Impact of Climate Change on Microbiological Hazards in Food and Drinking Water in Sweden

Objective and scope: To increase our knowledge on how climate change can affect microbiological food safety in Sweden, during this century, a risk profile was developed. The focus of the report is to identify existing and emerging microbiological hazards (pathogenic microorganisms and toxins) that may be of concern and may affect the safety of food and water consumed in Sweden. Specific issues addressed are how the different stages in the food chain can be affected, and which hazards are most relevant for different food groups. The report is based on published scientific literature and governmental reports. Climate change scenarios: Human emissions of carbon dioxide and other greenhouse gases affect a range of climate-related factors and lead to changes beyond those natural variations that have always occurred. These climate changes are already evident and will, according to various scenarios, continue during the rest of the century. The scenario assessed in the report was RCP8.5. Globally, this means higher annual average temperatures, changing precipitation patterns, reduced access to freshwater in many regions, rising sea levels, and acidification of the oceans. In Sweden, the climate will become warmer compared to today, especially in winter. Rainfall will generally increase, mostly in winter and spring, especially in the northern parts of Sweden. In the southeastern part of the country, increased drought and water shortages are expected. Climate change is also expected to lead to more frequent extreme weather, for instance floods and heat waves. Impact on food safety: A changed climate will have several effects on the environment and society that can affect food safety. Examples of such effects are changing conditions for crop production, livestock production, infrastructure, energy supply, and water availability. Climate change can influence food safety in different ways and through different routes along the entire food chain. Much of the impact occurs at the first stage, primary production, and can then propagate in the rest of the chain. Two scenarios were highlighted in the report, both of which are relevant for all stages of the food chain, although they may be of varying importance depending on the stage and type of operation considered: The first scenario includes the impact on food safety due to a change in the normal conditions with higher average temperature, increased precipitation or drought, and milder winters. The second scenario includes an increased frequency of extreme events such as torrential rains, floods, and dry periods, with potential consequences such as power failures and other disruptions of infrastructure that can have a major impact on the food chain and, in turn, on food safety. Climate change adaptations: In order to address the challenges associated with new “normal conditions”, climate change adaptation is needed in the production chains of food and drinking water. The normal conditions in Sweden may become similar to the current situation in southern Europe. This description of the new potential situation in this scenario is useful for communication purposes, and gives the stakeholders an idea of what adaptation measures may be needed. Additionally, an increased preparedness is needed to prevent and manage extreme events in the second scenario that can lead to an increased occurrence of pathogens and toxins in the raw materials and in drinking and process water as well as to increased frequency of disturbances in infrastructure. To some extent, changed conditions in primary production can be addressed through the application of Good Agricultural Practice and/or certification standards. However, despite these frameworks, the challenges in this first stage of the food chain can be expected to be particularly high. It is more difficult to implement direct management measures here than at later stages of the food chain. There, HACCP-based procedures and PRPs such as good hygiene practices and good production practices have been used with good results. Microbiological hazards: Assessing the impact of climate change on microbiological hazards is complex. This is partly because the changes that will take place are interrelated and can affect our environment in several different ways. It is also due to the fact that the available studies on which the assessment is based vary greatly, both in terms of the hazards that are studied and in terms of scope and methodological designs. Bacteria that are likely to increase in the environment, water, animals, plants, and/or food raw materials due to a changing climate, and for which the level of evidence is considered high, are Bacillus anthracis, Francisella tularensis, Salmonella spp., Shigella spp., and Vibrio spp. Potentially, all food-borne viruses are expected to increase in occurrence due to climate change. However, the level of evidence is intermediate for noroviruses and low for hepatitis A virus and hepatitis E virus. Most parasites will potentially increase in occurrence due to climate change, but the level of evidence is low for most. For Cryptosporidium spp., Giardia intestinalis, and Toxoplasma gondii, the level of evidence is intermediate. Among the mycotoxins, it is estimated that all Fusarium toxins addressed (DON, T2/HT2, ZEN, and fumonisins) will increase, of which the evidence level is highest for DON and fumonisins. Further, aflatoxins are expected to increase with a high level of evidence. In addition to the microbiological hazards listed, several other species of bacteria, viruses, and parasites as well as types of mycotoxins are also considered likely to increase, but due to a lack of data and in some cases conflicting indications, these assessments are uncertain. None of the microbiological hazards discussed in the report have been assessed likely to decrease in occurrence due to climate change. However, it should be noted that some climatic factors may influence microbiological hazards in both positive and negative directions. At the local level, it may thus be the case that certain hazards that have been assessed as potentially increasing instead remain unchanged or even decrease in occurrence. The final outcome also depends on the effectiveness of measures taken to address the challenges of climate change. Microbiological hazards and food groups: The microbiological hazards increasing in importance due to a changing climate are likely to vary for different food groups. The pathogenic microorganisms and toxins judged potentially to increase in occurrence and of relevance in different food groups due to a changed climate have been compiled (Table 1). It has not been possible, on the basis of existing data, to rank the hazards. The assessment suggests that it is of greatest importance to consider which pathways and types of hazards (properties, resistance) may be relevant in the different food groups because the control measures will in most cases be similar for different types of hazards. Capture4.PNG Concluding remarks: Many sources of uncertainty for the assessments were identified. The main sources include knowledge gaps associated with data on the extent to which the climate will impact on microbiological hazards, difficulties in identifying causal relationships based on correlations, knowledge gaps associated with the methodology of carrying out this type of complex assessment against uncertain future scenarios, and knowledge gaps regarding the future climate and its effects. A further contributing uncertainty is knowledge gaps on potential feedback mechanisms between climate change and its effects. Despite the uncertainties, the increased food safety challenges qualitatively identified in this report are considered likely. These challenges are the consequences of the impacts that climate change under the RCP8.5 scenario may have on several of the microbiological hazards in terms of increased or potentially increased occurrence in the environment, water, animals, plants, and/or food raw materials. Conclusions on the change of specific microbiological hazards, the extent of the impact, and the rate of change are subject to significantly greater uncertainty. This is not least because the impact of climate change depends on the accuracy of the climate scenarios and on what measures are put in place. The risk profile is an initial and general compilation of knowledge that can form a basis for further and more detailed studies and activities in the various sectors in the food chain. The complete report can be downloaded from: L 2021 — No 19 — Microbiological hazards (livsmedelsverket.se).

An application of UK Myeloma Research Alliance Risk Profile for the evaluation of efficacy and prognosis in elderly patients with newly diagnosed multiple myeloma / 中华老年医学杂志

Objective:To evaluate the predictive value of the UK Myeloma Research Alliance Risk Profile(MRP)score based on clinical outcomes in elderly patients with newly diagnosed multiple myeloma(NDMM).Methods:Patients aged ≥65 years with NDMM in our hospital from March 2018 to September 2021 were divided into three groups with low, medium and high risk according to MRP scores.Their therapeutic efficacy, adverse effects, and survival were analyzed.Results:A total of 63 NDMM patients were enrolled with median age of 69 years(65-84 years)and median follow-up of 13.3(1.2-43.4)months.Based on MRP score, there were 22 patients in the low-risk group, 13 cases in medium-risk group, 28 patients in the high-risk group.The median progression-free survival(PFS)time of the three groups was 38.4, 25.1 and 21.2 months respectively, and the estimated 2-year PFS rate was 83.9%, 60.0%, and 45.6%, respectively(all P=0.177). The estimated 2-year overall survival(OS)rate was 100.0%, 90.0%, 74.6%, respectively(all P=0.049). Among patients with grade 2 or above hematological adverse events, there were 20 cases(71.4%), 7 cases(53.8%)and 8 cases(36.4%)in the high-, medium-and low-risk groups, with statistically significant differences( χ2=6.154, P=0.046). Among patients with grade 3 or higher non-hematological adverse events, there were 17 cases(60.7%), 5 case(38.5%)and 5 cases(22.7%)in the high-, medium-and low-risk groups, with statistically statistical significance( χ2=7.389, P=0.025). The patients experiencing interruption, delay or replacement of chemotherapy regimen were 6 cases(46.2%)and 19 cases(67.9%)in the medium-and high-risk groups, which were higher than in the low-risk group(31.8%, χ2=6.543, P=0.038). Conclusions:It is feasible to conduct MRP score in elderly NDMM patients.The MRP score can be used to predict the adverse events of chemotherapy, etc, and has certain value for the prognosis evaluation of patients.

Perfil del riesgo de brotes alimentarios por intoxicación estafilocócica en Cuba / Risk profile of staphylococcal food poisoning outbreaks in Cuba

Introducción: Staphylococcus ocasiona con frecuencia intoxicaciones alimentarias; en Cuba es una de las principales causas de brotes. Objetivo: analizar el perfil del riesgo de brotes alimentarios por Staphylococcus en Cuba. Métodos: Se realizó un estudio observacional analítico sobre los factores higiénicos y epidemiológicos asociados al riesgo de la intoxicación alimentaria por Staphylococcus en Cuba, en el Instituto Nacional de Higiene Epidemiología y Microbiología, durante el periodo de enero a noviembre de 2018. La información se obtuvo mediante revisión bibliográfica sistémica, análisis de datos del Laboratorio de Referencia Nacional en Microbiología Sanitaria y informes de brotes de la Dirección Nacional de Salud Ambiental. Se estimó el riesgo microbiológico mediante el programa semicuantitativo Ross-Sumner. Resultados: Se identificó como principal peligro Stahylococcus aureus, productores de enterotoxina A y la determinación de aislamientos resistentes a los antimicrobianos, como Stahylococcus aureus meticilina resistentes. Los alimentos más implicados fueron los productos de repostería y la inocuidad se afectó en mayor frecuencia por la contaminación cruzada en el 31,4 por ciento brotes y la inadecuada conservación en 46,1 por ciento. La predicción de personas que enferman por año en la población de interés fue de 6 260. Conclusiones: El riesgo de la ocurrencia de brotes por Staphylococcus se estimó como alto; la vigilancia se recomienda en alimentos que requieren manipulación directa y no se aplica tratamiento térmico antes del consumo, con gestiones de riesgo dirigidas a productores y consumidores(AU)

Introduction: Staphylococcus is a frequent cause of food poisoning. In Cuba it is one of the main causes of outbreaks. Objective: Analyze the risk profile of staphylococcal food poisoning outbreaks in Cuba. Methods: An observational analytical study was conducted about hygienic and epidemiological factors associated to the risk for staphylococcal food poisoning in Cuba. The study was carried out at the National Institute of Hygiene, Epidemiology and Microbiology from January to November 2018. The information was obtained from a systematic bibliographic review, analysis of data from the Medical Microbiology National Reference Laboratory, and outbreak reports from the National Environmental Health Division. Microbiological risk was estimated with Ross-Sumner semi-quantitative software. Results: The main hazard identified was Staphylococcus aureus, enterotoxin A producers and determination of antimicrobial resistant isolates like methicillin-resistant Staphylococcus aureus. The food items most commonly involved were sweets, and safety was most frequently affected by cross-contamination in 31.4 percent of the outbreaks and inadequate preservation in 46.1 percent. Prediction of members of the population of interest becoming ill every year was 6 260. Conclusions: Risk for the occurrence of staphylococcal food poisoning outbreaks was considered to be high; surveillance is recommended of food items requiring direct manipulation and appropriate thermal treatment is not applied before consumption, with risk management actions aimed at manufacturers and consumers(AU)

Correlation of different Framinghan vascular risk factors and cognitive impairment / 中华行为医学与脑科学杂志

Objective To evaluate the relationship between different Framinghan vascular risk factor and cognitive impairment in the middle-aged and elderly.methods 71 participants from Physical Examination Center,Zhongnan Hospital of Wuhan University were consecutively recruited from March 2016 to May 2016.Framingham Cardiovascular Disease Risk Profile (FCVDRP),Framingham Stroke Risk Profile (FSRP) and Framingham Coronary Heart Disease Risk Profile (FCHDRP) were respectively used to evaluate the vascular burden of the participants.Mini-mental state examination (MMSE) and digital sign conversion test (DST) were used to evaluate the cognitive function of the participants.Partial correlation analysis was used to investigate the correlation between FCVDRP,FSRP and FCHDRP scoring methods and cognitive function.Result s(1)After adjusting for education years,with the increase of vascular burden scores,the scores of MMSE (FCVDRP:low-risk group (28.29±1.38),mid-risk group(27.40±1.73),high-risk group (26.72±1.93);FSRP:low-risk group (28.00±1.60),mid-risk group (26.26±2.46),high-risk group (27.2±2.04);FCHDRP:low-risk group (27.74±1.73),mid-risk group (27.46±2.00),high-risk group (27.18±1.59)) and DST (FCVDRP:low-risk group (29.24±5.54),mid-risk group (27.40±1.73),high-risk group (26.72±6.76);FSRP:low-risk group (30.09±5.61),mid-risk group (25.11±7.55),high-risk group (23.53±5.60);FCHDRP:low-risk group (30.37±6.41),mid-risk group (25.46±6.76),high-risk group (26.82±5.99)) were significantly decreased(all P<0.05).(2)The Result s of partial correlations analysis showed that the scores of FSRP were significantly correlated with MMSE (r=-0.249) and DST (r=-0.291)(both P<0.05).Conclusion Aggregation of vascular risks factors may aggravate cognitive impairment in middle-aged and elderly people.Compared to FCVDRP and FCHDRP,FSRP assessment may be more significantly associated with vascular cognitive impairment.

A study on risk profile in acute ischemic stroke patients at Urban Medical College, Tamil Nadu

Background: Risk factor modification remains as the principal aspect of care for stroke prevention. Understanding of risk factors has advanced and several options are now available to treat modifiable risk factors. Prevention of stroke begins with awareness of risk factors by patients and clinicians. Aim: The aim of our study was to study the association of various risk factors for acute ischemic stroke. Materials and methods: A total of 50 patients who presented with acute ischemic stroke were enrolled into the study after confirmation by CT scan. A detailed history regarding age, smoking, alcohol intake, diabetes, hypertension, dyslipidemia and ischemic heart disease were taken. Blood sugar, lipid profile and CRP estimation were done.50 normal persons without any evidence of stroke were taken as control subjects. The prevalence of risk factors in patients with ischemic stroke was studied and compared with control subjects. Results: Mean age of stroke patient was 60.62 years and control was 58.22 years. Smokers and alcoholic were 32% (case -21%, control 11%) and 36% (case -26%, control 10%) respectively. Diabetes, hypertension and IHD patients constituted 27% (case -20%, control 7%),37% (case -30%, control 7%) and 20% (case -13%, control 7%) respectively. High CRP level was found in 47% (case - 35%, control 12%) of patients. Dyslipidemia was found in 44% (case -38%, control 6%) of patients. Conclusion: In our study smoking, alcohol, diabetes, hypertension, IHD, dyslipidemia and high CRP levels correlated well with ischemic stroke. Age and sex were not correlated with ischemic stroke.

Perfil de riesgo de los antidepresivos inhibidores selectivos de la recaptación de serotonina (ISRS) / Risk profile of antidepressants selective reuptake inhibitors (SSRIs)

Los antidepresivos inhibidores selectivos de la recaptación de serotonina son ampliamente utilizados en la práctica clínica y han desplazado a otros grupos de antidepresivos en las últimas décadas. Esto parece estar vinculado al concepto de su mayor perfil de seguridad y a la minimización de los potenciales efectos adversos que su uso podría generar. Sin embargo el número de efectos adversos tanto leves como graves reportados no son despreciables y es importante su conocimiento con el fin de evitar o diagnosticar en forma precoz y actuar en consecuencia

Selective serotonin receptor inhibitor are widely used in clinical practice and have moved to other antidepressive drugs in recent decades. This seems to be linked to the concept of their greater safety profile and to minimize potential adverse effects that their use could generate. However, the number of both minor and serious reported adverse effects are not negligible and knowledge is important in order to prevent or diagnose early and act accordingly

Resultados del Grupo de Investigación en Muerte Súbita, 20 años después de su creación / The Research Group on Sudden Death and its results after 20 years

La muerte súbita representa en la actualidad uno de los principales desafíos para los sistemas sanitarios a nivel mundial dada su elevada incidencia, dramatismo en su presentación y años de vida que se pierden prematuramente como consecuencia de esta entidad. OBJETIVO: describir los antecedentes de la creación hace 20 años del Grupo de Investigación en Muerte Súbita en Cuba y mostrar sus resultados más significativos. MÉTODO: se realizó una revisión documental de los primeros 20 años de trabajo de investigación científica del Grupo de Investigación en Muerte Súbita en Cuba (1995-2014). RESULTADOS: se estudiaron 24 758 muertes naturales a las cuales se les aplicó un algoritmo diagnóstico para documentar 1 953 eventos de muerte súbita cardiovascular, que representaron el 7,8 por ciento de la mortalidad global registrada. El 98,1 por ciento de la casuística investigada correspondió a 14 municipios de la provincia La Habana. El 2 por ciento restante incluyó 26 municipios de 11 provincias del país. Los estudios han demostrado un incremento en la probabilidad para este evento en pacientes con hipertensión arterial, obesidad, diabetes mellitus, cardiopatía isquémica, necrosis miocárdica previa, tabaquismo, engrosamiento ventricular izquierdo y alteración del perfil lipídico. CONCLUSIONES: la creación del Grupo de Investigación en Muerte Súbita ha permitido, en los últimos 20 años, el diseño y ejecución de investigaciones científicas encaminadas a la caracterización epidemiológica de este problema de salud en Cuba, elementos útiles para trazar estrategias de intervención que permitan lograr una disminución sensible en la incidencia e impacto económico, familiar y social de esta entidad(AU)

Sudden death presently represents one of the main challenges for the health care systems worldwide due to high incidence, dramatic presentation and life years prematurely lost as a result of this event. OBJECTIVE: to describe the background of the creation of the research group on sudden death in Cuba twenty years ago, and to show its most significant results. METHODs: a documentary review of the first 20 years of scientific research work performed by the Research Group on Sudden Death in Cuba (1995-2014). RESULTS: twenty four thousand eight hundred and seventy six deaths of natural causes were studied and applied a diagnostic algorithm to document 1 953 events of sudden cardiovascular death accounting for 7.8 percent of recorded global mortality. In the studied casuistry, 98.1 percent went to 14 municipalities from 11 provinces. The studies showed increased probabilities for this event in patients suffering blood hypertension, obesity, diabetes mellitus, ischemia, previous myocardial necrosis, smoking, left ventricle thickening, and lipid profile impairment. CONCLUSIONS: the creation of the Research Group on Sudden Death allowed in the last twenty years designing and performing scientific research studies aimed at the epidemiological characterization of this health problem in Cuba and those are useful elements to draw up intervention strategies to significantly reduce the incidence and the economic, family and social impact of this event(AU)

Hormone therapy with tamoxifen reduces plasma levels of NT-B-type natriuretic peptide but does not change ventricular ejection fraction after chemotherapy in women with breast cancer

The objective of this study was to evaluate the effect of tamoxifen on the plasma concentration of NT-pro-B-type natriuretic peptide (NT-proBNP) in women undergoing chemotherapy for breast cancer and to correlate changes in NT-proBNP with the left ventricular ejection fraction (LVEF). Over a period of 12 months, we followed 60 women with a diagnosis of breast cancer. The patients were separated into a group that received only chemotherapy (n=23), a group that received chemotherapy + tamoxifen (n=21), and a group that received only tamoxifen (n=16). Plasma levels of NT-proBNP were assessed at 0 (T0), 6 (T6), and 12 (T12) months of treatment, and echocardiography data were assessed at T0 and T12. Plasma NT-proBNP levels were increased in the chemotherapy-only group at T6 and T12, whereas elevated NT-proBNP levels were only found at T6 in the chemotherapy + tamoxifen group. At T12, the chemotherapy + tamoxifen group exhibited a significant reduction in the peptide to levels similar to the group that received tamoxifen alone. The chemotherapy-only group exhibited a significant decrease in LVEF at T12, whereas the chemotherapy + tamoxifen and tamoxifen-only groups maintained levels similar to those at the beginning of treatment. Treatment with tamoxifen for 6 months after chemotherapy significantly reduced the plasma levels of NT-proBNP and did not change LVEF in women with breast cancer.

A newfangled study using risk silhouette and uncertainty approximation for quantification of acyclovir in diverse formulation / 药物分析学报

Risk assessment and uncertainty approximation are two major and important parameters that need to be adopted for the development of pharmaceutical process to ensure reliable results. Additionally, there is a need to switch from the traditional method validation checklist to provide a high level of assurance of method reliability to measure quality attribute of a drug product. In the present work, evaluation of risk profile, combined standard uncertainty and expanded uncertainty in the analysis of acyclovir were studied. Uncertainty was calculated using cause-effect approach, and to make it more accurately applicable a method was validated in our laboratory as per the ICH guidelines. While assessing the results of validation, the calibration model was justified by the lack of fit and Levene’s test. Risk profile represents the future applications of this method. In uncertainty the major contribution is due to sample concentration and mass. This work demonstrates the application of theoretical concepts of calibration model tests, relative bias, risk profile and uncertainty in routine methods used for analysis in pharmaceutical field.

Estimating risk of stroke in elderly people by use of Framingham Stroke Risk Profile / 上海预防医学

Objective To explore the application of Framingham Stroke Risk Profile in elderly people. Methods A total of 5 148 people aged 55 years and older who received physical examination in a community were enrolled.Information of their healthy status and risk factors were collected by interview using a questionnaire.Height, weight, waist circumference (WC), and blood pressure as well as fasting plasma glucose ( FPG) , and serum lipid were measured. Results The average 10-year probabilities of stroke in elderly people were 9.79% in men and 6.20% in women ( P <0.05).Besides aging factor, higher risk probability in men might be related to their higher proportions of smoking and atrial fibrillation. In addition to blood pressure and FPG which were variables associated with risk profile, WC/height ratio ( WHR) and serum triglyceride level were associated with increased risk of stroke estimated by stroke risk profile (OR=1.598, 95%CI:1.371~1.864;OR=1.487, 95%CI:1.225~1.783), respectively. Conclusion Besides factors which had been included by risk profile, it is important to pay attention to weight control and triglyceride level.For elderly male, to quit smoking is an important measure that decreases their risk of stroke.

Association of stroke risk profile and vascular cognitive impairment / 中华行为医学与脑科学杂志

Objective To investigate the correlation between Framingham stroke risk profile(FSRP) and vascular cognitive impairment in stroke-free patients with cerebrovascular risk factors.Methods One hundred and eighty-four stroke-free subjects,selected from Zhejiang hospital,were divided into low risk group (56 subjects),moderate risk group (70 subjects) and high risk group (58 subjects) according to their FSRP score,and their cognitive function including memory ability,attention,executive function and language ability were assessed by Montreal cognitive assessment (MoCA),auditory verbal learning test (AVLT),digit symbol test,trail making test(TMT),digit span and verbal fluency test.Results The total MoCA scores which were (7.2±4.6),(13.8±3.9),(29.6± 12.7) respectively,AVLT-delay recall scores which were(8.2± 1.6),(6.7± 1.4),(5.9± 1.5) respectively,and digit symbol test score which were(34.7±9.3),(32.6± 16.4),(29.7± 13.6) respectively in low,intermediate and high risk groups,decreased with the increasing risk of stroke(P＜0.05).The elapsed time in TMT-B which were (115.2 ±36.9) s,(147.6±44.8) s,(173.9±58.5) s respectively in low,intermediate and high risk groups,prolonged with the increasing risk of stroke (P＜0.05).FSRP was associated with cognitive function,but inversely related to MoCA,AVLT-delay recall,digit symbol test,TMT-B and digit span fall back (P＜0.05),but positively related to consuming time in TMT-B (P＜ 0.05).Multivariate regression analysis showed that advanced age,hypertension,diabetes and smoking were the risk factors for vascular cognitive impairment(P＜0.05).Conclusion Advanced age,smoking,hypertension and diabetes are the most important in vascular risk factors for cognitive impairment.Vascular risk factors can damage cognitive function with the increased risk of stroke,among which delayed recall and executive function are the main affected cognitive area.

Perfil de riesgo vascular aterosclerótico del fallecido por muerte cardíaca súbita / Atherosclerotic vascular risk profile in patients who died of sudden cardiac death

Objetivo: determinar el perfil de riesgo vascular aterosclerótico en los fallecidos por muerte cardíaca súbita atendidos en el Hospital Julio Trigo López en el período 2007-2011. Métodos: estudio observacional, analítico, de casos y controles no pareados. Resultados: algunos factores de riesgo vasculares ateroscleróticos se expresaron de forma significativa en el grupo de fallecidos por causas cardíacas súbitas (hipertensión arterial, tabaquismo, obesidad, cardiopatía isquémica, hipertrofia ventricular izquierda, alcoholismo). Se corroboró que la existencia de 3 o más factores eleva exponencialmente el riesgo de muerte cardíaca súbita sobre la mortalidad cardiovascular total. Se halló presencia significativa de lesiones ateroscleróticas coronarias en ambos grupos, que determinaron la aparición de trombosis coronaria y/o infarto agudo del miocardio, con predominio en las muertes súbitas. Conclusiones: no existieron factores de riesgo específicos para la muerte cardíaca súbita. Algunos de estos mostraron un incremento en la probabilidad para este tipo de evento. La búsqueda de un perfil de riesgo en fallecidos de muerte cardíaca súbita debe ir orientada al diseño de investigaciones donde se incluyan las estadísticas vitales de mortalidad global y no por causas específicas (cardiovasculares)

Objective: to determine the atherosclerotic vascular risk profile in patients who died of sudden cardiac death, treated in Julio Trigo López Hospital during the period 2007- 2011. Methods: an observational, analytical, and non-matched case-control study was conducted. Results: some atherosclerotic vascular risk factors were expressed significantly in the group of patients who died of sudden cardiac deaths (hypertension, smoking, obesity, ischemic heart disease, left ventricular hypertrophy, alcoholism). It was confirmed that the existence of 3 or more factors exponentially increases the risk of sudden cardiac death on total cardiovascular mortality. A significant presence of coronary atherosclerotic lesions was found in both groups, which determined the onset of coronary thrombosis and/or acute myocardial infarction that predominated in sudden deaths. Conclusions: there were no specific risk factors for sudden cardiac death. Some of them showed an increased probability for this type of event. The search for a risk profile for sudden cardiac death should be oriented to the research design which would include vital statistics of global mortality and not the specific causes (cardiovascular)

Risco de preço na comercialização da soja: uso de derivativos pelos produtores rurais de Maracaju-MS / Price risk in marketing soybeans: use of derivatives by farmers from Maracaju-MS, Brazil

O presente trabalho analisou o comportamento do produtor de soja de Maracaju-MS quanto ao risco de preço e ao uso de derivativos agropecuários, buscando identificar os mecanismos de proteção de preço utilizados e as razões de seu uso ou rejeição. Para tanto, um questionário foi aplicado a uma amostra de produtores de soja, sendo também entrevistados representantes de tradings, armazéns gerais, cooperativas, corretoras e agentes financeiros. Constatou-se que a utilização de ferramentas de proteção de preço é ainda pouco expressiva, já que apenas 11% dos produtores usam o Mercado Futuro (hedge) e o Mercado de Opções, e 38% os utilizaram alguma vez. O principal mecanismo usado é o Mercado a Termo. Produtores que já usaram o Mercado Futuro (hedge) e o de opções atuam em médias e grandes propriedades, têm nível de escolaridade alto e estão mais capitalizados. A baixa utilização dos derivativos (Futuros e Opções) se dá, principalmente, pela falta de conhecimento e pela ausência de profissionais de confiança capazes de orientar os produtores.

The present research analysed the behavior of the soybean farmer of Maracaju-MS, Brazil in relation to price risk and use of agricultural derivatives, seeking to identify the price protection mechanisms used and the reasons for their use or rejection. A questionnaire was applied to a sample of soybean farmers. Also, representatives of trading houses, storage plants, cooperatives, brokers and financial agents were interviewed. Results showed that the use of price protection tools is still scarce, as only 11% of farmers use future market price (hedge) and the options market, and 38% have used them before. The main mechanism used is the forward market. Farmers who already have used futures market (hedge) and options manage medium and large properties, have a high level of education and are better capitalized. The low use of derivatives (futures and options) is mainly due to the lack of both knowledge and trustful professionals to guide farmers in such task.

Incidencia de la práctica de actividad física sobre la ansiedad y depresión en mujeres: perfiles de riesgo / Effect of physical activity on anxiety and depression among women: risk profiles

La literatura científica indica que existe una relación positiva entre la realización de ejercicio físico y la mejora en diferentes aspectos psicológicos, como la ansiedad y la depresión. También algunas variables sociodemográficas parecen influir en esta relación y factores de tipo sociocultural pueden ser importantes. El presente estudio busca conocer la influencia de la práctica de actividad física sobre la ansiedad y la depresión, y determinar los perfiles de mayor riesgo en función de determinadas variables sociodemográficas (edad, nivel de estudios, ocupación e hijos). Participaron 200 mujeres del municipio de Cartagena, Murcia (España), con edades comprendidas entre 18 y 65 años. Los resultados muestran un perfil que caracteriza al grupo de mujeres más vulnerable a manifestar niveles mayores de ansiedad (mujer sedentaria, de entre 18 y 24 años o de más de 54, sin estudios o con estudios secundarios, estudiante, ama de casa o trabajadora por cuenta ajena, y sin hijos) y depresión (mujer sedentaria, de más de 54 años o entre 18 y 24, con estudios secundarios y ama de casa).

Scientific literature indicates that there is a positive relationship betweenexercise and the improvement of several psychological aspects such asanxiety and depression. Some sociodemographic variables also seem to be involved in this relationship, and socio-cultural factors can be important.This study intended to find out the influence of practicing physical activityon anxiety and depression and to determine the profiles at greater riskwith regard to certain sociodemographic variables (age, level of studies,occupation, and children). Participants were 200 women from the city ofCartagena, Spain, between 18 and 65 years of age. Results show that themost vulnerable groups of women for suffering greater levels of anxiety anddepression are characterized by the following profiles: anxiety (sedentarywomen, between 18-24 years of age or older than 54 years, who have notcompleted studies or those with secondary studies, housewives or thosewho work outside the home, and those without children) and depression(sedentary women, older than 54 years of age or between 18-24 years, thosewith secondary studies, and housewives).

Fatores de risco para doença cerebrovascular e função cognitiva em idosos / Risk factors for cerebrovascular disease and cognitive function in the elderly

OBJETIVO: Identificar a concomitância de fatores de risco para acidente vascular cerebral e de disfunção na cognição de idosos acima de 60 anos. MÉTODOS: Idosos com diferentes graus de risco de acordo com a escala de Framinghan para acidente vascular cerebral (AVC) tiveram comparadas suas habilidades cognitivas. O risco de evento isquêmico cerebral foi calculado pela escala de Framingham para AVC. Os instrumentos neuropsicológicos aplicados foram os testes de memória seletiva de Buschke, fluência verbal (animais), desenho do relógio, teste de aprendizado auditivo verbal de Rey, dígito span e vocabulário. O estudo foi feito com uma amostra randômica e representativa de todos os 200 idosos residentes na área de abrangência de uma unidade de atenção primária de saúde (posto Morada das Flores, Porto Alegre). Foi incluído no estudo um número representativo de 46 idosos. RESULTADOS: Os idosos com escore de risco obtiveram um desempenho inferior em testes de memória (SOL com p=0,02) e na capacidade de planejamento (Teste do relogio com p=0,03). A presença de diabetes manteve-se como fator associado ao desempenho da evocação tardia do teste de aprendizado auditivo verbal de Rey (p=0,04). CONCLUSÃO: A presença de fatores de risco para AVC esteve associada com pior performance cognitiva em funções de memória e em funções executivas em idosos.

OBJECTIVE: To determine whether stroke risk factors and cognitive dysfunction are concomitant in individuals over the age of 60. METHODS: The cognitive abilities of elderly individuals with different degrees of risk as per the Framingham stroke risk profile were compared. The Framingham stroke risk profile was used to calculate the risk of an ischemic cerebral event. Neuropsychological tests included the Buschke Selective Reminding Test, verbal fluency (animals), clock drawing, Rey Auditory Verbal Learning, digit span and vocabulary. A random and typical population sample was used in the study, selected from the 200 elderly residents in the area surrounding the primary health care facility (Morada das Flores Clinic, Porto Alegre). Forty-six elderly individuals were included in the study. RESULTS: The elderly individuals with a risk profile, had lower memory test performance levels (NF, p=0.02) and planning capacity (clock drawing test, p=0.03). Diabetes proved to be related to delayed recall performance in the Rey auditory verbal learning test (p=0.04). CONCLUSION: The presence of stroke risk factors in the elderly was associated with worse cognitive performance for memory and executive functions.