Association of Baseline Pre-Diagnosis and Post-Diagnosis Obesity and Weight Change with Cardiovascular Risk and Survival Among Nonmetastatic Prostate Cancer Survivors.

INTRODUCTION: Obesity in prostate cancer survivors may increase mortality. Better characterization of this effect may allow better counseling on obesity as a targetable lifestyle factor to reduce mortality in prostate cancer survivors. The purpose of this study was to determine whether pre- and post-diagnostic obesity and weight change affect all-cause mortality, cardiovascular disease specific mortality, and prostate cancer specific mortality in patients with nonmetastatic prostate cancer. PATIENTS AND METHODS: We performed a retrospective cohort analysis of 5,077 patients diagnosed with localized prostate cancer from 1997 to 2017 with median follow-up of 15.5 years. The Utah Population Database linked to the Utah Cancer Registry was used to identify patients at a variety of treatment centers. RESULTS: Pre-diagnosis obesity was associated with a 62% increased risk of cardiovascular disease specific mortality and a 34% increased risk of all-cause mortality (HR 1.62, 95% CI 1.05-2.50; HR 1.34, 95% CI 1.07-1.67, respectively). Post-diagnosis obesity increased the risk of cardiovascular disease specific mortality (HR 1.83, 95% CI 1.31-2.56) and all-cause mortality (HR 1.37, 95% CI 1.16-1.64) relative to non-obese men. We found no association between pre-diagnostic obesity or post-diagnostic weight gain and prostate cancer specific mortality. CONCLUSION: Our study strengthens the conclusion that pre-, post-diagnostic obesity and weight gain increase cardiovascular disease and all-cause mortality but not prostate cancer specific mortality compared to healthy weight men. An increased emphasis on weight management may improve mortality for prostate cancer survivors who are obese.

Disparities in Provider Ordering Practices of Image-Guided Interventions and Surgery for Patients With Low Back Pain: A Cohort Study.

OBJECTIVE: To assess individual- and neighborhood-level sociodemographic factors associating with providers' ordering of nonpharmacologic treatments for patients with low back pain (LBP), specifically physical therapy, image-guided interventions, and lumbar surgery. METHODS: Our cohort included all patients diagnosed with LBP from 2000 to 2017 in a statewide database of all hospitals and ambulatory surgical facilities within Utah. We compared sociodemographic and clinical characteristics of (1) patients with LBP who received any treatment with those who received none and (2) patients with LBP who received invasive LBP treatments with those who only received noninvasive LBP treatments using the Student's t test, Wilcoxon's rank-sum tests, and Pearson's χ2 tests, as applicable, and two separate multivariate logistic regression models: (1) to determine whether sociodemographic characteristics were risk factors for receiving any LBP treatments and (2) risk factors for receiving invasive LBP treatments. RESULTS: Individuals in the most disadvantaged neighborhoods were less likely to receive any nonpharmacologic treatment orders (odds ratio [OR] 0.74 for most disadvantaged, P < .001) and received fewer invasive therapies (0.92, P = .018). Individual-level characteristics correlating with lower rates of treatment orders were female sex, Native Hawaiian or other Pacific Islander race (OR 0.50, P < .001), Hispanic ethnicity (OR 0.77, P < .001), single or unmarried status (OR 0.69, P < .001), and no insurance or self-pay (OR 0.07, P < .001). CONCLUSION: Neighborhood and individual sociodemographic variables associated with treatment orders for LBP with Area Deprivation Index, sex, race or ethnicity, insurance, and marital status associating with receipt of any treatment, as well as more invasive image-guided interventions and surgery.

Mental health outcomes in a population-based cohort of patients with prostate cancer.

BACKGROUND: Few studies have evaluated mental health disorders comprehensively among patients with prostate cancer on long-term follow-up. The primary aim of our study was to assess the incidence of mental health disorders among patients with prostate cancer compared with a general population cohort. A secondary aim was to investigate potential risk factors for mental health disorders among patients with prostate cancer. METHODS: Cohorts of 18 134 patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73470 men without cancer matched on age, birth state, and follow-up time were identified. Mental health diagnoses were identified from electronic health records and statewide health-care facilities data. Cox proportional hazard models were used to estimate hazard ratios. All statistical tests were 2-sided. RESULTS: The hazard ratios for mood disorders, including depression, among prostate cancer survivors increased for all follow-up periods compared with the general population. The hazard ratios for any mental illness increased with Hispanic, Black, or multiple races; people who were underweight or obese; those with advanced prostate cancer; and those undergoing their first course cancer treatment. We also observed statistically significantly increased hazard ratios for mental health disorders among patients with lower socioeconomic status (P < .0001) and increasing duration of androgen-deprivation therapy (P = .0348). Prostate cancer survivors had a 61% increased hazard ratio for death with a depression diagnosis. CONCLUSION: Prostate cancer diagnosis was associated with a higher risk of mental health disorders compared with the general population, which was observed as long as 10-16 years after cancer diagnosis. Providing long-term mental health support may be beneficial to increasing life expectancy for patients with prostate cancer.

Comparing Active Surveillance and Watchful Waiting With Radical Treatment Using Machine Learning Models Among Patients With Prostate Cancer.

PURPOSE: In 2021, 59.6% of low-risk patients with prostate cancer were under active surveillance (AS) as their first course of treatment. However, few studies have investigated AS and watchful waiting (WW) separately. The objectives of this study were to develop and validate a population-level machine learning model for distinguishing AS and WW in the conservative treatment group, and to investigate initial cancer management trends from 2004 to 2017 and the risk of chronic diseases among patients with prostate cancer with different treatment modalities. METHODS: In a cohort of 18,134 patients with prostate adenocarcinoma diagnosed between 2004 and 2017, 1,926 patients with available AS/WW information were analyzed using machine learning algorithms with 10-fold cross-validation. Models were evaluated using performance metrics and Brier score. Cox proportional hazard models were used to estimate hazard ratios for chronic disease risk. RESULTS: Logistic regression models achieved a test area under the receiver operating curve of 0.73, F-score of 0.79, accuracy of 0.71, and Brier score of 0.29, demonstrating good calibration, precision, and recall values. We noted a sharp increase in AS use between 2004 and 2016 among patients with low-risk prostate cancer and a moderate increase among intermediate-risk patients between 2008 and 2017. Compared with the AS group, radical treatment was associated with a lower risk of prostate cancer-specific mortality but higher risks of Alzheimer disease, anemia, glaucoma, hyperlipidemia, and hypertension. CONCLUSION: A machine learning approach accurately distinguished AS and WW groups in conservative treatment in this decision analytical model study. Our results provide insight into the necessity to separate AS and WW in population-based studies.

Adverse health outcomes among rural prostate cancer survivors: A population-based study.

INTRODUCTION: Rural cancer survivors experience considerable health disparities compared to urban cancer survivors for cancer treatment and survival. The objective of our study was to investigate the risk of developing diseases for rural compared to urban prostate cancer survivors in Utah. METHODS: We identified a cohort of 3575 rural prostate cancer survivors and 17,778 urban prostate cancer survivors from the Utah Cancer Registry. The Fine-Gray subdistribution hazards model was used to estimate hazard ratios and 95 % confidence intervals for diseases in major body systems among rural compared to urban prostate cancer survivors at > 1-5 years and > 5 years after prostate cancer diagnosis. RESULTS: Rural residence was associated with an increased risk of diseases of the respiratory system at > 5 years (HR: 1.16, 95 % CI: 1.01-1.32) after cancer diagnosis compared to urban residence among prostate cancer survivors in Utah. Decreased risks were observed in infectious and parasitic diseases, diseases of the blood and blood-forming organs, diseases of the nervous system and sense organs, and diseases of the skin and subcutaneous tissue for rural prostate cancer survivors between 1 and 5 years after cancer diagnosis. CONCLUSIONS: Rural prostate cancer survivors in Utah were somewhat healthier compared to urban prostate cancer survivors. Further studies are needed to confirm whether these associations are also supported for rural prostate cancer survivors in other regions of the U.S.

Determining the association of rurality and cardiovascular disease among prostate cancer survivors.

PURPOSE: Rural disparities in prostate cancer survivorship and cardiovascular disease remain. Prostate cancer treatment also contributes to worse cardiovascular disease outcomes. Our objective was to determine whether rural-urban differences in cardiovascular outcomes contribute to disparities in prostate cancer survivorship. MATERIALS AND METHODS: Data were collected from the Utah Population Database. Rural and urban prostate cancer survivors were matched by diagnosis year and age. Cox proportional hazards models were used to estimate hazard ratios for cardiovascular disease (levels 1-3) based on rural-urban classification, while controlling for demographic and socioeconomic characteristics. We identified 3,379 rural and 16,253 urban prostate cancer survivors with a median follow-up of 9.3 years. RESULTS: Results revealed that rural survivors had a lower risk of hypertension (HR 0.90), diseases of arteries (HR 0.92), and veins (HR 0.92) but a higher risk of congestive heart failure (HR 1.17). Interactions between level 2 cardiovascular diseases and rural/urban status, showed that diseases of the heart had a distinct between-group relationship for all-cause (P = 0.005) and cancer-specific mortality (P = 0.008). CONCLUSIONS: This study revealed complex relationships between rural-urban status, cardiovascular disease, and prostate cancer. Rural survivors were less likely to be diagnosed with screen-detected cardiovascular disease but more likely to have heart failure. Further, the relationship between cardiovascular disease and survival was different between rural and urban survivors. It may be that our findings underscore differences in healthcare access where rural patients are less likely to be screened for preventable cardiovascular disease and have worse outcomes when they have a major cardiovascular event.

Surveillance Imaging with PET/CT and CT and/or MRI for Head and Neck Cancer and Mortality: A Population-based Study.

Background To the knowledge of the authors, no strong evidence supports surveillance imaging in patients with head and neck cancer (HNC). Purpose To investigate the association between surveillance imaging and mortality using a population-based study design with statewide cancer registry data, all-payer claims data, and health care facility data. Materials and Methods The retrospective population-based study identified patients with HNC diagnosed between January 2012 and December 2017. Current Procedural Terminology codes were used to search surveillance imaging procedures. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for mortality with adjustment for sex, ethnicity, age, health insurance status, cancer site, stage, and treatment. Results The study identified 1004 patients (mean age, 61 years ± 12 [SD]; 753 men), including 902 patients with squamous cell carcinoma (SCC) HNC and 102 patients with non-SCC. The effect of imaging on mortality among patients with SCC was not statistically significant when the entire sample was analyzed (HR, 0.76; 95% CI: 0.57, 1.02; P = .07). However, in stratified analyses by cancer stage, surveillance imaging was associated with lower mortality among patients with SCC for regionalized cancer stage (HR, 0.55; 95% CI: 0.36, 0.83; P = .005) and distant cancer stage (HR, 0.40; 95% CI: 0.19, 0.83; P = .01). Among patients with non-SCC, surveillance imaging was associated with lower mortality versus no surveillance imaging (HR, 0.19; 95% CI: 0.04, 0.94; P = .04). PET/CT was associated with lower mortality for patients with SCC (HR, 0.29; 95% CI: 0.09, 0.94; P = .04), and CT and/or MRI was associated with lower mortality for patients with non-SCC (HR, 0.11; 95% CI: 0.01, 0.94; P = .04). Conclusion Surveillance imaging was associated with lower mortality among patients with head and neck squamous cell carcinoma with regionalized or distant disease. The surveillance imaging protective association was observed up to 2 years after treatment completion. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Branstetter in this issue.

Spatial multicriteria approach to support water resources management with multiple sources in semi-arid areas in Brazil.

Semi-arid regions often face severe drought events that reduce agricultural and livestock production. In recent years, some international studies have used multicriteria decision analysis (MCDA) approaches combined with geographic information systems (GIS-MCDA) to support decision-makers in assessing the suitability of agricultural land for irrigation in semi-arid regions. Unlike previous studies, which have only considered a single source of water for crop irrigation, this study proposes a GIS-MCDA approach that considers all potentially available local water sources (e.g., groundwater, surface water, and wastewater) as possible alternatives for better multisource water resource management (MWRM) in regions facing water shortages. The geospatial multicriteria evaluation implemented in this study considers a series of technical, environmental, and agricultural productivity criteria using the analytical hierarchy process (AHP) method. Three independent baseline maps were generated, showing the spatial distribution of suitable areas for crop irrigation for each considered water source in the studied area. Surface water, groundwater, and wastewater offered suitable crop irrigation for 83%, 70%, and 26% of the study area, respectively. Overlapping these areas produced a final map showing all the feasible areas for each crop irrigation alternative at the same time. The MWRM approach considering all water sources increased the coverage of suitable areas to be irrigated in the study area by 2.2%, 20.4%, and more than 225% compared to considering surface water, groundwater, and wastewater, respectively, independently. The GIS-MCDA framework proposed in this study provides better support for decision-makers and stakeholders, favouring a reduction in possible conflicts over water scarcity, the diversification of irrigated crops, and an improvement in the quality-quantitative management of water resources in semi-arid regions.

Interfaces entre a produção do espaço urbano e o risco de desabastecimento de água / Interfaces between production of urban space and the water shortage risk

RESUMO O contínuo crescimento de áreas urbanas é uma realidade vivenciada no âmbito global. Esse crescimento, no entanto, na maioria das vezes, não é seguido de um planejamento da ocupação territorial, especialmente no que diz respeito às articulações com o provimento dos serviços de infraestrutura urbana, a exemplo dos sistemas de abastecimento de água. Dentre outras consequências, esses distanciamentos, somados ao crescimento populacional, agravam o risco de desabastecimento de água nessas áreas. Analisando-se a cidade paraibana Campina Grande, Nordeste do Brasil, o presente artigo identificou interfaces entre o chamado processo de produção do espaço urbano e o consequente risco de desabastecimento. Analisa-se especificamente o bairro Catolé, representativo de acelerada urbanização nas últimas três décadas, decorrente de ações de diferentes agentes produtores do espaço. É empregada análise espacial multicritério para determinação do risco de desabastecimento, realizando-se análise comparativa entre os anos de 2000 e 2010. Os resultados apontam a importância de elevar a profundidade nas discussões a respeito da forma como as cidades são construídas, considerando-se não apenas os critérios técnicos e avançando-se na compreensão de como diferentes interesses envolvidos no processo de produção do espaço urbano condicionam a cidade a um maior ou menor risco de desabastecimento de água.

ABSTRACT The continuous growth of urban areas is a reality experienced globally. However, this growth is sometimes not supported by a suitable urban land-use planning, in particular, there is a lack between infrastructure services (e.g. water supply systems) planning and urban planning. Among other consequences, these disconnections, coupled with population growth, exacerbate the risk of water shortage in these urban areas. This article analyzes the city of Campina Grande, Northeast Brazil, and identifies the interfaces between the so-called urban space production process and the consequent risk of water shortage. The analysis focuses on the Catolé district, which is a representative case of accelerated urbanization in the last three decades, due to the actions of different urban built-up stakeholders. A spatial multicriteria analysis is used to determine the water shortage risk, making a comparative analysis between 2000 and 2010. The results point out to the importance of increasing an in-depth discussion about the built-up process of cities. Besides, the study takes into account technical criteria, plus the understanding of how different interests groups involved in the built-up process submits a city to a high or low water shortage risk.

Vulnerabilidade domiciliar em situação de intermitência no abastecimento de água / Household vulnerability to intermittent water supply systems

RESUMO Os sistemas de abastecimento em regime de intermitência fornecem água aos usuários por um período limitado de tempo, produzindo efeitos adversos à rede de abastecimento de água e aos usuários do sistema, em especial os usuários domésticos, cuja demanda é pouco flexível e a capacidade de adaptação limitada. Neste trabalho é proposto um conjunto simplificado de indicadores que permite identificar diferentes níveis de vulnerabilidade ao desabastecimento de água aos quais uma população urbana está sujeita em situação de intermitência no abastecimento. Os indicadores podem ser obtidos de dados censitários, de informações topológicas, topográficas e hidráulicas do sistema de abastecimento e de levantamentos cadastrais ou de sensoriamento remoto da localidade, podendo ser processados em Sistemas de Informações Geográficas (SIGs). Os indicadores são aplicados ao caso de Campina Grande, Paraíba, com base em levantamentos disponíveis sobre usuários que vivenciaram a situação de intermitência no abastecimento. Os resultados permitem a identificação das áreas cujos usuários podem ser potencialmente mais afetados pela intermitência no abastecimento e a recomendação de medidas mitigadoras para a redução de sua vulnerabilidade.

ABSTRACT Intermittent supply in water distribution systems occurs when the water service is available for a limited period of time, producing adverse effects on the water supply network and users of the system, in particular domestic users, whose demand is not flexible and the adaptive capacity is limited. This paper proposed a simplified set of indicators to identify different levels of vulnerability to water shortages to which an urban population is subject, in a situation of intermittent water supply. The indicators can be obtained from census data, topological, topographic, and hydraulic information from the supply system and from cadastral surveys or remote sensing of the locality, and can be processed in geographic information systems (GIS). This article presented the formulation of the indicators and their application to the Campina Grande system, Paraíba, Brazil, based on available surveys on users in intermittent supply situations. The results allow the identification of areas whose users may be potentially most affected by intermittent supply and the recommendation of mitigating measures to reduce their vulnerability.

A cidade sensível à água sob a perspectiva do metabolismo urbano e da análise da produção do espaço / The water-sensitive city from the urban metabolism and space production analysis perspective

RESUMO Neste artigo, argumenta-se que a sensibilidade urbana em relação aos recursos hídricos pode ser aumentada pela compreensão do processo de produção do espaço e do metabolismo urbano. Propõem-se duas análises integradas do espaço urbano: a primeira é relativa ao desempenho hidrológico, em que são levantados os potenciais de diversificação hídrica por meio do desenvolvimento de indicadores quantitativos e da geração de cenários possíveis à diversificação; a segunda refere-se à produção do espaço, em que é realizado levantamento histórico das condições de acesso à água. Verifica-se como se dá o processo de produção do espaço e o impacto desse processo sobre os recursos hídricos. Mais detalhadamente, observam-se as correlações entre os agentes e as transformações espaciais, visando identificar as associações que comandam essas transformações. Essa proposta metodológica é aplicada à cidade de Campina Grande, Paraíba, elegendo-se um bairro que sofreu expressivas transformações espaciais nos últimos 20 anos. Os resultados mostram um potencial de 243% para diversificação por uso de água de chuva e 69% por reuso de água residuária. Por meio da combinação de possibilidades de diversificação hídrica, o sistema de abastecimento, que atualmente é centralizado, poderia ter essa centralização reduzida a até 57%. A análise da dinâmica urbana revela a necessidade de intervenção do poder público quanto à adoção de medidas de controle da ocupação do solo. Atualmente, os promotores imobiliários e proprietários fundiários condicionam o processo de produção do espaço, o que dificulta a melhoria do desempenho hidrológico urbano.

ABSTRACT The present work is based on the premise that the urban sensitivity in relation to water resources can be increased by the understanding of urban metabolism. Two related urban space analyses are proposed: the former is related to the hydrological performance, in which water diversification potentials are raised by developing quantitative indicators and by the generation of possible scenarios for diversification; the latter refers to the space production, in which a historical survey of the access conditions to water is studied. The space production proceeding is verified, and the impact of its process on the water resources. In more details, the correlations between agents and spatial transformations are observed, aiming to identify the associations that command these transformations. This methodological propose is applied in the city of Campina Grande, Paraíba, choosing a specific neighborhood that has undergone significant spatial transformations in the last 20 years. Results showed a potential of 243% for diversification by using rainwater, and 69% by reusing wastewater. Through the combination of possibilities for water diversification, the supply system, which is currently fully centralized, could have this centralization reduced to up to 57%. The urban dynamics analysis reveals the need for public intervention in the adoption of control measures of soil occupation. Currently, real-estate developers and entrepreneurs lead the space production process, which makes it difficult to improve urban hydrological performance.

Perfil nutricional de pacientes onco-hematológico internados em um Hospital Especializado em câncer em São Luís - MA / Nutritional Profile of Onco-hematological Patients Hospitalized in a Cancer Specialized Hospital in São Luís - MA

Objetivo: Avaliar o perfil nutricional de pacientes onco-hematológicos internados em um hospital especializado em câncer em São Luís - MA. Metodologia: Estudo transversal, retrospectivo, analítico, com coleta de dados secundária, envolvendo pacientes com idade mínima de 18 anos, de ambos os gêneros e que tenham sido submetidos a pelo menos uma ASG-PPP (Avaliação Subjetiva Global Produzida Pelo Paciente). Os dados foram coletados em registros do Serviço de Nutrição e Dietética do hospital. Analisaram-se dados demográficos (gênero e idade), clínicos (diagnóstico) e nutricionais: Índice de massa corporal (IMC), circunferên-cia braquial (CB), prega cutânea tricipital (PCT), circunferência muscular do braço (CMB) e ASG-PPP. As análises foram realizadas no programa estatístico Stata® 13.0. O nível de significância utilizado para os testes foi de p<0,05. Resultados: Foram avaliados 330 pacientes, onde foi constatado que 67,58% eram de adultos e 32,42% de idosos, com maior frequência do sexo masculino, com 60,30%. Ocorreu maior incidência de leucemia (58,48%), seguidos de linfomas (24,85%), mieloma múltiplo (13,33%) e síndrome mielodisplásica (3,3%). Na avaliação do estado nutricional os resultados mostraram que a ASG-PPP detectou maior número de pacientes com algum grau de desnutrição do que outros indicadores (93,94%), seguido pela PCT (65,76%), CMB (53,64%), CB (45,45%) e IMC (14,87%). De acordo com o IMC, foi encontrado maior incidência de eutrofia, correspondendo a 57,27% da amostra. Conclu-são: Diante do que foi encontrado, destaca-se que a desnutrição é um aspecto de extrema importância a ser considerado no tratamento de pacientes onco-hematológicos, visto que pode interferir diretamente no prognóstico da doença. (AU)

Objective: To evaluate the nutritional profile of onco-hematological patients admitted to a specialized cancer hospital in São Luís - MA. Methodology: Cross-sectional, retrospective, analytical study, with secondary data collection, involving patients aged at least 18 years, of both genders and having undergone at least one ASG-PPP (Subjective Global Assessment Produced by the Patient). Data were collected from records of the Hospital's Nutrition and Dietetics Service. Demographic (gender and age), clinical (diagnostic) and nutritional: Body Mass Index (BMI), Brachial Circumference (CB), Tricipital Skinfold (PCT), Muscular Arm Circumference (CMB) and ASG-PPP data were analyzed. The analyses were performed using the Stata® 13.0 statistical program. The level of significance used for the tests was p<0.05. Results: 330 patients were evaluated, in which it was found that 67.58% are adults and 32.42% are elderly, with a higher frequency of males with 60.30%. There was a higher incidence of Leukemia (58.48%), followed by Lymphomas (24.85%), Multiple Myeloma (13.33%) and Myelodysplastic Syndrome (3.3%). In the assessment of nutritional status, the results showed that ASG-PPP detected a greater number of patients with some degree of malnutrition than other indicators (93.94%), followed by PCT (65.76%), CMB (53.64%), CB (45.45%) and BMI (14.87%). According to the BMI, a higher incidence of eutrophy was found, which corresponds to 57.27% of the sample. Conclusion: In view of what was found, it is highlighted that malnutrition is an extremely important aspect to be considered in the treatment of onco-hematological patients, since it can directly interfere in the prognosis of the disease. (AU)

Groundwater Management in Coastal Areas through Landscape Scale Planning: A Systematic Literature Review.

Groundwater is one of the main resources for social-ecological systems. As part of the total water cycle and deeply connected with land use, groundwater management faces many challenges, especially in coastal areas. Landscape Scale Planning is an emerging approach for land use planning providing a framework for management based on evidence, given that landscapes have physical and information flows. Landscape Scale Planning embraces the following three dimensions: (i) the spatial dimension centres on the recognition of distinct landscape units; (ii) the temporal dimension entails past, current and future uses of a landscape; and (iii) the modification dimension involves the anthropogenic alterations that affected and will affect the landscape and its features along the spatial and temporal dimensions. Through a systematic literature review of 28 selected publications, this paper explores how groundwater management can be improved through a Landscape Scale Planning approach. The results show that Landscape Scale Planning can be applied as an integrative framework for groundwater management. Landscape units based on, but not limited to, geology, topography, cultural and socio-economic aspects can aid groundwater management to consider the differing spatial and temporal characteristics of the aquifer. Landscape Scale Planning can also favour the inclusion of land use change dynamics in groundwater management processes. To this end, the paper proposes guidelines for applying Landscape Scale Planning to inform groundwater management and consider land use changes.

Piezometric level and electrical conductivity spatiotemporal monitoring as an instrument to design further managed aquifer recharge strategies in a complex estuarial system under anthropogenic pressure.

Recife Metropolitan Region (RMR, NE Brazil) lies over a multi-layered aquifer system located in an estuarial area. The region has experienced fast population growth and repeated droughts in the last three decades, which led to unprecedented anthropogenic pressure on groundwater resources because of intense water pumping. Accordingly, scientific and stakeholder communities have been challenged to ensure the maintenance of sustainable groundwater resource by managing all water cycle. Because controlling pumping rates is difficult due to the large number of illegal wells, the Managed Aquifer Recharge (MAR) strategies are now under consideration. The RMR presents a tropical climate and an annual average rainfall rate of approximately 2450 mm year-1, providing great potential volumes of water to be used for piezometric level recovery. However, MAR implementation requires a detailed and in-depth knowledge of the human-impact on the hydrogeological behavior of the resource over the long-term, in order to find out the most appropriate recharge strategy. Therefore, the present study illustrates how routine data monitoring, i.e., piezometric level and electrical conductivity (EC), in combination with the geological knowledge, may allow proposing further MAR strategies. Two contrasted behaviors were observed in RMR: (i) groundwater level decrease and stable EC in the North and Southernmost areas of Recife; and (ii) stable groundwater level and high/varying EC values next to the estuarial zone. Although aquifers are undergoing over-abstraction, this spatiotemporal heterogeneity suggests that a recharge is possibly locally favored next to the estuarial area of the RMR thanks to hydraulic connections between surface and deep aquifers throughout extended paleo-channels. Thus, based on this typology, MAR implementation through controlled infiltration close to the estuarial area seems to be more appropriated, whereas the direct deep injection appears to be more relevant in more distant zones.

Obesidade abdominal e fatores associados em adultos atendidos em uma clínica escola / Abdominal obesity and associated factors among adults attending a university health center / Obesidad abdominal y factores asociados en adultos asistidos en una clínica escuela

Objetivo: Determinar a prevalência de obesidade abdominal e identificar associação entre fatores socioeconômicos e estilo de vida em adultos atendidos numa clínica escola em São Luís, Brasil. Métodos: Estudo retrospectivo e transversal, realizado entre março e abril de 2015, com 1.022 prontuários de adultos de ambos os sexos, atendidos numa clínica escola, nos últimos cinco anos. Foram coletadas informações sobre dados socioeconômicos (sexo, idade, estado civil, renda familiar e escolaridade), antropométricos (peso atual, altura, IMC e CC) e estilo de vida (tabagismo, ingestão de álcool e atividade física). A variável dependente foi a obesidade abdominal, definida pela razão cintura/estatura (RCest). Realizou-se análise multivariada pelo método regressão logística. Resultados: A prevalência de obesidade abdominal foi de 79,8%, de acordo com a RCest e, segundo IMC, o excesso de peso correspondeu a 77,1%. Verificou-se que as idades de 30 a 59 anos foram fator de risco para obesidade abdominal para ambos os sexos e, quando estratificada, para o sexo feminino. Porém, com relação ao sexo masculino, somente a faixa etária de 50 a 59 anos foi fator de risco (OR=5,76; IC=1,13-29,35; p=0,035). Viver com companheiro (OR=1,53; IC=1,07-2,18; p=0,017) e consumir álcool (OR=1,62; IC=1,09-2,40; p=0,015) apresentaram risco para ambos os sexos, sendo este também fator de risco para o sexo masculino (OR=2,46; IC=1,02-5,95; p=0,045). Conclusão: Observou-se alta prevalência de obesidade abdominal, que se mostrou associada à faixa etária de 30 a 59 para mulheres e 50 a 59 anos para homens, à convivência com o companheiro e ao consumo de álcool para ambos os sexos.

Objective: To determine the prevalence of abdominal obesity and identify the association between socioeconomic factors and lifestyle among adults attending a university health center. Methods: Retrospective and cross-sectional study conducted between March and April 2015 with 1,022 medical records of adults of both genders attending a university health center in the last five years. We collected sociodemographic data (gender, age, marital status, household income and education), anthropometric data (current weight, height, BMI and WC) and information on lifestyle (smoking, drinking and physical activity). The dependent variable was abdominal obesity, defined by the waist-height ratio (WHtR). Multivariate analysis was performed using the logistic regression method. Results: The prevalence of abdominal obesity was 79.8% according to WHtR and, according to BMI, excessive weight accounted for 77.1%. It was found that the ages 30-59 years were a risk factor for abdominal obesity for both genders, and for women when stratified. However, with regard to men, only the age group 50-59 years constituted a risk factor (OR=5.76; CI=1.13-29.35; p=0.035). Living with a partner (OR=1.53; CI=1.07-2.18; p=0.017) and drinking (OR=1.62; CI=1.09-2.40; p=0.015) constituted risk factors for both genders and also for men (OR=2.46; CI=1.02- 5.95; p=0.045). Conclusion: There was a high prevalence of abdominal obesity and it was associated with the age groups 30-59 years for women and 50-59 years for men, and living with a partner and drinking for both genders.

Objetivo: Determinar la prevalencia de obesidad abdominal e identificar su asociación con los factores socioeconômicos y estilo de vida de adultos asistidos en una clínica escuela de São Luís, Brasil. Métodos: Estudio retrospectivo y transversal realizado entre marzo y abril de 2015 en 1.022 historiales clínicos de adultos de ambos los sexos, asistidos en una clínica escuela em los últimos cinco años. Se recogieron informaciones de datos socioeconómicos (el sexo, la edad, el estado civil, la renta familiar y la escolaridad), antropométricos (el peso actual, la altura, el IMC y la CC) y estilo de vida (el tabaquismo, la ingesta de alcohol y la actividad física). La variable dependiente fue la obesidad abdominal que fue definida por la razón cintura/estatura (RCest). Se realizó un análisis multivariado por el método de regresión logística. Resultados: La prevalencia de la obesidad abdominal fue del 79,8%, según la RCest y según el IMC, el exceso de peso correspondió al 77,1%. Se verificó que las edades entre 30 y 59 años fueron factor de riesgo para la obesidad abdominal para ambos los sexos y, al estratificar, para el sexo femenino. Sin embargo, respecto al sexo masculino solamente la franja de edad entre 50 y 59 años fue factor de riesgo (OR=5,76; IC=1,13-29,35; p=0,035). Vivir con un compañero (OR=1,53; IC=1,07-2,18;p=0,017) y consumir alcohol (OR=1,62; IC=1,09-2,40; p=0,015) fueron identificados como riesgo para ambos los sexos y este último ha sido también un factor de riesgo para el sexo masculino (OR=2,46; IC=1,02-5,95; p=0,045). Conclusión: Se observo alta prevalencia de obesidad abdominal que estuvo asociada a la franja de edad entre 30 y 50 años para las mujeres y 50 y 59 años para los hombres, a la convivencia con el compañero y al consumo de alcohol para ambos los sexos.

Método de Coleta e a Qualidade do Esfregaço de Mucosa Oral / Collection Method and the Quality of the Smears from Oral Mucosa

A citopatologia é um método diagnóstico, baseado na análise das características morfológicas de um pequeno conjunto de células que se destacam das superfícies epiteliais, decorrente do processo constante de esfoliação e renovação celular. O estudo dessas células pode sugerir um diagnóstico de acordo com as alterações estruturais encontradas, sendo útil tanto na avaliação inicial de lesões incipientes como no acompanhamento de áreas que passaram por ressecção prévia. Existem relatos de inúmeros métodos de coleta dessas células na literatura. A citologia esfoliativa convencional e a citologia esfoliativa em base líquida são dois dos mais conhecidos dentre esses métodos. Nesse sentido, o presente trabalho tenta estabelecer as principais vantagens e desvantagens, indicações e contraindicações das duas técnicas em questão.

The cytology is a diagnostic method based on analysis of morphological characteristics of a small cluster of cells that stand out from the epithelial surfaces, resulting from the constant process of exfoliation and cellular renewal. The study of these cells may suggest a diagnosis according to the structural changes found, being useful both in the initial evaluation of incipient lesions in the monitoring of areas that have undergone previous resection. There are reports of several methods of collecting these cells in the literature. The exfoliative cytology exfoliative cytology and conventional liquid-based are two of the best known among these methods. Accordingly, the present paper tried to establish what are the main advantages and disadvantages, indications and contraindications of the two techniques in question.

Prevalência de maloclusöes na América Latina e consideraçöes antropológicas / Prevalence of malocclusion in the Latin America and anthropological considerations

Os autores, após tecerem algumas consideraçöes de natureza antropológica, nas quais mostram as variaçöes morfológicas faciais nas várias raças, apresentam alguns trabalhos epidemiológicos sobre a incidência de maloclusöes na América Latina. Observam que as pesquisas säo escassas, de natureza regional e näo obedecem a uma metodologia uniforme. De maneira geral, os percentuais de maloclusöes obtidos na totalidade destas pesquisas raramente estäo abaixo de 50(por cento)

Tendência do crescimento facial: estudo cefalométrico em escolares de Araçatuba-SP / Facial growth tendency: cephalometric study in scholars of Araçatuba-SP

O autor estudou a tendência do crescimento facial numa amostra de escolares com idades variando entre 11 e 15 anos. Utilizou o método cefalométrico de Tweed que avalia o crescimento através da amplitude do ângulo ANB. As crianças foram examinadas clinicamente e, posteriormente telerradiografadas. Os cefalogramas e respectivas mensurações foram executados por computador

Seqüência e cronologia da erupçäo de caninos e pré-molares: estudo em escolares na faixa etária de 10 a 15 anos / Sequency and chronology of cuspids and bicuspids eruption: study in students between 10 and 15 years

O autor estudou a cronologia e a seqüência da erupçäo de caninos e pré-molares numa amostra de crianças na faixa etária de 10 a 15 anos, de ambos os sexos. Foram examinados 401 escolares das zonas urbana e rural da cidade de Araçatuba, Säo Paulo. Os resultados säo comentados e comparados com os outros pesquisadores. Com respeito à cronologia, foi observada alguma variabilidade da erupçäo em relaçäo à idade civil sem, entretanto, distanciar-se das tabelas usuais. Ficou constatado que, de maneira geral, os dentes permanentes das crianças do sexo feminino erupcionam mais precocemente do que no masculino. Concluiu-se que a seqüência mais freqüente foi aquela considerada ideal pela maioria dos ortodontistas, ou seja, para o arco interior, os caninos antecedendo os primeiros e, em seguida os segundos pré-molares, e para o arco superior os primeiros pré-molares, seguido dos segundos pré-molares, irrompendo antes dos caninos