Fatores associados a quedas em pacientes idosos ambulatoriais menos ativos e mais ativos

BACKGROUND: Fall-related factors in older adults with different levels of physical activity, within a multidimensional approach, have not been widely investigated. OBJECTIVE: To explore fall-related factors among older adults with different physical activity levels. METHODS: A cross-sectional, exploratory study with 118 older adult outpatients. Participants who reported at least one fall in the previous 12 months were considered fallers. The activity level was assessed through the Human Activity Profile. A cutoff of 54 points was used to define the less active group and the more active group. A multidimensional questionnaire and a set of physical functioning tests were applied. RESULTS: Fall prevalence was lower among the more active older adults (47.4%) when compared with the less active older adults (71.4%) (p<0.013). Logistic regression analysis showed that, among the more active group, falls were associated with: depressive symptoms (OR=0.747, 95%CI=0.575-0.970; p=0.029), concern about falling (OR=1.17, 95%CI=1.072-1.290; p=0.001), and self-selected walking speed (OR=0.030, 95%CI=0.004-0.244; p=0.001). For the less active group, the model was composed of age (OR=1.197, 95%CI=1.032-1.387; p=0.017) and functional disability (OR=14.447, 95%CI=1.435-145.45; p=0.023). CONCLUSION: For the more active older adults, reduced self-efficacy suggests that falling can trigger some protective behavior, such as slower gait and depressive symptoms, but the casual link between falls and these outcomes should be further investigated. These data emphasize that physical therapists should be aware that there are differences in fall-related factors depending on the older patients' physical activity level, and this must be considered when planning interventions for this population.CONTEXTUALIZAÇÃO: Fatores relacionados a quedas em idosos com diferentes níveis de atividade física, por meio de uma abordagem multidimensional, não têm sido amplamente investigados. OBJETIVO: Explorar os fatores relacionados a quedas em idosos com diferentes níveis de atividade física. MÉTODOS: Estudo transversal exploratório com 118 pacientes idosos ambulatoriais. Participantes que relataram ao menos uma queda nos últimos 12 meses foram considerados caidores. O nível de atividade física foi avaliado por meio do Perfil de Atividade Humana (PAH). O ponto de corte de 54 pontos foi usado para definir o grupo menos ativo e o grupo mais ativo. Um questionário multidimensional e uma bateria de testes físico-funcionais foram utilizados. RESULTADOS: A prevalência de quedas foi menor no grupo de idosos mais ativos (47,4%) quando comparada à dos idosos menos ativos (71,4%) (p<0,013). A análise de regressão logística multivariada identificou que, no grupo mais ativo, ter caído estava associado a sintomas depressivos (OR=0,747, IC95%=0,575-0,970; p=0,029), preocupação em cair (OR=1,17, IC95%=1,072-1,290; p=0,001) e velocidade de marcha autosselecionada (OR=0,030, IC95%=0,004-0,244; p=0,001). Para o grupo menos ativo, o modelo foi composto de idade (OR=1,197, IC95%=1,032-1,387; p=0,017) e incapacidade funcional (OR=14,447, IC95%=1,435-145,45; p=0,023). CONCLUSÃO: Para os idosos mais ativos, a redução na autoeficácia pode sugerir que cair desencadeia alguns comportamentos protetores, tais como lentidão na marcha e sintomas depressivos, mas a relação causal entre quedas e esses desfechos devem ser mais investigados. Esses dados enfatizam que os fisioterapeutas devem ficar atentos ao fato de que há diferenças nos fatores relacionados a quedas, dependendo do nível de atividade física dos pacientes idosos, e isso deve ser considerado ao se planejarem intervenções para tal população.Universidade da Cidade de São Paulo Program in Physical TherapyUniversidade Estadual de Campinas Program in GerontologyUniversidade Federal de São Paulo (UNIFESP) Geriatrics and Gerontology DepartmentUNIFESP, Geriatrics and Gerontology DepartmentSciEL

MFSD2A is a novel lung tumor suppressor gene modulating cell cycle and matrix attachment

<p>Abstract</p> <p>Background</p> <p>MFSD2A (major facilitator superfamily domain containing 2) gene maps on chromosome 1p34 within a linkage disequilibrium block containing genetic elements associated with progression of lung cancer.</p> <p>Results</p> <p>Here we show that MFSD2A expression is strongly downregulated in non-small cell lung cancer cell lines of different histotypes and in primary lung adenocarcinomas. Experimental modulation of MFSD2A in lung cancer cells is associated with alteration of mRNA levels of genes involved in cell cycle control and interaction with the extracellular matrix. Exogenous expression of MFSD2A in lung cancer cells induced a G1 block, impaired adhesion and migration <it>in vitro</it>, and significantly reduced tumor colony number <it>in vitro </it>(4- to 27-fold, P < 0.0001) and tumor volume <it>in vivo </it>(~3-fold, P < 0.0001). siRNA knockdown studies in normal human bronchial epithelial cells confirmed the role of MFSD2A in G1 regulation.</p> <p>Conclusion</p> <p>Together these data suggest that MFSD2A is a novel lung cancer tumor suppressor gene that regulates cell cycle progression and matrix attachment.</p

Nécropole Santa Rosa (Rome, Cité du Vatican)

La nécropole Santa Rosa est, en fait, une partie de la nécropole romaine qui longeait la Via Trionfale. Elle a fait l’objet d’une intervention de fouilles préventives liée l’aménagement d’un parking souterrain. Si l’analyse des données archéologiques et épigraphiques était largement avancée, il n’en était pas de même des investigations anthropologiques relatives aux sépultures à crémation, pour lesquelles rien n’avait encore été engagé. Afin de pallier cette carence, une convention quadripart..

Nécropole Santa Rosa (Rome, Cité du Vatican)

L’année 2013 a vu se poursuivre les recherches anthropologiques entreprises depuis novembre 2011 dans cette portion de la vaste nécropole romaine qui longeait la Via Triumphalis, dont la fouille s’est déroulée dans un contexte d’archéologie préventive. Ces travaux s’inscrivent dans le programme d’une convention quadripartite qui a été signée au printemps 2012 entre la Direction des Musei Vaticani, l’École française de Rome, l’Université Bordeaux 1 (UMR 5199, Laboratoire d’Anthropologie) et la..

Nécropole Santa Rosa (Rome, Cité du Vatican)

Les recherches anthropologiques commencées en novembre 2011 ont été poursuivies dans la nécropole Santa Rosa, une portion de la vaste zone funéraire qui se développait à l’époque antique le long de la Via Triumphalis. Lors de la fouille de cet ensemble, qui s’est déroulée dans un contexte d’archéologie préventive, les monuments ont été dégagés mais les urnes cinéraires prises dans la maçonnerie ont été conservées in situ avec leur contenu, de sorte qu’il est aujourd’hui possible de les étudie..

Estudo de seguimento por dois anos de idosos residentes em São Paulo, Brasil: metodologia e resultados preliminares

INTRODUCTION: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil s rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO ( Epidemiologia do Idoso ) Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.INTRODUÇÃO: Estudos transversais recentes mostraram alta prevalência de doenças crônicas e incapacidades físicas entre idosos. Considerando o rápido processo de envelhecimento do Brasil e as conseqüências que esse aumento de idosos com doenças crônicas e incapacidades associadas acarretará para o sistema de saúde, fazia-se necessário estudo que pudesse superar as limitações dos dados transversais, permitindo determinar quais os fatores determinantes de uma vida longa e livre de doenças incapacitantes, o chamado envelhecimento bem sucedido. É apresentada a metodologia do primeiro estudo epidemiológico longitudinal com idosos residentes na comunidade, no Brasil. MÉTODO: O perfil do cohorte inicial é comparado com dados de estudos anteriores a com o perfil dos não respondentes para avaliar a validade de análises longitudinais futuras.O projeto EPIDOSO (Epidemiologia do Idoso) seguiu por dois anos 1.667 idosos (65+), residentes em São Paulo. Consistiu de duas ondas, cada qual com três inquéritos: domiciliar, clínico e laboratorial. RESULTADOS E CONCLUSÕES: O perfil da população não diferiu de estudos anteriores, mostrando maioria de mulheres, viúvas, vivendo em domicílios multigeracionais, com uma alta prevalência de doenças crônicas, distúrbios psiquiátricos e incapacidades físicas. A despeito de todas as dificuldades inerentes a um estudo longitudinal, o grupo de não-respondentes ao segundo inquérito domiciliar não diferiu significativamente dos respondentes, assegurando análises longitudinais livres desse tipo de viés. Em relação aos inquéritos clínico e laboratorial, os não-respondentes mostraram-se mais velhos e mais incapacitados que os respondentes, limitando o uso dos dados clínicos e laboratoriais a análises pertinentes a uma cohorte mais jovem e saudável. Sexo, educação, apoio familiar e nível socioeconômico não influenciaram de forma significativa a taxa de não - resposta, ao contrário do que se costuma verificar.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Rapid effects of extrafine beclomethasone dipropionate/formoterol fixed combination inhaler on airway inflammation and bronchoconstriction in asthma: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>The dose-dependent anti-inflammatory effects of a recent fixed combination of extrafine beclomethasone dipropionate/formoterol (BDP/F) were investigated using non-invasive markers of inflammation, exhaled nitric oxide (NO) and adenosine monophosphate (AMP) provocative challenge. The aim was to assess the onset of the anti-inflammatory action of low and high doses and evaluate the suitability of non-invasive assessments to demonstrate dose response.</p> <p>Methods</p> <p>Steroid naïve adult out-patients with mild asthma, sensitive to AMP with baseline exhaled NO > 25 parts per billion entered a double-blind, placebo-controlled, 3-way, cross-over study. Patients were randomised to low dose (1 actuation) or high dose (4 actuations) extrafine BDP/F 100/6 μg, or placebo administered twice daily on Days 1 and 2 and once in the morning on Day 3 of each period. Exhaled NO was measured pre-dose on Day 1, then 2 and 4 hours post-administration on Day 3. The AMP challenge was performed 4 hours post-administration on Day 3 and forced expiratory volume in 1 second (FEV₁, L) was measured from 0 to 4 hours post-dose on Day 1. Endpoints were NO at 2 and 4 hours, AMP challenge at 4 hours after the fifth dose on Day 3 and FEV₁area under the curve from 0 to 4 h post-dose on Day 1. Analysis of covariance was performed for NO and FEV₁and analysis of variance for AMP challenge.</p> <p>Results</p> <p>Eighteen patients were randomised and completed the study. Exhaled NO was significantly lower for both doses of extrafine BDP/F versus placebo at 2 and 4 hours (high dose LS mean difference: -22.5 ppb, p < 0.0001 and -20.5 ppb, p < 0.0001; low dose: -14.1 ppb, p = 0.0006 and -12.1 ppb, p = 0.0043) with a significant dose response (p = 0.0342 and p = 0.0423). Likewise, AMP challenge revealed statistically significant differences between both doses of extrafine BDP/F and placebo (high dose LS mean difference: 4.8 mg/mL, p < 0.0001; low dose: 3.7 mg/mL, p < 0.0001), and a significant dose response (p = 0.0185). FEV₁was significantly improved versus placebo for both doses (high dose LS mean difference: 0.2 L, p = 0.0001; low dose: 0.2 L p = 0.0001), but without a significant dose response.</p> <p>Conclusions</p> <p>The fixed combination inhaler of extrafine BDP/F has early dose-dependent anti-inflammatory effects with a rapid onset of bronchodilatation in mild asthmatic patients.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01343745">NCT01343745</a></p

Prioritizing research challenges and funding for allergy and asthma and the need for translational research-The European Strategic Forum on Allergic Diseases

The European Academy of Allergy and Clinical Immunology (EAACI) organized the first European Strategic Forum on Allergic Diseases and Asthma. The main aim was to bring together all relevant stakeholders and decision-makers in the field of allergy, asthma and clinical Immunology around an open debate on contemporary challenges and potential solutions for the next decade. The Strategic Forum was an upscaling of the EAACI White Paper aiming to integrate the Academy's output with the perspective offered by EAACI's partners. This collaboration is fundamental for adapting and integrating allergy and asthma care into the context of real-world problems. The Strategic Forum on Allergic Diseases brought together all partners who have the drive and the influence to make positive change: national and international societies, patients' organizations, regulatory bodies and industry representatives. An open debate with a special focus on drug development and biomedical engineering, big data and information technology and allergic diseases and asthma in the context of environmental health concluded that connecting science with the transformation of care and a joint agreement between all partners on priorities and needs are essential to ensure a better management of allergic diseases and asthma in the advent of precision medicine together with global access to innovative and affordable diagnostics and therapeutics.Peer reviewe

Multipotent Capacity of Immortalized Human Bronchial Epithelial Cells

While the adult murine lung utilizes multiple compartmentally restricted progenitor cells during homeostasis and repair, much less is known about the progenitor cells from the human lung. Translating the murine stem cell model to humans is hindered by anatomical differences between species. Here we show that human bronchial epithelial cells (HBECs) display characteristics of multipotent stem cells of the lung. These HBECs express markers indicative of several epithelial types of the adult lung when experimentally tested in cell culture. When cultured in three different three-dimensional (3D) systems, subtle changes in the microenvironment result in unique responses including the ability of HBECs to differentiate into multiple central and peripheral lung cell types. These new findings indicate that the adult human lung contains a multipotent progenitor cell whose differentiation potential is primarily dictated by the microenvironment. The HBEC system is not only important in understanding mechanisms for specific cell lineage differentiation, but also for examining changes that correlate with human lung diseases including lung cancer