Os custos da aterosclerose em Portugal

Introduction and objectivesCardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease‐related costs.MethodsCosts were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real‐world data from primary care, the 2014 National Health Interview Survey, and expert opinion.ResultsThe total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%).ConclusionsAtherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.     

Does consideration of future consequences moderate the relationship between aggression and alcohol use in adolescents? Results from the United Kingdom

Background: An increasing body of literature suggests that those who give greater consideration to the future consequences (CFC) of their present behaviours are at a reduced risk of negative health outcomes. However, it remains unclear to what degree consideration of immediate or long-term consequences are important. The present study examined whether higher CFC (immediate and future) scores moderated the relationship between trait aggression and self-reported alcohol use in a large sample of adolescents in the United Kingdom. Methods: Participants were 1058 adolescents from Northern Ireland. Participants completed questionnaires assessing Anger, Hostility, Verbal Aggression, Physical Aggression, Consideration of Future Consequences, and alcohol use. Results: Results revealed that higher CFC immediate and CFC future both significantly moderated the relationship between higher trait aggression and higher self-reported alcohol use, but only for females. Conclusions: This finding adds to the increasing body of literature examining the relationship between temporal orientation and health-related outcomes. However, more work is needed to help untangle the gender-specific effects.     

Benefits,risks and possibilities of strength training in school Physical Education: a brief review

Sport Sciences for Health - Strength training (ST) uses different training methods, such as free weights, body weight, elastic bands or machines to generate resistance force. There is evidence of...     

Short-term amino acid infusion improves protein balance in critically ill patients

IntroductionEvidence behind the recommendations for protein feeding during critical illness is weak. Mechanistic studies are needed to elucidate the effects of amino acid and/or protein supplementation on protein metabolism before larger clinical trials with higher levels of protein feeding are initiated.MethodsWe studied the effects of parenteral amino acid supplementation (equivalent to 1 g/kg/day) over the course of 3 hours on whole-body protein turnover in critically ill patients in the intensive care unit (ICU) during the first week after admission. Patients were studied at baseline during ongoing nutrition and during extra amino acid supplementation. If the patient was still in the ICU 2 to 4 days later, these measurements were repeated. Protein kinetics were measured using continuous stable isotope-labeled phenylalanine and tyrosine infusions.ResultsThirteen patients were studied on the first study occasion only, and seven were studied twice. Parenteral amino acid supplementation significantly improved protein balance on both occasions, from a median of −4 to +7 μmol phenylalanine/kg/hr (P =0.001) on the first study day and from a median of 0 to +12 μmol phenylalanine/kg/hr (P =0.018) on the second study day. The more positive protein balance was attributed to an increased protein synthesis rate, which reached statistical significance during the first measurement (from 58 to 65 μmol phenylalanine/kg/hr; n =13; P =0.007), but not during the second measurement (from 58 to 69 μmol phenylalanine/kg/hr; n =7; P =0.09). Amino acid oxidation rates, estimated by phenylalanine hydroxylation, did not increase during the 3-hour amino acid infusion. A positive correlation (r =0.80; P <0.0001) was observed between total amino acids and/or protein given to the patient and whole-body protein balance.ConclusionExtra parenteral amino acids infused over a 3-hour period improved whole-body protein balance and did not increase amino acid oxidation rates in critically ill patients during the early phase (first week) of critical illness.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-0844-6) contains supplementary material, which is available to authorized users.     

Volvulus of the cecum. A case report

The authors present one case of intestinal obstruction by volvulus of the cecum. The patient had abdominal pain for 4 days. This pain was colicky in nature and of greatest in density in the left iliac fossa. He was nauseated, had anorexia, and had been vomiting. Abdominal distension was present. Plain-roentgenogram of the abdomen showed an enormously distended gas-filled intestinal loop in the upper abdomen just to the left of midline. At surgery there was volvulus of the cecum located in the upper abdomen to the left of midline. The cecum was viable and was relocated in the right lower quadrant and secured to the antero-lateral abdominal wall (cecopexy). The patient made a good postoperative recovery.     

Recombinant human factor IX: replacement therapy, prophylaxis, and pharmacokinetics in canine hemophilia B

Recombinant human factor IX (rFIX) has been expressed in transduced cultured cell systems since 1985. Because there has been limited in vivo testing of rFIX in hemophilia B subjects, this study was undertaken using the severe hemophilia B canines of the Chapel Hill strain. Three groups of hemophilic dogs received either 50, 100, or 200 IU/kg of rFIX. As a control, a fourth group of hemophilic dogs received 50 IU/kg of a high purity, plasma-derived human FIX (pdFIX). The coagulant and hemostatic effects of rFIX and pdFIX were similar with all comparative dosing regimens. Based on activity data, the elimination half-life of rFIX was 18.9 +/- 2.3 hours and pdFIX was 17.9 +/- 2.1 hours. A prophylactic regimen administering rFIX daily resulted in a continuous therapeutic level of plasma FIX and was accompanied by a two-fold increase in recovery levels by day 5, compared to that observed with administration of a single bolus. The mechanisms of the high to complete recovery of FIX with the prophylactic regimen could depend not only on the degree of saturation of the vascular endothelial binding sites but also on the altered dynamics of the balance of FIX distribution between the intravascular and extravascular compartments. The pharmacokinetic (PK) parameters for rFIX and pdFIX were similar. However, the relative PK values for V1 and V5s of both products on day 5 differed greatly from day 1 and may reflect the changing equilibrium of FIX between compartments with elevated levels of plasma FIX. Neutralizing antihuman FIX antibodies resulting from human FIX antigen being administered to FIX deficient dogs were observed beginning at 14 days. The antigenicity of rFIX and pdFIX appeared to be comparable. Despite the very different procedures used for production of rFIX and pdFIX products, in vivo testing in hemophilia B dogs showed the functional behavior of these products is similar; they are highly effective for replacement therapy and for prophylaxis.