Smallest worthwhile effect of exercise programs to prevent falls among older people: estimates from benefit-harm trade-off and discrete choice methods.

BACKGROUND: the smallest worthwhile effect (SWE) of an intervention is the smallest treatment effect that justifies the costs, risks and inconveniences associated with that health intervention. OBJECTIVE: to estimate the SWE of exercise programs designed to prevent falls among older people and to compare estimates derived by two methodological approaches. STUDY DESIGN AND SETTING: discrete choice experiment (n = 220) and benefit-harm trade-off (subsample n = 66) methods were used. PARTICIPANTS: community-dwelling older people who reported a past fall or a mobility limitation answered online or face-to-face questionnaires. RESULTS: a substantial proportion of participants (82% in the discrete choice experiment and 50% in the benefit-harm trade-off study) did not consider that participation in the proposed exercise programs would be worthwhile, even if it reduced their risk of falling to 0%. Among remaining participants, the average SWE of participation in an exercise program was an absolute reduction in the risk of falling of 35% (standard deviation [SD] = 13) in the discrete choice experiment and 16% (SD = 11) in the benefit-harm trade-off study. CONCLUSIONS: many participants did not consider the hypothetical falls' risk reduction of the proposed exercise programs to be worth the associated costs and inconveniences. Greater community awareness of the fall prevention effects of exercise for older people is required.

Antioxidant enzymes activities of Burkholderia spp. strains-oxidative responses to Ni toxicity.

Increased agriculture production associated with intense application of herbicides, pesticides, and fungicides leads to soil contamination worldwide. Nickel (Ni), due to its high mobility in soils and groundwater, constitutes one of the greatest problems in terms of environmental pollution. Metals, including Ni, in high concentrations are toxic to cells by imposing a condition of oxidative stress due to the induction of reactive oxygen species (ROS), which damage lipids, proteins, and DNA. This study aimed to characterize the Ni antioxidant response of two tolerant Burkholderia strains (one isolated from noncontaminated soil, SNMS32, and the other from contaminated soil, SCMS54), by measuring superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), and glutathione S-transferase (GST) activities. Ni accumulation and bacterial growth in the presence of the metal were also analyzed. The results showed that both strains exhibited different trends of Ni accumulation and distinct antioxidant enzymes responses. The strain from contaminated soil (SCMS54) exhibited a higher Ni biosorption and exhibited an increase in SOD and GST activities after 5 and 12 h of Ni exposure. The analysis of SOD, CAT, and GR by nondenaturing PAGE revealed the appearance of an extra isoenzyme in strain SCMS54 for each enzyme. The results suggest that the strain SCMS54 isolated from contaminated soil present more plasticity with potential to be used in soil and water bioremediation.

Efecto del masaje terapéutico como cuidado de enfermería en la capacidad funcional del adulto mayor / The effect of therapeutic massage as part of nursing care for the functional capacity of the elderly / Efeito da massagem terapêutica como cuidado da enfermagem na capacidade funcional do idoso

Objetivo: Evaluar el efecto del masaje terapéutico clásico como cuidado de enfermería en la capacidad funcional del adulto mayor en una casa hogar. Métodos: Estudio cuantitativo, longitudinal, cuasiexperimental. Se evaluó la capacidad funcional del adulto mayor antes y después del masaje terapéutico clásico con el índice de Barthel, alfa de Cronbach de 0.95. Muestreo no probabilístico por conveniencia. En total se estudiaron 15 adultos mayores divididos aleatoriamente en grupo de estudio y control, con base en Epidat 3.1. El análisis se realizó con estadística descriptiva y no paramétrica a través de T de Wilcoxon y U de Mann Whitney para lo cual se utilizó el programa SPSS v.19. Resultados: El promedio de edad fue de 84.14 ± 9.68 vs. 80.25 ± 10.49 para el grupo control y de estudio respectivamente; el 73% del género masculino. Previo y posterior al masaje terapéutico en la prueba de Wilcoxon, el resultado fue: grupo control (Z = 0, p = 1) vs. grupo experimental (Z = 2.47, p = 0.01). En la U de Mann Whitney (U = 0.5, p = 0.001). En la posprueba del grupo de estudio se observó un aumento significativo de la capacidad funcional. No existen estudios similares, sin embargo, algunas investigaciones han demostrado que el masaje terapéutico es efectivo para mejorar el dolor, la amplitud de movimiento y la fuerza de agarre en adultos mayores. Conclusiones: El masaje terapéutico clásico es efectivo para incrementar la capacidad funcional del adulto mayor institucionalizado.

Objective: To assess the effect of traditional therapeutic massage on the functional capacity of elderly adults in a residential care facility. Methods: Quasi-experimental, longitudinal and quantitative study. The elderly adults' functional capacity was assessed before and after the classic therapeutic massage using Barthel's index. Cronbach alpha turned out to be 0.95. The sampling was by convenience and not probabilistic. In total, 15 studied elderly adults were randomly assigned to a control group and a study group using Epidat 3.1. Descriptive and not parametric analysis was performed using Wilcoxon T and Mann Whitney U tests with the SPSS v.19 program. Results: The average age was 84.14 ± 9.68 and 80.25 ± 10.49 in the control and study groups respectively. Seventy-three percent were masculine. The Wilcoxon test results were Z = 0, P = 1 in the control group, and Z = 2.47, P = .01 in the experimental group. The Mann Whitney test result was U = 0.5, P = .001. The study group post-test showed a significant increase in the functional capacity. There are not many similar works in the literature; however some research studies have demonstrated that therapeutic massage is effective in improving movement and gripping strength, and also in reducing pain among elderly adults. Conclusions: Traditional therapeutic massage is effective in increasing the functional capacity of institutionalized elderly adults.

Objetivo: Avaliar o efeito da massagem terapêutica clássica como um cuidado de enfermagem na capacidade funcional do idoso no Lar. Métodos: Estudo qualitativo, longitudinal, quase experimental. Avaliou-se a capacidade funcional do idoso antes e depois da massagem terapêutica clássica com o índice de Barthel, alfa de Cronbach de 0.95. Amostragem não probabilística por conveniência. No total estudaram-se 15 idosos divididos aleatoriamente em grupo de estudo e de controle, utilizando Epidat 3.1. A análise realizou-se com estatística descritiva e não paramédica a través de T de Wilcoxon e U de Mann Whitney para o qual se utilizou o programa SPSS v. 19. Resultados: A média de idade foi de 84.14 ± 9.68 vs 80.25 ± 10.49 grupo controle e de estudo respectivamente, 73% gênero masculino. Prévio e posterior à massagem terapêutica na prova de Wilcoxon, o resultado foi: o grupo controle (Z = 0, p = 1) vs grupo experimental (Z = 2.47, p = 0.01). No U de Mann Whitney (U = 0.5, p = 0.001). No pós-teste do grupo de estudo observou-se um aumento significativo da capacidade funcional. Não existem estudos similares, porém, algumas pesquisas têm demonstrado que a massagem terapêutica é efetiva para a melhoria da dor, da amplitude de movimento e da força de preensão em idosos. Conclusões: A massagem terapêutica clássica é efetiva para incrementar a capacidade funcional do idoso numa instituição.

Age and video capsule endoscopy in obscure gastrointestinal bleeding: a prospective study on hospitalized patients.

BACKGROUND: The influence of aging on video capsule endoscopy (VCE) in obscure gastrointestinal bleeding (OGIB) has never been prospectively assessed. AIMS: To demonstrate if age is a risk factor for incomplete VCE examination in a setting of ongoing hospitalization for OGIB and if it affects the yield of VCE. METHODS: Forty-eight consecutive patients referred to our unit for obscure-overt GI bleeding from March 2007 to September 2009 were prospectively evaluated. Patients were divided into two groups according to their age: ≤65 years (group A) and >65 years (group B). The VCE completion rate and clinically significant findings were studied. RESULTS: The cecum was reached in 73% of patients. There was no difference between the two groups of patients in the VCE completion rate (78% vs. 68%, P=0.4). The overall diagnostic yield was 61%. A significant difference in the diagnostic yield between group A and group B (45% vs. 75%, P=0.04) was shown. Angiodysplasia was diagnosed in 13 out of 24 (54%) patients of group B, whereas mucosal breaks, such as erosions or ulcers, accounted for over a quarter of the group A findings. CONCLUSIONS: Old age is not a risk factor for incomplete VCE examination and it is associated with increased VCE yield.

Long-acting octreotide as rescue therapy in chronic bleeding from gastrointestinal angiodysplasia.

BACKGROUND: Octreotide has shown to be effective against rebleeding from gastrointestinal angiodysplasias, but a long-term daily parenteral administration is recommended. Long-acting octreotide (LAR-OCT) could overcome such a limitation, but it has not been studied extensively. AIM: To investigate the usefulness of long-acting octreotide in the control of chronic bleeding from gastrointestinal angiodysplasias. METHODS: Thirteen patients with chronic gastrointestinal bleeding because of angiodysplasias were enrolled. Diagnosis was made by endoscopy and wireless video capsule. Long-acting octreotide was administered intramuscularly at a dosage of 10 mg/monthly for 1 year. Patients were followed up for a minimum period of 1 year, and haemoglobin levels, blood transfusions, iron supplementation and hospitalizations were recorded 1 year before and after starting long-acting octreotide therapy. RESULTS: Follow-up ranged from 12 to 60 months. Nine of 13 patients (69%) did not need blood transfusions and iron supplementation any longer; a partial improvement was observed in one patient; no effect was found in the others. No side effect was recorded in any patient. CONCLUSIONS: Long-acting octreotide for 1 year may be beneficial as a rescue therapy for controlling chronic bleeding from gastrointestinal angiodysplasias in patients not eligible for surgery. Its monthly administration represents an advantage, which makes such a formulation the choice when a long-term treatment is mandatory.

Headspace gas chromatography-mass spectrometry of volatile compounds in murici (Byrsonima crassifolia l. Rich).

Northern and Northeastern Brazil have a natural diversity of fruits, many of which are considered exotic, presenting different flavors and aromas. The enormous diversity of fruits represents a promising area for research on aromas. There is also a great potential for the manufacture of juices, desserts or other processed products. Murici is a typical fruit from these regions presenting a different flavor, reminiscent of that of cheese. This fruit is consumed mainly as juice, ice cream or as liquor, greatly appreciated by the local population. Headspace volatile compounds of three lots of the fruit from Ceará (Fortaleza) were collected by suction on Porapak Q for 2 h and desorbed with 300 microl of acetone. The isolated volatile compounds were separated by high resolution GC. Forty-six volatile compounds were detected, of which 41 were identified by gas chromatography-mass spectrometry and Kovats indices. The most abundant compounds were ethanol (28.3%) and ethyl hexanoate (25.1%). Butanoic acid (5.1%), hexanoic acid (5.1%) and methyl butyrate (2.8%) were also detected in the headspace of the fruit and confirm its unusual cheese aroma.

Composition of total, neutral, and phospholipids in Mapará (Hypophthalmus sp.) from the Brazilian Amazonian area.

Ten lots of mapará (Hypophthalmus sp.), captured from the Amazon River, Brazil, were analyzed for their lipid content and fatty acid composition. This knowledge would allow for the development of adequate processing methods and the formulation of therapeutic diets. Separation into neutral and phospholipids was accomplished by silica-gel column chromatography. Fat from the muscular tissue and from the orbital cavity of the mapará was analyzed by high-resolution gas chromatography-mass spectrometry in two different seasonal periods. There were high levels of saturated and monounsaturated fatty acids in the total and neutral lipid with the principal components 16:0, 18:1omega9, 18:0, 16:1omega7, 14:0, 18:3omega3, and 18:1omega7 in both seasons. In the phospholipids there was a high level of polyunsaturated fatty acids, including primarily 16:0, 18:1omega9, 18:0, 16:1omega7, 22:6omega3, 20:4omega6, 18:3omega3, and 20:5omega3. The ratio omega3/omega6 was the same in the muscular tissue and in the orbital cavity, in both seasonal periods. The muscle tissue could be used in diets that need high levels of polyunsaturated fatty acids, but use of the head to produce an omega3 fatty-acid-rich oil still requires greater study with respect to its economic viability.

Volatile composition of some Brazilian fruits: umbu-caja (Spondias citherea), camu-camu (Myrciaria dubia), Araça-boi (Eugenia stipitata), and Cupuaçu (Theobroma grandiflorum).

Twenty-one volatile compounds were identified for the first time by GC-MS in umbu-caja and in camu-camu, plus 30 volatile compounds were identified in araça-boi samples. Terpenic compounds predominated among the volatile compounds in these fruit samples, with the major compounds being identified as cis-beta-ocimene and caryophyllene in the northeastern fruit; alpha-pinene and d-limonene were the most abundant volatile compounds in the headspace of the Amazonian fruit camu-camu. Sesquiterpenes were the most abundant compounds in the araça-boi sample, with germacrene D presenting a higher relative percentage. The chemical class of esters predominated in the cupuaçu sample. Ethyl butyrate and hexanoate were the major compounds in the headspace of this Amazonian fruit.

Kinetics of the reconstituted tricarboxylate carrier from eel liver mitochondria.

The tricarboxylate carrier from eel liver mitochondria was purified by chromatography on hydroxyapatite and Matrix Gel Blue B and reconstituted into liposomes by removal of the detergent with Amberlite. Optimal transport activity was obtained by using a phospholipid concentration of 11.5 mg/ml, a Triton X- 114/phospholipid ratio of 0.9, and ten passages through the same Amberlite column. The activity of the carrier was influenced by the phospholipid composition of the liposomes, being increased by cardiolipin and phosphatidylethanolamine and decreased by phosphatidylinositol. The reconstituted tricarboxylate carrier catalyzed a first-order reaction of citrate/citrate or citrate/malate exchange. The maximum transport rate of external [14C]citrate was 9.0 mmol/min per g of tricarboxylate carrier protein at 25 degrees C and this value was virtually independent of the type of substrate present in the external or internal space of the liposomes. The half-saturation constant (Km) was 62 microM for citrate and 541 microM for malate. The activation energy of the citrate/citrate exchange reaction was 74 kJ/mol from 5 to 19 degrees C and 31 kJ/mol from 19 to 35 degrees C. The rate of the exchange had an external pH optimum of 8.

Partial purification and reconstitution of the tricarboxylate carrier from eel liver mitochondria.

The tricarboxylate carrier of the inner membrane of eel liver mitochondria has been solubilized with Triton X-100 and partially purified by chromatography of the mitochondrial extract on dry hydroxyapatite. The purified fraction has been reconstituted into liposomes and functionally analyzed. The reconstituted carrier protein catalyzed a 1,2,3-benzenetricarboxylate-sensitive citrate uptake in liposomes. The substrate specificity and the inhibitor sensitivity of the tricarboxylate carrier are similar to those previously determined for the same protein of mammalian mitochondria.

[Infant mortality and activities of the health care system from 1988-1992. Chiqui Gomez health area]. / Comportamiento de la mortalidad infantil y accion del sistema de salud durante los años 1988 a 1992. Area de salud "Chiqui Gomez".

A study on infant mortality was carried out in the Chiqui Gómez health area of Santa Clara City during a 5-year period (1988-1992). Data were collected from the Statistics Department; analyses of familial health records; medical micro-histories of pregnant women in family doctors' home offices; and from the supervision report of the Basic Work Group; diagnostic health status of the area was also taken into account. The method employed was descriptive and analytic. The study is concluded with the evaluation of the fulfillment of the Maternal-Child Program as satisfactory in this health area. Causes of death in the first place were main perinatal disorders and congenital anomalies. Factors having a higher incidence in infant mortality in the study are; short intergenesic period; delivery before the 37th week of pregnancy; pregnancy in adolescence; and low birth weight. There is an evident relationship between pregnancy in adolescence and low birth weight; the results attained in prenatal care and infant care prior to children's death are considered adequate.

Association of physical and emotional symptoms with the menstrual cycle and life-style.

The frequency and severity of physical and emotional menstrual symptoms were investigated with a cross-sectional study of 502 women not seeking treatment for menstrual symptoms. The most frequent symptoms were abdominal bloating, backache, headache, constipation, low abdominal pain, fatigue and symptoms related to depression. Some symptoms increased during the late luteal phase, and others were related to the women's life-style. Lack of schooling and living in rural areas were associated with headache, backache, sadness, insecurity, restlessness and weakness. Women from urban areas with more schooling had more breast tenderness, abdominal pain, irritability, depression, aggressiveness and increased sexual desire. Younger women had increased appetite, lack of concentration, insecurity, desire to be alone, weakness and dissatisfaction with their looks. Heavier women had more leg cramps, swollen feet, lack of coordination and polydipsia. Menstrual symptoms seem to be determined by the interplay of the menstrual cycle with biologic factors and life-style.