Predictors of subclinical carotid atherosclerosis in middle-aged women.

BACKGROUND: Traditional strategies for primary cardiovascular prevention have been insufficient in reducing the high rates of coronary ischemic events in women, probably because these women are often stratified into low-risk groups. However, cardiovascular diseases continue to be the main cause of morbidity and mortality in women worldwide. We hypothesized that carotid atherosclerosis (CA) is common in middle-aged women. METHODS: We prospectively evaluated asymptomatic peri- and post-menopausal women with no cardiovascular diseases or the use of hormone therapy from two gynecologic clinics. All the patients underwent full clinical and laboratory evaluation and underwent a B-mode ultrasound for carotid evaluations. The presence of CA was defined as the presence of plaque and/or carotid intima-media thickness (CIMT)>1.00 mm. We performed logistic regression to evaluate independent predictors of CA. RESULTS: We studied 823 women (age: 54.4±5.4 years; body mass index-BMI: 28.5±4.9 kg/m2; diabetes:10%; hypertension: 58%). The prevalence of CA was 12.7% for the entire population and 11% for the low-risk sub-group as defined by a Framingham risk score <5%. In the multivariate model, age: odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25-1.89,p<0.001; current smoker status: OR = 2.69, 95% CI = 1.48-4.91, p = 0.001; total cholesterol: OR = 1.13, 95% CI = 1.03-1.24, p = 0.008; and systolic blood pressure: OR = 1.01, 95% CI = 1.00-1.02, p = 0.030 remained independently associated with CA. CONCLUSION: Subclinical CA is common among asymptomatic middle-aged women, and traditional risk factors are independently associated with CA. These findings are particularly relevant for improving cardiovascular health in women.

Quality of life amongst older Brazilians: a cross-cultural validation of the CASP-19 into Brazilian-Portuguese.

INTRODUCTION: As population ageing becomes a global phenomenon the need to understand the quality of life of older people around the world has become increasingly salient. The CASP-19 is a well established measure of quality of later life. The scale is composed of 19 items which map onto the four domains of control (C), Autonomy (A), Self-Realisation (S) and Pleasure (P). It has already been translated to 12 languages and has been used in a number of national and international studies. However use of the scale outside of Europe has been very limited. The objective of this study was to translate and evaluate the use of the CASP-19 amongst older Brazilians. METHODS: The CASP-19 was translated from English to Portuguese, back-translated and submitted to an analysis of equivalence by a committee of judges. The scale was then administered to a sample of community dwelling older people in Recife, Brazil (n = 87), and tested for psychometric properties. The Control and Pleasure domains exhibited good internal consistency. By removing one item from each of the Autonomy and Self Realisation domains their internal consistency was improved. RESULTS: The mean age of the sample was 75.6±0.7 years, subjects were mainly female (52.9%), white (52.9%), who lived without a partner (54%), and had a monthly income varying from USD 340.00 to USD 850.00. Translation and cross-cultural adaptation permitted good understanding and applicability of final version. Psychometric analyses revealed that the removal of two items improved the internal consistency of the Autonomy and Pleasure domains. Confirmatory factor analyses suggest that a 16 item, four factor, model best fits the data. CONCLUSION: In this small exploratory study the CASP-19 Brazil demonstrated good psychometric properties. It was easy to use for both participants and researchers. Hopefully future studies in Brazil will employ the scale so that more direct cross national comparisons can be made with older people in Europe and the US.

An improved intragastric balloon procedure using a new balloon: preliminary analysis of safety and efficiency.

BACKGROUND: The authors developed a new intragastric balloon procedure with the objective of making it safer, faster, and less expensive than the established ones. The proposed procedure uses a new gastric balloon with technical improvements in the placement and removal procedures. METHODS: From June 2006 to July 2007, 52 patients were submitted to the new treatment with the Silimed Gastric Balloon (SGB), as part of a multidisciplinary program involving clinical, psychological, and behavioral approaches. RESULTS: The new placement and removal procedures of the SGB were effective and safe in all the cases. Due to simplicity and shortened duration of the procedures, all the patients left the outpatient clinic in less than 1 h after the placement or removal of the SGB. For the 14 patients who had completed the 6-month treatment, the initial mean weight, mean body mass index (BMI), and mean excess of weight (EW) were, respectively, 100.7 kg, 35.7 kg/m(2), and 30.0 kg. After the 6-month treatment, these values decreased significantly: 89.4 kg, 31.8 kg/m(2), and 19.6 kg. CONCLUSIONS: Preliminary data suggest that the procedure with the new balloon comes forth as a safe and effective alternative to the treatment of weight loss in patients with appropriate indication of use.

Infertilidade: associação com transtornos mentais comuns e a importância do apoio social / Infertility: association with common mental disorders and the role of social support

Introdução: O diagnóstico da infertilidade pode ser devastador na vida de um casal. Muitas mulheres inférteis percebem a situação como estigmatizante, causadora de sofrimento psíquico e isolamento social. O estudo objetivou determinar as variáveis econômicas, demográficas, interpessoais, sociais e também a prevalência de transtornos mentais comuns na população de mulheres atendidas nos ambulatórios de referência de esterilidade do Hospital Agamenon Magalhães, Centro Integrado de Saúde Amaury de Medeiros eInstituto Materno Infantil de Pernambuco e encaminhadas ao Ambulatório de Saúde Mental em Reprodução Humana do Hospital Universitário Oswaldo Cruz. Método: A pesquisa foi transversal, durante o ano de 2007, com um total de 60 pacientes, que responderam a dois questionários autoaplicáveis: o Self-Reporting Questionnaire-20 (SRQ-20) e outro, formulado pela pesquisadora. Resultados: Das 60 mulheres pesquisadas, 55% tinham 31 anos ou mais. A prevalência total dos transtornos mentais comuns foi de53,3%, sendo que a ocorrência de transtornos mentais comuns foi bem mais elevada entre as que tinham 31 anos ou mais do que entre as que tinham até 30 anos (66,7 versus 37%). As que evitavam situações sociais que podiam causar desconforto emocional apresentaram maior incidência de transtornos mentais comuns. Conclusões: A prevalência dos transtornos mentais comuns e sua associação com enfrentamento social embasam a necessidade de atendimento interdisciplinar, incluindo profissionais de saúde mental. Nossos dados confirmam a importância do apoio social e da inclusão dos parceiros no processo de avaliação da infertilidade.

Introduction: A diagnosis of infertility may be devastating for a couple. Many infertile women perceive the situation as stigmatizing, a cause of psychic distress and social isolation. This study aimed at determining the economic, demographic, interpersonal, social and work variables and also the prevalence of common mental disorders in a population of women seen in reference hospitals for infertility (Hospital Agamenon Magalhães, Amaury de Medeiros Integrated Health Center and Instituto Materno Infantil de Pernambuco), and referred to the Mental Health in Human Reproduction Outpatient Clinic at Hospital Universitário Oswaldo Cruz. Method: This was a cross-sectional study conducted in 2007 with a total of 60 patients, who answered two self-eporting questionnaires: the Self-Reporting Questionnaire-20 (SRQ-20) and a questionnaire designed by the researcher. Results: Of the 60 women studied, 44% were aged 31 or older. The overall prevalence of common mental disorders was 53.3%. It was much more common in women aged 31 or older than in those aged 30 or less (66.7 vs. 37.0%). The patients who avoided social situations that could cause emotional discomfort presented a higher rate of common mental disorders.Conclusions: The prevalence of common mental disorders and their association with social coping underlies the need for an interdisciplinary approach, including mental health professionals. Our data confirm the importance of social support and the inclusion of the male partner in the infertility evaluation process.

Prevalence of oral mucosa lesions in diabetic patients: a preliminary study.

AIM: The present study aimed to evaluate the prevalence of superficial lesions in the oral cavity mucosa in diabetic patients. METHODS: The sample was made of 30 patients. To obtain these results we did rigorous clinical and complementary tests. RESULTS: Of the 30 patients, 9 (30%) were males and 21 (70%) females. Of the studied patients, 40% were below 60 years of age, and 60% were older than 60 years. Thirteen different types of mucosal alterations were diagnosed. Tongue varicose veins (36.6%) and candidiasis (27.02%) were the most prevalent. Such alterations can be associated with the fact that these conditions are commonly found in senile patients and are also associated with prolonged wear of dentures. Xerostomia was diagnosed in only 1 (3.33%) patient, disagreeing with most of the studies observed in the literature. CONCLUSION: Most of the diabetic patients presented at least one type of oral mucosa lesion or alteration.

Prevalência das alterações da mucosa bucal em pacientes diabéticos: estudo preliminar / Prevalence of oral mucosa lesions in diabetic patients: a preliminary study

OBJETIVO: O objetivo do presente estudo foi o de verificar a prevalência das lesões superficiais da mucosa da cavidade bucal em pacientes diabéticos. MÉTODOS: A amostra foi constituída de 30 pacientes. Para a obtenção dos resultados foram realizados exames clínicos criteriosos e exames complementares quando necessário. RESULTADOS: Dos 30 indivíduos, 9 (30 por cento) eram do sexo masculino e 21 (70 por cento), do sexo feminino. Dos pacientes estudados, 40 por cento tinham idade até 60 anos e 60 por cento possuíam idade superior. Foram diagnosticados 13 diferentes tipos de alterações da mucosa em diversas regiões, sendo a varicosidade lingual (36,6 por cento) e a candidíase (27,02 por cento) as mais prevalentes. Tais alterações podem estar relacionadas ao fato de serem achados semiológicos comuns em pacientes senis e também ao uso prolongado de próteses. A xerostomia foi diagnosticada em apenas 1 (3,33 por cento) paciente divergindo da maioria dos estudos observados na literatura. CONCLUSÃO: A maioria dos pacientes diabéticos apresentou pelo menos um tipo de lesão da mucosa bucal.

AIM: The present study aimed to evaluate the prevalence of superficial lesions in the oral cavity mucosa in diabetic patients. METHODS: The sample was made of 30 patients. To obtain these results we did rigorous clinical and complementary tests. RESULTS: Of the 30 patients, 9 (30 percent) were males and 21 (70 percent) females. Of the studied patients, 40 percent were below 60 years of age, and 60 percent were older than 60 years. Thirteen different types of mucosal alterations were diagnosed. Tongue varicose veins (36.6 percent) and candidiasis (27.02 percent) were the most prevalent. Such alterations can be associated with the fact that these conditions are commonly found in senile patients and are also associated with prolonged wear of dentures. Xerostomia was diagnosed in only 1 (3.33 percent) patient, disagreeing with most of the studies observed in the literature. CONCLUSION: Most of the diabetic patients presented at least one type of oral mucosa lesion or alteration.