Hasil untuk "Public aspects of medicine"

Betine Pinto Moehlecke Iser

Zi-ling Cai, Liao-yao Wang, Bing-yue Zhang et al.

Abstract Objective: This study aimed to evaluate the methodological quality of existing meta-analyses (MA) and the quality of evidence for outcome indicators to provide an updated overview of the evidence concerning the therapeutic efficacy of the Mediterranean diet (MD) for various types of CVD. Design: We conducted comprehensive searches of PubMed, Cochrane Library, and Embase databases. The quality of the MA was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist, while the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence evaluation system was employed to evaluate the quality of evidence for significant outcomes. Setting: The CVD remains a significant contributor to global mortality. Multiple MA have consistently demonstrated the efficacy of medical interventions in managing CVD. However, due to variations in the scope, quality and outcomes of these reviews, definitive conclusions are yet to be established. Participants: This study included five randomized trials and twelve non-randomized studies, with a combined participant population of 716 318. Results: The AMSTAR 2 checklist revealed that 54·55 % of the studies demonstrated high quality, while 9·09 % exhibited low quality, and 36·36 % were deemed critically low quality. Additionally, there was moderate evidence supporting a positive correlation between MD and CHD/acute myocardial infarction, stroke, heart failure, cardiovascular events, coronary events and major adverse cardiovascular events. Conclusions: This study indicates that although recognizing the potential efficacy of MD in managing CVD, the quality of the methodology and the evidence for the outcome indicators remain unsatisfactory.

Zhou C, Li X, Shen W et al.

Chi Zhou,1,&ast; Xu Li,1,&ast; Wenli Shen,2 Qunfang Huang,1 Xiaoling Lin,1 Gaofeng Zhang,3 Yin Dong3,4 1Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Health Development, Hangzhou Xixi Hospital, Hangzhou, Zhejiang, People’s Republic of China; 3The People’s Hospital of Yuhuan, Taizhou, Zhejiang, People’s Republic of China; 4Vanke School of Public Health, Tsinghua University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yin Dong, The People’s Hospital of Yuhuan, No. 18 Changle Road, Yucheng Street, Yuhuan, Taizhou, 317600, People’s Republic of China, Tel +86-18957678008, Email 9597082@qq.comBackground: The responsiveness of community health centers can reflect the soft capacity of medical institutions and is related to the improvement of health outcome indicators. This study is aimed at assessing the level and distribution of community health centers’ responsiveness and its associated factors among outpatients under the health-oriented integrated healthcare system in China.Methods: A total of 634 outpatients were recruited from six community health centers in Zhejiang Province, China, in July 2022. SPSS software was used to conduct the analysis (version 23.0). Health system responsiveness was used as a measure of outpatient responsiveness to health care services through a self-administered questionnaire. Determinants of community health centers’ responsiveness were determined by using a multiple linear regression model at a p-value < 0.05.Results: The total score of community health centers responsiveness was 8.25± 1.01, and the Gini coefficient is 0.027. Within these domains, social support and dignity received the highest scores, while choice of providers and autonomy scored the lowest. Age group between 60– 74 years (β: 0.129; 95% CI: 0.042– 0.529), ≥ 75 years (β: 0.095; 95% CI: 0.006– 0.707), monthly income with 8000 RMB and above (β: 0.098; 95% CI: 0.035– 0.653), having a family doctor (β: 0.124; 95% CI: 0.096– 0.410), and satisficing with community health service (β: 0.298; 95% CI: 0.848– 1.428) were significant predictors of community health centers’ responsiveness.Conclusion: The Chinese community health centers show high responsiveness, indicating that the construction of a health-oriented integrated healthcare system has been effective. The family doctor contract service is important and should continually enhance both technical proficiency and health promotion capabilities. Encourage residents to actively participate in their treatment process is also essential.Keywords: responsiveness, community health center, outpatient

Sally K. Stauder, Shalmali R. Borkar, Anna Najor et al.

Background: Decreasing primary care access and increasing emergency department (ED) usage is a potential contributor to declining cancer screening prevalences in those facing barriers to health care access. The ED is a non-traditional yet potentially high-yield setting for implementation of interventions to monitor and increase cancer screening. Methods: An ED-administered survey in July 2022 gathered data on breast, cervical, and colorectal cancer screening, as well as human papillomavirus (HPV) vaccination status of females presenting to the ED for care. This was compared with electronic health record (EHR) data extraction of all ED patients during the same timeframe. Primary outcome was proportion of cancer screening and HPV vaccination not up to date in each group. Results: ED survey was administered to 101 individuals; EHR data was extracted on 2934 patients. Survey versus EHR, respectively, found cervical cancer screening was not up to date in 6.2% vs. 77.6%, breast cancer screening in 14.3% vs. 73.4%, colorectal cancer screening in 22.9% vs. 56.5%, and HPV vaccination in 33.3% vs. 57.8%. p value was < 0.001 for all screening category comparisons between survey and EHR. Discussion: Our data indicate significant discrepancies between self-reported screening history and EHR data. ED survey results were more in line with the observed screening rates in various surveillance systems and published in the literature. This suggests that point-of-care ED survey administration may be more effective in identifying those needing preventative cancer screening, especially in individuals with less access to routine health care.

Hnin Wai Lwin Myo, Akiko S Hosler, Lawrence M Schell et al.

Abstract Objective: The Burmese population is one of the fast-growing refugee populations in the USA. This study investigated behavioural and environmental factors associated with fruit and vegetable (FV) consumption among Burmese refugees. Design: We conducted a cross-sectional interview survey in 2018–2019. The 24-h recall was used to assess dietary behaviour. Multivariable logistic regression models were constructed with meeting the daily FV consumption recommendation (two or more servings of fruits and three or more servings of vegetables) as the outcome variable. We selected socio-economics, nutritional knowledge, food shopping frequency, ethnicity of preferred food store owners, perceived neighbourhood food environment and network distance to preferred food stores as potential explanatory variables. Setting: Two Upstate New York counties. Participants: Burmese refugees (n 173) aged ≥18 years. Results: Forty-five percentage of respondents met the daily FV consumption recommendation, and nearly all respondents identified ethnic (Burmese, Chinese/pan-Asian, or South Asian/halal) stores as their preferred stores to purchase FV. In the best-fit model, age (OR 1·08, 95 % CI (1·04, 1·12)) and shopping frequency (OR 1·51, 95 % CI (1·01, 2·26)) were positively associated, and network distance to preferred stores in kilometres (OR 0·81, 95 % CI (0·73, 0·90)) was negatively associated with meeting the daily FV consumption recommendation. No significant effect modifications by car ownership, poverty, length of stay in the USA and Supplemental Nutrition Assistance Program participation were detected. Conclusions: The findings suggested that having Asian ethnic food stores within a short, walkable distance from home and shopping at these stores often can promote healthy dietary behaviour among Burmese refugees.

Sry Desnayati Purba, Bagus Sidiq, Ingkai Krisdayanti Purba et al.

<p><em>Muscle weakness in stroke patients will affect muscle contraction. Muscle contraction  due to reduced blood</em><em> </em><em>supply</em><em> </em><em>to</em><em> </em><em>the</em><em> </em><em>brain, thereby blocking the main nerves of the   brain</em><em> </em><em>and</em><em> </em><em>spinal</em><em> </em><em>cord . Blockage ofa oxygen and nutrientsto the brain causes serious</em><em> </em><em>health</em><em> </em><em>problems because it can cause hemiparesis and</em><em> </em><em>even death . The occurrence    ofa disturbances in the level ofa physical mobilization of patients is often caused by a movement in the form</em><em> </em><em>of</em><em> </em><em>bed rest. The</em><em> </em><em>ofa a weakened muscle</em><em> </em><em>condition associated with a lack ofa physical activity usually appear within a few days. Control ofa the brain  to   regulate muscle   movement has decreased function resulting in reduced muscle</em><em> </em><em>mass. This study</em>i<em>aims to determine the effectiveness ofa ROM (range of motion ) on muscle strength in stroke patients at the</em><em> </em><em>Royal</em>i<em>Prima Hospital in Medan. This study</em>i<em>used</em>i<em>a</em><em> quasi-experiment with one</em>i<em>group pre-posttest. The instrument used is  an observation sheet while the Wilcoxon test is used for testing. Prior to ROM training, most ofa the respondents ' strength was on a scale ofa 3 (67.9 %) and minority   muscle   strength was on a scale of 4 (10.7%). After doing ROM (Range of Motion) exercise there was an increase in muscle strength where the majority muscle strength on a scale ofa 4 was (45.5) and the muscle strength of the minority patient was on a scale ofa 5 (30.0%). There is an Effectiveness of</em>i<em>ROM</em>i <em>(Range</em> of <em>Motion) on Muscle Strength in Stroke Patients at the Royal Prima Hospital Medan in 2021 with p-value of</em> <em>0.004.</em></p><em>Keywords: <strong>ROM</strong>, <strong>Exercises , Muscle Strength</strong></em>

Jonathan C. K. Wells

BackgroundEarly women's marriage is associated with adverse outcomes for mothers and their offspring, including reduced human capital and increased child undernutrition and mortality. Despite preventive efforts, it remains common in many populations and is often favored by cultural norms. A key question is why it remains common, given such penalties. Using an evolutionary perspective, a simple mathematical model was developed to explore women's optimal marriage age under different circumstances, if the sole aim were to maximize maternal or paternal lifetime reproductive fitness (surviving offspring).MethodsThe model was based on several assumptions, supported by empirical evidence, regarding relationships between women's marital age and parental and offspring outcomes. It assumes that later marriage promotes women's autonomy, enhancing control over fertility and childcare, but increases paternity uncertainty. Given these assumptions, optimal marriage ages for maximizing maternal and paternal fitness were calculated. The basic model was then used to simulate environmental changes or public health interventions, including shifts in child mortality, suppression of women's autonomy, or promoting women's contraception or education.ResultsIn the basic model, paternal fitness is maximized at lower women's marriage age than is maternal fitness, with the paternal optimum worsening child undernutrition and mortality. A family planning intervention delays marriage age and reduces child mortality and undernutrition, at a cost to paternal but not maternal fitness. Reductions in child mortality favor earlier marriage but increase child undernutrition, whereas ecological shocks that increase child mortality favor later marriage but reduce fitness of both parents. An education intervention favors later marriage and reduces child mortality and undernutrition, but at a cost to paternal fitness. Efforts to suppress maternal autonomy substantially increase fitness of both parents, but only if other members of the household provide compensatory childcare.ConclusionEarly women's marriage maximizes paternal fitness despite relatively high child mortality and undernutrition, by increasing fertility and reducing paternity uncertainty. This tension between the sexes over the optimal marriage age is sensitive to ecological stresses or interventions. Education interventions seem most likely to improve maternal and child outcomes, but may be resisted by males and their kin as they may reduce paternal fitness.

Ashraf Reda, Hany Ragy, Kanwal Saeed et al.

Abstract Background Both hypertension and dyslipidemia are considered as major modifiable risk factors of cardiovascular diseases (CVDs), and their prevalence in Egypt has increased in recent years. Evidence-based systematic evaluation of data on hypertension and dyslipidemia is critical for effective patient-centric management to reduce the overall risk of CVDs in Egypt. This semi-systematic review aimed to quantify and identify data gaps in the prevalence and distribution of patient journey touchpoints including awareness, screening, diagnosis, treatment, adherence, and control of hypertension and dyslipidemia to provide the basis for research prioritization, practice guidance, and health care reforms in Egypt. Main body Structured search was conducted on MEDLINE and Embase to identify articles published in English between January 2010 and December 2019 that reported key patient journey touchpoints in hypertension and dyslipidemia management. Unstructured search was conducted on public or government websites with no date restriction. Data from all sources were extracted and presented descriptively. In total, 22 studies published between 1995 and 2020 on hypertension and dyslipidemia were included in the final analyses. The prevalence of hypertension in Egypt ranged from 12.1 to 59%. Studies reported awareness (37.5% and 43.9%), diagnosis (42% and 64.7%), treatment (24% and 54.1%), and adherence to antihypertensive medication (51.9%) to be low. Furthermore, the percentage of patients who had their blood pressure controlled ranged from 8 to 53.2%. The prevalence of dyslipidemia varied in the general population (range 19.2–36.8%) but was higher in patients with acute coronary syndrome (ACS) (50.9% and 52.5%) and coronary artery disease (58.7%). A national report indicated that 8.6% of the general population was screened for dyslipidemia; however, no data was available on the diagnosis and treatment rates. Among ACS patients, 73.9% were treated for dyslipidemia. Data indicated low levels of medication adherence (59%) among dyslipidemia patients, with overall low control rates ranging from 5.1 to 34.4% depending on CVD risk in populations including ACS patients. Conclusion Data on patient journey touchpoints of hypertension and dyslipidemia are limited in Egypt, indicating the need for more systematic and high-quality evidence-based studies covering different aspects of patient-centric management for better management of CVD and its risk factors.

Pieter C Steketee, Federica Giordani, Isabel M Vincent et al.

Subspecies of the protozoan parasite Trypanosoma brucei are the causative agents of Human African Trypanosomiasis (HAT), a debilitating neglected tropical disease prevalent across sub-Saharan Africa. HAT case numbers have steadily decreased since the start of the century, and sustainable elimination of one form of the disease is in sight. However, key to this is the development of novel drugs to combat the disease. Acoziborole is a recently developed benzoxaborole, currently in advanced clinical trials, for treatment of stage 1 and stage 2 HAT. Importantly, acoziborole is orally bioavailable, and curative with one dose. Recent studies have made significant progress in determining the molecular mode of action of acoziborole. However, less is known about the potential mechanisms leading to acoziborole resistance in trypanosomes. In this study, an in vitro-derived acoziborole-resistant cell line was generated and characterised. The AcoR line exhibited significant cross-resistance with the methyltransferase inhibitor sinefungin as well as hypersensitisation to known trypanocides. Interestingly, transcriptomics analysis of AcoR cells indicated the parasites had obtained a procyclic- or stumpy-like transcriptome profile, with upregulation of procyclin surface proteins as well as differential regulation of key metabolic genes known to be expressed in a life cycle-specific manner, even in the absence of major morphological changes. However, no changes were observed in transcripts encoding CPSF3, the recently identified protein target of acoziborole. The results suggest that generation of resistance to this novel compound in vitro can be accompanied by transcriptomic switches resembling a procyclic- or stumpy-type phenotype.

Vivek B Ravindran, Aravind Surapaneni, Nicholas D Crosbie et al.

Hesse, Bradford William

Internet-augmented medicine has a strong role to play in ensuring that all populations benefit equally from discoveries in the medical sciences. Yet, data from the Centers for Disease Control and Prevention collected from 1999 to 2014 suggested that during the first phase of internet diffusion, progress against mortality has stalled, and in some cases, receded in rural areas that are traditionally underserved by medical and broadband resources. This problem of failing to extend the benefits of extant medical knowledge equitably to all populations regardless of geography can be framed as the “last mile problem in health care.” In theory, the internet should help solve the last mile problem by making the best knowledge in the world available to everyone worldwide at a low cost and no delay. In practice, the antiquated supply chains of industrial age medicine have been slow to yield to the accelerative forces of evolving internet capacity. This failure is exacerbated by the expanding digital divide, preventing residents of isolated, geographically distant communities from taking full advantage of the digital health revolution. The result, according to the Federal Communications Commission’s (FCC’s) Connect2Health Task Force, is the unanticipated emergence of “double burden counties,” ie, counties for which the mortality burden is high while broadband access is low. The good news is that a convergence of trends in internet-enabled health care is putting medicine within striking distance of solving the last mile problem both in the United States and globally. Specific trends to monitor over the next 25 years include (1) using community-driven approaches to bridge the digital divide, (2) addressing structural disconnects in care through P4 Medicine, (3) meeting patients at “point-of-need,” (4) ensuring that no one is left behind through population management, and (5) self-correcting cybernetically through the learning health care system.

Jasmin Schlax, Claus Jünger, Manfred E. Beutel et al.

Abstract Background Socioeconomic status (SES) has a strong association with depression or physical and mental health in general. However, as SES is a multifaceted construct these associations are not easy to explain. Further, there are several indicators and many studies only investigating two or less indicators at the same time. Therefore, this study aims to analyze the cross-sectional and longitudinal association of three defined SES dimensions (education, occupational position and household net-income) with the occurrence of elevated symptoms of depression relative to the impact of important covariates. Methods The study included observational data from 12,484 participants of the Gutenberg Health Study. The outcome was “elevated depressive symptoms” as defined by Patient Health Questionnaire (PHQ-2) ≥ 2 at the 2.5-year follow-up. Regression coefficients were adjusted for baseline covariates (age, sex, partnership, depression, anxiety, medical history of depressive or anxiety disorder and major medical diseases (MMD)) in addition to SES sum score and the three single indicators. We further examined interaction terms of the SES with sex, partnership and major medical diseases. We analyzed the sample stratified by elevated depressive symptoms at baseline, as we expected different trajectories in both subgroups. Results SES, education and household net-income were lower in the group of persons with PHQ-2 ≥ 2 at baseline, and they predicted the occurrence of PHQ-2 ≥ 2 at 2.5 year follow-up in the group of persons without elevated depressive symptoms at baseline after multivariable adjustment (SES: Odds Ratio (OR) 0.96, 0.95–0.98, p <  0.0001; education: OR 0.96, 0.93–0.99, p = 0.036; household net-income: OR 0.96, 0.92–0.99, p = 0.046) but not in the group of persons with elevated depressive symptoms at baseline. Further, we found that the impact of major medical diseases on the development of elevated depressive symptoms was buffered by high income. In addition, living in a partnership buffered the impact of a low occupational position. Conclusions Regarding the SES, the dimensions education and household net-income seem to play the most important role for socioeconomic inequalities in persons in Mid-West Germany with depressive symptoms. Trial registration Reference no. 837.020.07; original vote: 22.3.2007, latest update: 20.10.2015

Stefan ePinzke

Working conditions and the prevalence of perceived musculoskeletal symptoms (MSSs) among dairy farmers in 2013 were monitored by repeating a mail survey of dairy workers in Scania, southern Sweden, using the same method for collecting data on MSSs and working conditions employed in previous surveys conducted in 1988 and 2002.All dairy enterprises in Scania (total 419) were sent two copies of a questionnaire. One or more responses were received from 232 enterprises (55.4%), of which those from 247 dairy farmers (75% men, 25% women) in 199 enterprises are included in this study.The farmers had increased their weekly working hours in 2013 compared with 2002 (males ¯x = 43.9, 40.7; females ¯x = 37.9, 33.9). Each male milked on average 30 cows in 1988, 44 cows in 2002, and 86 cows in 2013. The corresponding numbers milked by female farmers were 29, 60, and 102, respectively. In 1988, almost all farmers used tethered systems, while in 2013 54.4% of male and 66.1% of female farmers instead worked with loose-housing systems. Of the farmers who used loose-housing systems, 50.7% had a robotic milking system.In 2013, 79.0% of male and 88.5% of female farmers reported MSSs on some occasion, especially in the lower back, shoulders, and knees for men and in the shoulders, lower back, and wrists/hands for women. However, there was no statistical change compared with the frequency of MSSs in 2002.In 2013, there was a tendency for younger dairy farmers (≤35 years) to report MSSs, especially in the shoulders, elbows, lower back, and feet, more frequently than younger farmers in 2002.The males who worked with robot milking systems in 2013 indicated less discomfort in the shoulders than men who worked with other systems. The corresponding females indicated fewer problems in the lower back in 2013.Various aspects of milking system design and technology have been improved to reduce the workload and prevent MSSs in dairy farmers. Nevertheless, more improvements are needed to make the milking process more attractive and reduce health problems, especially in younger farmers currently working with milking and in new recruits.

Jaana E. Laine, Merja R. Häkkinen, Seppo Auriola et al.

Qualitative trapping profile of reactive metabolites arising from six structurally different compounds was tested with three different d-peptide isomers (Peptide 1, gly–tyr–pro–cys–pro–his-pro; Peptide 2, gly–tyr–pro–ala–pro–his–pro; Peptide 3, gly–tyr–arg–pro–cys–pro–his–lys–pro) and glutathione (GSH) using mouse and human liver microsomes as the biocatalyst. The test compounds were classified either as clinically “safe” (amlodipine, caffeine, ibuprofen), or clinically as “risky” (clozapine, nimesulide, ticlopidine; i.e., associated with severe clinical toxicity outcomes). Our working hypothesis was as follows: could the use of short different amino acid sequence containing d-peptides in adduct detection confer any add-on value to that obtained with GSH? All “risky” agents’ resulted in the formation of several GSH adducts in the incubation mixture and with at least one peptide adduct with both microsomal preparations. Amlodipine did not form any adducts with any of the trapping agents. No GSH and peptide 2 and 3 adducts were found with caffeine, but with peptide 1 one adduct with human liver microsomes was detected. Ibuprofen produced one Peptide 1-adduct with human and mouse liver microsomes but not with GSH. In conclusion, GSH still remains the gold trapping standard for reactive metabolites. However, targeted d-peptides could provide additional information about protein binding potential of electrophilic agents, but their clinical significance needs to be clarified using a wider spectrum of chemicals together with other safety estimates.

Eva Josefina Quintero Fleites, Edgar F. Romero Monteagudo, Esther C. Díaz-Véliz Martínez

Andreasen Anne H, Diderichsen Finn, Nielsen Signe S et al.

<p>Abstract</p> <p>Background</p> <p>This study compared the incidence of cardiovascular disease (CVD) and acute myocardial infarction (AMI) between native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia. Furthermore, we examined whether different indicators of socioeconomic status (SES), such as employment, income and housing conditions influenced potential differences.</p> <p>Methods</p> <p>In this registry-based follow-up study individuals were identified in a large database that included individuals from two major regions in Denmark, corresponding to about 60% of the Danish population. Incident cases of CVD and AMI included fatal and non-fatal events and were taken from registries. Using Cox regression models, we estimated incidence rates at 5-year follow-up.</p> <p>Results</p> <p>Immigrant men and women from Turkey and Pakistan had an increased incidence of CVD, compared with native Danish men. In the case of AMI, a similar pattern was observed; however, differences were more pronounced. Pakistanis and Turks with a shorter duration of residence had a lower incidence, compared with those of a longer residence. Generally, no notable differences were observed between former Yugoslavians and native Danes. In men, differences in CVD and AMI were reduced after adjustment for SES, in particular, among Turks regarding CVD. In women, effects were particularly reduced among Yugoslavians in the case of CVD and in Turks in the case of CVD and AMI after adjustment for SES.</p> <p>Conclusions</p> <p>In conclusion, country of birth-related differences in the incidence of CVD and AMI were observed. At least some of the differences that we uncovered were results of a socioeconomic effect. Duration of residence also played a certain role. Future studies should collect and test different indicators of SES in studies of CVD among immigrants.</p>

Lori L. Sanderson MSW, MPH

The purpose of this research letter is to report on the availability of evidence-based interventions for promoting lifestyle change in children and adolescents with diabetes or kidney disease. References for this review were obtained using several electronic databases, including Ebsco Host, PsychInfo, Medline, and CINAHL. Search topics included transplant adherence, diabetes adherence, kidney adherence, obesity and transplant, kidney disease, transplant noncompliance, renal failure, renal disease, chronic kidney failure, end-stage renal disease, obesity and diabetes, overweight and kidney disease, overweight and diabetes, overweight, treatment interventions and overweight, treatment interventions for obesity, children and obesity, growth chart, diabetes intervention, kidney disease intervention, obesity intervention, obesity and transplantation, obesity transplant intervention, motivational interviewing, physical activity level, physical activity, exercise intervention, body mass index measurement, body fat percentage, psychosocial issues of kidney disease, psychosocial issues of transplant, and coping with kidney disease. Search results included English language only and between the years 2000 and 2009. Very few lifestyle interventions have been shown to be effective for obese children or adolescents with diabetes and none for obese children and adolescents with kidney diseases. More research is needed to develop effective interventions for this vulnerable population.

Gustavo Horacio Marín, Cecilia Homar, Germán Niedfeld et al.

Objetivo: Evaluar la eficacia de un programa de promoción de salud y prevención de patologías asociadas al envejecimiento, para evitar complicaciones asociadas y mejorar la calidad de vida en adultos mayores. Metodología: Estudio desarrollado durante 12 meses (años 2006-2007) en 700 adultos mayores de Buenos Aires-Argentina, separados de forma aleatoria en 2 grupos: intervención y control. A todos se les realizaron mediciones pre y postintervención de peso, talla, tensión arterial, colesterol, triglicéridos, glucemia y problemas cardiovasculares (infarto, accidente vascular cerebral), osteoarticulares (fracturas), ingresos hospitalarios y calidad de vida evaluada con la Encuesta-SF12. La intervención consistió en actividad física periódica (bisemanal) destinada a fortalecer grupos musculares que otorgan autonomía de movimientos, así como actividades recreativas, talleres de nutrición y manipulación de alimentos. A cada individuo del grupo intervención se le asignó un estudiante de medicina que semanalmente lo visitó y acompañó en las actividades. El grupo control continuó con actividades habituales. Resultados: El grupo de intervención mostró una reducción significativa en valores de tensión arterial, triglicéridos y colesterol respecto al control. Además, redujo un 31% los eventos cardiovasculares, 18,2% las fracturas de cadera, 21,1% los ingresos hospitalarios por problemas cardiovasculares, osteoarticulares y de salud mental respecto al control. La encuesta de calidad de vida postintervención incrementó un 28,7% las respuestas favorables respecto su registro basal y 33,4% respecto al grupo control. Conclusión: El programa implementado logró reducir los factores de riesgo y las complicaciones asociadas al envejecimiento en el grupo de intervención respecto al control.<br>Objective: This paper evaluates the effectiveness of a Public Health program for the elderly based on health promotion and pathologies prevention, in order to avoid complications associated with illnesses and improves the quality of life (QOL) in elderly adults (EA). Methods: A 12 month intervention studies used 700 EA randomized in 2 groups: intervention and control. Each group was submitted to pre-post intervention measurements that included weight, height, blood pressure (BP), cholesterol, lipids, glycaemia, cardiovascular (infarct, stroke) and bone fractures events, hospitalization, and a QOL survey. Intervention consisted of periodic physical activity to fortify muscular groups, as well as recreational activities, nutritional and food manipulation training visits. A medical student was assigned to each participant from the intervention group to assure periodical contact and to share activities. The control group continued with their normal activities during observational period. Results: The intervention group showed a significant reduction in the BP, lipids and cholesterol values compared to control group. Reduction on cardiovascular events (-31%), hip fractures (-18.2%) and number of hospital admittance (-21.1%) were obtained for group A in relation to B. The QOL survey showed 28.7% improvement for group A compared with 33.4% improvement compared with control group. Conclusion: The health program with exhaustive follow-up administration, significantly reduced risk factors and complications associated with aging.

Wahrlich Vivian, Anjos Luiz Antonio dos

A taxa metabólica basal (TMB) é uma das informações fisiológicas mais importantes em estudos nutricionais clínicos ou epidemiológicos, seja para se determinar as necessidades energéticas ou calcular o gasto energético de indivíduos ou populações. O presente artigo discute, com base numa revisão da literatura, a importância e os aspectos mais relevantes da medição da TMB. Inicialmente, faz-se um histórico do desenvolvimento dos conceitos e da técnica de medição da TMB até os dias atuais. São discutidos os fatores individuais (idade, antropometria, tabagismo, atividade física, dieta, ciclo menstrual e etnia) e os possíveis fatores ambientais presentes na hora da medição (temperatura, local e repouso) que podem influir no valor da TMB. Apresenta-se as várias equações de predição de TMB disponíveis, em especial a sugerida pela Organização Mundial da Saúde em 1985, e discute-se os estudos realizados desde então, que tentam validar seu uso internacionalmente, particularmente, em populações vivendo nos trópicos. O artigo aponta para a necessidade de se obter mais informações sobre o metabolismo basal nos vários segmentos populacionais vivendo em diferentes regiões do mundo, para que melhores estimativas possam ser fornecidas tanto para o uso clínico quanto epidemiológico.

José María Tenías, Damian Mifsut Miedes

Fundamento: La incidencia de fractura de cadera ha sido estimada en nuestro país en periodos cortos de tiempo, sin valorar los cambios temporales de tendencia y estacionalidad. El objetivo de este trabajo es estimar la incidencia de fractura de cadera en un Área de Salud de la Comunidad Valenciana durante 7 años (1994-2000), explorando su tendencia, estacionalidad y los cambios geográficos por zonas de salud y tipo de núcleo, rural o urbano. Métodos: Estudio descriptivo de los casos de FC en mayores de 45 años. Se excluyeron los pacientes no residentes en el Área, las fracturas patológicas y las producidas por accidente de tráfico. Los cambios temporales y geográficos de la incidencia se estimaron por regresión de Poisson. Resultados: La incidencia global de fractura de cadera en mayores de 45 años fue de 274 casos por 100000 habitantes y año (IC95% 259-288). En hombres fue de 149 y en mujeres de 383 casos por 100000 habitantes-año. La distribución temporal mostró una tendencia positiva aunque no significativa, con un incremento medio mensual de la incidencia del 0,04%. Esta tendencia fue mayor para hombres que para mujeres. Se observó una clara estacionalidad, con incidencias relativas menores en los meses de primavera y verano. La incidencia no varió significativamente por zonas de salud ni por el tipo de núcleo urbano o rural. Conclusiones: La incidencia de FC es similar aunque algo superior a la de otras provincias españolas. Se observa una discreta tendencia positiva y una clara estacionalidad, sin cambios geográficos significativos.