Introdução A orfandade pode trazer conseqüências importantes para as condições de vida das crianças. Na África subsaariana, por exemplo, órfãos tem apresentado maiores riscos de desnutrição em relação aos não-órfãos. No Brasil, não há relatos sobre as relações entre variáveis relacionadas à orfandade e o estado nutricional de crianças. Objetivos Avaliar o estado nutricional de órfãos por aids ou homicídios residentes em São Paulo e estimar a associação de índices nutricionais com variáveis relacionadas à orfandade. Métodos - Estudo transversal de base domiciliar que utilizou amostra representativa de 484 indivíduos de 5 a 14 anos que perderam um ou ambos os pais durante os anos de 2000 e 2004 devido à aids ou homicídios no município de São Paulo. A avaliação nutricional foi feita com o índice de massa corporal-para-idade e da altura-para-idade. A associação entre índices nutricionais e variáveis relacionadas à orfandade foi estimada em análise hierárquica, com uso de modelo de regressão linear múltiplo. Resultados Órfãos por aids ou homicídios diferiram quanto às características da orfandade e à idade média. As condições econômicas, domiciliares, o estado de saúde e o estado nutricional foram semelhantes entre os grupos. O déficit de IMC ocorreu em 1,3 por cento das crianças abaixo de 10 anos e em 2,1 por cento dos adolescentes. O déficit de altura ocorreu em 0,7 por cento das vii crianças e em 4,0 por cento dos adolescentes. O excesso de peso ocorreu em 19 por cento e 20 por cento das crianças e adolescentes, respectivamente. A análise hierárquica indicou ausência de efeito das variáveis relacionadas à orfandade sobre o IMC ou a altura; o principal determinante do estado nutricional foi de natureza econômica. Conclusão Órfãos por aids ou homicídios de São Paulo apresentaram estado nutricional semelhante e majoritariamente influenciado pela situação econômica. O perfil nutricional identificado no grupo, caracterizado pelo excesso de peso, sugere que órfãos de São Paulo não apresentam riscos adicionais decorrentes da orfandade. / Introduction Orphanhood has important consequences in life conditions of children. In sub-Saharan Africa, for example, children orphaned by AIDS have shown increased risks for undernutrition when compared to their counterparts. There are no studies available investigating the relation among orphanhood-related variables and nutritional status of children. Objectives To evaluate the nutritional status of children orphaned by AIDS or homicides in the city of Sao Paulo and to estimate the association of nutritional indexes with orphanhood-related variables. Methods Household survey carried out between 2006 and 2007. We sampled 484 children representative of Sao Paulo, aged 5-14 years old who lost either or both of their parents from AIDS or homicides between 2000 and 2004. We selected bodymass- index(BMI)-for-age and height-for-age as outcome for analysis. Multiple linear regression in the light of a conceptual hierarchical approach was used for estimating the factors associated BMI-for-age and height-for-age. Results Children from AIDS and homicides groups differed in terms of orphanhood-related variables and age. Economic, household, health and nutritional conditions were similar among groups. Underweight accounted for 1.3 per cent and 2.1 per cent of children under the age of 10 and adolescents, respectively. Stunting accounted for 0.7 per cent and 4.0 per cent of children and ix adolescents, respectively. Overweight accounted for 19 per cent and 20 per cent of children and adolescents, respectively. BMI-for-age and height-for-age were unaffected by orphanhood-related variables after adjusting for selected classical determinants of nutritional status in hierarchical model. Economic condition was the main determinant of nutritional profile. Conclusion Nutritional status of children orphaned by AIDS or homicides from Sao Paulo was similar and mainly influenced by the economic condition. Nutritional profile, characterized by being overweight, suggests that these orphans have not shown additional risks due to those orphanhoodrelated variables.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-11-21T16:47:28Z No. of bitstreams: 1 Cezar Henrique de Azevedo.pdf: 1203250 bytes, checksum: a19bd2904008c5bd6596a637a2e2b515 (MD5) / Made available in DSpace on 2016-11-21T16:47:28Z (GMT). No. of bitstreams: 1 Cezar Henrique de Azevedo.pdf: 1203250 bytes, checksum: a19bd2904008c5bd6596a637a2e2b515 (MD5) Previous issue date: 2016-06-27 / Universidade Católica de Santos - Católica de Santos / Many families ejected from the urban centers by the social transformations found in the rural areas of Baixada Santista Metropolitan Area ¿ BSMA some housing opportunities to develop their comunities, however they have settled in chemical waste deposit areas of the industrial center of Cubatão. The effect of the exposure to social, environmental and dietary features on the elderly health and nutrition are rare or nonexistent. Objective: Investigating the associated features to the nutritional status and anemia in the elderly in contaminated and noncontaminated areas by chemical waste in the BSMA. Methods: cross-sectional study. Participants were 224 elderly, residents in contaminated ¿ Quarentenário neighborhood (n=114) and uncontaminated area ¿ Tancredo Neves neighborhood (n=110), between May and June 2015. The elderly have responded the socio-economic, occupational, environmental and health anamnesis, food anamnesis and food frequency questionnaire, mini nutritional assessment (MNA) to the nutritional diagnosis. Anthropometric and body composition measurement and hemoglobin count to identify anemia were carried out. We carried out descriptive analyses. To evaluate the association between qualitative variables it was used the Chi-square test. To the quantitative variables it was used the student¿s t test (normality and homoscedasticity) and the Mann-Whitney U test. To evaluate associated factors to the outcomes it was used the univariate and multiple logistic regression model. The significance level was set at 5%. Results: There was an association between living in Quarentenário neighborhood and having income of up to R$ 1000,00 and low education, while living in Tancredo Neves¿ neighborhood was associated with the presença of all sanitation itens, using just some part of the money to purchase food and not contributing financially with family, non-exposing to contaminants at work and a normal nutritional status (p<0,05). Anthropometric and food habit related measurements weren¿t different between the elderly in both neighborhoods (p>0,05). The factors related to risk/malnutrition in the final multiple logistic regression model were incomplete education to elementary school (OR=2,02; IC95%: 0,97 ¿ 4,21), having joint desease (OR=2,60; IC95%: 1,06 ¿ 6,42), thinner exposure (OR=3,14; IC95%: 1,01 - 9,74), chlorine exposure (OR=2,03; IC95%: 1,02 ¿ 4,01), not having breakfast (OR=21,40; IC95%: 2,28 ¿ 200,72) and underweight Body Mass Index ¿ BMI (OR=9,61; IC95%: 2,98 ¿ 31,05); inverse association was obtained by spending more than half of financial resources with food (OR=0,32; IC95%: 0,14 ¿ 0,72). The independent variables associated with anemia in the final model were being older than 80 years (OR=15,98; IC95%: 2,32 ¿ 109,82), diabetes (OR=2,86; IC95%: 1,37 ¿ 5,97), quarry dust exposure (OR=12,21; IC95%: 2,40 ¿ 62,04); inverse association was obtained with drinking alcoholic beverage (OR=0,08; IC95%: 0,01 ¿ 0,77). Conclusion: Several factors but not the neighborhood of living were associated with risk/malnutrition and/or anemia. Some of them are preventable and interventions must be done to minimize adverse effects. The elderly ones who have chronic disease, who were exposed to chemical and dust during laboral activities, with socio-economic limitations, who are underweight and do not have one of the main meals of the day deserve to be more carefully evaluated and follow-up by primary attention services, as well as those with anemia, which indicates manifestation of chronic disease. / Muitas famílias expulsas dos núcleos urbanos pelas transformações sociais encontraram nas áreas rurais da Região Metropolitana da Baixada Santista ¿ RMBS oportunidade de moradia e desenvolveram suas comunidades, entretanto assentaram-se em áreas de depósito de resíduos químicos do polo industrial de Cubatão. O efeito da exposição aos fatores sociais, ambientais e alimentares sobre a saúde e nutrição dos idosos são raros ou inexistentes. Objetivo: Investigar os fatores associados ao estado nutricional e anemia em idosos em área contaminada e não contaminada por resíduos químicos na RMBS. Métodos: estudo transversal, com 224 idosos, residentes em área contaminada ¿ Quarentenário (n=114) e não contaminada ¿ Tancredo Neves (n=110), entre maio e junho de 2015. Idosos responderam a anamnese socioeconômico-ocupacional-ambiental e de saúde, anamnese alimentar e questionário de frequência alimentar, mini avaliação nutricional (MAN) para o diagnóstico nutricional. Foram realizadas a avaliação antropométrica e de composição corporal e dosagem de hemoglobina para identificação de anemia. Foi realizada a análise descritiva. Para se avaliar a associação entre as variáveis qualitativas foi utilizado o teste de Qui-quadrado. Para as variáveis quantitativas foram utilizados os testes t de student (normalidade e homocedasticidade) e teste U de Mann-Whitney. Para se avaliar os fatores associados aos desfechos analisados foi utilizado modelo de regressão logística univariada e múltipla. O nível de significância adotado foi de 5%. Resultados: Houve associação entre residir no Quarentenário e ter baixa renda e ter baixa escolaridade, ao passo que residir no bairro Tancredo Neves as associações foram para a existência de todos os itens do saneamento básico, usar pouco dos recursos financeiros para aquisição de alimentos e não contribuir financeiramente com a família, não estarem expostos a contaminantes laborais e estado nutricional Normal (p<0,05). Medidas antropométricas e relacionadas ao hábito alimentar não foram diferentes entre os idosos pelo bairro de moradia (p>0,05). Os fatores associados ao Risco/Desnutrição no modelo múltiplo final foram escolaridade até ensino fundamental incompleto (OR=2,02; IC95%: 0,97 ¿ 4,21), ter doença articular (OR=2,60; IC95%: 1,06 ¿ 6,42), exposição a tíner (OR=3,14; IC95%: 1,01 - 9,74), exposição a cloro (OR=2,03; IC95%: 1,02 ¿ 4,01), não realização do desjejum (OR=21,40; IC95%: 2,28 ¿ 200,72) e índice de massa corporal ¿ IMC de baixo peso (OR=9,61; IC95%: 2,98 ¿ 31,05); associação inversa foi obtida pelo gasto de mais da metade dos recursos financeiros com alimentação (OR=0,32; IC95%: 0,14 ¿ 0,72). As variáveis independentes associadas a anemia no modelo final foram idade acima de 80 anos (OR=15,98; IC95%: 2,32 ¿ 109,82), diabetes (OR=2,86; IC95%: 1,37 ¿ 5,97), exposição poeira de pedreira (OR=12,21; IC95%: 2,40 ¿ 62,04); associação inversa foi obtida na ingestão de bebida alcoólica (OR=0,08; IC95%: 0,01 ¿ 0,77). Conclusão: vários fatores, mas não morar em área contaminada, se mostraram com Risco/Desnutrição e/ou anemia. Alguns deles são preveníveis e intervenções devem ser feitas para minimizar efeitos adversos. Os idosos que tenham doenças crônicas, que foram expostos a produtos químicos e à poeira durante o trabalho, com limitações socioeconômicas, que apresentem peso baixo e que não realize uma das principais refeições do dia merecem avaliação mais cuidadosa e acompanhamento por parte dos serviços de atenção básica, assim como aqueles com anemia que indica manifestação de doença crônica.

O comprometimento do estado nutricional (EN) é um achado frequente em idosos que apresentam demência devido à Doença de Alzheimer (DA), e pode se agravar com a progressão da doença. O objetivo foi identificar as principais alterações do estado nutricional nas fases iniciais da demência devido à DA. Participaram do estudo 38 idosos, alocados em dois grupos: Controle, composto por 19 idosos saudáveis, e grupo Doença de Alzheimer, composto por 19 idosos que apresentavam a demência em estágio inicial (CDR-1), sem comorbidades. Foi realizada avaliação do estado nutricional utilizando a Mini-Avaliação Nutricional (MAN), além do exame de bioimpedância para análise da composição corporal dos idosos. A média de idade do grupo controle foi de 68,6 ± 6,2 anos, e do grupo DA foi de 75,4 ± 4,2 anos (p<0,01). O IMC médio do grupo controle foi 25,2 ± 3,2, enquanto do grupo DA foi 22,9 ± 3,9(p=0,06). Não foi observada diferença significativa em relação à composição corporal entre os grupos. De acordo com a MAN, todos os idosos do grupo controle apresentavam estado nutricional normal. No grupo DA, 11 (57,9%) apresentavam estado nutricional normal, 7 (36,8%) estavam em risco nutricional e 1 (5,3%) estava desnutrido. Em relação ao escore da MAN, o grupo controle apresentou média de 27,7 ± 1,7 pontos, enquanto o DA apresentou 23,2 ± 4,4 pontos (p<0,01). Dados da literatura corroboram com os resultados encontrados, e indicam que a demência devido a Doença de Alzheimer em fase inicial já pode estar associada ao comprometimento do estado nutricional. / The impairment of the nutritional status (NS) is a frequent finding in elder patients with dementia due to Alzheimer\'s disease (AD), and may worsen with the progression of said dementia. The purpose was to identify the main changes in the nutritional status in the early stages of the dementia due to AD. Thirty-eight elderly patients were enrolled in the study; being assigned to two groups: Control, composed of 19 healthy elderly patients, and Alzheimer\'s disease group, composed of 19 elderly patients who experienced early stages of dementia (CDR-1), with no comorbidities. The evaluation of the nutritional status was performed using the Mini Nutritional Assessment (MNA), in addition to the bioimpedance analysis for body composition evaluation in the elderly. The average age of the control group was 68.6 ± 6.2 years, and the AD group was 75.4 ± 4.2 years (p<0,01). The average BMI of the control group was 25.2 ± 3.2, while the AD group was 22.9 ± 3.9 (p=0,06). There was no significant difference observed in relation to the body composition between groups. According to the MNA, all patients in the control group presented with normal nutritional status. In the AD group, 11 (57.9%) presented with normal nutritional status, 7 (36.8%) were at nutritional risk, and one (5.3%) experienced malnutrition, in relation to the MNA score, whilst AD reported 23.2± 4.4 points (p<0.01). Literature data supports the results found, and indicate that dementia, due to early stages of Alzheimer\'s disease, may already be associated with the impairment of the nutritional status.

Objectives: The aim of this cross-sectional study was to assess the nutritional status and physical performance of the individuals over 65 years living in home for the elderly and as the main research question to assess whether there is a correlation between impaired nutritional status and worsened physical performance in older adults. Also tests whether the unwanted weight loss for the last 3 month affects impaired results in a standardized SPPB test and handgrip test. And finally, verify whether the optimal BMI valided for the elderly predispozes a good physical performance and considered as a protective factor in case of frailty - on functional status. Methods: The research was executed by a quantitative method with the investigation of respondents as a data collection technique. To elaborate the practical part and answer the research questions were used outputs from nutritional status testing (BMI, nutritional status according to MNA-FF, SMI) and functional evaluation (dynamometry, SPPB battery). The results of these variables diagnosed seniors in the norm, at risk and with pathology. Results: The resulting research sample consisted of 40 seniors, of whom 29 were women (72,5 %) and 11 were men (27,5 %). The normal nutritional status was found in the majority of participants - 67,5 %, the risk...

Background: Malnutrition is a major problem in Bangladesh. One third of the population in Bangladesh is malnourished, but figures for older persons specifically are scant. Aims: This thesis describes the nutritional status of individuals aged 60+ years, living in a rural community in Bangladesh, with particular focus on the impact of demographic, health and social factors on nutritional status. A main aim is to examine the magnitude of malnutrition in this population. Second, the thesis focuses on the impact of demographic, health and social factors on nutritional status. Third, this thesis also aims to investigate the influence of nutritional status on functional abilities. Methods: A cross-sectional study of people aged 60+ years was conducted in Matlab, a rural area in Bangladesh during 2003-2004. Data were obtained through home interviews, clinical examination and cognitive tests. Nutritional status was assessed using a modified form of the Mini Nutritional Assessment. Physical function was measured by self-reported and performance-based instruments. Cognitive function was assessed using general and specific cognitive tasks. A total of 850 individuals were randomly selected for the purpose of the study, of which 625 participated in the home interviews and 473 underwent clinical examinations and cognitive tests. Information on complete nutritional status was available for 457 individuals. Results: About 26% of older people living in a rural community in Bangladesh were malnourished and 62% were at risk of malnutrition (Studies I-IV). Self-reported health problems (Study I), physician’s diagnoses (Study II), food expenditure (Study I), literacy (Studies I, II), personal income (Study II), female gender (Studies I, II) and financial support (Study II) were significantly associated with nutritional status. Health indicators accounted for the largest variations in nutritional status compared to demographic and socio-economic indicators (Studies I, II). Nutritional status was directly associated with self-reported and performance-based physical functions (Study III), as well as general and specific cognitive functions (Study IV). Conclusion: In low income countries, nutritional status of older persons needs to be addressed both from a health and a socio-economic perspective. Good nutritional status is essential for older persons to be functionally active, both physically and cognitively.

ABSTRACT   The purpose of this medical record research was to study 30 patients with chronic subdural hematoma on a neurosurgical clinic, mapping documented nutritional status, preoperative fasting and hydration and energy supply before surgery. In addition peroperative administration of fluid and vasoactive drugs, as well as postoperative complications and length of hospital stay were studied. The mean age of the patients was 71 years. Nutritional status was evaluated in 12 patients, out of these seven were judged to be at risk for under nutrition. Fifteen patients had surgery day 1 (total fasting time on average m 11 h), eleven had surgery day 2 (29 h), three had surgery day 3 (35 h). One patient had surgery day 4 (61 h). Fluid and energy administration during the preoperative fasting did not meet the basic requirements. The majority of the patients received vasoactive drugs and more than twice the normal requirement of fluids during anesthesia. Postoperative complications were documented in 11/30 records. There was a significant correlation between preoperative fasting hours and length of hospital stay, however there may not be a causal relationship.   The conclusion is that the fasting period is significantly longer than the guidelines recommend and the patients do not receive their preoperative fluid and energy requirements, which may lead to an increased number of postoperative complications and prolonged hospital stay. A goal of the treatment should be that the preoperative fasting time is kept as short as possible and that the basal fluid and energy requirements are met. An evidence based strategy for this purpose should be created.

Syftet med denna systematiska litteraturstudie som inkluderar 18 artiklar, har varit att belysa vilka nutritionsstöd som kan förebygga och behandla malnutrition hos barn med cancer samt vilka omvårdnadsbehov som finns i samband med nutritionsbehandling. Resultatet visade att barn med cancer som behandlas med strålning och/eller cytostatika ofta drabbas av olika biverkningar som påverkar nutritionen. Cirka 46 % av barnen utvecklade malnutrition. Näringsintaget försämrades ofta på grund av biverkningarna vilket fick till följd att behandlingen försämrades samt tillväxt och utveckling påverkades negativt. Olika sätt fanns för att upprätthålla gott nutritionsstatus. Oralt intag förordades för att upprätthålla mag- tarmkanalens struktur och funktion. Alternativ för kostbehandling när barnet inte klarade att inta oral kost var nasogastrisk sond (NS), Perkutan Endoskopisk Gastrostomi (PEG) och Total Parenteral Nutrition (TPN). NS visade sig vara relativt biverkningsfritt och ett alternativ att tillgå under kortare nutritionsbehandlingar. PEG var ett gott alternativ med relativt få biverkningar då barnet behöver nutritionsstöd under längre tid. TPN var ett alternativ enbart då barnet inte kunde äta relaterat till bristande upptag i mag- tarmkanalen. Försämrat näringsintag påverkade barnets livskvalitet. Familjen påverkades genom att ätandet var en stark källa till konflikt mellan barnet och föräldrarna. Det var viktigt att barnet och familjen fick stöd i barnets förmåga att kunna äta samt att erbjudas näringsrik kost. Bedömning av nutritionsstatus och dokumentation av oralt intag, parenteralt intag och effekter av nutritionsbehandlingen var av stor vikt för att kunna ge barnet optimal omvårdnad.

Introducción. El estado nutricional de los individuos es considerado un valioso indicador del estado de salud de la población, así como también del accionar de factores socio-económicos y ambientales. Objetivos: Analizar la relación entre el estado nutricional, las enteroparasitosis y las condiciones socioambientales en niños de Aristóbulo del Valle, Misiones. Métodos. Estudio antropométrico transversal y parasitológico en niños de ambos sexos y entre 6 a 11 años de escuelas públicas del Municipio de Aristóbulo del Valle. Para el análisis de desnutrición se utilizó como referencia CDC/NCHS y para exceso de peso IOTF. El análisis parasitológico se realizó mediante la toma de muestras seriadas de materia fecal y escobillado anal. El relevamiento de las condiciones socio-ambientales se realizó mediante encuestas estructuradas. Resultados. El estado nutricional indicó mayor desnutrición crónica (7,5%) que global y aguda y mayor sobrepeso (9,8%) respecto a obesidad. Los niños presentaron alto porcentaje de parasitismo (86%) y las especies más prevalentes fueron Blastocystis hominis, Enterobius vermicularis y Giardia lamblia. La mayoría de las familias de estos niños habitaban viviendas de chapa y madera, con limitado acceso a servicios públicos, altos niveles de desempleo y padres con un nivel educativo básico. / Introduction: The study of the growth and nutritional status of the individuals is considered an important sign of the population health, as well as the action of socio-economic and environmental factors. Objectives: To analyze the relationship among the nutritional status, enteroparasitoses and socio-environmental conditions in children from Aristóbulo del Valle, Misiones. Methods: A cross-sectional anthropometrical and parasitological study was made in children from both sexes between 6 to 11 years old of public school from Municipality of Aristóbulo del Valle. NCHS was employed as reference in the analysis of undernutrition, and IOTF for the excess of weight. The parasitological analysis was realized by faecal samples and anal brushes. Socio-environmental conditions were evaluated through structured interviews. Results: The nutritional status indicated higher chronic undernutrition (7.5%) than underweight and wasting, and higher overweight than obesity (9.8%). Children showed high percentage of parasitism (86%) and Blastocystis hominis, Enterobius vermicularis and Giardia lamblia were the more prevalent species. Most families of these children live in precarious constructions made out of wood and/or masonry, with limited access to public services, high unemployment levels and a basic educational level of parents. Conclusions: The results obtained indicate the impact of the socio-economic, educational and sanitary impairment, in the children health from a sector Aristóbulo del Valle population, that entails to the coexistence of undernutrition, overweight and parasitic infections.

In the middle of the 1990s many adolescents became vegetarians. There was concern among adults about whether these new young vegetarians got enough energy and nutrients from their dietary intake. The aim of this thesis was to investigate the prevalence of young vegetarians, the food and lifestyle habits, dietary intake and nutritional status of vegetarian and omnivorous adolescents. The prevalence of adolescents eating a vegetarian school lunch in 124 Swedish secondary schools was investigated by interviewing matrons. Information about prevalence of vegetarians, food and lifestyle habits, of 2041 15-year old students from Umeå, Stockholm and Bergen, was obtained by a questionnaire. The dietary intake and nutritional status of thirty 16-20 year-old vegans were compared with thirty age, sex and height matched omnivores. Five percent of the adolescents (16-20 years) in Sweden were found to eat vegetarian food at school lunch. In Umeå there was a significantly higher prevalence (15.6%) of 15-year-old vegetarians compared with Stockholm (4.8%) and Bergen (3.8%). It was also found that more females than males (15 years old) chose a vegetarian dietary regime. Even though the female vegetarians consumed vegetables significantly more often than the omnivores, the intake (32 times/month) was not as often as might be expected of a vegetarian population. The male vegetarians reported eating vegetables not even once a day (25 times/month). No difference in the consumption frequency of fruits/berries, alcoholic beverages, sweets/chocolates and fast foods was seen between vegetarians and omnivores. However, female vegetarians more often than female omnivores consumed dietary supplements. Furthermore, lifestyle characteristics of vegetarians were similar those of omnivores regarding exercise, use of alcohol and smoking habits. No significant difference in validity of reported energy expenditure or energy and protein intakes was found between vegans and omnivores. Young vegans (16-20 year-olds) were seen to have a higher calculated intake of vegetables, legumes, and dietary supplements and a lower intake of ice creams, cakes/cookies, and candies/chocolate than omnivores. The dietary intake was below the average requirements of riboflavin for 73% of the vegans, vitamin B12 for all vegans, vitamin D for 43% of the vegans, calcium for 77% of the vegans and selenium for all vegans and 43% of the omnivores. If intake of supplements was included the intake of e.g. calcium and selenium was still lower than the average requirements for 67% and 73% of the vegans respectively. Low iron stores were as prevalent among vegans as among omnivores (20% and 23% with low stores) and three vegans had low vitamin B12 concentrations in blood. The findings imply that food and lifestyle habits of young vegetarians are different than what previous studies of vegetarians have shown. There is a need for future research of the long-term health effects of being vegetarian.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.