Overweight postmenopausal women with different plasma estradiol concentrations present with a similar pattern of energy expenditure and substrate oxidation rate before and after a fatty meal challenge.

Menopause-related withdrawal of ovarian estrogens is associated with reduced energy metabolism and overall impairment of substrate oxidation. Estradiol's withdrawal after menopause is associated with a reduction in energy metabolism and impaired substrate oxidation, which contributes to weight gain and visceral fat accumulation. Here we aimed to investigate the association between plasma estradiol concentrations and energy expenditure (EE)/substrate oxidation in a group of overweight postmenopausal women before and after a fatty meal challenge. Women were divided into three groups according to their plasma estradiol concentrations (E2): group 1 - E2 ≤ 39, group 2 - 40 ≤ E2 ≤ 59, and group 3 - E2 ≥ 60 pg/mL. VO2 and VCO2 volumes were collected following indirect calorimetry 5 h following a single lipid overload meal (1100 kcal, 72% of fat). For comparisons between groups and within the same group, a linear regression model with mixed effects was applied (P < 0.05). Forty-four women aged 55 ± 0.7 years-old, 8 ± 1.1 years following menopause, with a BMI of 30.5 ± 0.5 kg/m2, and 41.9 ± 0.7% of body fat were enrolled the study. Plasma E2 concentrations were: group 1 - 30.4 ± 1.9, group 2 - 46.9 ± 1.5, and group 3 - 91.3 ± 12.0 pg/mL (P < 0.0001). EE at baseline and in the resting state was 1320 ± 24.3 kcal/d, and increased to 1440 ± 27.0 kcal/d 30 min following ingestion of the fatty meal (P < 0.0001), and rose again to an average of 1475 ± 30.3 kcal/d at the completion of experiment (P < 0.0001). Carbohydrate oxidation (Chox) was 0.155 ± 0.01 g/min at resting, maintained as 0.133 ± 0.00 g/min 30 min after ingestion of the fatty meal, and was 0.123 ± 0.01 g/min at the end of the testing period. Lipid oxidation (Lipox) was 0.041 ± 0.003 g/min at resting, increasing to 0.054 ± 0.003 g/min at 30 min (P = 0.01), and reaching 0.063 ± 0.003 g/min at the end of the experiment (P < 0.0001). There was no difference between groups for EE, Chox or Lipox. Our data suggest that EE and substrate oxidation were modulated following a lipid-meal challenge equally in all groups and this did not differ with plasma E2 concentrations.

Considerações sobre custo-benefício nas políticas de saúde: tratamento curativo versus o preventivo da osteoporose / Cost-benefit considerations for health policies: curative versus preventive treatment of osteoporosis

A partir da década de 1990 vários paradigmas da prática médica foram sendo modificados, o que levou ao desenvolvimento de novas abordagens médicas, mais eficientes e eficazes. O conhecimento da osteoporose passa por modificações: antes correlacionava redução de massa óssea à elevação do risco de fratura e direcionava o diagnóstico somente a indivíduos idosos; posteriormente, baseia-se em um modelo que privilegia a observação simultânea das duas matrizes ósseas: protéica ou verdadeira e a inorgânica ou secundária, desde tenra idade. Os dois modelos se distinguem basicamente por uma abordagem curativa, que diagnostica o quadro de osteoporose já instalado e adota práticas posteriores ao mal e, de outro lado, por uma abordagem preventiva, que visa evitar que o mal se instale. Dessa forma, com o objetivo de avaliar a relação custo-benefício e custo-efetiva do tratamento curativo versus o preventivo da osteoporose nas políticas públicas de saúde, foi realizada uma pesquisa comparativa dos pacientes atendidos no HCFMRP-USP entre 2007-2009. A partir dos dados obtidos foi efetuada a análise dos custos incorridos versus os benefícios auferidos. Os resultados da pesquisa consideram a abordagem preventiva da osteoporose viável economicamente, por meio do rastreamento da microarquitetura óssea. Nesse sentido, além das evidências econômicas, o estudo permitiu analisar a importância da aplicação de um novo paradigma da osteoporose nas políticas públicas de saúde, a fim de alcançar a melhoria das condições de vida e bem-estar da população.

From the 1990 decade, several paradigms of daily medical practice have been modified, favoring new, more efficient and effective medical approaches. The knowledge about osteoporosis underwent changes; it previously correlated the reduction of bone mass to an increased risk of fracture and directed the diagnosis only at elderly individuals. A later a model favors, since an early age, the simultaneous observation of the two bone matrices, the protein or real one and the inorganic or secondary one. The two models basically differ in terms of approach: one takes a curative approach, that diagnoses the signs and symptoms already installed of osteoporosis and adopts practices that follow the disease; the other, a preventive approach aiming at avoiding the installation of the disease. Thus, in order to evaluate the costs and benefits of curative against preventive approaches of osteoporosis in public health policies, a comparative study of patients treated in 2007-2009 on HCFMRP – USP was carried out. Data obtained were analyzed as for the costs incurred versus the benefits gained. The results of the study show that the preventive approach to osteoporosis, by means of bone micro-architecture screening, is economically viable. In this respect, in addition to providing economic evidence, the study analyzed the importance of applying a new paradigm regarding osteoporosis on the part of public healthcare policy in order to achieve better living conditions and well-being for the population.

Depressão no climatério: indicadores biopsicossociais / Depression during the climacteric: biopsychosocial indicators

OBJETIVO: Identificar a presença de sintomas depressivos em mulheres no climatério, analisando os indicadores biopsicossociais relacionados. MÉTODOS: Aplicaram-se o Questionário de Identificação e Contexto da Mulher no Climatério (ICMC) e o inventário de Beck a 30 mulheres em primeiro atendimento no Ambulatório Multidisciplinar do Climatério do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCRP/FMRP/USP). Os dados foram estatisticamente trabalhados por análise bivariada e multivariada. RESULTADOS: Observa-se que, de acordo com o inventário de Beck, foi identificada depressão em 14 das 30 mulheres atendidas no ambulatório no período de novembro de 2003 a dezembro de 2004. CONCLUSÃO: Os resultados mostraram que os sintomas depressivos estavam aumentados em mulheres na faixa dos 40 aos 49 anos, não-brancas, que tinham companheiro pertencente ao grupo biológico B ou C, que tinham problemas com o cônjuge, que vivenciaram hábito de beber, situação de óbito recentemente e/ou desemprego na família.

OBJECTIVE: This study aimed to identify the presence of depressive symptoms in women during the climacteric and to analyze the related biopsychosocial indicators. METHODS: The Questionnaire for the Identification and Context of Women during the Climacteric and Becks Inventory were applied to 30 women who first attended the Multidisciplinary Menopause Outpatient Clinic at the HCRP/FMRP/USP, Brazil. Data were statistically processed through bivariate and multivariate analysis. RESULTS: According to the Beck Inventory the presence of depression was identified in 14 of the 30 women attended in that outpatient clinic from November 2003 to December 2004. CONCLUSION: Results showed the increased presence of depressive symptoms in non-white women between 40 and 49 years old, who had a partner, belonged to biological groups B or C, were going through problems with their partner, had drinking habits and had faced a situation of recent death or unemployment in the family.