Association between leukocyte telomere length and sex by quantile regression analysis

ABSTRACT Introduction: Telomere length (TL) is a biomarker of cellular proliferative history. In healthy individuals, leukocyte TL shortens with age and associates with the lifespan of men and women. However, most of studies had used linear regression models to address the association of the TL attrition, aging and sex. Methods: We evaluated the association between the TL, aging and sex in a cohort of 180 healthy subjects by quantile regression. The TL of nucleated blood cells was measured by fluorescent in situ hypridization (flow-FISH) in a cohort of 89 men, 81 women, and 10 umbilical cord samples. The results were validated by quantitative polymerase chain reaction (qPCR) and compared to a linear regression analysis. Results: By quantile regression, telomere dynamics slightly differed between sexes with aging: women had longer telomeres at birth and slower attrition rate than men until the sixth decade of life; after that, TL eroded faster and became shorter than that in men. These differences were not observed by linear regression analysis, as the overall telomere attrition rates in women and men were similar (42 pb per year, p < 0.0001 vs. 45 pb kb per year, p < 0.0001). Also, qPCR did not recapitulate flow-FISH findings, as the telomere dynamics by qPCR followed a linear model. Conclusion: The quantile regression analysis accurately reproduced a third-orderpolynomial TL attrition rate in both women and men, but it depended on the technique applied to measure TL. The Flow-FISH reproduced the expected telomere dynamics through life and, differently from the qPCR, was able to detect the subtle TL variations associated with sex and aging.

Blood donation deferral policies among men who have sex with men in Brazil

ABSTRACT Reevaluation of the deferral from voluntary blood donation by men who have sex with men (MSM) is being discussed in several countries, motivated by the need to ensure a blood supply free from transfusion-transmissible infections (e.g., HIV, syphilis). Policies being considered include: permanent exclusion for any male-male sexual encounter, temporary deferral (3 months, 12 months, 5 years) from the last encounter, or specifying behaviors that differentiate MSM at high risk from those at low risk. Current Brazilian regulations defer MSM from blood donation for 12-months after the last male-male sexual encounter. Broad epidemiological evidence indicates that many MSM are at increased risk for HIV in the present era, and few data exist to distinguish which men are likely to be in the immunological window for detection of these infections. A multicenter study developed in Brazil demonstrated that the history of male-male sex was the most strongly associated with being an HIV-positive blood donor. Meanwhile, the blanket deferral of MSM from blood donation has generated considerable controversy. Rejection of the deferral policies stems in part from perspectives defending human rights, promoting equality and citizenship, and alleging bias and discrimination. The objective of this report is to discuss the current situation of blood donation among MSM in Brazil. We highlight the lack of evidence for a true risk profile for male-male sex in the context of blood donation upon which to base sound policy. We recommend research to establish effective and acceptable criteria for blood donation by MSM and other blood donors.

Longitudinal assessment of grip strength using bulb dynamometer in Duchenne Muscular Dystrophy

BACKGROUND: Grip strength is used to infer functional status in several pathological conditions, and the hand dynamometer has been used to estimate performance in other areas. However, this relationship is controversial in neuromuscular diseases and studies with the bulb dynamometer comparing healthy children and children with Duchenne Muscular Dystrophy (DMD) are limited. OBJECTIVE: The evolution of grip strength and the magnitude of weakness were examined in boys with DMD compared to healthy boys. The functional data of the DMD boys were correlated with grip strength. METHOD: Grip strength was recorded in 18 ambulant boys with DMD (Duchenne Group, DG) aged 4 to 13 years (mean 7.4±2.1) and 150 healthy volunteers (Control Group, CG) age-matched using a bulb dynamometer (North Coast- NC70154). The follow-up of the DG was 6 to 33 months (3-12 sessions), and functional performance was verified using the Vignos scale. RESULTS: There was no difference between grip strength obtained by the dominant and non-dominant side for both groups. Grip strength increased in the CG with chronological age while the DG remained stable or decreased. The comparison between groups showed significant difference in grip strength, with CG values higher than DG values (confidence interval of 95%). In summary, there was an increment in the differences between the groups with increasing age. Participants with 24 months or more of follow-up showed a progression of weakness as well as maintained Vignos scores. CONCLUSIONS: The amplitude of weakness increased with age in the DG. The bulb dynamometer detected the progression of muscular weakness. Functional performance remained virtually unchanged in spite of the increase in weakness. .

Laboratory animals and respiratory allergies: The prevalence of allergies among laboratory animal workers and the need for prophylaxis

OBJECTIVE: Subjects exposed to laboratory animals are at a heightened risk of developing respiratory and allergic diseases. These diseases can be prevented by simple measures such as the use of personal protective equipment. We report here the primary findings of the Laboratory Animals and Respiratory Allergies Study regarding the prevalence of allergic diseases among laboratory animal workers, the routine use of preventive measures in laboratories and animal facilities, and the need for prevention programs. METHODS: Animal handlers and non-animal handlers from 2 Brazilian universities (University of São Paulo and State University of Campinas) answered specific questionnaires to assess work conditions and symptoms. These subjects also underwent spirometry, a bronchial challenge test with mannitol, and skin prick tests for 11 common allergens and 5 occupational allergens (rat, mouse, guinea pig, hamster, and rabbit). RESULTS: Four hundred fifty-five animal handlers (32±10 years old [mean±SD], 209 men) and 387 non-animal handlers (33±11 years old, 121 men) were evaluated. Sensitization to occupational allergens was higher among animal handlers (16%) than non-animal handlers (3%, p<0.01). Accessibility to personal protective equipment was measured at 85% (median, considering 73 workplaces of the animal handler group). Nineteen percent of the animal handlers indicated that they wear a respirator at all times while handling animals or working in the animal room, and only 25% of the animal handlers had received an orientation about animal-induced allergies, asthma, or rhinitis. CONCLUSION: In conclusion, our data indicate that preventive programs are necessary. We suggest providing individual advice to workers associated with institutional programs to promote a safer work environment. .

Clinical judgment to estimate pretest probability in the diagnosis of Cushing's syndrome under a Bayesian perspective / Contribuição do julgamento clínico na estimativa da probabilidade pré-teste do diagnóstico da síndrome de Cushing sob a perspectiva Bayesiana

OBJECTIVE: To estimate the pretest probability of Cushing's syndrome (CS) diagnosis by a Bayesian approach using intuitive clinical judgment. MATERIALS AND METHODS: Physicians were requested, in seven endocrinology meetings, to answer three questions: "Based on your personal expertise, after obtaining clinical history and physical examination, without using laboratorial tests, what is your probability of diagnosing Cushing's Syndrome?"; "For how long have you been practicing Endocrinology?"; and "Where do you work?". A Bayesian beta regression, using the WinBugs software was employed. RESULTS: We obtained 294 questionnaires. The mean pretest probability of CS diagnosis was 51.6% (95%CI: 48.7-54.3). The probability was directly related to experience in endocrinology, but not with the place of work. CONCLUSION: Pretest probability of CS diagnosis was estimated using a Bayesian methodology. Although pretest likelihood can be context-dependent, experience based on years of practice may help the practitioner to diagnosis CS. Arq Bras Endocrinol Metab. 2012;56(9):633-7.

OBJETIVO: Estimar a probabilidade pré-teste do diagnóstico de síndrome de Cushing (SC) por meio de julgamento clínico utilizando abordagem Bayesiana. MATERIAIS E MÉTODOS: Médicos res­ponderam a três perguntas, em sete congressos de endocrinologia. Após obtenção da história clínica/exame físico, sem exames laboratoriais, apenas com base em sua experiência pessoal, qual a probabilidade de diagnosticar SC?; Há quanto tempo você pratica endocrinologia?; Onde você trabalha? Uma regressão beta Bayesiana, utilizando o software WinBugs, foi empregada. RESULTADOS: Foram obtidos 294 questionários. A estimativa Bayesiana da probabilidade média de diagnosticar SC foi 51,6% (IC 95%: 48,7-54,3). Houve relação direta entre probabilidade de diagnosticar SC e experiência da prática endócrina, porém não com o local de trabalho. CONCLUSÃO: A probabilidade pré-teste do diagnóstico de SC foi estimada utilizando uma metodologia Bayesiana. Embora a probabilidade pré-teste possa ser dependente do contexto, a experiência de anos de prática pode auxiliar no diagnóstico intuitivo da CS. Arq Bras Endocrinol Metab. 2012;56(9):633-7.

Pronto-atendimento ou atenção básica: escolhas dos pacientes no SUS / Emergency care or primary care: patient's choices on the national health service

Um dos principais desdobramentos do modelo assistencial brasileiro é a sobrecarga dos serviços de pronto atendimento por pessoas que apresentam queixas compatíveis com a Atenção Primária à Saúde. O presente trabalho buscou conhecer as razões da não adesão às unidades básicas e de saúde da família (UBS e USF) por parte de pacientes que procuraram o serviço de Pronto Atendimento (PA) com queixas compatíveis com a Atenção Básica (AB). De caráter descritivo e abordagem quantitativa, desenvolveu-se a pesquisa em um Distrito de Saúde com 140 mil habitantes, integrado por equipes de Saúde da Família, UBS e serviço de PA para urgência e emergência 24 horas. Levantaram-se Fichas de Atendimento de dois meses típicos, distinguindo-se pacientes com queixas compatíveis com a AB daqueles com queixas e agravos relativos ao PA. Identificou-se sua frequência geral ao SUS e específica no PA no período de 67 meses. Realizaram-se entrevistas domiciliares semi-estruturadas a pacientes definidos por meio de sorteio. Embora procedentes de 12 diferentes UBS/PSF, em 3 delas concentraram-se 54,6% dos pacientes que buscaram o PA. 55% deles procuraram o SUS por pelo menos 30 vezes no período. Destacam-se 14 pacientes que procuraram o SUS mais de 200 vezes, sendo um deles por 1.012 vezes, um por 1.097 vezes e outro por 2.744 vezes, todos buscando procedimentos típicos da AB. Das 347 visitas realizadas foram obtidas 105 entrevistas...

One of the main outcomes of care model in Brazil is the burden placed on emergency care services for people with complaints compatible with the Primary Health Care. Despite international studies which show that countries that have organized their health systems from the Primary Care had better levels of health and more efficiently, our system is still predominantly focused on acute health problems. Initiatives to strengthen the Primary Health Care (PHC), as the implementation of Family Health Strategy and the creation of the National PHC policy, are enrolling in our country with reference to its four main attributes: attention to the first contact, longitudinality of care, comprehensiveness or completeness care and integration or coordination of care. This study sought to ascertain the reasons for not adhering tobasic units and family health (UBS and USF) by patients who sought the service of Attendance (PA) with complaints compatible with the PHC. Descriptive and quantitative approach, developed into a health district with 140,000 inhabitants, comprising teams of Family Health, UBS and BP service to emergency rooms 24 hours. At the emergency unit, were analyzed sheets of two typical months, distinguishing patients with complaints compatible with the PHCof those with complaints and disorders related to PA. We identified its overall frequency to the National Health Service (SUS) and specifically in the PA during the period of 67 months. There were semi-structured household interviews the patients defined by lot. Although coming from 12 different UBS / PSF, 3 of them were concentrated 54.6% of patients who sought the PA . 55% of them sought the SUS by at least 30 times in the period. Among them 14 patients who sought the SUS more than 200 times, one of them by 1012 times, 1097 times for one and other times by 2744, all seeking procedures typical of PHC. Of the 347 visits were obtained 105 interviews...

Efeitos morfológicos do retorno da sobrecarga após imobilização em alongamento de músculo esquelético de ratas / Morphological effects of resumption of loading after immobilization of skeletal muscles in lengthened position in female rats

CONTEXTUALIZAÇÃO: Na reabilitação, a imobilização em alongamento do músculo esquelético é realizada como contramedida para reverter efeitos de encurtamento muscular severo e em eventos pós-cirúrgicos. Acredita-se que o retorno às atividades funcionais normais estimule mecanotransdutores capazes de reorganizar a citoarquitetura normal muscular, porém a descrição das alterações histopatológicas relacionadas a esses procedimentos são escassas na literatura. OBJETIVOS: Avaliar e quantificar anomalias histológicas induzidas pela imobilização em alongamento do músculo EDL (Extensor Digitorum Longus) e confrontá-las com a livre movimentação do animal após esse procedimento. MÉTODOS: Foram utilizadas 18 ratas Wistar, distribuídas nos grupos: controle (GC); imobilizadas em flexão plantar (EDL em posição alongada) por 14 dias (GI); imobilizadas por 14 dias e liberadas por dez dias (GIL). Fragmentos do EDL foram congelados, seccionados e processados com reações imuno-histoquímica para colágenos I e III e histoquímica para Adenosina Trifosfatase Miofibrilar e Hematoxilina-Eosina. RESULTADOS: Os animais do GI apresentaram discreto aumento da expressão de colágeno I e de fibras em processo degenerativo/necrótico, redução da proporção de fibras tipo (FT) 2A e do diâmetro menor de todos os tipos de fibras, quando comparados com os animais do GC. Para o GIL, observou-se retorno da quantidade de colágeno I às condições controle, além de redução na proporção de FT2D, aumento do número de núcleos centralizados e do diâmetro menor das fibras quando comparadas com o GI, porém a expressão de FT2B e FT2D não atingiu os valores de referência. CONCLUSÕES: Os dados apresentados mostram que a retomada da função durante dez dias foi parcialmente eficiente na recuperação das características do músculo EDL após o período de imobilização e que, se extrapolados os dados à clínica fisioterapêutica, a adoção de procedimentos orientados às disfunções primárias do músculo pode favorecer a resposta morfofuncional do segmento e o seu íntegro restabelecimento.

BACKGROUND: In rehabilitation, immobilization of skeletal muscles in the elongated position is performed as a countermeasure in order to reverse the effects of severe muscle shortening and postoperative events. The return to normal functional activities is believed to stimulate mechanotransducers capable of reorganizing the normal muscle cytoarchitecture, but few data describing the histopathological changes relating to these procedures are available in the literature. OBJECTIVES: To assess and quantify histological abnormalities induced by immobilization of the extensor digitorum longus (EDL) muscle in elongation and to compare them with free movement of the animal after this procedure. METHODS: Eighteen female Wistar rats were used, divided into the following groups: Control; Immobilized in plantar flexion (EDL in an elongated position) for 14 days (GI); Immobilized for 14 days and released for 10 days (GIL). EDL fragments were frozen, sectioned and processed through immunohistochemical reactions for collagens I and III and histochemical methods for myofibrillar adenosine triphosphatase using hematoxylin-eosin. RESULTS: GI animals presented slight increases in collagen I and fiber expression in a degenerative/necrotic process, and reductions in the proportion of FT2A fibers and in the diameters of all fiber types, compared with the controls. In GIL, the quantity of collagen I returned to control conditions; the proportion of FT2D decreased; the number of centralized nuclei increased; and the fiber diameter was smaller than in GI. However, FT2B and FT2D expression did not reach the reference values. CONCLUSIONS: The data presented show that the recovery of function over a 10-day period was partially efficient with regard to recuperation of the characteristics of the EDL muscle after the period of immobilization. If the data are extrapolated to physiotherapeutic clinical practice, use of procedures directed towards primary dysfunctions of the muscle may favor a morphofunctional response in the segment and its full recovery.

Proposta de um programa de bem estar vocal para professores: estudo de caso / A proposal for a program of vocal well-being for educators: a study of case

Objetivo: Este artigo propõe e analisa um programa de promoção de saúde vocal para professores, caracterizado por ações que buscam a sua adequação às características da rotina dos envolvidos, objetivando fornecer conscientização e percepção dos fatores associados ao processo saúde-doença da disfonia. Métodos: A pesquisa foi conduzida em uma escola com pedagogia Waldorf. Na 1ª etapa do estudo, de avaliação individual, 22 participantes responderam a um instrumento com questões relacionadas à voz e ao seu trabalho. Na 2ª etapa, os participantes foram divididos em quatro pequenos grupos de 2 a 6 pessoas para doze encontros semanais de aproximadamente uma hora de duração, sendo abordados os temas: vivência do problema, anatomia e fisiologia da laringe, higiene vocal, respiração, articulação, ressonância, aquecimento e desaquecimento vocal e revisão dos exercícios. Na 3ª etapa, foi feita uma reavaliação individual e uma avaliação dos encontros. Resultados: As mudanças decorrentes da intervenção se evidenciaram pelas declarações dos participantes, que demonstraram que a ação proporcionou reflexão sobre seus hábitos e as origens de seus problemas vocais, além de trazer a oportunidade de observar o uso sistemático da voz pelos seus alunos, o reconhecimento da importânciada voz e a vivência dos efeitos dos exercícios vocais. Conclusão: A proposta de ação de promoção de saúde obteve êxitos na ampliação da percepção e conscientização dos professores a respeito dos fatores que atuam de maneira favorável ou prejudicial à voz.

Purpose: This article proposes and analyses a program for improving the vocal health of teachers, characterized by actions that aim to adequate it to the characteristics of their professional routine, aiming to provide awareness and understanding of factors associated with the health-disease process of dysphonia. Methods: The research was conducted in a school based on Waldorf pedagogy. In the first stage of the study, 22 participants answered a questionnaire with questions related to voice and their work. In the second stage, the participants were divided into small groups of 2 to 6 persons for a series of twelve weekly meetings with duration of 1 hour each, which addressed the topics: personal experience of the problem, anatomy and physiology of the larynx, vocal hygiene, breath, articulation, resonance, vocal warm-up and vocal cool-down and review exercises. In the third stage, a new individual evaluation and an evaluation of the meetings were made. Results: The changes resulting from the intervention is supported by the statements of participants, which demonstrated that the action provided a reflection on their habits and the origins of their vocal problems, and bring the opportunity to observe the systematic use of voice for their students, recognizing the importance of voice and the experience of the effects of vocal exercises. Conclusions: The action for health promotion here proposed was successful in increasing the awareness and perception of teachers about the factors that act in a beneficial or harmful way to the voice.

Objetivo: En el presente artículo se propone y se analiza un programa de promoción de la salud vocal para maestros, que se caracteriza por las acciones que tratan de adecuarse a las características de su rutina, con el objetivo de proporcionar un conocimiento y comprensión de los factores asociados con el proceso salud-enfermedad de la disfonía. Métodos: El estudio se realizó en una escuela que sigue el método Waldorf. En la primera etapa del estudio, la evaluación individual, 22 participantes respondieron a un cuestionario con preguntas relacionadas con voz y su trabajo. En la segunda etapa, los participantes se dividieron en cuatro pequeños grupos de 2 a 6 sujetos para doce encuentros semanales de alrededor de una hora de duración, donde se abordaron los temas: viviendo el problema, anatomía y fisiología de la laringe, higiene vocal, respiración, articulación, resonancia, calentamiento y descalentamineto vocal y revisión de ejercicios. En la tercera etapa, se hizo una re-evaluación individual y una evaluación de los encuentros. Resultados: Los cambios resultantes de la intervención se evidenciaron por las declaraciones de los participantes, que demostraron que la acción proporcionó una reflexión sobre sus hábitos y los orígenes de sus problemas vocales, además de traer la oportunidad de observar el uso sistemático dela voz por sus alumnos, el reconocimient o la importancia de la voz y la vivencia de los efectos de los ejercicios vocales. Conclusión: La propuesta de acción para la promoción de la salud ha demostrado su eficacia en el aumento de la percepción y conciencia de los profesores sobre los factores que actúan de manera favorable o perjudicial para la voz.

Avaliação do conhecimento sobre hemoterapia e segurança transfusional de profissionais de enfermagem / Evaluation of knowledge about hemotherapy and transfusional care of nurses

Os riscos envolvidos na transfusão de sangue e hemoderivados podem ser conseqüentes de procedimentos inadequados, erros ou omissões dos profissionais responsáveis pela transfusão. O presente estudo objetivou determinar o nível de conhecimento sobre o assunto e a adequação das práticas transfusionais dos profissionais de Enfermagem que atuam em um grande hospital universitário do interior de São Paulo. O estudo foi realizado durante um treinamento teórico em Hemoterapia, onde foi aplicado um instrumento de coleta de dados antes e após o treinamento, caracterizando estes profissionais e avaliando seus conhecimentos sobre o tema. Participaram enfermeiros, auxiliares e técnicos de enfermagem responsáveis pela administração de transfusões. Mais da metade se sente pouco ou mal informada sobre o assunto. Grande parte referiu que os pacientes não são orientados sobre sinais e sintomas de reações transfusionais, ainda referindo procedimentos incorretos para aquecimento do sangue. A avaliação de conhecimentos evidenciou lacunas importantes na capacitação destes profissionais.

The risks involved in blood and blood component transfusion can be caused by inadequate procedures and mistakes or omissions by professionals responsible for transfusion. The present study aims at evaluating the level of knowledge on this issue and about the adequacy of the transfusional practices of nurses at a large university hospital in the State of São Paulo, Brazil. The study was conducted during an in-service training course on hemotherapy. A data collection instrument was applied before and after the training, when the professionals were asked about their knowledge of transfusion practices. Study participants were nurses and nursing assistants, all of whom were responsible for transfusion procedures. More than half the participants felt that they were given little information or were badly informed about transfusions. A large portion of the professionals mentioned that the signs and symptoms of transfusion reactions are not explained to patients. Many participants reported inadequate blood warming procedures. The evaluation of the knowledge showed significant defects in the education of these nursing professionals.

Rastreamento de cåncer de colo uterino em São Paulo: resultados parciais em 3.000 mulheres / Cervical cancer screening in São Paulo: preliminary results for 3.000 women

Foram examinadas 3.000 mulheres entre fevereiro de 2002 e março de 2003 para prevençao de cancer do colo uterino