Physical fitness effect on bone mass is mediated by the independent association between lean mass and bone mass through adolescence: a cross-sectional study

We studied 278 adolescents (169 females) aged 13.0–18.5 years to elucidate whether an independent effect of physical fitness and lean mass in the differences between male and female bones can be detected. Lean and fat masses and bone mineral content (BMC) were measured with DXA. Physical fitness was evaluated with six different tests included in the EUROFIT test battery (flexibility, isometric, dynamic and endurance strength, speed, and cardiovascular fitness). To test the independent relationship between physical fitness and bone mass, multiple regression analysis was applied, including lean mass, age, and Tanner development as covariates. The males had a 43% lower fat mass and 40% and 16% higher lean mass and total BMC compared with the females (all P < 0.05). After adjustment for differences in body size and lean mass, the females exhibited a 7.4% higher BMC than the males (P < 0.05). The multiple regression analysis showed that lean mass had an independent relationship with bone mass (P < 0.001), explaining 67% of the total variance in whole-body BMC. In males, change in R ² was 0.658 for hand grip and 0.035–0.151 for the rest of physical fitness-related variables; but 0.019–0.042 in females (all P–0.001); however, the independent relationships between physical fitness and bone disappeared after controlling for lean mass. In conclusion, it is likely the differences between male and female in bone mass could be explained by differences in lean mass and physical fitness.     

The Public's ability to recognize Alzheimer disease and their beliefs about its causes

The authors report how the population identifies symptoms of Alzheimer disease (AD) and the causes attributed to this disorder in the city of S?o Paulo, Brazil. A total of 500 household residents aged 18 years and above were examined in a cross-sectional design, in S?o Paulo. Instruments were a case vignette depicting AD and a structured questionnaire. The symptoms of AD were identified by 46.4% as memory loss. The term AD was used in only 4% of the responses, although 39.4% of the respondents believed it was a mental illness. The main causes attributed were of psychosocial in nature: "drug use" and "isolation." Factors most influencing responses about causes were marital status, level of education, and economic status. In summary, medical-scientific concepts are not usually used in S?o Paulo. Causal attributions show that the laypersons' beliefs have important differences from the results of scientific evidence.     

Public conceptions of schizophrenia in urban Brazil

Objective

Little is known about public conceptions of mental disorders in Latin America and the Caribbean. The aim of this article is to assess how the population identifies symptoms of schizophrenia and the causes attributed to this disorder in the city of São Paulo, Brazil.

Method

A household survey was carried out in 2002 with a probabilistic sample of 500 individuals, residents of São Paulo with ages ranging from 18 to 65. Vignette describing in colloquial language an individual with schizophrenia (according to DSM-IV and ICD-10) was presented together with a structured questionnaire with questions about the vignette.

Results

The symptoms of schizophrenia were identified by 23.4% as depression. The term schizophrenia was used in only 2.2% of the responses. A bit more than half of the respondents believed it was a mental illness. The main causes attributed were “drug use” and “isolation”. Factors most influencing responses about causes were years of schooling and identification as a mental illness.

Conclusions

Medical–scientific concepts are used less in São Paulo than in other countries. The main causes attributed by the public relate to psychosocial stress. Causes of biological or moral nature are considered less relevant.

     

NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines

The NCCN Soft Tissue Sarcoma Guidelines include a subsection about treatment recommendations for gastrointestinal stromal tumors (GISTs). The standard of practice rapidly changed after the introduction of effective molecularly targeted therapy (such as imatinib and sunitinib) for GIST. Because of these changes, NCCN organized a multidisciplinary panel composed of experts in the fields of medical oncology, molecular diagnostics, pathology, radiation oncology, and surgery to discuss the optimal approach for the care of patients with GIST at all stages of the disease. The GIST Task Force is composed of NCCN faculty and other key experts from the United States, Europe, and Australia. The Task Force met for the first time in October 2003 and again in December 2006 with the purpose of expanding on the existing NCCN guidelines for gastrointestinal sarcomas and identifying areas of future research to optimize our understanding and treatment of GIST.     

The use of the Clinical Interview Schedule for the evaluation of mental health in the aged community

As a part of a survey to study the health and living conditions of the elderly population, a random sample of residents aged 65 and over are examined using the Clinical Interview Schedule (CIS) in order to evaluate their psychiatric status. The aim of this study is to evaluate this standard method of assessment as a case-identification instrument in our country. The schedule was completed by 91 subjects. It is easily administered, easily scored, and economical on time. Its completion rate is high. The weighted total scores (WTS) range from 0 to 48. Using the case criteria defined by Cooper & Schwarz (1982), 27 subjects (30%) are considered cases and 64 (70%) are regarded as non-cases. The sensitivity coefficients for the WTS are examined against the overall severity rating at different cut-off points. The optimum cut-off can be anywhere between 16 and 20 points. The WTS has higher validity coefficients to detect the following diagnostic categories (sensitivity, specificity): normals (100%,-); personality (100%, 92%) and affective disorders (100%, 75%). In general the CIS items are given low ratings. Psychotic symptoms are rarely found in this sample. One main problem arose: the item depersonalization is misunderstood by some patients probably because of interpreting it as an upsetting memory disturbance.     

Prone position may increase temperature around the head of the infant

Recommendations to adopt the supine position were followed by a dramatic decrease of SIDS. But no explanation has been given for the association between SIDS and the prone position nor for its decrease in the supine position. We report data on an infant and a mannequin demonstrating an increase in temperature around the head in the prone position. A 4-month-old boy presented an acute life-threatening event related to temperature after febrile otitis despite treatment: 40.5°C, heart rate 280 bpm with circulatory failure and cardiorespiratory arrest requiring resuscitation. There were no seizures. Blood and CSF cultures were negative. The course under antibiotics was favourable. On d 3, we measured temperature at several sites on and around the heat. Temperatures were higher in the prone than in the supine position in pericephalic areas: + 1°C (supracephalic), +2.5°C (peritemporal), and +3.5°C (submandibular). In a thermoregulated room, we used a mechanically ventilated mannequin of an infant. The prone position was also associated with an increase in temperature around the head: +3.3°C (supracephalic), +1.8°C (peritemporal), and +1.1°C (submandibular). Changing from the supine to prone position thus increased temperature around the head (infant and mannequin). To our knowledge, this has not been reported before. SIDS is related to factors modifying temperature status and environment. Furthermore, evacuation of heat is mandatory for an infant. We think the increase in temperature around the head in the prone position is due to the absence of convective fluxes, and speculate it could impair thermolysis.     

High dose chemotherapy with ABMT in soft tissue sarcomas: a report of 22 cases.

Twenty-two patients with locally advanced or metastatic soft tissue sarcomas received high dose chemotherapy with autologous bone marrow graft. Eleven patients receiving melphalan also received fractionated total body irradiation. Six patients (four in CR and two in PR) were intensified after first line therapy. Thirteen patients were grafted after chemosensitive relapse: seven in second CR, one in third CR, one in first PR, three in second PR and one in fourth PR. Three patients with primary refractory disease were intensified. The overall response rate in 66% in nine evaluable patients. The overall median survival and disease-free survival were 19 and 15 months, respectively. The actuarial survival rates at 2 and 5 years were 40% and 32% respectively. There was one treatment-related death due to infection. We conclude that high dose chemotherapy is feasible and provides reasonable response rates in patients with advanced soft tissue sarcomas.