The rs2165241 polymorphism of the Loxl1 gene in postmenopausal women with pelvic organ prolapse.

OBJECTIVE: This study aimed to verify the presence of polymorphism rs2165241 of the lysyl oxidase-like 1 (Loxl1) gene and its association with pelvic organ prolapse (POP) in Brazilian women and determine risk factors for POP development. METHODS: The study was previously approved by the local research and ethics board. Postmenopausal women were included and divided into POP (stages III and IV) and control (stages 0 and I) groups. Peripheral blood samples were collected, and the DNA sequence of interest was analyzed by real-time reverse-transcriptase polymerase chain reaction. We used logistic regression and considered a recessive model of inheritance for the analysis, with p < 0.05 for significance. RESULTS: A total of 836 women were assessed: 426 POP cases and 410 controls. The frequencies of CC, CT and TT genotypes were similar in both groups. Age (odds ratio [OR] = 1.1, 95% confidence interval [CI] = 1.07; 1.14), number of vaginal births (OR = 17.06, 95% CI = 5.94; 48.97), family history (OR = 2.87, 95% CI = 1.57; 5.22) and weight of largest newborn (OR = 1.001, 95% CI = 1.0003; 1.001) were independent risk factors for POP, while multiple cesarean sections (two or more) was protective (OR = 0.17, 95% CI = 0.07; 0.42). CONCLUSION: No association was detected between rs2165241 of the Loxl1 gene and POP.

Prolonged ingestion of ovalbumin diet by sensitized mice improves the metabolic consequences induced by experimental food allergy.

The prevalence of food allergy is rising in the western world. Allergen restriction is the chosen treatment in this condition, but continuous ingestion of the antigen has shown positive results in clinical trials. In a previous study, we have shown several allergic and metabolic alterations after 7 days of ovalbumin (OVA) ingestion by sensitized mice. The aim of this study was to investigate whether prolonged ingestion of antigen by sensitized mice would reverse the metabolic consequences caused by experimental food allergy. For this, allergic and metabolic parameters were analysed after prolonged ingestion of an OVA diet by OVA-sensitized mice. As shown previously, after 7 days of OVA consumption, sensitized mice showed increased serum levels of anti-OVA immunoglobulin (Ig)E and IgG1, aversion to the antigen ingestion, marked body and adipose tissue weight loss, followed by adipose tissue inflammation and decreased serum levels of adipokines, glucose and triglycerides. However, after 14 days of oral challenge, sensitized mice showed an anti-OVA IgE level similar to the mice that were only sensitized, but the specific IgG1 did not change. With this prolonged ingestion of OVA, sensitized mice were protected from OVA-induced anaphylaxis when the antigen was given systemically at a dose of 2 mg/animal. Moreover, various parameters analysed were significantly ameliorated, including adipose tissue inflammation, body and adipose tissue loss, as well as serum levels of adipokines and triglycerides. Therefore, our data suggest that prolonged ingestion of OVA by sensitized mice results in an improvement of the metabolic consequences caused by experimental food allergy.

Cluster coordination and photoluminescence properties of α-Ag2WO4 microcrystals.

In this paper, we report our initial research to obtain hexagonal rod-like elongated silver tungstate (α-Ag(2)WO(4)) microcrystals by different methods [sonochemistry (SC), coprecipitation (CP), and conventional hydrothermal (CH)] and to study their cluster coordination and optical properties. These microcrystals were structurally characterized by X-ray diffraction (XRD), Rietveld refinements, Fourier transform infrared (FT-IR), X-ray absorption near-edge structure (XANES), and extended X-ray absorption fine structure (EXAFS) spectroscopies. The shape and average size of these α-Ag(2)WO(4) microcrystals were observed by field-emission scanning electron microscopy (FE-SEM). The optical properties of these microcrystals were investigated by ultraviolet-visible (UV-vis) spectroscopy and photoluminescence (PL) measurements. XRD patterns and Rietveld refinement data confirmed that α-Ag(2)WO(4) microcrystals have an orthorhombic structure. FT-IR spectra exhibited four IR-active modes in a range from 250 to 1000 cm(-1). XANES spectra at the W L(3)-edge showed distorted octahedral [WO(6)] clusters in the lattice, while EXAFS analyses confirmed that W atoms are coordinated by six O atoms. FE-SEM images suggest that the α-Ag(2)WO(4) microcrystals grow by aggregation and the Ostwald ripening process. PL properties of α-Ag(2)WO(4) microcrystals decrease with an increase in the optical band-gap values (3.19-3.23 eV). Finally, we observed that large hexagonal rod-like α-Ag(2)WO(4) microcrystals prepared by the SC method exhibited a major PL emission intensity relative to α-Ag(2)WO(4) microcrystals prepared by the CP and CH methods.

Cashew nut meal as feed supplement for lambs.

Cashew nut meal (CNM) is widely used in tropical countries due to the high protein and energy levels; therefore, it has potential to be an alternative feed supplementation for livestock. Our objective was to evaluate the use of CNM as feed supplement for lambs. Twenty-four lambs were divided into a randomized block design with four treatments, starting with a diet control of Tifton 85 (Cynodon spp.) hay and CNM as a supplement at three different levels representing 6, 12, and 18% of the total mixed ration (TMR) provided. There were evaluated intake (g/day and g/kgBW0.75); the digestibility of DM and nutrients; nitrogen balance; and ingestive behavior. The CP and ether extract (EE) intake (g/day) as well as DM, and organic matter (OM) intake (g/kgBW0.75) were influenced by supplementation with CNM in a positive linear increase (P < 0.05). The digestibility of DM, OM and NDF increased according to the levels of CNM up to 12% and markedly decreased at the higher level (P < 0.05). The EE and CP digestibility raised according to the CNM levels (P < 0.05) and consequently increased the nitrogen retention resulting in a positive nitrogen balance. The protein and energetic characteristics of CNM show that it can be used as an alternative supplementation to low-quality forages for lambs. However, its use as a single supplement ingredient above 7% on total mixed ration may reduce fiber digestibility.

Breakthrough cancer pain: review and calls to action to improve its management.

In this paper, we review the current state of breakthrough cancer pain (BTcP) management. BTcP is a heterogeneous condition and a global problem for cancer patients. It is often managed suboptimally, which results in a negative outcome for patients, healthcare providers, and healthcare systems. Several barriers to the appropriate management of BTcP have been identified. These include, among others, an incomplete definition of BTcP, poor training of healthcare providers and patients alike, a lack of a multidisciplinary approach and the absence of specific protocols and tools. We provide some actions to help physicians and patients improve their approach to BTcP, including specific training, the design of easy-to-use tools for BTcP identification and assessment (such as checklists and pocket-sized cards), individualized treatment, and the use of multidisciplinary teams.

Evolution of older patients diagnosed with early breast cancer in Spain between 1998 and 2001 included in El Alamo III project.

INTRODUCTION: An increase in the number of cancer cases is expected in the near future. Breast cancer (BC) mortality rates increase with age even when adjusted for other variables. Here we analyzed BC disease-free survival (BCDFS) and BC specific survival (BCSS) in the El Alamo III BC registry of GEICAM Spanish Breast Cancer Group. MATERIALS AND METHODS: El Alamo III is a retrospective registry of BC patients diagnosed between 1998 and 2001. Patients with stage I-III invasive BC of age groups 55-64 years (y), 70-74 years and ≥ 75 years were included. Patients and tumors characteristics, treatments and recurrences and deaths were analyzed. RESULTS: 4343 patients were included within the following age intervals: 2288 (55-64 years), 960 (70-74 years), and 1095 (≥ 75 years). Older patients (≥ 70 years) were diagnosed with more advanced tumors (stage III) than younger patients (21.5% versus 13.4%, p < 0.0001). Mastectomies were performed more on older patients and they received less chemotherapy than younger patients (66.6% versus 43.1%, p < 0.00001 and 30.8% versus 71.6%, p < 0.0001, respectively). With a median follow-up of 5.9 years, 17.7% patients had BCDFS events in the younger group and 19.8% in the older group (p < 0.0001). A decrease in BCSS was also observed in older patients, either when analyzing patients ≥ 70y (p < 0.0001) and when differentiating by the two older groups (p < 0.0001). CONCLUSIONS: Our study suggests that older BC patients have worse outcomes what can be a consequence of receiving inadequate adjuvant treatments. Specific trials for these patients are warranted to allow us to treat them with the same scientific rigor than younger patients.

[Evaluation of the cefoxitin 30 microg disk diffusion method for detection of methicillin-resistance in selected Staphylococcus aureus isolates]. / Evaluación del método de difusión en disco de 30 microg de cefoxitina en la detección de resistencia a meticilina en aislamientos seleccionados de Staphylococcus aureus.

Oxacillin tests may fail to detect some methicillinresistant S. aureus populations. The objective of this study is to evaluate the discriminative capacity of the Clinical and Laboratory Standards Institute (CLSI) disk diffusion method with a cefoxitin 30 microg disk on S. aureus isolates with unusual phenotypic characteristics of antimicrobial resistance. We studied 53 clinical S. aureus isolates. The antimicrobial susceptibility of all isolates was routinely studied by the VITEK 2 System (bioMérieux). Methicillin resistance was also studied by CLSI oxacillin method and confirmed by a previously described multiplex polymerase chain reaction (PCR) method which permits S. aureus identification and simultaneous detection of methicillin resistance. MecA positive isolates presenting a diffuse growth within the zone of inhibition when exposed to oxacillin were considered heteroresistant; mecA negative, oxacillin intermediate or resistant isolates were considered borderline. All the isolates were tested with a cefoxitin 30 microg disk, according to the CLSI guidelines (susceptibility: > 22 mm; resistance: < 21 mm). Control strains for all assays included MRSA ATCC 43300 and MSSA ATCC 25923. The isolates formed four groups. Group I: 20 multiresistant, oxacillin susceptible and mecA negative isolates; group II: 16 resistant or with intermediate oxacillin susceptibility and mecA negative isolates; group III: 11 heteroresistant and mecA positive isolates; group IV: six mecA positive isolates with atypical resistance profiles (penicillin and oxacillin, or ciprofloxacin and erythromycin resistance). Thirty-five mecA negative isolates included in groups I and II showed inhibition zones > 22 mm; one isolate from group II showed 20 mm. The 17 mecA positive isolates from groups III and IV showed resistance to cefoxitin disk. The 30 microg cefoxitin disk diffusion method is proposed as an efficient method for the detection of methicillin resistance and permits a clear determination set S. aureus isolates, even those with atypical antimicrobial characteristics.

Associação entre síndrome metabólica e rigidez arterial / Association between metabolic syndrome and arterial stiffness

Introdução: A síndrome metabólica (SM) é considerada um importante fator de risco para doenças cardiovasculares por promover mudanças biomecânicas nas paredes dos vasos que acarretam rigidez arterial (RA). Objetivo: Analisar a associação entre a síndrome metabólica e rigidez arterial. Além de descrever a população de estudo segundo características sociodemográficas e clínicas. Métodos: Estudos transversal de base populacional, na área restrita do Vale do Ogunjá, Salvador-Bahia. Foram obtidos dados sociodemográficos, por meio de questionário e dados clínicos. A VOP foi avaliada por tonometria de aplanação com o aparelho SphygmoCor® (AtCor Medical Pty Ltd, New South Wales, Austrália). Foram obtidas medidas de frequência e descritivas de central e dispersão, e o teste Qui-quadrado para análise estatística. Resultados: A VOP alterada foi mais prevalente em indivíduos que foram diagnosticados com a síndrome metabólica (37,2%), com uma razão de prevalência 2,0 vezes maiores quando comparados aos indivíduos hígidos (IC95%: 0,86 ­ 4,45). Houve também maior prevalência da RA no sexo masculino (30,4%), na faixa etária entre 40 a 74 anos (38,7%), em autodeclarados preto/pardo (27,4%), em divorciados/viúvos (38,9%) e com baixo nível de escolaridade (38,5%). As diferenças proporcionais entre os indivíduos com e sem rigidez arterial foram estatisticamente significantes entre as variáveis escolaridade (p=0,022), faixa etária (p=0,001) e hipertensão arterial (p=0,000). Por outro lado, não foram encontradas diferenças proporcionais estatisticamente significantes (p>0,05) entre as variáveis sexo, cor e estado civil, assim como para a síndrome metabólica e as variáveis que fazem parte da sua definição (hipertrigliceridemia, HDL, glicemia de jejum e obesidade abdominal), com exceção da hipertensão arterial. Conclusão: Apesar da maior prevalência de rigidez arterial em indivíduos com síndrome metabólica, não foi encontrada uma associação estatisticamente significante entre essas duas variáveis. Foi possível verificar uma associação estatisticamente significante entre a hipertensão arterial, indivíduos com idade mais avançada e com baixo nível de escolaridade e a rigidez arterial. (AU)

iomechanical changes in the walls of the vessels that cause arterial stiffness (AR). Objetive: Analyze the association between Metabolic Syndrome (MS) and arterial stiffness and to characterize the study population according to sociodemographic and clinical characteristics. Methods: Cross-sectional population-based studies, in the restricted area of Vale do Ogunjá, Salvador-Bahia. Sociodemographic data, through questionnaire and clinical data were obtained. A PWV was evaluated by applanation tonometry using the device SphygmoCor® (AtCor Medical Pty Ltd, New South Wales, Australia). Frequency and descriptive measurements of central and dispersion were obtained, and the Chi-square test to statistical analysis. Results: The altered PWV was more prevalent in individuals who were diagnosed with the metabolic syndrome (37.2%), with a prevalence ratio 2.0 times higher when compared to healthy individuals (95% CI: 0.86 - 4.45). There was also a higher prevalence of AR in males (30.4%), aged between 40 and 74 years (38.7%), in self-declared black / brown (27.4%), in divorced / widowed (38, 9%) and with a low level of education (38.5%). The proportional differences between individuals with and without arterial stiffness were statistically significant between the variables education (p = 0.022), age group (p = 0.001) and arterial hypertension (p = 0.000). On the other hand, there were no statistically significant proportional differences (p> 0.05) between the variables gender, color and marital status, as well as for the metabolic syndrome and the variables that are part of its definition (hypertriglyceridemia, HDL, blood glucose) fasting and abdominal obesity), with the exception of arterial hypertension. Conclusion: Despite the higher prevalence of arterial stiffness in individuals with metabolic syndrome, no statistically significant association was found between these two variables. It was possible to verify a statistically significant association between arterial hypertension, individuals with older age and with low level of education and arterial stiffness.

[Modified EMJH medium for cultivation of Leptospira interrogans serogroup ballum]. / Medio EMJH modificado para el cultivo de Leptospira interrogans serogrupo Ballum.

Strains within the Ballum serogroup of spirochete Leptospira show fastidious growth with more exigent nutritional requirements than those of other Leptospira pathogenic strains. The influence of 37 nutritional compounds on the growth of Leptospira interrogans serogroup Ballum was investigated employing the synthetic EMJH medium as the base for the study. Microbial growth was estimated spectrophotometrically and direct counts were performed with a Petroff-Hausser counting chamber. Virulence stability was evaluated by calculating the mean lethal dose in hamsters. Antigenicity stability was evaluated by Western blotting using a specific antiserum. Cell yields commonly obtained in EMJH were triplicated without virulence or antigenicity depletions after culturing in a modified EMJH medium with an increased concentration of Tween 80, and the incorporation of sodium acetate and beef extract. Neither the increased concentration of at least 6 components of EMJH nor the incorporation of a variety of new nutrients stimulated cell yields or the growth rate of the microorganism. The results allow us to make use of an enriched culture medium that promotes high cell yields of this fastidious serogroup most prevalent in humans in Cuba.

Comparative in vitro activity of oral antimicrobial agents against Enterobacteriaceae from patients with community-acquired urinary tract infections in three European countries.

Enterobacteriaceae causing community-acquired urinary tract infections were examined in selected outpatient clinics and hospitals in Belgium, Germany and Spain using EUCAST breakpoints for susceptibility. A total of 1190 isolates were collected. Escherichia coli isolates were resistant to amoxicillin-clavulanic acid (28.1%), ciprofloxacin (23.4%) and trimethoprim-sulfamethoxazole (21.4%) compared with fosfomycin and nitrofurantoin (each, <1.5%). Ceftibuten (MIC50/90 0.25/0.5 mg/L) and ceftriaxone activity (MIC50/90 ≤0.25 mg/L) was comparable. Ceftibuten (MIC90 ≤0.25 mg/L) was also active against Proteus mirabilis and Klebsiella spp. Extended-spectrum ß-lactamase phenotypes were 7.1% for E. coli, 5.6% for Klebsiella pneumoniae and 0.4% for P. mirabilis. Resistance was common among men and elderly women.

[Immunogenicity and protective capacity of leptospiral whole-cell monovalent serogroup Ballum vaccines in hamsters]. / Inmunogenicidad y capacidad protectora en hamsters de vacunas antileptospirósicas monovalentes de células enteras del serogrupo Ballum.

Leptospira serogroup Ballum is at present the first cause of human leptospirosis in Cuba. Killed whole-cell vaccines were formulated with two clinical isolates of Leptospira interrogans serogroup Ballum using aluminum hydroxide as adjuvant. Agglutinins levels induced by each vaccine in hamsters were estimated by microscopic agglutination test and specific IgG activities were quantified by a whole cell-based enzyme-linked immunosorbent assay. Homologous and cross protective capacity against lethal and sublethal infection were determined in vaccinated animals by challenge with 100 and 10,000 LD50 of five virulent strains belonging to serogroups Ballum, Canicola, Icterohaemorrhagiae and Pomona. Both monovalent serogroup Ballum vaccines were immunogenic and induced complete homologous protection in the animal model. Cross-protection was only significant in one of the two vaccines against challenge with 100 LD50 of serogroup Canicola. The results of this study demonstrate the high immunogenicity and protective capacity in hamsters of whole-cell monovalent vaccines formulated with two vaccine candidate strains belonging to the most prevalent serogroup of Leptospira in Cuba.

Vegetative and reproductive phenology of Butia purpurascens Glassman (Arecaceae) under the effects of leaf harvesting.

Butia purpurascens is an endemic and threatened palm tree species that occurs in open areas of the Brazilian Cerrado, predominantly in southwestern Goiás. The leaves of this palm tree are harvested by local people to fabricate brooms. This study evaluated changes in vegetative and reproductive phenology in two different natural populations of this palm tree: one population with leaf harvesting and another non-harvested population. Twenty plants were monitored in each area for 23 months. The phenophases were related to the temperature and precipitation averages for a 30-year period. Leaf sprouting occurred throughout the year, with a slight reduction in periods of low temperatures and low rainfall. The first spathes emerged in March and flowering began during the dry season (June), continuing until January of the following year, concurrent with the period of most intense fruiting. Flowering and fruiting appear to be triggered by periods of drought, which are commonly observed in the Cerrado. The harvested sites produced significantly fewer leaves, spathes, inflorescences and infructescences than the non-harvested sites. Thus, the supply of resources to the local fauna is possibly reduced in sites under leaf exploitation, which in the long term can represent damage to the palm tree population's structure and dynamics. Other socioeconomic and ecological studies about the effects of leaf harvesting in B. purpurascens are necessary to enable strategies for sustainable use, devise management alternatives and conserve this threatened palm species.

Novel dialkylphosphorylhydrazones: Synthesis, leishmanicidal evaluation and theoretical investigation of the proposed mechanism of action.

As part of a program to develop new drugs for the treatment of neglected diseases, new dialkylphosphorylhydrazones were synthesized and evaluated against the trypanosomatid parasites Leishmania braziliensis and Leishmania amazonensis. The synthesis of these compounds proved satisfactory with yields ranging from moderate to good. The most active compounds against L. braziliensis presented IC50 values in the 10(-2) µM range, similar to that of the reference drug pentamidine. Two compounds, 4m and 4n, showed a significant dose dependent decrease in the infection index of L. amazonensis infected macrophages and caused a complete healing of nodules and ulcers when tested in vivo against L. amazonensis-infected mice, but the control of parasite burden at the inoculation site was statistically significant only in the case of treatment with 4n. A target fishing (reverse docking) approach using molecular docking with 15 enzymes of L. braziliensis indicated that the probable target of the active compounds was hexokinase, the first enzyme of the glycolytic pathway.

Mupirocin resistance in methicillin-resistant Staphylococcus aureus clinical isolates in a Spanish hospital. Co-application of multiplex PCR assay and conventional microbiology methods.

A total of 1785 Staphylococcus aureus clinical isolates were collected in our hospital during 1998 (526), 1999 (564) and 2000 (695). Among them, one hundred and thirty (39, 33 and 58, respectively) were phenotypically assigned as methicillin-resistant Staphylococcus aureus (MRSA); sixteen of these isolates (3, 2 and 11, respectively) were detected as highly mupirocin-methicillin resistant Staphylococcus aureus (MMRSA). In this work, our goal was to characterize MRSA and MMRSA clinical isolates by co-application of phenotypic and genotypic methods in order to determine the MMRSA incidence in our hospital during the period 1998-2000. With this purpose we compared and integrated the results obtained using conventional microbiology methods with those obtained using a multiplex polymerase chain reaction (PCR) assay. Our results showed a good complementation between these two approximations to determine the incidence of MMRSA clinical isolates and permitted to estimate that such incidence increased from 7.7% in 1998 to 19% in 2000.

Prognostic significance of Ki-67 nuclear proliferative antigen, bcl-2 protein, and p53 expression in follicular and diffuse large B-cell lymphoma.

We analyzed 104 patients with non-Hodgkin's lymphoma, follicular or diffuse large-B-cell-type lymphoma, in order to evaluate the correlation between clinical characteristics and immunohistochemical parameters. Immunostaining was performed by means of monoclonal antibodies against Ki-67, bcl-2, and p53 expression. Forty-nine of the patients showed follicular lymphoma. A high expression of bcl-2 was found in 93%, high expression of p53 in 57%, and low expression of Ki-67 in 96%. Follicular lymphoma grade III showed a p53 expression (p = 0.07) slightly higher than follicular lymphoma grades I and II, not reaching statistical significance. Follicular lymphoma grades I and II tended to express lower Ki-67 and higher levels of bcl-2 expression than grade III (p = 0.06). Fifty-five cases showed diffuse large-B-cell lymphoma. Among them, bcl-2 was absent in 39%, whereas p53 and Ki-67 expression were high in 38%. In the diffuse large-B-cell lymphomas, a high bcl-2 expression correlated with stages III and IV (p = 0.03) and involvement of more than one extranodal area (p = 0.03). High Ki-67 expression was also associated to extranodal involvement of more than one area (p = 0.03). Overall survival of patients did not show statistically significant differences regarding Ki-67, bcl-2, and p53 tumoral expression. Prognostic factors for overall survival in the multivariate analysis were age (p = 0.02) and LDH (p = 0.003). Time to progression was worse among follicular lymphoma with high p53 expression than with mild/moderate p53 expression (p = 0.009).

Chronic alcoholic myopathy and nutritional status.

To investigate the prevalence of alcoholic myopathy and its relationship to the nutritional status, we performed a muscle biopsy on the vastum lateralis of 60 consecutive hospitalized alcoholic patients using a Tru-Cut needle, processing it for light microscope and ultrastructural analysis. The nutritional status was assessed by anthropometric measurements such as midarm circumference, triceps skinfold and midarm muscle area, and serum albumin. The hallmark of chronic alcoholic myopathy, fiber muscle atrophy, was present in 33% of the patients, necrosis scarcely being observed (1.5%). Ultrastructural alterations as lipid and glycogen accumulation or mitochondrial and myofibrillar alterations were nonspecific and observed in nearly all the cases where atrophy was present. Malnutrition was frequent in our patients: 39% and 34% showed a triceps skinfold and a midarm muscle area, respectively, under the fifth populational percentile. Patients with muscle fiber atrophy or ultrastructural changes showed a worse nutritional status, not only regarding muscle protein (assessed by midarm muscle area or creatininuria and explained by fiber atrophy), but also regarding fat stores assessed by triceps skinfold. Toxic effect of ethanol and malnutrition may act synergistically leading to chronic alcoholic myopathy.

Polyvinyl alcohol hydrogel irradiated and acetalized for osteochondral defect repair: mechanical, chemical, and histological evaluation after implantation in rat knees.

Polyvinyl Alcohol (PVA) hydrogel plugs were implanted in artificial osteochondral defects on the trochlear groove of rat knees. After 0, 3, 6, 12, and 24 weeks of followup, samples containing the implants were mechanically evaluated by creep indentation test, chemically, and histologically by optical microscopy. The mechanical test pointed towards an increase of the implant creep modulus and the chemical analysis exhibited an increasing concentration of calcium and phosphorus within the implants over time. Optical microscopy showed no foreign body reaction and revealed formation, differentiation, and maintenance of new tissue at the defect/implant interface. The absence of implant wear indicated that the natural articular lubrication process was not disturbed by the implant. The performance of the irradiated and acetalized PVA was considered satisfactory for the proposed application.

Pain in clinical oncology: patient satisfaction with management of cancer pain.

BACKGROUND: Despite effective analgesic therapy, inadequate pain control is frequently perceived by patients and caregivers. AIMS: To assess satisfaction with management of pain in cancer patients. METHODS: Between January and May 2007, a cross-sectional multicentre study was conducted in 64 Medical Oncology Departments throughout Spain. A total of 525 outpatients with oncological diseases completed a questionnaire with demographic data, characteristics and intensity of pain, and perceptions and attitudes towards pain management at the time of a routine clinical visit. Physicians also completed a questionnaire with tumour-related and treatment-related data. Cluster analysis was used to classify patients into three groups (satisfied, neither satisfied nor dissatisfied or neutral, dissatisfied) according to pain intensity and satisfaction with treatment. RESULTS: Patients satisfied with their analgesic treatment (33%) had lower pain intensities and, when regularly asked about their pain, considered their physicians to be more involved in their treatment. Neither satisfied nor dissatisfied patients (neutral) (44%) had higher mean pain intensities. Two-thirds of them achieved marked relief of their pain and also thought that physicians were aware of their situation. Dissatisfied patients (23%) had moderate to severe pain intensities, and said that they were asked less frequently about their pain, and thought that their physicians were less involved in their analgesic treatment. CONCLUSION: Physician-patient communication and information provided to patients are essential aspects of patient perceptions and attitudes towards control of cancer-related pain. Pain is seen as a condition that may be controlled but affects the capacity to lead a normal life.

[Influence of the self-reported skin color on the prevalence of metabolic syndrome in an urban Brazilian population]. / Influência da cor de pele auto-referida na prevalência da síndrome metabólica numa população urbana do Brasil.

BACKGROUND: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. OBJECTIVE: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. RESULTS: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3%), mulattos (23.3%) and blacks (23.4%). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2%, 95%CI: 20.7-31.7), in comparison to blacks (17.5%, 95%CI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9%, 95%CI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0%, 95%CI: 22.2-31.8, and lower among the whites, 20.5%, 95%CI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). CONCLUSION: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.