What factors explain the increase in obesity in Brazil? An ecological analysis of contextual and behavioural components.

OBJECTIVES: It has been suggested that contextual factors may be related to obesity; however, they have not yet been widely investigated. The main objective of this ecological time-series study was to analyse factors associated with the increase in obesity in the adult and elderly population in Brazil from 2006 to 2020. STUDY DESIGN: This is an ecological time-series study. Data were collected by the Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL), the main health survey in Brazil. METHODS: The outcome was the annual obesity growth rate (in percentage points). Independent variables were behavioural and contextual factors. Data analysis was performed using Prais-Winsten regression for temporal analyses, and Spearman correlation and crude and adjusted linear regression (beta and 95% confidence intervals [CIs]). RESULTS: The annual obesity growth rate was 0.58 percentage points (p.p.) (95% CI: 0.54; 0.63) per year. Demographic density and the percentage of the population employed showed an inverse association with the growth of obesity. Variables such as Gross Domestic Product (GDP) per capita, Gini coefficient, urbanisation rate, percentage of the population with low level of education and percentage of the population without an income were directly associated with the increase in obesity rates. The variables maintained in the final model explained 81% of the growth in obesity in Brazil over the last 15 years (2006-2020). CONCLUSIONS: The growth of obesity in Brazil was mostly explained by contextual factors, especially those of a socio-economic nature. Therefore, interventions to mitigate the increase in obesity must go beyond behavioural factors.

[Reconstruction of lower limbs in old age-an interdisciplinary approach : Geriatric assessment, perioperative management, diagnostics and treatment targets]. / Rekonstruktion der unteren Extremität im Alter ­ ein interdisziplinärer Ansatz : Geriatrisches Assessment, perioperatives Management, Diagnostik und Therapieziele.

Complex injuries of the lower extremities in geriatric patients with multiple pre-existing comorbidities represent an increasing challenge to an interdisciplinary team of surgeons. Functional reconstruction of the extremity through osteosynthesis, revascularization and defect coverage aims to preserve mobility and achieve an early return to activities of daily life at home, while avoiding major amputation and the associated risks regarding morbidity and mortality. An interdisciplinary assessment of geriatric patients regarding dystrophy of soft tissue and skín, cardiovascular and metabolic comorbidities as well as specific geriatric diagnostics are crucial steps in ensuring favorable outcomes. Perioperatively, all improvable risk factors should be actively optimized and a specialized interdisciplinary approach to treatment planning (extremity board) is absolutely necessary for success of treatment. It outlines the special features of the geriatric assessment, diagnostics, perioperative management and treatment targets.

Exploring links between common mental health problems, alcohol/substance use and perpetration of intimate partner violence: A rapid ethnographic assessment with men in urban Kenya.

INTRODUCTION: Kenya has some of the highest rates of gender-based violence (GBV) in the world, particularly intimate partner violence. World Vision completed a rapid ethnographic assessment to explore common problems faced by men and local perspectives about the links between men, mental health, alcohol use and GBV. METHODS: Data from community free-listing surveys (n = 52), four focus group discussions and two key informant interviews formed the basis for thematic analysis and findings. RESULTS: Lack of jobs, 'idleness' and finances were viewed as top priority concerns facing men; however, alcohol and substance use were equally prioritised. Family problems, crime and general psychosocial issues (e.g., high stress, low self-esteem) were also reported. Men withdrawing socially, changing behaviour and increasing alcohol consumption were described as signs that men were experiencing mental health challenges. The community observed alcohol use as the biggest cause of GBV, believing men resorted to drinking because of having 'too much time', marital conflict, psychosocial issues and access to alcohol. The findings theorise that a circular link between unemployment, alcohol and crime is likely contributing to familial, psychosocial and gender concerns, and that men's mental health support may assist to re-direct a trajectory for individuals at risk of perpetrating GBV. CONCLUSIONS: Data confirmed that GBV is a major concern in these Kenya communities and has direct links with alcohol use, which is subsequently linked to mental health and psychosocial problems. Attempting to disrupt progression to the perpetration of violence by men, via mental health care interventions, warrants further research.

[The role of cross-sectional imaging in staging of rectal cancer]. / Bedeutung der Schnittbildverfahren für das Staging des Rektumkarzinoms.

The ongoing diversification of treatment strategies for rectal cancer justifies the demand for highly specialized radiological imaging. Currently, numerous studies have underlined the ability of magnetic resonance imaging (MRI) to determine those parameters that are critical for therapeutic decision-making and prognosis in rectal cancer. Computed tomography (CT) does not meet the criteria of a first line diagnostic procedure with regard to local staging but will remain the workhorse in the search for distant metastases. The increasing acceptance of extended MRI-based concepts will, however, improve cost-effectiveness and simplify patient management. Response evaluation and detection of recurrent disease are the major indications for positron emission tomography (PET)/CT, which is currently not routinely recommended.

Renewable energy powered membrane technology. 1. Development and characterization of a photovoltaic hybrid membrane system.

In isolated communities where potable water sources as well as energy grids are limited or nonexistent, treating brackish groundwater aquifers with small-scale desalination systems can be a viable alternative to existing water infrastructures. Given the unavailability of power in many such situations, renewable energy is an obvious solution to power such systems. However, renewable energy is an intermittent power supply and with regards to the performance of intermittently operated desalination systems, only very limited experience exists, both with regards to efficiency as well as water quality. In this paper, this lack of knowledge is addressed by evaluating a system operated with varying parameters (pressure and flow) with constant power as a step toward defining a safe operating window, and they provide a basis for interpreting future data obtained with a renewable energy source. Field trials were performed on a brackish (5300 mg/L TDS; 8290 microS/cm) bore in Central Australia with a photovoltaic-powered membrane filtration (PV-membrane) system. Four nanofiltration and reverse osmosis membranes (BW30, ESPA4, NF90, TFC-S) and a number of operation parameter combinations (transmembrane pressure, feed flow, TFC-S) and operating parameters transmembrane pressure and feed flow were investigated to find the best operating conditions for maximum drinking water production and minimum specific energy consumption (SEC). The ESPA4 membrane performed best for this brackish source, producing 250 L/h of excellent drinking water (257 mg/L TDS; 400 microS/ cm) at an SEC of 1.2 kWh/m3. The issue of brine disposal or reuse is also discussed and the article compares the salinity of the produced brine with livestock water. Since the feedwater is disinfected physically using ultrafiltration (UF), the brine is free from bacteria and most viruses and hence can be seen more as a reusable product stream than a waste stream with a disposal problem.

Biomedical conflicts of interest: a defence of the sequestration thesis-learning from the cases of Nancy Olivieri and David Healy.

No discussion of academic freedom, research integrity, and patient safety could begin with a more disquieting pair of case studies than those of Nancy Olivieri and David Healy. The cumulative impact of the Olivieri and Healy affairs has caused serious self examination within the biomedical research community. The first part of the essay analyses these recent academic scandals. The two case studies are then placed in their historical context-that context being the transformation of the norms of science through increasingly close ties between research universities and the corporate world. After a literature survey of the ways in which corporate sponsorship has biased the results of clinical drug trials, two different strategies to mitigate this problem are identified and assessed: a regulatory approach, which focuses on managing risks associated with industry funding of university research, and a more radical approach, the sequestration thesis, which counsels the outright elimination of corporate sponsorship. The reformist approach is criticised and the radical approach defended.

Cost factors and chemical pretreatment effects in the membrane filtration of waters containing natural organic matter.

This paper compares the membrane processes available for water treatment. Membranes have the advantage of currently decreasing capital cost, a relatively small footprint compared to conventional treatment, generally a reduction in chemicals usage and comparably low maintenance requirements. Three membrane processes applicable to water treatment, micro- (MF), ultra- (UF), and nanofiltration (NF), are compared in terms of intrinsic rejection, variation of rejection due to membrane fouling and increase in rejection by ferric chloride pretreatment. Twelve different membranes are compared on the basis of their membrane pore size which was calculated from their molecular weight cut-off. A pore size of < 6 nm is required to achieve substantial (> 50%) organics removal. For a fouled membrane this pore size is about 11 nm. UV rejection is higher than DOC rejection. Coagulation pretreatment allows a higher rejection of organics by MF and UF and the cut-off criterion due to initial membrane pore size is no longer valid. A water quality parameter (WQP) is introduced which describes the product water quality achieved as a function of colloid, DOC and cation rejection. The relationship between log (pore size) and WQP is linear. Estimation of membrane costs as a function of WQP suggests that open UF is superior to MF (similar cost at higher WQP) and NF is superior to tight UF. Chemical pretreatment could compensate for the difference between MF and UF. However, when considering chemicals and energy costs, it appears that a process operated at a higher energy is cheaper at a guaranteed product quality (less dependent on organic type). This argument is further supported by environmental issues of chemicals usage, as energy may be provided from renewable sources.

Bedside rationing by physicians: the case against.

Society should not accept the inevitability of rationing medical resources, at least not in the short term. Because of the high degree of waste and duplication that characterize the Canadian and, even more, the American healthcare system, the invitation to focus on rationing procedures known to be useful is likely to divert attention from the need to eliminate waste. If and when extensive rationing becomes necessary, however, Ubel's proposal that we adopt bedside rationing by physicians ought nevertheless to be rejected because it is ethically objectionable. Such a scheme would violate the bond of trust between doctor and patient, leading to arbitrary and discriminatory decisions. Since most physicians lack both the time and the expertise to perform cost-benefit calculations properly, Ubel's scheme would be inefficient as well as unethical. There is a better alternative.

Neurodevelopmental outcome after prenatal exposure to opiates.

UNLABELLED: To study the developmental effects of prenatal exposure to opiates, a prospective follow up study of 34 drug-exposed (opiates and nicotine) and 42 reference infants (nicotine exposure only) was conducted from January 1992 to September 1995. At the time of delivery, 12 of 34 mothers used opiates without medical control. Twenty-two mothers participated in a methadone maintenance programme. At 1 year, the average Griffiths Developmental Quotient (DQ) was lower in the drug-exposed group (mean: 100.5 vs. references 107.9; P < 0.001). This difference was mainly due to lower subscales "locomotor" (mean 100.8 vs. 111.4; P < 0.05) and "intellectual performance" (mean 100.8 vs. 108.5; P < 0.05) in the drug-exposed group. Severe developmental retardation mean DQ (-2 SD) was diagnosed in 2 drug-exposed infants. Mild developmental retardation (mean DQ: 1 SD- > 2 SD) was found in 7 drug-exposed and in 3 reference infants (P < 0.05). Neurological abnormalities were found more frequently in the drug-exposed group (11 vs. 3 infants; P < 0.01). Among the opiate-exposed infants, the subscales "hearing and speech" and "intellectual performance" were lower in the uncontrolled drug-using than in the methadone group. The 17 fostered infants showed no difference in developmental outcome compared with the 10 infants living with their biological parents (mean DQ: 100.0 versus 101.3). CONCLUSIONS: At 1 year infants prenatally exposed to opiates are at risk for mild psychomotor developmental impairment.

Assessment of plasma neopterin in clinical kidney transplantation.

Serial plasma samples of 172 kidney transplant recipients and 42 chronic dialysis patients were evaluated retrospectively in a radioimmunoassay to determine the clinical relevance of plasma neopterin levels. Dialysis patients had a higher neopterin level 196 +/- 82 nmol/L (mean +/- SD) than 70 healthy controls (7 +/- 4 nmol/L). In 45 patients with a completely uneventful postoperative course, elevated pretransplant neopterin levels dropped rapidly within a week to a mean of 30 nmol/L and remained stable thereafter. In 22 outpatients with stable graft function there was a highly significant correlation between 170 paired serum creatinine and plasma neopterin values (r = 0.94). A group of 13 patients had experienced delayed graft function (ATN) without rejection. Their one-week mean neopterin level was 100 nmol/L and continued to drop in parallel with the serum creatinine. Another 15 patients rejected their kidneys irreversibly within 3 weeks-6 of them had extremely high neopterin levels during the rejection process (range 500-1000 nmol/L) that were not seen in other patients. A total of 169 rejection episodes in 43 patients were treated with bolus-dose cortisone. On the day of bolus therapy, both serum creatinine (P less than 0.002) and neopterin (P less than 0.005) were elevated. At 24 hours prior to bolus cortisone therapy, creatinine levels were not significantly elevated, whereas there was a significant rise in plasma neopterin (P less than 0.01). The overall sensitivity of neopterin increase was 86% with a 17% probability of false positives, and the sensitivity was 95% in biopsy-proved rejections. Plasma neopterin appears to be a useful marker for early detection of rejection and for identifying severe rejections that are not responsive to treatment.

Experimentation with human subjects: a critique of the views of Hans Jonas.

The ethics of experimentation on human subjects has become the subject of much debate among medical scientists and philosophers. Ethical problems and conflicts of interest become especially serious when research subjects are recruited from the class of patients. Are patients who are ill and suffering in a position to give voluntary and informed consent? Are there inevitable conflicts of interest and moral obligation when a personal physician recruits his own patients for an experiment designed partly to advance scientific knowledge and only partly as therapy for those patients? The views of the eminent American ethicist Hans Jonas on these issues are briefly summarised and criticised, and some moral guidelines are then proposed to regulate experimentation on human subjects.

KIE: The influence of Hans Jonas' view on the ethics of human experimentation has prompted Schafer to reconsider Jonas' 1969 Daedalus article, "Philosophical reflections on experimenting with human subjects." Jonas' initial absolutist position that the 'sacrosanctity' of the potential research subject overrides the social good of medical research virtually rules out all such research, but he reluctantly adopts a more utilitarian approach that permits patients to participate in experiments related to their diseases. Schafer proposes a broader concept of consent to risk in the experimental setting, while at the same time valuing Jonas' reminder of the dangers inherent in a strictly utilitarian assessment of research benefits.