Stature estimation using the knee height measurement amongst Brazilian elderly.

INTRODUCTION: Stature is an important variable in several indices of nutritional status that are applicable to elderly persons. However, stature is difficult or impossible to measure in elderly because they are often unable to maintain the standing position. A alternative is the use of estimated height from measurements of knee height measure. AIMS: This study aimed to evaluate the accuracy of the formula proposed by Chumlea et al. (1985) based on the knee of a Caucasian population to estimate the height and its application in calculation of body mass index in community- dwelling older people residents in Viçosa, Minas Gerais, Brazil. METHODS: The sample included 621 elderly aged 60 years old and older, living in the community. Measures of weight, height and knee height (KH) were taken and Body Mass Index (BMI) was calculated with the measured weight and estimated. The Student`s t-test was used for comparison of measurements of height between the genders. For the comparison of estimated and measured values it was used paired t-test and also the methodology proposed by Bland and Altman to compare the difference between measurements. To evaluate the agreement between the classifications for BMI was used Cohen's Kappa. RESULTS: The average values obtained from KH were higher than those measured in the whole sample and women. There underestimation of BMI in females and also in the whole. CONCLUSIONS: The present results suggest that the equation Chumlea was not adequate to estimate the height of the sample in question, especially for women.

Introducción: La estatura es una variable importante en varios índices del estado nutricional que son aplicables a las personas mayores. Sin embargo, la estatura es difícil o imposible de medir en la edad avanzada, ya que a menudo son incapaces de mantener la posición de pie. Una alternativa es el uso de altura estimada a partir de mediciones de medida de altura de la rodilla. Objetivos: Este estudio tuvo como objetivo evaluar la exactitud de la fórmula propuesta por Chumlea et al. (1985), basado en la altura de la rodilla de una población caucásica para estimar la altura y su aplicación en el cálculo del índice de masa corporal en las personas mayores residentes en la comunidad de Viçosa, Minas Gerais, Brasil. Métodos: La muestra incluyó a 621 adultos mayores de 60 anõs y más, que viven en la comunidad. Se tomaron medidas de peso, talla y altura de la rodilla (AR) y el Índice de Masa Corporal (IMC) se calculó con el peso medido y estimado. Se utilize la prueba T del estudiante para la comparación de las mediciones de altura entre los géneros. Para la comparación de los valores estimados y medidos se utilizó la prueba T pareada y también la metodología propuesta por Bland y Altman para comparar la diferencia entre las mediciones. Para evaluar el acuerdo entre las clasificaciones para el IMC se utilizó el Kappa de Cohen. Resultados: Los valores medios obtenidos a partir de AR fueron más altos que los medidos en la muestra completa y mujeres. Hay subestimación de IMC en mujeres y también en el conjunto. Conclusiones: Los resultados sugieren que la ecuación Chumlea no era adecuado para estimar la altura de la muestra en cuestión, especialmente para las mujeres.

Percepção de mães e profissionais de saúde sobre o aleitamento materno: encontros e desencontros / The perception of mothers and health professionals about breastfeeding: agreements and disagreements

Objetivo: Identificar as vantagens do aleitamento materno e as causas de desmame precoce segundo a percepção de mães e profissionais do Programa de Saúde da Família (PSF) do município de Teixeiras, em Minas Gerais. Métodos: Estudo transversal com abordagem quantitativa, cujos dados foram obtidos por meio de dois questionários semi-estruturados direcionados aos 36 profissionais de saúde do PSF e às 137 mães de bebês com até 24 meses de idade, cadastradas no programa. A análise dos dados foi realizada pelo programa Epi-Info 6.04. Resultados: Dentre os entrevistados, 38,3% das mães e 48,5% dos profissionais de Saúde consideraram como principais causas finais para a interrupção da amamentação questões relacionadas à quantidade de leite e à estética, representadas pelas construções sociais: ôleite fracoõ, ôleite secouõ e ôleite insuficienteõ e ôas mamas caem com a amamentaçãoõ. Entretanto, houve divergência de relatos, com predominância de questões estéticas entre os profissionais de saúde e de questões relacionadas à produção de leite entre as mães. Quanto às vantagens da amamentação, a questão da imunização da criança foi a mais citada pelos dois grupos. Conclusões: A percepção de mães e profissionais sobre a amamentação mostrou-se polarizada em dois aspectos importantes. Por um lado, houve concordância quanto aos benefícios do aleitamento materno, com vantagens relacionadas à saúde e ao bem-estar da criança. Por outro, observou-se um distanciamento entre o olhar do profissional de saúde e o relato das mães em relação às causas do desmame precoce. Essa divergência precisa ser trabalhada a fim de promover a amamentação de forma mais efetiva.

Objective: To identify the advantages of breastfeeding and the causes of early weaning according to the perception of mothers and Family Health Program professionals from the district of Teixeiras, Minas Gerais, Brazil.Methods: This cross-sectional study included 36 health professionals and 137 mothers of infants up to 24 months of age, registered in this program. A semi-structured questionnairewas applied to both groups of adults. Data was analyzed by Epi-Info 6.04 software. Results: Among the studied population, 38.3% of mothers and 48.5% of health professionals considered as main cause for breastfeeding interruption questions related to the amount of produced milk and to body aesthetic. Both groups reported constructions like ôweak milkõ, ôno milk,õ ônot enough milkõ and ôthe breasts fall with breastfeedingõ. However, divergences between these two groups of causes were noted: health professionals reported more aesthetic questions and mothers reported more milk production issues. Regarding advantages of breast feeding, the immunization of the child was the most cited by both groups.Conclusions: Mothers and professionals perception about breastfeeding showed two different aspects. There was agreement about the perceptions of the benefits of breastfeeding, with emergence of child health concerns. Nevertheless, there was divergence in the perceptions of causes related to early breastfeeding weaning. This heterogeneity of perceptions needs to be solved in order to effectively promote breastfeeding.

Are there any news about the antipsychotic medications in the elderly?

Antipsychotic drugs are widely used in people with dementia to treat neuropsychiatic symptoms such as aggression, agitation and psychosis. Using antipsychotic agents in older patients is difficult, because it depends on co-morbid conditions, side effects, dosing strategies, duration of treatments and combinations of various medications. This paper discusses the use of atypical antipsychotics in a 1-year-observation on a group of patients followed by an expert dementia center.

Affective, behavior and cognitive disorders in the elderly with chronic musculoskelatal pain: the impact on an aging population.

Chronic musculoskeletal pain is a common, disabling condition that affects at least one in four elderly people. Figures are much higher in nursing homes, in which as many as 45-80% of residents has pain that contributes to functional impairment and decreased quality of life. Multiple comorbidity, under-reporting of symptoms and cognitive impairment make pain evaluation often difficult. Chronic pain is often associated with anxiety and depressive symptoms, but care must be taken to avoid attributing pain entirely to psychogenic causes. Indeed pain is an understudied problem in frail elderly patients, especially in those with cognitive impairment, delirium, or dementia. In a large Italian home care study, age of 85 years or more and low cognitive performance were predictors of failing to receive adequate analgesics. However, most patients with cognitive impairment and even those with severe dementia can be assessed using one of the available pain-intensity scales (verbal or not verbal). Structured programs are needed for routine pain assessment and treatment in older people.

Systematic review: Helicobacter pylori eradication for the prevention of gastric cancer.

BACKGROUND: Helicobacter pylori is recognized as one of the most significant risk factors for gastric cancer, and H. pylori eradication has been proposed as a possible primary chemo-preventive strategy to reduce gastric cancer incidence. AIM: To evaluate the available evidence on the efficacy of H. pylori eradication in the prevention of gastric cancer. METHODS: Epidemiological, observational and interventional studies, as well as decisional models, were taken into account in this review. RESULTS: Large-scale epidemiological studies clearly link H. pylori infection with non-cardia gastric cancer. Current evidence suggests that, in a subpopulation of treated subjects, H. pylori eradication prevents the progression of preneoplastic lesions. Studies that have attempted to evaluate the effect of H. pylori eradication on the incidence of gastric cancer have not provided definitive answers. H. pylori eradication seems to reduce the incidence of gastric cancer in patients without baseline precancerous gastric lesions. Decisional models suggest that H. pylori screening could be cost-effective, but there is not yet sufficient evidence to support the setting up of a general screening programme. CONCLUSION: Helicobacter pylori eradication is a plausible intervention for gastric cancer prevention; however, it seems to be relevant in only a subset of subjects.

Antineoplastic agents 463. Synthesis of combretastatin A-3 diphosphate prodrugs.

A new and more efficient synthesis of combretastatin A-3 (2a) was completed (8.4% overall yield) starting from methyl gallate and isovanillin with aldehyde 5 and phosphonium salt 8 as key intermediates. Conversion of combretastatin A-3 (2a) to a series of diphosphate prodrugs (10a-l) was readily achieved. Both the diphosphate sodium (10a) and potassium salts (10c) displayed aqueous solubility in excess of 220 mg/ml at room temperature and good cancer cell line inhibitory activity.

[The technical aspects of liver resection surgery: the authors' experience]. / Aspetti tecnici nella chirurgia resettiva epatica: contributo d'esperienza.

Based on their personal experience in hepatic resective surgery the authors dwell upon details of surgical technique which, well combined and sustained by advanced technological supports (ultrasonic dissector, laser-argon clotter, intraoperative echography), allow to perform wide parenchymal resections sheltered from dangerous complications. The safety achieved in such a surgery--now routinely performed--derives not only from improved diagnostic techniques (US, CT, MNR, angiography) and advances in anaesthesia-reanimation but, above all, from precise knowledge of organon segmental anatomy and close vascular correlations between the two hepatic hemisystems.