Barriers associated with frequency of leisure-time physical activity among Brazilian adults of different income strata.

This study aimed to estimate the prevalence of the main perceived barriers to leisure-time physical activity (LTPA) and their associations with the frequency of LTPA in a representative sample of industrial workers from Brazil (n = 47,477), according to their income strata (low income: ≤$US280, middle income: $US281-$US1400, and high income: ≥$US1401). Data were collected between 2006 and 2008 via questionnaires about the main perceived barrier to LTPA and the frequency of LTPA. Multinomial logistic regression was performed to evaluate differences among groups. There was a lower prevalence of regular practice of LTPA in the low- (15.8%) and middle-income strata (18.2%) than among the individuals of the high-income stratum (27.6%). A large proportion of workers who regularly participated in LTPA reported no barriers (low: 43.1%; middle: 46.8%; high: 51.6%). Additional obligations and fatigue were the two most common perceived barriers in all family income strata among participants who engaged in different frequencies of LTPA. The odds for all perceived barriers showed a positive trend related to frequency of LTPA (from regular to no LTPA), with higher values according to income. In summary, the ordering of the main perceived barriers to LTPA differed according to workers' income stratum and frequency of engaging in LTPA.

Active commuting reduces sociodemographic differences in adherence to recommendations derived from leisure-time physical activity among Brazilian adults.

OBJECTIVE: To investigate the consequences of including active commuting, compared with the leisure domain only, in the prevalence and sociodemographic factors associated with attending the physical activity recommendations, in Brazilian adults. STUDY DESIGN: Population-based cross-sectional study. METHOD: Adults between 20 and 59 years of age (n = 1720) were face-to-face interviewed from September 2009 to January 2010. Sociodemographic indicators and leisure-time and commuting physical activity were assessed by a validated questionnaire. Poisson regression was used to estimate crude and adjusted prevalence ratio (PR) and 95% confidence interval (95% CI). RESULTS: The prevalence of adherence to recommendations when only leisure-time physical activity was considered was 15.5% (95% CI: 13.6; 17.4) and was associated with men (PR: 1.57, 95% CI: 1.25; 1.96), adults without a partner (PR: 1.38 95% CI: 1.05; 1.81) and higher educational level and income. The prevalence of adherence to physical activity recommendations after the combination of leisure-time and commuting was 29.1% (95% CI: 26.5; 31.6). Percentages differences in favor of men, white adults and those with higher educational level and income were no longer significant after the inclusion of active commuting. CONCLUSION: The inclusion of active commuting expands the percentage of adults who achieved the health-related physical activity recommendations and reduced important sociodemographic differences derived from the analysis of leisure-time physical activity alone. Public health strategies should consider the different domains of physical activity in the monitoring and promotion of a more active lifestyle.

Clustering of physical inactivity in leisure, work, commuting and household domains among Brazilian adults.

OBJECTIVES: To identify the clustering of physical inactivity in leisure, work, commuting and household contexts, and the sociodemographic factors associated with the clustering of inactive behaviour in different domains among Brazilian adults. STUDY DESIGN: Cross-sectional population-based study. METHODS: The study was performed in Florianopolis, capital of Santa Catarina, one of the southern states of Brazil, from September 2009 to January 2010. Adults aged 20-59 years were interviewed. Physical inactivity in each domain was defined as non-participation in specific physical activities, using a validated Brazilian questionnaire. Clustering of physical inactivity was identified by the ratio between observed prevalence and expected prevalence of 16 different combinations. Multinomial logistic regression was used in the analysis of sociodemographic factors associated with clustering of physical inactivity. RESULTS: Of the 1720 interviewees, the greatest differences between the observed and expected proportions were observed in simultaneous physical inactivity in the leisure and household domains for men, and physical inactivity in the leisure domain alone for women (59% and 88%, respectively); these differences were higher than expected if the behaviours were independent. Physical inactivity in two or more domains was observed more frequently in men and in individuals with a higher per-capita family income. Ageing was associated with physical inactivity in three or four domains. CONCLUSIONS: Physical inactivity was observed in different domains according to gender. Men and older individuals with a higher per-capita family income were more likely to exhibit physical inactivity when all domains were considered together.

Effect of simulated leg length discrepancy on plantar pressure distribution in diabetic patients with neuropathic foot ulceration.

OBJECTIVE: To study the effect of a minor degree of artificially induced leg length discrepancy (LLD) on plantar pressure distribution in diabetic patients with neuropathic foot ulceration. METHOD: In-shoe plantar pressure distributions were measured on the ulcerated foot during walking using F-scan (Tekscan Inc.). To simulate minor LLD, the contralateral leg length was changed by asking patients to walk under three different conditions: wearing shoe of the same sole thickness (NLLD), walking with a bare foot (20mm long leg) and wearing a 40mm-high platform-sole shoe (20mm short leg). These three different walking conditions were compared in a randomised, single-blinded crossover design. RESULTS: The study included 28 diabetic patients with neuropathic foot ulcers (53.7 ± 6.8 years; 16 males, 12 female). Notably, the peak pressure and pressure time integral (PTI) were the most affected parameters. PTI significantly increased beneath total foot, mid-foot, 2nd, 3rd, 4th and 5th metatarsal heads (MTHs), and 3rd toe, when the 20mm short leg was simulated (79.4 ± 21.1; 61.5 ± 32.3; 59.9 ± 36.5; 69 ± 42.1; 70.6 ± 42.3; 63.9 ± 33.7; 40.± 33.2 kPa·s, respectively), compared with NLLD (73.7 ± 19.9; 55.524; 51.8 ± 30.1; 58.4 ± 37.6; 60.3 ± 39.5; 57.2 ± 32.3; 36.9 ± 33.3 kPa·s, respectively). CONCLUSION: The short leg of diabetic patients with neuropathic foot ulcers will be subjected to greater pressure load, primarily beneath the total foot, mid-foot and 2nd, 3rd, 4th and 5th metatarsal heads. As such, care should be taken to avoid minor LLD, as it could inadvertently develop on using offloading devices. DECLARATION OF INTEREST: The authors have nothing to declare.

The impact of topical phenytoin on recalcitrant neuropathic diabetic foot ulceration.

OBJECTIVE: To study the impact of topical phenytoin on the healing of recalcitrant neuropathic diabetic foot ulcers in patients with no clinical evidence of ischaemia or infection, and to evaluate its antibacterial effect. METHOD: Thirty-two patients were enrolled into the study. Topical phenytoin in the form of 2% aerosol powder was applied once daily in addition to the patient's usual treatment (weekly sharp debridement, offloading and use of a gauze dressing) for eight weeks. The primary outcome was change in ulcer area over time, measured by grid tracing. Secondary outcomes were the ability of topical phenytoin to eradicate bacterial isolates, and the occurrence of adverse events. RESULTS: Topical phenytoin significantly improved healing of recalcitrant neuropathic diabetic foot ulcers. Baseline wound area was 319.3 + 340.4 mm2, reducing to 286.1 + 341.1 mm2 and 269.1 + 341.2 mm2 after four and eight weeks respectively. However, the overall reduction in ulcer size was only 18.3% + 27.5% and 25.7% + 38.6 % respectively. Topical phenytoin therapy over eight weeks did not eradicate any of the bacterial wound isolates (Staphylococcus spp., Proteus spp. or Pseudomonas spp.). Of the 32 patients evaluated, only eight (25%) achieved more than 50% reduction in ulcer size after eight weeks of treatment. CONCLUSION: Topical phenytoin can enhance wound healing in recalcitrant neuropathic diabetic foot ulcers, although only one-quarter of patients achieved more than 50% reduction in ulcer size after eight weeks of therapy. Further research is needed to characterise those patients who will satisfactorily respond to such therapy.

MUC1 inhibition leads to decrease in PD-L1 levels via upregulation of miRNAs.

The PD-L1/PD-1 pathway is a critical component of the immunosuppressive tumor microenvironment in acute myeloid leukemia (AML), but little is known about its regulation. We investigated the role of the MUC1 oncoprotein in modulating PD-L1 expression in AML. Silencing of MUC1 in AML cell lines suppressed PD-L1 expression without a decrease in PD-L1 mRNA levels, suggesting a post-transcriptional mechanism of regulation. We identified the microRNAs miR-200c and miR-34a as key regulators of PD-L1 expression in AML. Silencing of MUC1 in AML cells led to a marked increase in miR-200c and miR-34a levels, without changes in precursor microRNA, suggesting that MUC1 might regulate microRNA-processing. MUC1 signaling decreased the expression of the microRNA-processing protein DICER, via the suppression of c-Jun activity. NanoString (Seattle, WA, USA) array of MUC1-silenced AML cells demonstrated an increase in the majority of probed microRNAs. In an immunocompetent murine AML model, targeting of MUC1 led to a significant increase in leukemia-specific T cells. In concert, targeting MUC1 signaling in human AML cells resulted in enhanced sensitivity to T-cell-mediated lysis. These findings suggest MUC1 is a critical regulator of PD-L1 expression via its effects on microRNA levels and represents a potential therapeutic target to enhance anti-tumor immunity.

Patient-derived xenotransplants can recapitulate the genetic driver landscape of acute leukemias.

Genomic studies have identified recurrent somatic mutations in acute leukemias. However, current murine models do not sufficiently encompass the genomic complexity of human leukemias. To develop preclinical models, we transplanted 160 samples from patients with acute leukemia (acute myeloid leukemia, mixed lineage leukemia, B-cell acute lymphoblastic leukemia, T-cell ALL) into immunodeficient mice. Of these, 119 engrafted with expected immunophenotype. Targeted sequencing of 374 genes and 265 frequently rearranged RNAs detected recurrent and novel genetic lesions in 48 paired primary tumor (PT) and patient-derived xenotransplant (PDX) samples. Overall, the frequencies of 274 somatic variant alleles correlated between PT and PDX samples, although the data were highly variable for variant alleles present at 0-10%. Seventeen percent of variant alleles were detected in either PT or PDX samples only. Based on variant allele frequency changes, 24 PT-PDX pairs were classified as concordant while the other 24 pairs showed various degree of clonal discordance. There was no correlation of clonal concordance with clinical parameters of diseases. Significantly more bone marrow samples than peripheral blood samples engrafted discordantly. These data demonstrate the utility of developing PDX banks for modeling human leukemia, and emphasize the importance of genomic profiling of PDX and patient samples to ensure concordance before performing mechanistic or therapeutic studies.

Iodometric microgram determination of chromium(III) and (VI) by use of chemical amplification reactions.

A simple, rapid and sensitive method is described for the iodometric determination of microgram amounts of chromium(III), based on the oxidation of chromium(III) with periodate at pH 3.2, removal of the unreacted periodate by masking with molybdate and subsequent iodometric determination of the liberated iodate. Chromium(VI) can be determined by this method after prior reduction to chromium(III) with sodium sulphite. The method can also be used for the analysis of organochromium compounds.

Incorporating health-fitness concepts in secondary physical education curricula.

This investigation ascertained effects of exposing high school students to classroom health-related fitness instruction involving a curriculum focused on the relationship of exercise to cardiorespiratory fitness, body composition, flexibility, strength (particularly as it relates to abdominal and lower-back muscoskeletal function), and muscular endurance. The curriculum included lectures, labs, and readings as part of the physical education course work. Ninety ninth and 10th grade students were assigned randomly to one of three physical education classes, which met daily for one, 12-week semester. Each class received the same skill-related instruction; however, the two experimental classes, in lieu of skill activities, were exposed to classroom instruction and readings dealing with health fitness topics on a one or two day per week basis. The third class of students, the control group, was engaged strictly in skill activities daily. Students exposed to health-related fitness classroom instruction displayed significantly more positive attitudes toward physical activity and a better understanding of health-related fitness than students who did not receive such information.

Eugenol improvement due to aging. A laboratory appraisal.

The characteristics of eugenol for dental use appear to improve with age. Exposure to air and light causes certain chemical and physical changes, but the exact nature of the age improvement requires further elucidation.

[Reinterventions for arterial reconstruction in anastomotic aneurysm]. / I reinterventi di ricostruzione arteriosa per aneurismi anastomotici.

We reviewed our experience on the surgical treatment of anastomotic false aneurysms from 1979 through 1990: two groups of patients were identified. Group 1 (31 patients) included patients who had been previously operated on at our Institute and then routinely followed-up with physical examination and ultrasonographic studies. The incidence of anastomotic aneurysm in this group was 4.03%; the interval between insertion of the prosthesis and detection of the false aneurysm varied from 5 to 144 months, with a median interval of 58 month. The surgical treatment of choice (false aneurysm resection and graft interposition) has been successfully performed (97% of cases) without mortality. Group 2 (8 patients) included patients with complications of false aneurysm (emergency operations); in this group radical treatment was not always applicable; mortality and amputations rate were significantly increased (respectively 25% and 37%). We conclude that, after prosthetic reconstructions, only a careful long-term follow-up (also with use of ultrasonic and/or CT-scan studies) may allow reduction in morbidity and improvement in late survival.

[Health risk behaviors, health status self-assessment and stress perception among industrial workers]. / Comportamentos de risco, auto-avaliação do nível de saúde e percepção de estresse entre trabalhadores da indústria.

OBJECTIVE: To identify the prevalence and association among health risk behaviors, stress perception, and health status self-assessment among industrial workers. METHODS: A cross-sectional study was performed using a questionnaire previously tested in a pilot study in the State of Santa Catarina, Brazil. Data on smoking, alcohol consumption, fruit and vegetables intake, physical activity, stress perception, and self-assessment of health status were available for 4,225 workers (67.5% males and 32.5% females). Subjects were selected using a 3-stage cluster sampling (5% error margin). Statistical analysis was performed using Chi-square, and logistic regression analysis (p<0.05). RESULTS: The mean age was 29.7 years old (SD=8.6). The prevalence of smokers was 20.6%, higher among males (23.1%) than females (15.6%). The proportion of heavy drinkers was high (57.2% among males and 18.8% among females). Almost half of the subjects (46.2%) reported no leisure-time physical activity (67% females and 34.8% males). Approximately 14% of subjects reported high levels of stress and difficulty to cope with daily tasks. About 15% of the workers perceived their health status as regular or poor. Gender, age, marital status, number of children, educational level and economic status were significantly associated with the prevalence of health risk behaviors. CONCLUSIONS: Despite the limitations of cross-sectional studies, based on self-report assessments, the study results suggest a high prevalence of alcohol consumption and physical inactivity during leisure time. The observed association between gender and health risk behavior suggests that both sexes engage in risk behaviors: for men these behaviors are direct or active (smoking, alcohol consumption) and for women, they are more indirect or passive (physical inactivity, stress).

[Primary angioplasty at the stage of acute myocardial infarction]. / Angioplastie primaire au stade aigu de l'infarctus du myocarde.

The success of thrombolytic therapy for acute myocardial infarction is limited by failure of reperfusing 25% of occluded arteries, bleeding complications in 0.4 to 1% of patients and the possibility of recurrent ischemia. These problems can be overcome by the use of immediate angioplasty without previous thrombolytic therapy. Between February and December 1993, twelve patients (ten men and two women) admitted for acute myocardial infarction were treated by immediate angioplasty. Five patients had a contraindication to thrombolysis and seven had angioplasty as a deliberate choice. Successful recanalisation was obtained in 11 patients (92%) with one reocclusion at 24 hours. Two patients admitted in cardiogenic shock 12 hours after the onset of symptoms died lately with multiorgan failure. Only one case of clinical restenosis was observed and was redilated. In conclusion, immediate angioplasty without prior thrombolytic therapy is a rapid method of revascularisation with minimal risk and good outcome when it is used early after acute myocardial infarction.

[Pseudo-occlusions of the internal carotid artery]. / Le pseudo-occlusioni della carotide interna.

The pseudo-occlusion (P.O.) of the internal carotid artery is defined as an atheromatous lesion causing a high-grade stenosis, which describes a peculiar angiographic finding ("string sing" or "slim sign"). The authors report their experience with 6 P.O. (angiographically diagnosed) that had been found in 16 months. In all these cases, whenever there was a clinical e/or B-scan ultrasound suspect, angiographic recommendations for the detection of that lesion have been applied. One of these 6 patients, clinically asymptomatic, refused surgery, remaining asymptomatic for cerebral ischemia during the successive 16 months; angiographic control evidenced an unmodified P.O. The other 5 patients, clinically symptomatic, underwent surgical correction: in one, intraoperative finding was a total carotid occlusion. In the other 4 patients the P.O. was confirmed and an endoarterectomy has been done. No immediate or later complications have been noted (clinical and ultrasonographic average follow-up time was 12 months). The experience described by the authors leeds to some considerations: a) the carotid P.O. is not so rare; specially if adequate angiographic technique has been employed; b) the non-invasive studies could not reliably distinguish a P.O; c) intraoperative findings do not confirm, always, angiographic ones but a fibrous, chronic and totally occluded internal carotid artery; d) the evolution of P.O. in a complete carotid occlusion is very probable but not obligatory, and if this happens it needs long period of time; consequently the surgical correction of P.O. could be justified but not urgently; e) the surgical correction of the P.O. can be done without particular difficulty and its outcome is so similar to those obtained from the routine carotid surgery.