, Orogenesis, Long-term strain/stress and Deposition of ore metals—PTDC/GEO-GEO/2446/2012: COMPETE: FCOMP-01-0124-FEDER-029192 and UID/GEO/04035/2013

Micromechanical Properties of Injection-Molded Starch–Wood Particle Composites

The micromechanical properties of injection molded starch–wood particle composites were investigated as a function of particle content and humidity conditions. The composite materials were characterized by scanning electron microscopy and X-ray diffraction methods. The microhardness of the composites was shown to increase notably with the concentration of the wood particles. In addition,creep behavior under the indenter and temperature dependence were evaluated in terms of the independent contribution of the starch matrix and the wood microparticles to the hardness value. The influence of drying time on the density and weight uptake of the injection-molded composites was highlighted. The results revealed the role of the mechanism of water evaporation, showing that the dependence of water uptake and temperature was greater for the starch–wood composites than for the pure starch sample. Experiments performed during the drying process at 70°C indicated that the wood in the starch composites did not prevent water loss from the samples.Peer reviewe

A Solve-RD ClinVar-based reanalysis of 1522 index cases from ERN-ITHACA reveals common pitfalls and misinterpretations in exome sequencing

Purpose Within the Solve-RD project (https://solve-rd.eu/), the European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies aimed to investigate whether a reanalysis of exomes from unsolved cases based on ClinVar annotations could establish additional diagnoses. We present the results of the “ClinVar low-hanging fruit” reanalysis, reasons for the failure of previous analyses, and lessons learned. Methods Data from the first 3576 exomes (1522 probands and 2054 relatives) collected from European Reference Network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies was reanalyzed by the Solve-RD consortium by evaluating for the presence of single-nucleotide variant, and small insertions and deletions already reported as (likely) pathogenic in ClinVar. Variants were filtered according to frequency, genotype, and mode of inheritance and reinterpreted. Results We identified causal variants in 59 cases (3.9%), 50 of them also raised by other approaches and 9 leading to new diagnoses, highlighting interpretation challenges: variants in genes not known to be involved in human disease at the time of the first analysis, misleading genotypes, or variants undetected by local pipelines (variants in off-target regions, low quality filters, low allelic balance, or high frequency). Conclusion The “ClinVar low-hanging fruit” analysis represents an effective, fast, and easy approach to recover causal variants from exome sequencing data, herewith contributing to the reduction of the diagnostic deadlock

Evaluation of the impact of a nutritional program for undernourished children in Brazil Avaliação do impacto de um programa de suplementação alimentar para crianças desnutridas no Brasil

To assess the effectiveness on child growth and body composition of a supplementary feeding program (Milk Supplement Program), a prospective, controlled study was conducted in Northeast Brazil. When entering the Program, children from 10 municipalities with the highest coverage rates in the Program (intervention group) were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates (control group). A total of 219 children aged 6-18 months were enrolled. At entry, both groups were comparable in terms of age, sex, and nutritional status. There were frequent gaps in delivery of the supplement, no extra milk was provided to siblings less than 5 years of age, intra-household redistribution of milk was high, and maternal compliance with recommendations was low. Adjusted analyses by multilevel modelling showed average changes in weight, length, weight-age and length-age Z-scores, and % body water (deuterium method), at 6 months, of 1.53kg, 6.34cm, 0.33, 0.05, and 1.11% respectively among supplemented children as compared to 1.54kg, 6.5cm, 0.26, 0.07, and 4.10% among controls, with no statistically significant difference between groups. Thus, the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil.<br>Um estudo prospectivo, controlado foi realizado no Nordeste do Brasil para avaliar a efetividade de um programa de suplementação alimentar (Programa do Leite) sobre crescimento infantil e composição corporal. Ao ingressar no programa, crianças de dez municípios com as maiores taxas de cobertura do programa (intervenção) foram comparadas a crianças não-beneficiárias de dez municípios com as menores taxas de cobertura (controle). Um total de 219 crianças de 6-18 meses de idade foram arroladas. Ao entrar no estudo, ambos os grupos eram comparáveis quanto a sexo, idade e estado nutricional. Houve freqüentes falhas na entrega do suplemento, não foi fornecido leite para os familiares menores de cinco anos, a redistribuição intradomiciliar do leite foi alta e a adesão materna ao recomendado, baixa. Análises ajustadas por modelos multiníveis mostraram variações em peso, comprimento, escore Z peso-idade, comprimento-idade e água corporal (método deutério), em seis meses, respectivamente de 1,53kg; 6,34cm; 0,33; 0,05 e 1,11%, entre as suplementadas; contra 1,54kg; 6,57cm; 0,26; 0,07 e 4,10% entre as controles, sem diferença estatisticamente significativa entre os grupos. Conclui-se que o programa não foi efetivo para compensar deficiências nutricionais no nordeste brasileiro