OBJETIVOS: Estimar a taxa de falência de desmame, identificar fatores de risco para a falência, estimar a taxa de mortalidade na unidade de terapia intensiva e hospitalar em um grupo heterogêneo de pacientes com ventilação mecânica prolongada. MÉTODOS: Trata-se de um estudo de coorte prospectivo de pacientes adultos consecutivamente internados em 11 unidades de terapia intensiva e que receberam ventilação mecânica por 3 dias ou mais. As variáveis de desfecho incluíram o resultado do desmame (falência ou sucesso) e o desfecho da UTI (alta ou óbito).RESULTADOS: Dos 189 pacientes incluídos, 149 (79%) foram desmamados com sucesso e 40 (21%) necessitaram de reintubação dentro de 48 horas, constituindo o grupo falência.Através da análise de regressão logística, o sexo feminino foi identificado como fator independentemente associado com a falência do desmame. Os pacientes com falência permaneceram por mais tempo na UTI (p < 0,01). A freqüência de traqueostomia foi maior no grupo com falência (p < 0,01). A taxa de mortalidade na UTI foi de 21%; IC de 95%: 15-27%. O modelo de regressão de Cox ajustado para a gravidade à admissão na UTI identificou que a falência do desmame aumentou o risco de morte na UTI (RR: 3,08; p < 0,01). CONCLUSÔES: Após o controle para variáveis clínicas e gravidade à internação na UTI, o sexo feminino apresentou associação independente com a falência do desmame. Pacientes com falência apresentaram maior tempo de internação na UTI, maior taxa de traqueostomia e maior risco de morte na UTI / OBJECTIVE: To determine the rate of weaning failure, risk factors, intensive care unit (ICU) and hospital outcomes in a number of heterogeneous patients with prolonged MV. DESIGN, SETTING, AND SUBJECTS: Prospective cohort of consecutive adult patients admitted to 11 ICU who received MV (³ 72 hours). Study endpoints included weaning failure vs success and ICU death vs survival. RESULTS: Of 189 intubated patients, 149 (79%) were succesfully extubated, and 40 (21%) required reintubation within 48 hours.Using multiple logistic regression, female gender was an independent predictor of weaning failure. The mean ICU length of stay was significantly longer in weaning failure group (p < 0.01). The rate of tracheostomy was higher in the failure group (p < 0.01). The ICU mortality rate was 21%; 95% CI, 15 - 27%. In a Cox model adjusting on severity at ICU admission, weaning failure increased the risk of death in the ICU (RR: 3.08; p < 0,01). CONCLUSION: After adjusting for severity of ilness and medical conditions, female gender had a significant independent association with increased risk of weaning failure (WF). WF had association with prolonged ICU stay and higher rate of tracheostomy. Patients with weaning failure were 3 times more likely to die in the ICU

Made available in DSpace on 2014-08-20T13:57:57Z (GMT). No. of bitstreams: 1 Tese_Maria_Clara_R_Mendez.pdf: 2257913 bytes, checksum: 52c896a3946855e35c039692e3b8ed69 (MD5) Previous issue date: 2012-10-09 / Although adolescent fertility rates are decreasing worldwide, adolescent childbearing keeps its visibility as a social phenomenon that needs special attention by policy makers and researchers. Many studies suggest that being a teenage mother have deleterious effects for her own health and her child s health during the first years of life. Other authors point out that teenage childbearing also had long-term consequences; however, the literature in this regard is limited, particularly in low and middle income countries. The 1982, 1993 and 2004 Pelotas birth cohorts provided a valuable opportunity to study the short and long-term consequences of adolescent childbearing on several offspring outcomes relate to health, behavior, education and employment. The hypothesis of an increased risk of death during the fetal, perinatal, neonatal, post-neonatal and infant periods among offspring of adolescent mothers was tested in all three cohorts. Additionally, we tested hypotheses regarding the long-term consequences on offspring, including health-related behaviors, sexual activity, education and employment in adolescents and young adults. Our results showed a greater likelihood of post-neonatal mortality among offspring of adolescent mothers after adjustment for confounders. However, this effect disappeared after controlling for factors such as weight gain during pregnancy and antenatal care. Moreover, children of teenage mothers were more likely to initiate sexual intercourse before age 16, to be themselves teenage parents, and to begin family formation earlier. On balance, the results from both Pelotas cohort studies and a systematic review of the literature suggest that pre-gestational socioeconomic and family characteristics explained most of the adverse events observed in children. Therefore, programs for prevention of adolescent childbearing should target to change the circumstances surrounding teenage mothers, such as low education and poverty, because these remain the most important predictors of the disadvantage conditions of their offspring in relation to health and socioeconomic characteristics. / Embora as taxas de fecundidade na adolescência estejam diminuindo, a maternidade na adolescência mantém sua visibilidade como fenômeno social que necessita especial atenção de gestores públicos e pesquisadores. Muitos estudos sugerem que ser mãe na adolescência tem efeitos deletérios para a saúde da própria mãe e para seu filho nos primeiros anos de vida. Outros autores apontam para efeitos adversos a longo prazo, porém, a literatura neste sentido é limitada, particularmente em países de renda media e baixa. As coortes de nascimentos de Pelotas de 1982, 1993 e 2004 ofereceram uma valiosa oportunidade para estudar as consequências a curto e longo prazo da maternidade na adolescência sobre diferentes desfechos relacionados à saúde, comportamento, educação e emprego dos filhos. A hipótese de que a maternidade na adolescência confere um maior risco de mortalidade nos períodos fetal, perinatal, neonatal, pós-neonatal e infantil foi testada nas três coortes. Adicionalmente, foram analisadas consequências a longo prazo, incluindo comportamentos relacionados à saúde, atividade sexual, escolaridade e emprego em adolescentes e adultos jovens. Nossos resultados apontaram para uma maior probabilidade de morte no período pós-neonatal entre filhos de mães adolescentes após ajuste para fatores de confusão. No entanto, este efeito desapareceu após controle para variáveis relacionadas aos cuidados durante a gravidez (ganho de peso e visitas pré-natais). Além disso, filhos de mães adolescentes apresentaram maior probabilidade de iniciar relações sexuais antes dos 16 anos, de serem pais na adolescência e de formarem suas próprias famílias mais precocemente. Em geral, tanto nos resultados das coortes de Pelotas quanto em uma revisão sistemática da literatura, identificou-se que características socioeconômicas e familiares pré-gestacionais explicaram a maior parte dos efeitos adversos observados nos filhos. Portanto, os programas para a prevenção da maternidade na adolescência devem visar à modificação das circunstâncias que envolvem as mães adolescentes, como a baixa escolaridade e a pobreza, pois estas continuam sendo as preditoras de maior importância das condições de desvantagens de seus filhos em relação à saúde e características socioeconômicas.

Abstract Uterine leiomyomas are the most common benign tumours in females. They are myometrial neoplasms, may present single or multiple, and may be located in various sites of the uterus. Leiomyomas distort the uterine cavity and the uterus itself, causing abnormal vaginal bleeding, reduced fertility and also pelvic pressure and pain symptoms. The aim of this study was to elaborate current knowledge on familial uterine leiomyomas and to explore the possible association between uterine leiomyoma and cardiovascular disease risk factors, and also the association between leiomyomas and endometriosis. The natural history of familial uterine leiomyoma study showed significant differences between familial and non-familial leiomyoma cases, familial cases having more severe clinical characteristics. They presented with multiple uterine leiomyomas and were more often symptomatic. They were also diagnosed at a younger age. The prevalence study on uterine leiomyomas and endometriosis offered confirmation of an association between the diseases. Uterine leiomyomas and endometriosis seem to decrease female fertility independently of each other. Uterine leiomyomas related to the hereditary leiomyomatosis and renal cell cancer (HLRCC) tumour syndrome were studied in regard to their clinical characteristics and immunophenotype. The study provided evidence that women with HLRCC may be identified through distinct leiomyoma clinical characteristics, and routine-use IHC of CD34 and Bcl-2. Distinguishing these leiomyoma cases from sporadic ones may identify families affected by fumarate hydratase (fumarase, FH) mutation. Uterine leiomyoma and cardiovascular disease risk factors were studied in The Northern Finland Birth Cohort 1966 (NFBC1966). The study showed an association between leiomyomas and raised cardiovascular disease risk factors, serum lipids and metabolic syndrome in particular. These findings may suggest that there are shared predisposing factors underlying both uterine leiomyomas and adverse metabolic and cardiac disease risks, or that metabolic factors have a role in biological mechanisms underlying leiomyoma development. This study provides novel information on clinical characteristics of familial uterine leiomyomas and on the immunophenotype of HLRCC-related leiomyomas. The study also offers significant confirmation of associations between uterine leiomyomas and both endometriosis and several CVD risk factors. / Tiivistelmä Kohdun leiomyoomat ovat naisten yleisin hyvänlaatuinen kasvain. Ne ovat myometriumin neoplastisia muutoksia ja ne ilmenevät joko yksittäisinä tai monilukuisina, ja ne voivat sijaita missä tahansa kohdun myometriumia. Leiomyoomat muuttavat kohdun ja kohtuontelon säännöllistä muotoa. Lisäksi ne aiheuttavat vuotohäiriöitä, alentunutta hedelmällisyyttä, ja lantion alueen painetta ja kipua. Tämän tutkimuksen tavoitteena oli laajentaa nykyistä tietämystä suvuittain esiintyvistä kohdun leiomyoomista ja selvittää mahdollista leiomyoomien ja kardiovaskulaaritautiriskin assosiaatiota, ja lisäksi selvittää leiomyoomien ja endometrioosin assosiaatiota. Suvuittain esiintyvien kohdun leiomyoomien taudinkulkua selvittävässä tutkimuksessa osoitettiin merkittäviä eroja suvuittain ja ei-suvuittain esiintyvien leiomyoomien välillä. Suvuittain esiintyvien leiomyoomien kliininen taudinkuva oli vaikeampi, leiomyoomia oli kohdussa useampia ja ne aiheuttivat useammin oireita ja lisäksi ne diagnosoitiin nuoremmalla iällä. Kohdun leiomyoomien ja endometrioosin yleisyyttä selvittävä tutkimus antoi lisävahvistusta sille havainnolle, että nämä taudit assosioivat keskenään. Tutkimustuloksen mukaan leiomyoomat ja endometrioosi vähentävät naisen hedelmällisyyttä toisistaan riippumatta. Perinnöllinen kohdun leiomyomatoosi ja munuaissyöpä (hereditary leiomyomatosis and renal cell cancer, HLRCC) -kasvainoireyhtymään liittyvän kohdun leiomyoomia selvittävän tutkimuksen tuloksien mukaan HLRCC-naisten kohdun leiomyoomien kliiniset ominaisuudet poikkeavat satunnaisesti esiintyvien leiomyoomien ominaisuuksista. Naisella HLRCC voitaisiinkin tunnistaa näiden poikkeavien ominaisuuksien perusteella, sekä immunohistokemiallisilla värjäyksillä CD34 ja Bcl-2. Fumaraattihydrataasi (fumaraasi, FH) -geenin mutaatiota kantava suku voitaisiin siten tunnistaa yksittäisen HLRCC leiomyoomatapauksen avulla. Pohjois-Suomen syntymäkohortti 1966 (Northern Finland Birth Cohort 1966, NFBC1966) tutkittiin kohdun leiomyoomia ja kardiovaskulaarisairauden riskitekijöitä. Tutkimustuloksien perusteella kohdun leiomyoomat assosioivat koholla olevien kardiovaskulaarisairauden riskien kanssa, erityisesti seerumin lipidien ja metabolisen syndrooman suhteen. Näiden tutkimustulosten perusteella voidaan esittää, että leiomyoomien ja terveydelle epäedullisen metabolian ja kardiovaskulaaritaudin riskien taustalla on mahdollisesti joitain yhteisiä altistavia tekijöitä, tai että metabolisilla tekijöillä on rooli kohdun leiomyoomien tautimekanismissa. Tämä tutkimus on tuottanut uutta tietoa suvuittain esiintyvien kohdun leiomyoomien kliinisestä taudinkuvasta ja HLRCC:n liittyvien leiomyoomien immunofenotyypistä. Lisäksi tämä tutkimus esittää lisävahvistusta kohdun leiomyoomien ja endometrioosin assosiaatiolle sekä useille kardiovaskulaaririskitekijöille.

Abstract Depression, anxiety and sleep disorders have been reported to be associated with low level of inflammation, i.e., low-grade inflammation, but mainly in males. The evidence has mainly been based on laboratory or clinical studies with small sample sizes or epidemiological studies with elderly subpopulations. In this study the association of low-grade inflammation with depression, anxiety, and sleep disturbances was investigated using the Northern Finland 1966 Birth Cohort (NFBC 1966). In women, the effect of hormonal factors, menopause and the use of oral contraceptives/hormone replacement therapy on the association between low-grade inflammation and depression was also studied by using the Pieksämäki Study data. In 31-year follow-up of NFBC 1966 (N=6007), the depressive and anxiety symptoms were assessed by Hopkins Symptom Checklist-25 (HSCL-25) and sleep disorders by 15-D questionnaires, while the marker of low-grade inflammation, plasma concentration of high sensitivity C-reactive protein (hs-CRP), was measured. In the Pieksämäki study a representative sample of inhabitants in the town of Pieksämäki were invited to clinical examination. Depressive symptoms were obtained by Beck’s Depression Inventory-21, and hs-CRP was measured (512 women). The results of this study revealed that at epidemiological level, elevated hs CRP levels of &#8805;1.0 mg/L increased the probability of current depressive symptoms of single depressive episode in the two highest subgroups (i.e., HSCL-25 mean scores &#8805;1.75 and &#8805;2.01) 1.4- and 1.7- fold in males, respectively. In addition, anxiety symptoms (HSCL-25 anxiety scale mean score &#8805;1.75) increased independently the probability of elevated hs-CRP levels (&#62;3.0 mg/L) in males over 2-fold. Risk ratio of 1.3 was found for males with moderate to severe sleep disturbances and elevated hs-CRP levels (&#8805;1.0 mg/L). Regarding females, a positive correlation between elevated hs-CRP levels and depressive symptoms was found only among peri- and postmenopausal women not using exogenous hormones. The results suggest that low-grade inflammation is associated not only with depression but also with anxiety and sleep disturbances in young adult men. In women, hormonal factors may have an effect on the association between low-grade inflammation and depression. Further investigations are called for to confirm these findings and furthermore, to determine the possible role of low-grade inflammation in the pathophysiology of these disorders. / Tiivistelmä Depressio, ahdistuneisuushäiriöt ja unihäiriöt on yhdistetty elimistön matala-asteiseen tulehdustilaan, joskin pääasiallisesti vain miehillä. Tulosten yleistettävyyttä ovat rajoittaneet tutkimusten pienet otoskoot tai painottuminen iäkkäisiin väestöaineistoihin. Tässä tutkimuksessa selvitettiin matala-asteisen tulehduksen yhteyttä depressioon, ahdistuneisuuteen ja unihäiriöihin Pohjois-Suomen syntymäkohortti 1966 -aineistossa. Lisäksi Pieksämäki-tutkimuksen aineistossa selvitettiin naisilla menopaussin ja ehkäisyvalmisteiden/vaihdevuosihormonikorvaushoidon vaikutusta depression ja matala-asteisen tulehduksen väliseen yhteyteen. Pohjois-Suomen syntymäkohortti 1966 -tutkimuksen 31-vuotisseurannassa kartoitettiin 6007 henkilöltä masennus- ja ahdistuneisuusoireita Hopkins Symptom Checklist-25 -arviointiasteikolla (HSCL-25) ja unihäiriöitä 15-D-kyselyllä. Lisäksi mitattiin matala-asteisen tulehduksen mittarina käytetyn herkän C-reaktiivisen proteiinin (CRP) pitoisuus. Pieksämäki-tutkimuksessa edustava otos Pieksämäen asukkaista kutsuttiin kliiniseen tutkimukseen ja depressiivisiä oireita kartoitettiin Beckin 21-osioisella arviointiasteikolla ja mitattiin herkkä CRP (512 naista). Nuorilla aikuisilla miehillä, joiden herkkä CRP oli kohonnut (&#8805;1.0 mg/l), todettiin 1.7-kertainen masennusoireiden riski, kun katkaisupisteenä käytettiin HSCL-25-kyselyn masennuskeskiarvopistettä &#8805;2.01. Ahdistuneisuusoireet (HSCL-25-kyselyn ahdistuneisuuskeskiarvopisteet &#8805;1.75) lisäsivät kohonneen herkän CRP:n riskiä (&#62;3.0 mg/l) yli kaksinkertaiseksi miehillä. Keskivaikeasta tai vaikeasta unihäiriöstä kärsivillä todettiin 1.3-kertainen kohonneen herkän CRP:n (&#8805;1.0 mg/l) riski. Naisilla positiivinen yhteys masennuksen ja kohonneen herkän CRP:n välillä todettiin vain peri- ja postmenopausaalisilla naisilla, jotka eivät käyttäneet hormonikorvaushoitoa tai suun kautta otettavia ehkäisyvalmisteita. Tutkimustulokset viittaavat matala-asteisen tulehduksen liittyvän depressioon, ahdistukseen ja unihäiriöön nuorilla aikuisilla miehillä. Naisilla hormonaaliset seikat mahdollisesti vaikuttavat depression ja matala-asteisen tulehduksen väliseen yhteyteen. Tulevaisuuden tutkimushaasteena on selvittää matala-asteisen inflammaation mahdollinen merkitys depression, ahdistuneisuuden ja unihäiriöiden patofysiologiassa.

Abstract Somatization is a widespread phenomenon causing subjective suffering and disability. The aim of the study was to assess somatization disorder (SD) and somatization symptoms among young adult population and their associations with sociodemographic factors, alexithymia and temperament as well as psychiatric comorbidity. Various suggestions have been presented to operationalize somatization but none of them has been shown to be superior to others. In this study two definitions were used: SD by DSM-III-R classification diagnostic criteria and "somatization" meaning four or more symptoms of the 35 symptoms of DSM-III-R SD criteria. The study population was a subsample of the Northern Finland Birth Cohort 1966 (NFBC 1966), consisting of cohort members living in Oulu (N = 1,609) on January 1st 1997. The NFBC 1966 is a general population birth cohort of 12,058 live-born children covering 96.3% of all deliveries in the catchment area. The best-estimated procedure was used for assessment of psychiatric morbidity including SD and somatization. Data were collected from the Finnish Hospital Discharge Register and from all available outpatient and inpatient records. Data on education were gathered from Statistics Finland. Other sociodemographic variables, alexithymia and temperament scores were drawn from questionnaires of the field study conducted in 1997 and from earlier follow-up studies. The prevalence of SD was 1.1% (N = 18). Of the subjects 6.1% (N = 97) had somatization. The female-to-male ratio was 5:1 and 6:1, respectively. SD was not recognized by any of the treating physicians, at least not documented in case notes. The observed occurrences of SD and somatization were at a level comparable with earlier international population studies. Somatization did not associate with depression or alexithymia, and neither could a characteristic temperament profile be recognized. Somatization was associated with psychological distress. These results indicate a need for training physicians to recognize SD and somatization and its comorbidity. This will have implications both for psychiatry and other medical specialties regarding collaboration and underlines the importance of liaison-psychiatry at general hospitals. The results suggest a need for more studies about the etiology and development of SD and somatization. / Tiivistelmä Somatisaatio on yleinen ilmiö, josta aiheutuu subjektiivista kärsimystä ja toimintakyvyn laskua. Tämän tutkimuksen tarkoitus oli arvioida somatisaatiohäiriön ja somatisaatio-oireilun yleisyyttä nuorilla aikuisilla sekä näiden ilmiöiden yhteyttä sosiodemografisiin tekijöihin, aleksitymiaan, temperamenttiin ja psykiatriseen sairastavuuteen. Somatisaation käsitteellistämiseksi on esitetty useita vaihtoehtoja mutta mikään niistä ei ole osoittautunut muita paremmaksi. Tässä tutkimuksessa käytetiin kahta määritelmää: DSM-III-R -diagnoosiluokituksen mukaista somatisaatiohäiriön diagnoosia tai somatisaatio-oireilua, jossa esiintyy neljä tai useampia DSM-III-R:n 35 somatisaatiohäiriön oireesta. Tutkimusaineiston muodostivat Pohjois-Suomen vuoden 1966 syntymäkohortin ne jäsenet, jotka asuivat Oulussa 1. tammikuuta 1997 (N =  1,609). Alkuperäinen kohortti koostuu 12,058 elävänä syntyneestä tutkittavasta, mikä kattaa 96.3 % kaikista synnytyksistä Pohjois-Suomessa. Niin kutsutun best-estimated -menettelyn avulla arvioitiin tutkittavien psykiatrista sairastavuutta mukaan lukien somatisaatiohäiriö ja -oireilu. Tietoa kerättiin sairaaloiden poistoilmoitusrekisteristä. Avohoidon sairauskertomustieto koottiin kattavasti. Koulutusasteesta saatiin tieto Tilastokeskukselta. Muita sosiodemografisia tekijöitä, aleksitymiaa ja temperamenttia arvioitiin vuoden 1997 kenttätutkimuksen ja aiempien seurantatutkimusten tietojen avulla. Somatisaatiohäiriön esiintyvyys oli 1.1 % (N =  18). Somatisaatio-oireita todettiin 6.1 % (N =  97) tutkittavista. Naisten osuus oli somatisaatiohäiriössä 5:1 ja somatisaatio-oireilussa 6:1. Osoittautui, että lääkärit eivät tunnistaneet somatisaatiohäiriötä, ainakaan sitä ei oltu kirjattu sairauskertomuksiin. Havaitut somatisaatiohäiriön ja -oireilun esiintyvyydet ovat sopusoinnussa aiempien kansainvälisten tutkimusten kanssa. Somatisaatio-oireilu ei liittynyt masennukseen tai aleksitymiaan eikä somatisaatio-oireilusta kärsiville tutkittavilla todettu tyypillistä temperamenttiprofiilia. Somatisaatio liittyi psyykkiseen stressiin. Johtopäätöksenä voidaan todeta, että lääkäreille tulisi tarjota koulutusta somatisaatiohäiriön ja -oireilun tunnistamisessa. On tärkeää tunnistaa somatisaatio ja siihen liittyvä oheissairastavuus. Havainnot korostavat yleissairaaloiden yhteistyöpsykiatrian ja muiden erikoisalojen yhteistyön merkitystä somatisaatiosta kärsivien potilaiden tutkimuksessa ja hoidossa. Somatisaatiohäiriön ja -oireilun etiologian ja kehittymisen selvittämiseksi tarvitaan uusia tutkimuksia.

Realizamos este estudo com o objetivo de analisar as principais variáveis clínicas dos pacientes que sofreram parada cardiorrespiratória e detectar fatores prognósticos de sobrevivência a curto e longo prazos, tentando oferecer subsídios aos profissionais de saúde que estão envolvidos com reanimação. Analisamos prospectivamente 452 pacientes que receberam reanimação em hospitais gerais de Salvador. Utilizou-se análise bivariada e estratificada nas associações entre as variáveis e a curva de sobrevida para análise de nove anos de evolução. Observamos 24% de sobrevida imediata e 5% de sobrevida à alta hospitalar. Os fatores prognósticos de sobrevida imediata foram: ter doença de base, a enfermidade cardiovascular, diagnosticar o ritmo cardíaco , ritmo de fibrilação ou taquicardia ventricular, tempo estimado pré-reanimação menor ou igual a cinco minutos; tempo de reanimação menor ou igual a 15 minutos. As variáveis prognósticas sobrevida a longo prazo foram: não usar adrenalina; ser reanimado em hospital privado;tempo de reanimação menor ou igual a 15 minutos / The objectives of this study are to analyze the main clinical and demographic characteristics of patients who suffer cardiac arrest and identify variables involved in survival outcomes. The study enrolled 452 patients, which received cardiopulmonary resuscitation in general hospitals. We prospectively analyzed the main variables associated with ROSC and survival to hospital discharge utilizing bivariate and stratified. The Kaplan-Meier technique was used to analyze the survival curves after nine years. Of the 452 resuscitation attempts, 107 (24%) patients had ROSC and only 22 (5%) were discharge from hospital. The variables with greatest prognostic value for immediate survival were: having a co-morbid condition, cardiovascular disease as the etiology, determination of cardiac rhythm, ventricular arrhythmia as rhythm of arrest, estimated pre-resuscitation time less than or equal to 5 minutes and the resuscitation effort duration less than or equal to 15 minutes. The variables associated with better long term survival were: not using adrenaline, being resuscitated in a private hospital and resuscitation efforts lasting less than or equal to 15 minutes

Background: Subjective cognitive decline (SCD), i.e., the self-perceived feeling of worsening cognitive function, may be the first notable syndrome of preclinical Alzheimer’s disease and other dementias. However, not all individuals with SCD progress. Stability of SCD, i.e., repeated reports of SCD, could contribute to identify individuals at risk, as stable SCD may more likely reflect the continuous neurodegenerative process of Alzheimer’s and other dementias. Methods: Cox regression analyses were used to assess the association between stability of SCD and progression to MCI and dementia in data derived from the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). Results: Of 453 cognitively unimpaired individuals with a mean age of 80.5 years (SD = 4.2), 139 (30.7 %) reported SCD at baseline. Over the study period (M = 4.8 years, SD = 2.2), 84 (18.5 %) individuals had stable SCD, 195 (43.1 %) unstable SCD and 174 (38.4 %) never reported SCD. Stable SCD was associated with increased risk of progression to MCI and dementia (unadjusted HR = 1.8, 95 % CI = 1.2–2.6; p < .01), whereas unstable SCD yielded a decreased progression risk (unadjusted HR = 0.5, 95 % CI = 0.4–0.7; p < .001) compared to no SCD. When adjusted for baseline cognitive functioning, progression risk in individuals with stable SCD was significantly increased in comparison to individuals with unstable SCD, but not compared to individuals without SCD. Conclusions: Our results, though preliminary, suggest that stable SCD, i.e., repeated reports of SCD, may yield an increased risk of progression to MCI and dementia compared to unstable SCD. Baseline cognitive scores, though within a normal range, seem to be a driver of progression in stable SCD. Future research is warranted to investigate whether stability could hold as a SCD research feature.

Yes / Heterozygous germline mutations of BMPR2 contribute to familial clustering of pulmonary arterial hypertension (PAH). To further explore the genetic basis of PAH in isolated cases, we undertook a candidate gene analysis to identify potentially deleterious variation. Members of the bone morphogenetic protein (BMP) pathway, namely SMAD1, SMAD4, SMAD5, and SMAD9, were screened by direct sequencing for gene defects. Four variants were identified in SMADs 1, 4, and 9 among a cohort of 324 PAH cases, each not detected in a substantial control population. Of three amino acid substitutions identified, two demonstrated reduced signaling activity in vitro. A putative splice site mutation in SMAD4 resulted in moderate transcript loss due to compromised splicing efficiency. These results demonstrate the role of BMPR2 mutation in the pathogenesis of PAH and indicate that variation within the SMAD family represents an infrequent cause of the disease.

Study design Retrospective cohort study. Objective Bracing is an accepted standard therapy for idiopathic scoliosis at Cobb angle ranges between 25° and 40°. However, it is unclear, if a specifically tailored regimen of daytime and nighttime braces (= double brace) yields superior results compared to the standard treatment (single brace for day and night). Methods One-hundred-fifteen patients with adolescent idiopathic scoliosis (AIS) were assessed before initiation of bracing treatment and at the final follow-up 2 years after deposition of the brace. They were divided into two groups: double-brace group (n = 66, 4 male, 62 female, age 13.1 ± 1.9 (mean ± SD), primary curvature thoracic n = 35, lumbar n = 31) and single-brace group (n = 49, 8 male, 41 female, age 14.1 ± 1.9, primary curvature thoracic n = 18, lumbar n = 31). Each patient underwent clinical and radiological examinations and Cobb angles were measured. Results Both therapy regimens succeeded to either stop progression or improve scoliosis in over 85% of cases. The nighttime brace showed a significantly higher primary correction than the daytime brace. Nevertheless, there was no significant difference in treatment success in the 2-year follow-up (p = 0.58). Conclusion It seems to be sufficient to treat idiopathic scoliosis with one well-tailored brace for day- and nighttime.

No / Initiation of breast feeding and duration of any breast feeding are known to differ by ethnic group, but there are limited data on differences in exclusive breast feeding. This study aimed to determine if there are ethnic differences in the initiation and duration of any and exclusive breast feeding. METHODS: Breast-feeding data were obtained from a subsample of 1365 women recruited to a multi-ethnic cohort study (Born in Bradford) between August 2008 and March 2009. Poisson regression was used to investigate the impact of socio-economic, life style and birth factors on ethnic differences in the prevalence of breast feeding. RESULTS: Compared with white British mothers, initiation of breast feeding was significantly higher in all ethnic groups and this persisted after adjustment for socio-economic, life style and birth factors [Pakistani: prevalence rate ratio (PRR) = 1.19 (95% confidence interval 1.10, 1.29); Other South Asian: PRR = 1.29 (1.18, 1.42); Other ethnicities: PRR = 1.33 (1.21, 1.46)]. There were no differences in exclusive breast feeding at 4 months [Pakistani: PRR = 0.77 (0.54, 1.09); Other South Asian: PRR = 1.55 (0.99, 2.43); Other ethnicities: PRR = 1.50 (0.88, 2.56)]. Any breast feeding at 4 months was significantly higher in mothers of all non-white British ethnicities [Pakistani: PRR = 1.27 (1.02, 1.58); Other South Asian: PRR = 1.99 (1.52, 2.62); Other ethnicities: 2.45 (1.86, 3.21)]. CONCLUSIONS: Whilst women of ethnic minority groups were significantly more likely to initiate breast feeding and continue any breast feeding for 4 months compared with white British women, the rates of exclusive breast feeding at 4 months were not significantly different once socio-economic, life style and birth factors were accounted for.