Effect of freezing and storage temperature on stability and antimicrobial activity of an antibiotic mixture used for decontamination of tissue allografts.

One of the most important risks to be controlled in tissue banking is the infection associated with the clinical use of auto- and allografts. Thus, tissue disinfection protocols are used, in addition to processing in controlled environments. For this purpose, combinations of antibiotics are designed to ensure a broad spectrum of antimicrobial activity. This type of protocol is usually validated by testing its antimicrobial efficacy. In this work, we have studied the effect of several factors on the potential of an antibiotic mixture: container, freezing, storage at 4 °C, storage at - 30 °C and storage at - 80 °C. The molecular stability of the compounds has also been tested, additionally to their efficacy. Our findings show that storage conditions affect the molecular stability of Fungizone and Tobramycin (only in case of frozen storage for the last one). Nevertheless, the solution retains its antimicrobial activity for several weeks. The availability of stored aliquots of disinfectant solution and defining expiry dates for different storage conditions can help to schedule tissue bank tasks.

Reference curves for BMI, waist circumference and waist-to-height ratio for Azorean adolescents (Portugal).

OBJECTIVE: There are no percentile curves for BMI, waist circumference (WC) or waist-to-height ratio (WHtR) available for Portuguese children and adolescents. The purpose of the present study was to develop age- and sex-specific BMI, WC and WHtR percentile curves for a representative sample of adolescents living in the Portuguese islands of Azores, one of the poorest regions of Europe, and to compare them with those from other countries. DESIGN: Cross-sectional school-based study. Weight, height and WC were objectively measured according to standard procedures. Smoothed percentile curves were estimated using Cole's LMS method. SETTING: Azores, Portugal. SUBJECTS: Proportionate stratified random sample of 1500 adolescents, aged 15-18 years. RESULTS: Results showed some sex differences in the shape of the BMI curves: in girls, the upper percentile values tend to decrease by the age of 16 and 17 years; whereas in boys, the upper percentiles tend to be flat between 15 and 16 years and then increase until the age of 18 years. In both sexes, the upper percentile values of both WC and WHtR decreased slightly by the age of 16 years and then increased steeply. In both sexes, the Azorean values for the 50th and 90th WC percentiles were higher than those reported for adolescents from the majority of other countries. CONCLUSIONS: The reference curves presented herein provide baseline data for the long-term surveillance of Azorean adolescents, as well as for national and international comparisons.

A proposed adaptation of the European Foundation for Quality Management Excellence Model to physical activity programmes for the elderly - development of a quality self-assessment tool using a modified Delphi process.

BACKGROUND: There has been a growing concern in designing physical activity (PA) programmes for elderly people, since evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Complete programme evaluations are a necessary prerequisite to continuous quality improvements. Being able to refine, adapt and create tools that are suited to the realities and contexts of PA programmes for the elderly in order to support its continuous improvement is, therefore, crucial. Thus, the aim of this study was to develop a self-assessment tool for PA programmes for the elderly. METHODS: A 3-round Delphi process was conducted via the Internet with 43 national experts in PA for the elderly, management and delivery of PA programmes for the elderly, sports management, quality management and gerontology, asking experts to identify the propositions that they considered relevant for inclusion in the self-assessment tool. Experts reviewed a list of proposed statements, based on the criteria and sub-criteria from the European Foundation for Quality Management Excellence Model (EFQM) and PA guidelines for older adults and rated each proposition from 1 to 8 (disagree to agree) and modified and/or added propositions. Propositions receiving either bottom or top scores of greater than 70% were considered to have achieved consensus to drop or retain, respectively. RESULTS: In round 1, of the 196 originally-proposed statements (best practice principles), the experts modified 41, added 1 and achieved consensus on 93. In round 2, a total of 104 propositions were presented, of which experts modified 39 and achieved consensus on 53. In the last round, of 51 proposed statements, the experts achieved consensus on 19. After 3 rounds of rating, experts had not achieved consensus on 32 propositions. The resulting tool consisted of 165 statements that assess nine management areas involved in the development of PA programmes for the elderly. CONCLUSION: Based on experts' opinions, a self-assessment tool was found in order to access quality of PA programmes for the elderly. Information obtained with evaluations would be useful to organizations seeking to improve their services, customer satisfaction and, consequently, adherence to PA programmes, targeting the ageing population.

Evaluation of physical activity programmes for elderly people - a descriptive study using the EFQM' criteria.

BACKGROUND: In the past years, there has been a growing concern in designing physical activity (PA) programmes for elderly people, because evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Quality is an important issue when designing a PA programme for older people. Some studies support the Excellence Model of the European Foundation for Quality Management (EFQM) as an operational framework for evaluating the quality of an organization. Within this context, the aim of this study was to characterize the quality management models of the PA programmes developed by Portuguese Local Administration to enhance quality of life for elderly people, according to the criteria of the EFQM Excellence Model. METHODS: A methodological triangulation was conducted in 26 PA programmes using questionnaire surveys, semi-structured interviews and document analysis. We used standard approaches to the statistical analysis of data including frequencies and percentages for the categorical data. RESULTS: Results showed that Processes (65,38%), Leadership (61,03%), Customer results (58,46) and People (51,28%) had high percentage occurrences of quality practices. In contrast, Partnerships and resources (45,77%), People results (41,03%), Policy and strategy (37,91%), Key performance results (19,23%) and Society results (19,23%) had lower percentage occurrences. CONCLUSIONS: Our findings suggest that although there are some good practices in PA programmes, there are still relevant areas that require improvement.

Metabolic risk factors, physical activity and physical fitness in Azorean adolescents: a cross-sectional study.

BACKGROUND: The prevalence of metabolic syndrome has increased over the last few decades in adolescents and has become an important health challenge worldwide. This study analyzed the relationships between metabolic risk factors (MRF) and physical activity (PA) and physical fitness (PF) in a sample of Azorean adolescents. METHODS: A cross-sectional school-based study was conducted on 417 adolescents (243 girls) aged 15-18 from the Azorean Islands, Portugal. Height, weight, waist circumference, fasting glucose, HDL-cholesterol, triglycerides, and blood pressure were measured. A sum of MRF was computed, and adolescents were classified into three groups: no MRF, one MRF and two or more MRF. PA was assessed by a sealed pedometer. PF was assessed using five tests from the Fitnessgram Test Battery. Dietary intake was obtained using a semi-quantitative food frequency questionnaire. RESULTS: Mean daily steps for girls and boys were 7427 ± 2725 and 7916 ± 3936, respectively. Fifty-nine percent of the adolescents showed at least one MRF and 57.6% were under the healthy zone in the 20 m Shuttle Run Test. Ordinal logistic regression analysis showed that after adjusting for sex, body mass index, socio-economic status and adherence to a Mediterranean diet, adolescents who were in the highest quartile of the pedometer step/counts (≥9423 steps/day) and those who achieved the healthy zone in five tests were less likely to have one or more MRF (OR = 0.56;95%CI:0.33-0.95; OR = 0.55;95%CI:0.31-0.98, respectively). CONCLUSIONS: Daily step counts and PF levels were negatively associated with having one or more MRF among Azorean adolescents. Our findings emphasize the importance of promoting and increasing regular PA and PF to reduce the public health burden of chronic diseases associated with a sedentary lifestyle.

Investigation of the in vitro antimicrobial activity of triclosan-coated suture material on bacteria commonly isolated from wounds in dogs.

OBJECTIVE: To investigate in vitro effects of triclosan coating of suture materials on the growth of clinically relevant bacteria isolated from wounds in dogs. SAMPLE: 6 types of suture material and 10 isolates each of methicillin-susceptible Staphylococcus pseudintermedius, methicillin-resistant S pseudintermedius, Escherichia coli, and AmpC ß-lactamase and extended-spectrum ß-lactamase-producing E coli from clinical wound infections. PROCEDURES: Isolates were cultured on Mueller-Hinton agar with 3 types of triclosan-coated suture, uncoated counterparts of the same suture types, and positive and negative controls. Zones of inhibition (ZOIs) were measured after overnight incubation. Sustained antimicrobial activity assays were performed with susceptible isolates. The ZOI measurements and durations of sustained antimicrobial activity were compared among suture types and isolates by statistical methods. Suture surface characteristics and bacterial adherence were evaluated qualitatively with scanning electron microscopy. RESULTS: ZOIs were generated only by triclosan-coated materials; triclosan-coated suture had sustained antimicrobial activity (inhibition) for 3 to 29 days against all tested pathogens. The ZOIs around triclosan-coated suture were significantly greater for S pseudintermedius isolates than for E coli isolates. Bacterial adherence to uncoated polyglactin-910 was greatest, followed by triclosan-coated polyglactin-910, and then uncoated monofilament sutures, with least adherence to coated monofilament sutures. CONCLUSIONS AND CLINICAL RELEVANCE: Surface characteristics of suture materials may be as important or more important than triclosan coating for microbial inhibition; however, triclosan coating appeared to affect bacterial adherence for multifilament sutures. Triclosan-coated, particularly monofilament, sutures inhibited pathogens commonly isolated from wounds of dogs, including multidrug-resistant bacteria. Further studies are required to assess clinical efficacy of triclosan-coated suture materials in vivo.

Plasma cytokine concentrations in dogs with a congenital portosystemic shunt.

Congenital portosystemic shunts (cPSS) are a well-recognised vascular anomaly in dogs. Recent studies have shown an association between inflammation and hepatic encephalopathy (HE), which is a common clinical syndrome in dogs with a cPSS. Pro-inflammatory cytokines such as interleukin (IL)-6 and tumour necrosis factor (TNF)-α are frequently increased in the plasma of human patients with liver disease and have been implicated in the development of HE. In the current study, plasma concentrations of IL-2, IL-6, IL-8 and TNF-α were measured using a multiplex electrochemiluminescence immunoassay in 36 dogs with a cPSS and compared to 25 healthy dogs. There were no significant differences in plasma IL-2, IL-8 and TNF-α concentrations between the two groups; however, plasma concentrations of IL-6 were significantly higher in dogs with a cPSS compared to healthy dogs (P=0.02).

Nanocrystalline silver dressing and subatmospheric pressure therapy following neoadjuvant radiation therapy and surgical excision of a feline injection site sarcoma.

UNLABELLED: CLINICAL SUMMARY: This is the first clinical report of use of a combination of nanocrystalline silver and subatmospheric pressure therapy to treat a resistant wound infection, following tumour removal and radiation therapy, in a difficult-to-manage surgical site in a cat. PRACTICAL RELEVANCE: The therapy was well tolerated and the authors suggest it is a valid treatment protocol for management of non-healing or infected wounds in the cat.

Study protocol: using the Q-STEPS to assess and improve the quality of physical activity programmes for the elderly.

BACKGROUND: Aging is one of the most important and obvious phenomenon observed in our society. In the past years, there has been a growing concern in designing physical activity (PA) programmes for elderly people, because evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Accordingly, a growing body of literature points to the importance of a sound approach to planning and evaluation in order to improve the quality of PA programmes. However, while numerous PA programmes have been designed for the elderly in recent years, their evaluation has been scarce. Quality management processes and tools provide a practical way for organisations to assess, identify and shed light on the areas requiring improvement. The Quality Self-assessment Tool for Exercise Programmes for Seniors (Q-STEPS) seems to provide a framework tailored to evaluate PA programmes for the elderly. FINDINGS: The primary purpose of this study is 1) to determine feasibility, acceptability and usability of the Q-STEPS. Secondary purposes of the study are: 2) to examine the quality of the PA programmes for elderly people developed by the Portuguese Local Administration over a three-year period of self-assessments in terms of: a) Enabler domains (Leadership, Policy and Strategy, People, Partnership and Resources, Processes); b) Result domains (Customer Results, People Results, Society Results and Key Performance Results); 3) to estimate the association between the use of Q-STEPS and some indicators relating to the elderly participants, during the three self-assessments, such as: attendance rates, physical fitness, health-related quality of life and the elderly's perceived quality of the programme. The study will be conducted in PA programmes for elderly adults from mainland Portuguese municipalities over a three-year period. The project will adopt a participative quality improvement approach that features annual learning cycles of: 1) self-assessment with the Q-STEPS; 2) feedback to and interpretation of results involving programme's staff; 3) action planning to achieve system changes; 4) implementation of strategies for change; and 5) review process through further self-assessment. The study will collect a range of process and outcome data that will be used to achieve the research aims. DISCUSSION: It is our understanding that the results of the Q-STEPS study will contribute directly to the evidence based on effectiveness of continuous quality improvement approaches, in order to improve customer satisfaction and adherence to PA programmes targeting the ageing population. This comprehensive evaluation will also add significant new knowledge regarding the characteristics associated with a sustainable public service.

Comparison of different VO(2max) equations in the ability to discriminate the metabolic risk in Portuguese adolescents.

There is increasing evidence that cardiorespiratory fitness (CRF) is an important health marker already in youth. This study aimed to determine the ability of five VO(2max) equations to discriminate between low/high Metabolic Risk in 450 Portuguese adolescents aged 10-18. We measured waist and hip circumferences, fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and blood pressure. For each of these variables, a Z-score was computed. The HDL-cholesterol was multiplied by -1. A metabolic risk score was constructed by summing the Z scores of all individual risk factors. High risk was considered when the individual had ≥1 SD of this score. Cardiorespiratory fitness (CRF) was measured with the 20-m shuttle run test. We estimated VO(2max) from the CRF tests using five equations. ROC analyses showed a significant discriminatory accuracy for the Matsuzaka and Barnett(a) equations in identifying the low/high metabolic risk in both genders (Matsuzaka girls: AUC=0.654, 95%CI: 0.591-0.713, p<0.001, VO(2max)=39.5 mL kg⁻¹min⁻¹; boys: AUC=0.648, 95%CI: 0.576-0.716, p<0.001, VO(2max)=41.8 mL kg⁻¹min⁻¹; Barnett(a) girls: AUC=0.620, 95%CI: 0.557-0.681, p<0.001, VO(2max)=46.4 mL kg⁻¹min⁻¹; boys: AUC=0.628, 95%CI: 0.555-0.697, p=0.04, VO(2max)=42.6 mL kg⁻¹min⁻¹), and the Ruiz equation in boys (AUC=0.638, 95%CI: 0.565-0.706, p<0.001, VO(2max)=47.1 mL kg⁻¹min⁻¹). The VO(2max) values found require further testing in other populations as well as in longitudinal studies; the identification of adolescents who have low CRF levels can help detect youth with an increased risk of metabolic disease.

Ability of different measures of adiposity to identify high metabolic risk in adolescents.

Introduction. This study aimed to evaluate the screening performance of different measures of adiposity: body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) for high metabolic risk in a sample of adolescents. Methods. A cross-sectional school-based study was conducted on 517 adolescents aged 15-18, from the Azorean Islands, Portugal. We measured fasting glucose, insulin, total cholesterol (TC), HDL-cholesterol, triglycerides, and systolic blood pressure. HOMA and TC/HDL-C ratio were calculated. For each of these variables, a Z-score was computed by age and sex. A metabolic risk score (MRS) was constructed by summing the Z-scores of all individual risk factors. High risk was considered when the individual had ≥1SD of this score. Receiver-operating characteristics (ROC) were used. Results. Linear regression analyses showed that, after adjusting for age and pubertal stage, all different measures of adiposity are positively and significantly associated with MRS in both sexes, with exception of WHtR for boys. BMI, WC, and WHtR performed well in detecting high MRS, indicated by areas under the curve (AUC), with slightly greater AUC for BMI than for WC and WHtR in both sexes. Conclusion. All measures of adiposity were significantly associated with metabolic risk factors in a sample of Portuguese adolescents.

Evaluation of physical activity programmes for the elderly - exploring the lessons from other sectors and examining the general characteristics of the programmes.

BACKGROUND: In Portugal, there are several physical activity (PA) programmes for elderly people developed by the local government. The importance of these programmes has been increasing since the evidence has shown that this type of health promotion interventions may reduce the deleterious effects of the ageing process. However, no study has already identified the general characteristics of these programmes nor if they use any scheme to assess the quality of the service provided. A widely-used scheme is the EFQM Excellence Model, which will be in the core of our present work. Thus, the main aims of this preliminary study were 1) to identify the general characteristics of the PA programmes developed by the Portuguese Local Public Administration 2) to determine the extent of implementation of quality initiatives in these programmes. METHODS: Data were collected by an on-line questionnaire sent to all Continental Municipalities (n = 278). Categorical data were expressed as absolute counts and percentages. Continuous data were expressed as the mean and SD. An open-ended question was analysed using qualitative content analysis with QSR NVivo software. Associations between categorical variables were tested by the use of contingency tables and the calculation of chi-square tests. Significance level was set at p ≤ 0.05. RESULTS: Results showed: i) a total of 125 PA programmes were identified in the 18 districts of the Portugal mainland; ii) the main goal of the majority (95.2%) was the participants' health promotion; iii) different characteristics of the programmes were found according to different regions of the country; iv) certain characteristics of the programmes were associated to the existence of other features; v) only one PA programme developed quality initiatives. CONCLUSIONS: In conclusion, although there are many PA programmes for elderly people spread throughout the country, aiming at improving the health of participants, the overwhelming majority does not adopt quality control initiatives. Considering that the quality of a service increases customer satisfaction, the continuous quality improvement of the PA programmes for elderly people should therefore be implemented since they can be useful and critical for elderly satisfaction and adherence.

Metabolic syndrome and physical fitness in a sample of Azorean adolescents.

BACKGROUND: Metabolic syndrome, a predecessor of cardiovascular disease and type 2 diabetes, has become prevalent in adolescents. This study aimed to estimate the prevalence of metabolic syndrome and its components and to analyze the relationship between metabolic syndrome and overall physical fitness levels in a sample of Azorean adolescents. METHODS: A cross-sectional school-based study, the Azorean Physical Activity and Health Study II, was conducted on 517 adolescents (297 girls, 220 boys) aged 15-18 years old from the Azorean Islands. Body height, weight, waist circumference, and arterial blood pressure were measured according to standards. Fasting intravenous blood samples were analyzed (high-density lipoprotein cholesterol, triglycerides, and glucose). Physical fitness was assessed using five tests from Fitnessgram Test Battery 8.0: Curl-up, push-up, trunk lift, pacer, and sit-and-reach. Adolescents were then classified as being in the healthy zone or above or under the healthy zone. Metabolic syndrome was defined according to the 2007 International Diabetes Federation's guidelines for adolescents. RESULTS: The prevalence of metabolic syndrome was 5% (4.7% in girls and 5.5% in boys, P > 0.05). Waist circumference was the most prevalent component (32.9%), and hypertriglyceridemia the least (4.4%). Logistic regression analysis showed that after adjusting for pubertal stage and socioeconomic status, unfit adolescents (healthy zone criteria in

Sitting time and body mass index, in a Portuguese sample of men: results from the Azorean Physical Activity and Health Study (APAHS).

The aim of this study was to verify the relation between body mass index (BMI) and sitting time in a sample of 4,091 Azorean men. BMI was calculated from self-reported weight and height. Total physical activity (PA) time and total sitting time were assessed with the IPAQ (short version). Linear Regression analysis showed that total sitting time (hours/day) was positively associated with BMI (B = 0.078; p < 0.001) after adjustments for age, meal frequency, alcohol and tobacco consumptions, island of residence, education level and total PA time. Although the cross sectional design precludes us from establishing causality, our findings emphasize the importance of reducing sedentary behavior to decrease the risk of obesity.