Foram analisados retrospectivamente os prontuários de 97 pacientes portadores de carcinoma do esôfago quanto às complicações intra-operatórias, complicações pós-operatórias precoces, complicações pós-operatórias tardias, alterações digestivas e nutricionais, mortalidade pós-operatória, qualidade de vida e sobrevida até 24 meses, após a reconstrução do trânsito esofágico, comparando esofagocoloplastia versus esofagogastroplastia. Os pacientes foram divididos em dois grupos: A, reconstruídos com o colon (55 pacientes) e B, reconstruídos com o tubo gástrico (42 pacientes). A histologia foi carcinoma espinocelular nos grupos A e B em 96,4% e 92,9%, respectivamente, e adenocarcinoma nos grupos A e B em 3,6% e 4,8% respectivamente. A faixa etária média nos grupos A e B foi de 55,1anos e 58,1anos. As complicações intra-operatórias mais importantes foram a hemorragia nos grupos A e B respectivamente, (1,8% e 28,6%) com diferença significativa, e lesão do nervo recorrente laríngeo (grupos A e B 5,5% e 0%, respectivamente). As complicações pós-operatórias precoces mais freqüentes foram às fístulas cervicais com os seguintes percentuais: grupos A e B 36,4% e 50,0%, e as infecções com destaque para as broncopneumonias (nos grupos A e B 14,6% e 23,8%). Estenose de anastomose ocorreu nos grupos A e B em 14,6% e 14,3%, com boa resolução através da dilatação endoscópica. As complicações pós-operatórias precoces totais foram maiores nos pacientes do grupo B do que nos do grupo A, com significância estatística. A mortalidade pós-operatória nos grupos A e B foi de 9,1% e 14,3%. O ganho ponderal variou de 0 a 12kg nos 6 primeiros meses de pós-operatório, com média nos grupos A e B de 3,3kg e 3,2kg. A capacidade de deglutição foi definida como boa, quando o paciente não apresentasse nenhuma dificuldade em ingerir sólidos, pastosos e líquidos e verificou-se nos pacientes dos grupos A e B os seguintes dados: 54,6% e 42,9%, boa capacidade de ingestão. A satisfação com o procedimento, traduzindo assim uma melhor qualidade de vida em relação ao período pré-operatório, alcançou nos grupos A e B 54,6% e 42,9%. A sobrevida até 24 meses nos grupos A e B registrou 67,3% e 42,9%. Conclui-se que a esofagogastroplastia associou-se a maior sangramento intra-operatório, e maior taxa de complicações totais no pós-operatório precoce, cabendo a ressalva da diferença entre operações realizadas em um único e dois tempos cirúrgicos. Estenoses tardias ocorrem em ambos os grupos, as quais foram resolvidas facilmente através de dilatações endoscópicas com uma média de três para cada paciente, com intervalo entre uma e outra de três a quatro semanas. Ganho ponderal e alterações digestivas e nutricionais foram semelhantes nos dois grupos. A sobrevida até 24 meses foi maior entre os pacientes do grupo A, com significância estatística. A coloplastia foi superior a gastroplastia em relação a alguns aspectos pós-operatórios tardios, sendo que para a maioria das variáveis ambos os procedimentos se equipararam / Medical records of 97 patients with carcinoma of the esophagus were reviewed, retrospectively, to determine intra-operatory complications, as well as early and late post-operatory complications, digestive and nutritional changes, post-operatory mortality, quality of life and survival up to 24 months after the reconstruction of the esophageal transit, by comparing esophagocoloplasty and esophagogastroplasty. The patients were divided in two groups: Group A, those who had undergone colon reconstruction (55 patients) and Group B, those who had their gastric tube reconstructed (42 patients). Histology was consistent with spinocellular carcinoma in groups A and B, with 96.4% and 92.9% respectively, while adenocarcinoma was a finding in groups A and B for 3.6% and 4.8% individuals, respectively. The average age for group A and B patients was 55.1 and 58.1 years. The most important intra-operatory complications were hemorrhage in group A and B patients, representing, respectively, 1.8% and 28.6%, with a significant difference, and a lesion of the recurrent laryngeal nerve (the figures for groups A and B are 5.5% and 0%, respectively). The most frequent early post-operatory complications were cervical fistulas, with the following percentages for group A and B patients, 36,4% and 50.0%, followed by infections. The most prevalent of those were bronchopneumonias (which represented 14.6% and 23.8% in group A and B patients, respectively). Stenoses of the anastomosis were noticed in 14.6% and 14.3% patients of groups A and B, with good resolution through endoscopic dilation. Total early post-operatory complications were higher for group B patients than for group A patients, with statistical significance. Post-operatory mortality in groups A and B was of 9.1% and 14.3%. Weight gain varied between 0 to 12 kg, in the first 6 months after the procedure, and the average figures were 3.3 kg and 3.2kg, for group A and B patients. The ability to swallow was defined as good when the patient didn\'t have any problems ingesting solid, creamy and liquid food, and it was possible to observed the following percentages in the two groups: 54.6% and 42.9%. In groups A and B 70.9% and 64.3% of the patients were satisfied with the procedure, which would represent better quality of life. relative to the pre-operatory status. Survival up to 24 months in groups A and B was recorded as 67,3% and 42,9%. It is then possible to conclude that an esophagogastroplasty was associated with more intra-operatory bleeding and a higher rate of total complications during the early post-operatory phase. It is worthwhile pointing out, at this time, that there was an outcome difference between surgery being performed as one or two separate procedures. Late stenoses happened in both groups and were easily solved through endoscopic dilations, an average of 3 per patient, at three to four week intervals. Weight gain and digestive and nutritional changes were similar for both groups. Survival within 24 months was greater for group A patients, a fact which proved to be statistically significant. Coloplasty was considered a better procedure than gastroplasty with regards to some late post-operatory aspects, but for most of the variables, both procedures can be considered equivalent

A proctocolectomia total com anastomose de reservatório ileal ao canal anal revolucionou a terapêutica cirúrgica da RCU tornando-se a operação de escolha, principalmente no adulto jovem, pois promove a retirada de toda a doença e permite a conservação esfincteriana. Após cerca de duas décadas de experiência com esta operação, cujos trabalhos iniciais preocupavam-se, sobretudo, com sua técnica e complicações, as atenções concentram-se atualmente no estudo da qualidade de vida de doentes submetidos à proctocolectomia com anastomose de reservatório ileal ao canal anal avaliando parâmetros sistêmicos, emocionais e sociais que possam interferir no cotidiano desses doentes. Para estudar a qualidade de vida após a operação, utiliza-se o Questionário de Doenças Inflamatórias Intestinais (IBDQ), pois apresenta boa reprodutibilidade, reflete as alterações importantes que ocorrem no estado de saúde dos doentes com Doença Inflamatória Intestinal, podendo ser plenamente utilizado para averiguação do impacto, eficácia e eficiência de medidas terapêuticas e, além disso, foi recentemente traduzido e validado para a língua portuguesa. Não conhecemos estudos nacionais (base de dados PUBMED) que avaliem a qualidade de vida destes doentes, operados há mais de dez anos. Por esta razão, decidimos empreender o atual estudo, empregando a mesma metodologia utilizada em dissertação de mestrado apresentada e aprovada no Departamento de Gastroenterologia da FMUSP e publicado posteriormente, agora com o IBDQ devidamente validado para o Brasil. O estudo é formado por 36 doentes portadores de retocolite ulcerativa (RCU) submetidos à proctocolectomia com conservação esfincteriana e anastomose de bolsa ileal em J ao canal anal operados há mais de 10 anos. Os doentes foram atendidos no Ambulatório do Serviço de Cirurgia do Cólon e Reto da Divisão de Clínica Cirúrgica II do HCFMUSP a partir de 1985. Após aplicação do IBDQ, verificou-se que a qualidade de vida foi excelente em nove doentes (25%), boa em 11 (30,6%), regular em 13 (%36,1) e má em três (8,3%). Comparando a classificação do IBDQ com o sexo notou-se um predomínio de bons resultados no sexo masculino em detrimento do feminino. Ao compararmos a classificação com a idade percebeu-se que os maus resultados tiveram maior associação com idade avançada. Houve diferença de qualidade de vida quando comparamos os domínios, sendo que os sintomas intestinais comparados aos sistêmicos e sistêmicos aos aspectos sociais apresentaram diferença significante. No domínio sintomas intestinais encontrou-se menor pontuação para diarréia e maior para sangramento retal. Ao analisarmos as questões do domínio sintomas sistêmicos, notou-se que uma adequada noite de sono, sem ter que acordar devido ao problema intestinal, foi a que obteve a menor pontuação, inclusive a menor em todo o IBDQ. Por outro lado, disposição física obteve a maior pontuação. No domínio aspectos sociais, lugares sem banheiro e compromisso social obtiveram, respectivamente, a menor e maior pontuação. Finalmente, no domínio aspecto emocional, irritado e satisfeito e agradecido com sua vida pessoal obteve, respectivamente, a menor e maior pontuação. Além disso, esta última questão obteve a maior pontuação em todo o questionário. Em nosso estudo pudemos determinar qualidade de vida adequada e satisfatória após 10 anos, similar a encontrada na literatura; 85% dos doentes estavam satisfeitos e agradecidos com a operação realizada. A qualidade de vida excelente ou boa em 55,6% dos doentes foi menor do que anteriormente encontrado na FMUSP, o que talvez possa ser explicado pela expectativa pessoal almejada individualmente, inadequado esclarecimento sobre expectativas excessivamente otimistas e permanência ou incremento da dependência medicamentosa anteriormente utilizada. Neste estudo, verificou-se que os domínios intestinal e social foram, possivelmente, os que mais influenciaram os resultados no questionário de qualidade de vida. Além disso, o domínio sistêmico foi o que apresentou menor peso na pontuação final do IBDQ em ambos os estudos. O elevado índice de satisfação obtido com esses resultados demonstra que a bolsa ileal permanece como operação adequada e com resultados aceitáveis, inclusive demonstrado pela questão que apresentou maior pontuação no IBDQ. Conclui-se, portanto, que a possibilidade de conservação esfincteriana deve ser sempre aventada, visto que os doentes permanecem clinicamente estáveis e com elevada qualidade de vida mesmo após longos períodos / Proctocolectomy with ileal pouch-anal anastomosis has revolutionized the surgical therapy of ulcerative colitis patients, making it the operation of choice, especially for the young adults for it completely removes the disease and allows the sphincter preservation. After about 20 years of experimenting with this operation, which initial work was concerned with, above all, its techniques and complications, currently has its attention focused on the study of the quality of life of patients submitted to proctocolectomy with ileal pouch-anal anastomosis, evaluating systemic, emotional and social parameters which may influence in the day-to-day life of these patients. To study the quality of life after the surgery, the Inflammatory Bowel Disease Questionnaire (IBDQ) was used since it presents reproducibility, reflects the important alterations which occur in the health condition of Inflammatory Bowel Disease patients and it can be thoroughly used to evaluate the impact, effectiveness and efficiency of the therapeutical measures, especially now, since it has been translated and validated to the Portuguese language. We are not aware of any national studies (PUBMED databasis) that evaluate the quality of life of patients who have been operated on over 10 years ago. For this reason, we decided to set this study out, employing the same methodology used in a Masters Dissertation presented and approved by the Gastroenterology Department at FMUSP which was later published, now with the IBDQ validated in Brazil. The study comprises of 36 Inflammatory Bowel Disease (IBD) patients submitted to proctocolectomy with sphincter preservation using the J pouch reconstruction who have been operated on over ten years ago. These patients have been taken care at the Rectum and Colon Surgery Ambulatory Services of the Second Surgical Clinic Division of HCFMUSP as of 1985. After applying the IBDQ, it was verified that the quality of life was excellent for 9 patients (25%), good for 11 patients (30,6%), regular for 13 patients (36,1%) and bad for 3 patients (8,3%). Comparing the IBDQ classification to gender, it was noticed that the best results occurred to males in detriment to females. Upon comparing the classification to age, it was verified that the worse the results were associated to the older patients. There has been a notable difference in the quality of life when domains where compared, being these domains the intestinal symptoms compared to the systemic symptoms and the latter to the social aspects. In the realm of intestinal symptoms, a lower score for diarrhea whereas a greater one for rectum bleeding was observed. Upon analyzing the issues in the realm of systemic symptoms, it was acknowledged that a good night of sleep, without having to get up due to the intestinal problem, was the issue with the lowest score, as a matter of fact; it was the lowest score in the whole IBDQ. On the other hand, physical disposition scored the highest. In the social aspects realm, places deprived of restrooms and social appointments scored, respectively, the lowest and highest score. Finally, in the realm of emotional aspects, irritated and satisfied and pleased with his/her life scored, correspondingly, the lowest and highest score. Furthermore, the latter has scored the highest in the whole questionnaire. In our study, we could determine an adequate and satisfactory quality of life 10 years later, similar to the one found in literature; 85% of the patients were happy and satisfied having undergone the surgery. An excellent or good quality of life for 55,6% of the patients was lower than the one found previously at FMUSP, which may be explained by the individually desired personal expectation, inadequate information on excessively optimistic expectations, and the remain or increment of previously used drug dependency. It could be observed in this study that the intestinal realm and the social realm were, possibly, the aspects which were most influential in the results of the quality of life questionnaire. Moreover, the systemic realm was the least influential in the final IBDQ score in both studies. The high level of satisfaction obtained from these results shows that the ileal pouch remain the adequate surgery with acceptable results, corroborated by the highest score result question of the IBDQ. We can conclude, therefore, that the possibility of the sphincter preservation must be always taken into account since patients remain clinically stable and have a high quality of life even after long periods

Os estudos de alto risco com descendentes de indivíduos portadores de psicoses fornecem uma oportunidade para estudar possíveis características fenotípicas e genéticas que podem estar envolvidas no desenvolvimento destes transtornos. Até o momento as pesquisas sobre a influência da vulnerabilidade genética e o ambiente sobre o comportamento das crianças de risco são escassos e inconclusivos. Objetivo: Revisão dos principais estudos genético-epidemiolólogicos e dos principais achados dos estudos de alto risco para psicose funcional. Revisão dos estudos genético-moleculares dos polimorfismos Ser9Gly (rs6280), VNTRDAT1 (NM_001044.3), Val66Met (rs6265) e 5HTTLPR (- X76753) e estudo de associação destes polimorfismos em mães portadoras de psicose funcional e em seus respectivos filhos. A distribuição destes polimorfismos em quatro características clínicas nos filhos (Síndrome Ansiedade/depressão e Retraimento/depressão do CBCL, atraso escolar e déficit intelectual) foi o objetivo secundário. Métodos: Sujeitos-Mães com esquizofrenia e transtorno afetivo bipolar atendidas no Instituto Psiquiatria do IPq-HCFMUSP e atendidas na Clínica de Ginecologia da mesma Universidade foram convidadas a participar.Para cada mãe, 1 filho foi escolhido, estratificando-se para gênero e idade (6-18 anos). Os entrevistadores eram cegos e aplicaram nas mães SCID (Entrevista Clínica Estruturada para DSM-IV) e GAF (Avaliação Global de Funcionamento) e nas crianças CBCL (Child Behavior Checklist) (Achenbach, 1983) e WASI (Wechsler Abbreviated Scale of Intelligence). Foi avaliado nível socioeconômico baseado em um instrumento utilizado em estudos de populacionais brasileiros (ANEP). As freqüências de polimorfismos da mães foi feita comparando-as segundo o diagnóstico psiquiátrico (Esquizofrenia, Transtorno Afetivo Bipolar e Controles). A análise das características das crianças foi realizado inicialmente segundo o diagnóstico da materno e posteriormente de acordo com possíveis síndromes clínicas que estas crianças apresentaram. A análise de dados foi executada pelo Programa Estatístico SPSS 15.0. Os grupos foram comparados de acordo com características através de Chi-quadrado de Pearson ou do Teste Exato de Fisher, adotando-se valor de significância de 0.05. RESULTADOS: 167 mães (58 com esquizofrenia, 47 com transtorno afetivo bipolar e 62 controles) e seus filhos participaram. Não se observaram diferenças significantes nos alelos e genótipos dos polimorfismos do Ser9Gly, VNTR-DAT1, Val66Met e 5HTTLPR. Houve diferença na freqüência das Síndromes Retraimento/depressão e Ansiedade/depressão no grupo de filhos de mães portadoras de TAB, porém sem associação com os polimorfismos estudados. Uma tendência de associação foi detectada entre homozigose ser9gly e prejuízo mental (p = 0,09) e uma associação entre homozigose 9 e 10 do VNTR-DAT1- (p=0,03) e Síndrome Ansiedade/Depressão nas crianças independente da diagnóstico da materno. CONCLUSÃO: Apesar da limitação do tamanho da amostra, nossos resultados apóiam a viabilidade metodológica dos estudos de risco alto para analise em genética molecular. Futuramente pretende-se explorar os dados encontrados com o aumento da amostra e com a introdução de novas variáveis advindas do segmento desta população. / The high-risk studies involving offspring of parents who developed psychoses provide the opportunity to clarify quantitative trait loci that may underlie liability traits. Until now, the research about the influence of genetic vulnerability and environmental factors on child behavior is scarce and inconclusive. Objective: In this research a review of the findings of previous HR studies in functional psychoses, the analyze polymorphisms distribution of the genes DRD3 (Ser9Gly - rs6280), DAT1 (VNTR-Variable Number of Tandem Repeats - NM_001044.3), BDNF (Val66Metrs6265) and serotonin transporter (5HTTLPR - X76753.2) among functional psychoses women and their offspring and polymorphisms distribution in four clinical characteristics among the offspring (Anxious/Depressed and Withdrawn/Depressed syndromes from CBCL, school delay and low intelligence coefficient) was done. Methods: Outpatient mothers with schizophrenia and bipolar referred from the Psychiatric Institute in Sao Paulo and outpatient mothers referred from the Gynecologic Clinic of the same university. For each mother, one offspring was chosen and stratified by gender and age (6-18 y.o.). Blinded interviewers applied the SCID (Structured Clinical Interview for DSM-IV) and Global Assessment of Functioning Scale (GAF) to the mothers, the Child Behavior Checklist (CBCL) (Achenbach, 1983) and WASI (Wechsler Abbreviated Scale of Intelligence) to the children. Socioeconomic status was evaluated based on a Brazilian standardized instrument used in population studies (ANEP). The polymorphisms distribution among mothers was done comparing the diagnoses (Controls, Bipolar Disorder and Schizophrenia). The analysis of the offspring characteristics was initially done according to mother s diagnosis and later according to likely clinical syndromes these children showed. Data analysis was performed with the Statistical Program for Social Sciences (SPSS - 15.0). The groups were compared according to characteristics using Pearson s Chi-square or Fisher s Exact Test adopting significance value of 0.05. RESULTS: 167 mothers (58 with schizophrenia, 47 with bipolar disorder and 62 controls) participated. No significant difference was observed in the allelic and genotype frequencies in the polymorphisms of the Ser9Gly, VNTR- DAT1, Val66Met- and 5HTTLPR. There was some difference in Anxious/Depressed and Withdrawn/Depressed syndromes frequency in the children from bipolar group, but without association with the polymorphism studied. A tendency of association was detected between homozygosis ser9gly DRD3 and mental impairment (p= 0,09), and an association between homozygosis 9* and 10* of DAT1-VNTR (p=0,03) and Anxious/Depressed in children, regardless of mother s diagnosis. CONCLUSION: Despite of the sample size limitation, our results supported the methodological feasibility of a high-risk study. Hereafter it intends to explore the data found by increasing the sample and introducing new variables from the follow up.

33 pacientes com fibromialgia (FM) foram submetidas a 8 sessões semanais de Yoga (grupo YR, n=17) ou Yoga e massagem Tui Na (grupo YRT, n=16). Foram avaliados: questionário de impacto da FM (FIQ), dolorimetria, escalas visuais analógicas para a dor (EVA) e notas verbais para a dor antes da 1ª sessão e 5+1 semanas após a 8ª sessão. As notas verbais foram também aplicadas na 8ª sessão e as EVA antes e depois de cada atendimento. Ambos os grupos apresentaram reduções significativas nos resultados do FIQ após o tratamento e nas EVA em todas as sessões. As EVA e notas verbais mostraram que o grupo YR apresentou reduções significantes da dor no seguimento, mas não na sessão 8, enquanto o grupo YRT as apresentou já na sessão 8, porém não no seguimento. Portanto, o Yoga mostrou-se eficaz na redução dos sintomas da FM e a adição da massagem reforçou estes efeitos a curto prazo, porém impediu benefícios a longo prazo / 33 fibromyalgic (FM) patients were submited to 8 weekly sessions of Yoga (RY group, n=17) or Yoga plus Tui Na massage (RYT group, n=16). FM impact questionnaire (FIQ), algometry, pain visual analogic scales (VAS) and verbal scores for pain were assessed before session 1 and 5+1 weeks after session 8 (followup). Verbal scores were applied also in session 8 and VAS before and after each session. FIQ after treatment and VAS values in every session significantly decreased in both groups. VAS and verbal scores showed that RY group had significant decrease in pain in followup, but not yet in session 8, while RYT group pain decrease was significant in session 8, but not in followup. So, yogic training showed efficacy in FM decreasing symptoms and massage addition reinforced these effects during treatment, but it impeded long term benefits

Os exercícios com pesos (EP) representam importante estratégia para diminuir a sarcopenia e melhorar a capacidade funcional para realizar as atividades da vida diária de pessoas idosas. Além disso, os EP têm também sido recentemente sugeridos para restaurar os efeitos da imunossenescência. Portanto, este estudo teve como objetivo determinar o efeito de doze meses de um programa de exercícios com pesos em parâmetros imunológicos funcionais e quantitativos de mulheres idosas clinicamente saudáveis. As voluntárias foram selecionadas de acordo com o protocolo SENIEUR e 38 mulheres clinicamente saudáveis e fisicamente inativas (60 a 77 anos de idade) foram randomicamente divididas em um programa de exercícios com pesos de baixa intensidade (GE: 67,74 + 5,28 anos [n: 28]) ou em um grupo controle (CG: 68,69 + 2,98 anos [n: 14]). O programa de EP foi constituído de 3 séries de 12 repetições a 54,87 + 2,37% do teste de uma repetição máxima (1-RM) para cinco diferentes exercícios (supino reto sentado, puxada alta, remada, extensão de joelhos e leg press) realizados três vezes por semana durante 12 meses. A atividade citotóxica das células natural killer (NKCA), resposta linfoproliferativa à fito-hemaglutinina (PHA) e ao OKT3, quantificação de linfócitos (CD3+, CD3-CD19+, CD3-CD16+CD56+), subpopulações linfocitárias (CD4+, CD8+, CD56dim, CD56bright), assim como de moléculas de expressão celular (CD25+, CD28+, CD45RA+, CD45RO+, CD69+, CD95+, HLA-DR+) foram determinadas por ensaios imunológicos. As variáveis foram mensuradas a cada 6 meses durante período de um ano (pré-programa [PRÉ], 6 meses [6M] e 12 meses [12M]). A análise estatística demonstrou que o GE incrementou a força muscular em 44,2% e 48,1% após 6 e 12 meses, respectivamente (p<0,05); mas que houve aumento no consumo de oxigênio de pico (VO2pico) após 6 meses (14,7%, p<0.05). Não houve diferença significativa entre os grupos (exceto para 20:1 em 12M) ou em função do tempo (exceção para 40:1 em GE) na NKCA assim como na resposta proliferativa independente do mitógeno empregado. Foi observado decréscimo significativo (p<0,05) em GE para a contagem total de linfócitos (PRÉ x 12M), CD3+ (PRÉ x 12M), CD3+CD4+ (PRÉ x 12M), CD3-CD19+ (PRÉ x 6M), CD3+CD45RA+ (PRÉ x 6M; PRÉ x 12M), CD3+CD45RO+ (PRÉ x 12M; 6M x 12M), CD4+CD45RA+ (PRÉ x 6M), CD4+CD45RO+ (PRÉ x 12M; 6M x 12M), CD3+CD95+CD28+ (PRÉ x 6M), CD4+CD95+CD28+ (PRÉ x 6M), CD8+CD95+CD28+ (PRÉ x 12M) e para CD56dimCD25+HLA-DR+ (6M x 12M). O GC também demonstrou diminuição significativa (p<0,05) na contagem total de linfócitos (PRÉ x 12M), CD3-CD19+ (PRÉ x 6M; PRE x 12M), CD3-CD16+CD56+ (PRÉ x 12M; 6M x 12M), CD3+CD45RO+ (PRÉ x 12M) e para CD56dim (PRÉ x 12M). É possível que outra variável independente, que não o programa de exercícios com pesos e/ou alguma tendência sazonal tenham influenciado os resultados devido ao fato de ambos os grupos terem apresentado menores níveis de expressão celular durante o período do estudo. Os resultados deste estudo permitem concluir que doze meses de um programa de exercícios com pesos de leve intensidade são suficientes para incrementar a força muscular assim como o consumo de oxigênio de pico, mas não para melhorar parâmetros imunológicos funcionais e quantitativos de mulheres idosas clinicamente saudáveis. Portanto, possivelmente sugerindo que o \'limiar de efeito\' nos parâmetros imunológicos de mulheres idosas clinicamente saudáveis seja dependente do estímulo e/ou maior do que o necessário para incrementar a força muscular e/ou o VO2pico. / Resistance training program represents an important strategy to reduce sarcopenia, improving muscle strength and mass, and consequently, functional capacity to perform activities of daily living in elderly people. Additionally, resistance training program has been also recently suggested to restore the deleterious effects of aging process on immune system. Thus, the aim of this study was to determine the effect of twelve months of light resistance training program on functional and quantitative immunological paremeters of clinically healthy elderly women. Volunteers were selected by SENIEUR protocol and thirty-eight clinically healthy untrained females (aged 60-77 year-old) were randomly assigned to either a light resistance training program (RTP: 67.74 + 5.28 year-old [n: 28]) or a control group (CG: 68.69 + 2.98 year-old [n: 14]). The RTP consisted of three sets of twelve repetitions at 54.87 ± 2.37% of one repetition maximum test (1-RM) for five different exercises (seated bench press, lattissimus pull down, seated row, leg extension and leg press) performed three times per week during twelve months. Natural killer cell cytotoxic activity (NKCA), lymphoproliferative response to the phytohemaglutinin (PHA) and OKT3, and quantification of the lymphocytes (CD3+, CD19+, CD3-CD16+CD56+) and subpopulations (CD4+, CD8+, CD56dim, CD56bright) as well as cellular expression molecules (CD25+, CD28+, CD45RA+, CD45RO+, CD69+, CD95+, HLA-DR+) were determined by immunological assays. Variables were measured each 6 months during one year (pre-program [PRE], 6 months [6M] and 12 months [12M]). Statistical analysis showed that RTP volunteers increased muscle strength in 44.2% and 48.1% after 6 and 12 months, respectivelly (p<0.05), whilst there was increased in maximal oxygen peak (VO2peak) after only 6 months (14.7%, p<0.05). There were no statistically significant differences between both groups (unless 12M for the 20:1) or according to the time (unless 40:1 for RTP) when NKCA was analyzed. RTP group preserved lymphoproliferative response, while CG increased significantly the lymphoproliferative response to the PHA and OKT3. There were statistically significant decrease (p<0.05) for RTP volunteers to the total lymphocytes (PRE x 12M), CD3+ (PRE x 12M), CD3+CD4+ (PRE x 12M), CD3-CD19+ (PRE x 6M), CD3+CD45RA+ (PRE x 6M; PRE x 12M), CD3+CD45RO+ (PRE x 12M; 6M x 12M), CD4+CD45RA+ (PRE x 6M), CD4+CD45RO+ (PRE x 12M; 6M x 12M), CD3+CD95+CD28+ (PRE x 6M), CD4+CD95+CD28+ (PRE x 6M), CD8+CD95+CD28+ (PRE x 12M), and to the CD56dimCD25+HLA-DR+ (6M x 12M). GC volunteers also showed statistically significant decrease (p<0.05) to the total lymphocytes (PRE x 12M), CD3-CD19+ (PRE x 6M; PRE x 12M), CD3-CD16+CD56+ (PRE x 12M; 6M x 12M), CD3+CD45RO+ (PRE x 12M), and to the CD56dim (PRE x 12M). It is possible that the other independent variable, which not the RTP, and/or some seasonal tendency have influenced the results because to the fact of both groups had presented lower cell expression levels during the period of the study. The results of this study permit to conclude that twelve months of light RTP were sufficient to increase muscle strength and maximal oxygen peak, but not to improve functional and quantitative immunological parameters of clinically healthy elderly women. Thus, possibly suggesting that the \'threshold of effects\' on immunological paremeters on clinically healthy elderly women would be dose-response dependent and/or could be rather than that to increase muscle strength and/or maximal oxygen peak.

33 pacientes com fibromialgia (FM) foram submetidas a 8 sessões semanais de Yoga (grupo YR, n=17) ou Yoga e massagem Tui Na (grupo YRT, n=16). Foram avaliados: questionário de impacto da FM (FIQ), dolorimetria, escalas visuais analógicas para a dor (EVA) e notas verbais para a dor antes da 1ª sessão e 5+1 semanas após a 8ª sessão. As notas verbais foram também aplicadas na 8ª sessão e as EVA antes e depois de cada atendimento. Ambos os grupos apresentaram reduções significativas nos resultados do FIQ após o tratamento e nas EVA em todas as sessões. As EVA e notas verbais mostraram que o grupo YR apresentou reduções significantes da dor no seguimento, mas não na sessão 8, enquanto o grupo YRT as apresentou já na sessão 8, porém não no seguimento. Portanto, o Yoga mostrou-se eficaz na redução dos sintomas da FM e a adição da massagem reforçou estes efeitos a curto prazo, porém impediu benefícios a longo prazo / 33 fibromyalgic (FM) patients were submited to 8 weekly sessions of Yoga (RY group, n=17) or Yoga plus Tui Na massage (RYT group, n=16). FM impact questionnaire (FIQ), algometry, pain visual analogic scales (VAS) and verbal scores for pain were assessed before session 1 and 5+1 weeks after session 8 (followup). Verbal scores were applied also in session 8 and VAS before and after each session. FIQ after treatment and VAS values in every session significantly decreased in both groups. VAS and verbal scores showed that RY group had significant decrease in pain in followup, but not yet in session 8, while RYT group pain decrease was significant in session 8, but not in followup. So, yogic training showed efficacy in FM decreasing symptoms and massage addition reinforced these effects during treatment, but it impeded long term benefits

O adequado planejamento e implementação de serviços comunitários para cuidados de pacientes com transtornos mentais graves depende do conhecimento sobre as características destes transtornos e sobre a necessidade de cuidados destes pacientes. O presente estudo visou investigar características da população de pessoas com transtorno mental grave (TMG) em áreas de São Paulo e sua evolução em um período de um ano, utilizando desenho de corte transversal seguido de coorte prospectivo. Foram avaliados sintomas psiquiátricos, ajustamento social, violência, uso de serviços e uso de álcool, tabaco e substâncias psicoativas. Foram incluídos 192 participantes na primeira fase do estudo e reavaliados 149 (77,6%). O diagnóstico mais frequênte foi o de esquizofrenia (59.7%); 6.8% dos indivíduos apresentaram ajustamento social pobre e 120 (81.6%) não toveram internação psiquiátrica nos últimos 12 meses / Adequate planning and implementation of community-based care for patients with functional psychoses requires good knowledge about the occurrence and characteristics of the illnesses, and about the sufferers' needs for care. The aims of the present study were to investigate characteristics of a population with severe mental illness (SMI) São Paulo the evolution in one year, using a cross-sectional study followed by a prospective cohort. Assessments included psychiatric symptoms, social adjustment, services use, violence and patterns of alcohol, tobacco and drug use. From 192 subjects included at the cross-sectional study, 149 (77.6%) were re-assessed, at 1-year follow-up. Of the 149 subjects, the most frequent diagnosis was schizophrenia (59.7%); 6.8% presented poor social adjustment, and 120 (81.6%) had no psychiatric admissions in the 1-year follow-up

Background: The survival rates for very low birthweight (VLBW; birthweight ≤1500 g) children are increasing, but they run a greater risk than controls of developing neurosensory disabilities and other functional problems during childhood. However, there is a great need for more knowledge regarding long-term outcome to adulthood in VLBW subjects. Aims: To evaluate long-term outcomes in a regional cohort of VLBW children born in 1987-88 regarding hospital readmissions, morbidity, neurological conditions, cognitive function, reading skills, school achievements, behaviour, growth, general health, and social functioning in relation to gender, neonatal risk factors, disability and Magnetic Resonance Imaging (MRI) findings. Study design: Prospective longitudinal case-controlled long-term regional follow-up. Material and Methods: A total of 86 (80.4%) children (47 boys out of 60 and 39 girls out of 47 live-borns) survived the neonatal period and were recruited to the follow-up study. A total of 86 term controls (45 boys and 41 girls) were included from the newborn period. Readmissions, hospital diagnoses, need of habilitation and child psychiatric care were checked in registers to 15 years of age. The VLBW children were enrolled in the follow-up study at 40 weeks gestational age and at 4, 9, and 15 years of age in assessing neurological conditions. At 15 years of age, the groups were assessed in cognition (WISC III), reading skills, school outcome, behaviour, vision and growth. Fifty-nine (69%) VLBW children were examined using cerebral MRI. Physical and mental health, weight and height, education, and socio-economic situation were assessed at 20 years of age in 77/85 VLBW and 69/84 control subjects by means of postal questionnaires. Results: VLBW boys had three times more readmissions compared with control boys (p=0.003). Gestational age below 30 weeks, birthweight less than 1000 g, and mechanical ventilation were neonatal risk factors for readmissions. Five (5.8%) children had moderate/severe cerebral palsy, 5 (5.8%) had attention deficit hyperactivity disorder, and 1 was blind due to retinopathy of prematurity. VLBW children were inferior in neurological function in comparison with controls at 40 weeks of gestational age and 4 and 15 years of age. Fourteen of 56 (25%) VLBW children without overt disability had abnormal MRI findings. Mechanical and/or intraventricular haemorrhages (IVH) were significantly related to less favourable neurological outcome. VLBW children performed significantly lower than their controls on a few reading variables and on WISC III. Half of them had IQ lower than 85. Ten VLBW children with IQ &lt; 70 had not been clinically identified earlier and a majority of these children attended mainstream school. Small head circumference correlated with low IQ. Mechanical ventilation and IVH correlated with lower IQ and poorer reading skills. At 20 years of age, the VLBW subjects did not differ significantly from the controls in self-perceived health, education, occupation and way of living. Conclusions: Most VLBW subjects were without major health problems up to 20 years of age and had attended mainstream schools. The presence of IVH and mechanical ventilation during the neonatal period negatively influenced health outcomes. VLBW children without overt neurological disability performed somewhat less well in neurological examinations in comparison with controls. VLBW children achieved poorer results in cognitive tests, but reading skills made a catch-up to 15 years of age. A majority of VLBW subjects managed transition to adulthood similar to that of controls. / Bakgrund: Överlevnaden för nyfödda barn med mycket låg födelsevikt (1500 g eller lägre; VLBW) har ökat avsevärt under de senaste årtionden och man finner nu att ca 90 % av barnen skrivs ut från neonatalavdelningar. Risken för cerebral pares (CP) har visat sig vara ökad jämfört med barn födda i fullgången tid. Studier visade att VLBW-barn som kommit upp i skolåldern hade högre frekvens av läs- och skrivsvårigheter, oftare behövde specialundervisning, samt hade högre grad av beteendeproblem jämfört med klasskamrater. Uppföljningsstudier var tidigare mestadels gjorda på populationer från större sjukhus, kontrollgrupp saknades eller inlemmades efter flera år, uppföljningstiden var kort och flera viktiga områden av barnets utveckling var ofullständigt undersökta. I Sverige saknades en studie med långtidsuppföljning av VLBW-barn födda under en tidsperiod då alltfler barn hade börjat erhålla andningshjälp med respirator. Socioekonomiska förhållanden i Sverige kan inte heller helt och hållet jämföras med flertalet andra länder. Syfte: Den här avhandlingens syfte var att studera hur det går för VLBW-barn upp till 15 års ålder avseende sjuklighet, motoriska funktioner, kognitiva funktioner, skolprestationer och beteende, samt vid 20 års ålder avseende hälsotillstånd, sysselsättning och boende. Undersökningsresultaten relaterades till nyföddhetsfaktorer och fynd vid magnet resonans-undersökning (MRI) av hjärnan vid 15 års ålder. Material och metoder: 86 överlevande VLBW-barn samt 86 barn födda i fullgången tid från 1/2 1987 till 30/4 1988 i sydöstra sjukvårdsregionen (Jönköpings, Kalmar och Östergötlands län) har ingått i studien. Uppgift om antalet sjukhusinläggningar och huvuddiagnos inhämtades från Slutenvårdsregistret, Epidemiologiskt centrum, Socialstyrelsen. Uppgifter om antalet barn med CP, ADHD, mental retardation och barnpsykiatriskt vårdbehov inhämtades från habiliteringscentraler och barnpsykiatriska kliniker i regionen. Information om skolbetyg från 9:e årskursen och skolgång inhämtades från kommunerna. Neurologiska och motoriska undersökningar utfördes på barn utan synligt handikapp enligt särskilda protokoll såväl neonatalt som vid 4, 9 och 15 års ålder. Vikt och längd, kognitiv test (WISC III), lästester och MRI undersökning (enbart VLBW-barn) gjordes vid 15 års ålder. Barn och föräldrar fick fylla i formulär om beteende. Vid 20 års ålder (december 2007) fick deltagarna tre frågeformulär: ett studiespecifikt med frågor om hälsa, vikt och längd, användning av tobak och alkohol, gymnasiestudier, nuvarande sysselsättning och boende; SF-36, som belyser fysisk kapacitet, allmän hälsa, vitalitet och psykiskt välbefinnande; samt KASAM (känsla av sammanhang), som belyser hur man upplever sitt eget sätt att fungera, uppdelat i begriplighet, hanterbarhet och meningsfullhet. Resultat: VLBW-barn (mest pojkar) vårdades oftare på sjukhus under första levnadsåren jämfört med kontroller. Infektioner och neurologiska sjukdomar dominerade för både VLBW-pojkar och -flickor. Fem (5.8 %) VLBW-barn hade måttlig/svår CP och fem hade ADHD. Hjärnblödning eller respiratorbehandling under nyföddhetsperioden var de faktorer som oftast var relaterade till sämre hälsotillstånd. Det var ingen skillnad i antal barn med behov av barnpsykiatrisk vård mellan grupperna. Det var ingen skillnad i summering av 9 slutbetyg mellan grupperna, men VLBW-pojkar hade lägre betyg i matematik och teknologi jämfört med sina kontroller. VLBW-barnen var lättare och kortare, men skillnaderna var störst mellan VLBW-flickor och deras kontroller. VLBW-barnen (fr.a. pojkarna) presterade lägre i neurologiska undersökningar, samt i kognitiva test. Tio av tolv av barnen som hade IQ under 70 var tidigare inte kända. Det fanns skillnader mellan grupperna i lästester, men signifikant enbart i ett test. Jämfört med lästester vid 9 års ålder hade VLBW-barnen gjort en upphämtning. Det framkom inga skillnader i beteende mellan grupperna, men VLBW-flickor uppgav färre beteendeproblem än sina kontroller. Vid 20 års ålder framkom inga skillnader i självuppskattad hälsa eller behov av vårdkontakter och läkemedel mellan grupperna. Tobaksanvändning var lika i grupperna, men fler i VLBW-gruppen var icke-användare av alkohol. Det var ingen signifikant skillnad i andel som gått ut gymnasiet, nuvarande sysselsättning eller boendeform mellan grupperna. Det var inga signifikanta skillnader i resultat på SF-36 och KASAM mellan grupperna. Konklusion: Hjärnblödning och respiratoranvändning under nyföddhetsperioden var de faktorer som hade störst inverkan på VLBW-barnens hälsotillstånd upp till 20 års ålder. CP och ADHD förekom hos relativt få, men lågt IQ var vanligt. VLBW-pojkar hade större sjukvårdsbehov, presterade lägre i neurologiska test och hade lägre skolbetyg än sina kontroller. VLBW-gruppen skilde sig inte från kontroll-gruppen avseende beteendeproblem. Självuppskattad hälsa vid 20 år skilde sig inte mellan grupperna. Särskilda uppföljningsprogram för VLBW-barn är nödvändigt där kognitiva tester ingår vilka bör utföras före skolstart.

The purpose of this study was to determine how often smoking patients receive quit advice and if patient age, and number and type of clinical encounters are associated with odds of receipt. Behavioral Risk Factor Surveillance System (BRFSS) 2000 data were used to study 10,582 smokers (aged ³ 18) having ³ 1 of three types of clinical encounters in the past year: routine checkups, other physician encounters, or dental visits. Multivariate-adjusted odds ratios (ORs) for quit advice by patient age, encounter type, and number of doctor's visits were calculated. Almost 55% of patients were advised to quit smoking. There was a 4-23% chance of receiving quit advice at any given doctor's visit. Odds of receiving advice did not increase with increasing number of visits. With advancing age, men were more likely, women less likely, to receive quit advicebut only significantly for White men. Compared to those having dental visits, ORs for receiving quit advice for patients having checkups and other physician encounters were 3.35 (95% CI 2.ll, 5.31) and 3.03 (95%CI 1.32, 6.97) respectively. These cross-sectional data suggest that whereas a small majority of smoking patients are advised to quit at some clinical encounter, smoking patients are not advised to quit at the majority of encounters. Being young and male, or seeing dentists rather than doctors made patients less likely to receive quit adviceas did having lower education or BMI, no insurance or coverage other than military or private, not having asthma, or not having breast exams or follow-up Papanicolaou smears if female. Based on a previously-reported absolute quit difference of 1.9%, if smoking patients received quit advice just once at any of their encounters with physicians in a year, at least 800,000 more U.S. smokers would quit at an economic savings of $2.4 billion.

Objectives. To study whether birth weight (BW) was correlated to cardiovascular risk factors, coronary heart disease (CHD), cardiovascular disease (CVD), and prostate cancer (PCA) at adult ages, whether a possible relationship depended on mediating factors from birth time, hereditary circumstances, and adult life variables, and what importance possible associations might have for the rate of the complaint in the general population. Material and methods. Population-based cohorts of men born in 1913 and followed up until old age. Risk of outcome was estimated using Cox’s and Poisson regressions. The results were transformed to population attributable risk percentage (PAR%) of the complaint that could be attributed to low or high BW, given causality between exposure and outcome. Results. After adjustment for the influence of covariates, systolic blood pressure at age 50 decreased by 3.7 mmHg per 1000 g increase in BW, the prevalence of antihypertensive treatment decreased by 32%, diabetes by 53%, serum total cholesterol decreased by 0.20 mmol L-1, and being in top quintile of serum cholesterol decreased by 23%. The adjusted risks were somewhat more marked relative to the crude risks. CHD and CVD incidence and mortality were virtually unaffected by BW. In the general population, the risk percentage attributable to a BW ≤3000 g was 18% for diabetes, 2.5% for cholesterol, and ≤1% for antihypertensive treatment and CHD and CVD incidence and mortality. PCA incidence and mortality risk increased by 62% and 82%, respectively, among those whose BW was ≥4250 g compared with those whose BW was 3001-4249 g. The risk percentages attributable to a BW ≥4250 g in the general population for PCA incidence and mortality were 7.8% and 10.8%. Conclusions. Low BW seemed to affect cardiovascular risk factors but not incidence and mortality from CHD and CVD. A high proportion of diabetes on the community level could be attributed to low BW, while the proportional burden of other cardiovascular complaints that could be attributed to low BW was modest. PCA incidence and mortality seemed to be affected by high BW.