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Este estudo objetivou analisar o sofrimento emocional de idosos com diabetes mellitus tipo 2 da Estratégia Saúde da Família de Ribeirão Preto, São Paulo. Trata-se de um estudo descritivo do tipo inquérito domiciliar de base populacional, de delineamento transversal. Empregou-se a versão brasileira do questionário Problems Areas in Diabetes para verificar o grau de sofrimento emocional. Participaram 338 pessoas com idade igual ou superior a 60 anos, 66,3% eram mulheres, 51,5% encontravam-se na faixa etária de 60 a 69 anos, possuíam baixa renda e escolaridade. O escore médio de sofrimento emocional foi de 20,2 (DP=16,6) e variou de 0 a 74. Na subdimensão relacionada aos problemas emocionais verificou-se que 35,2% dos idosos se preocupavam com o futuro e com a possibilidade de sérias complicações. Acerca do tratamento, 20,4% relataram problemas nas metas claras e concretas no cuidado da doença. Além disso, 25,1% dos idosos referiram a existência de sentimentos de privação a respeito da comida e refeições. Na subdimensão sobre o apoio social, 6,8% se sentem sozinhos com o diabetes. O alto grau de sofrimento emocional mostrou-se associado a: autopercepção de saúde, idade do diagnóstico, número de doenças associadas ao DM2, uso de insulina isolado ou associado aos antidiabéticos orais, autoeficácia e disfunções renais (p

Aim: To analyse the emotional distress in elderly people with type 2 diabetes mellitus who attend primary healthcare centres in the city of Ribeirão Preto, state of São Paulo, Brazil. Methods: This is a cross-sectional, descriptive, populational, home-survey study. The Brazilian version of the questionnaire called Problems Areas in Diabetes was used to assess the level of emotional distress. Results: A total of 338 low-income people older than 60 years old participated in the study, in which 66.3% were women and 51.5% were aged between 60 and 69 years, all with low schooling level. The mean score of emotional distress was 20.2 ranging from 0 to 74. The high level of emotional distress was found to be associated with self-perception of health, age of diagnosis, number of diseases associated with diabetes, use of insulin associated or not with oral anti-diabetic drugs, self-efficacy, and renal dysfunctions (p < 0.05). The main problem reported by the participants was their concern with the future and likelihood of severe complications (35.2%). Conclusion: This study was able to assess some aspects of emotional distress amongst diabetic elderly people. The evidence from this research enables the strategic planning of actions at the geriatric population attending the primary healthcare centres to ensure quality of life during ageing.

Objective The objective of this study was to compare the efficacy of renal perfusion with Custodiol (Dr Franz-Kohler Chemie GmbH, Bensheim, Germany) versus enriched Ringer's solution for renal protection in patients undergoing open thoracoabdominal aortic aneurysm (TAAA) repair. Methods Ninety consecutive patients scheduled for elective open TAAA repair were enrolled between 2015 and 2017 in a single-center, phase IV, prospective, parallel, randomized, double-blind trial (the CUstodiol versus RInger: whaT Is the Best Agent [CURITIBA] trial), and randomized to renal arteries perfusion with 4°C Custodiol (Dr Franz-Kohler Chemie GmbH, Bensheim, Germany; n = 45) or 4°C lactated Ringer's solution (n = 45). The incidence of acute kidney injury (AKI) in patients undergoing TAAA open surgery using Custodiol renal perfusion versus an enriched Ringer's solution was the primary end point. Results Ninety patients completed the study (45 patients in each group). The incidence of postoperative AKI was significantly lower in the Custodiol group (48.9% vs 75.6%; P = .02). In the multivariable model, only the use of Custodiol solution resulted as protective from the occurrence of any AKI (odds ratio, 0.230; 95% confidence interval, 0.086-0.614; P = .003), whereas TAAA type II extent was associated with the development of severe AKI (odds ratio, 4.277; 95% confidence interval, 1.239-14.762; P = .02). At 1-year follow-up, serum creatinine was not significantly different from the preoperative values in both groups. Conclusions The use of Custodiol during open TAAA repair was safe and resulted in significantly lower rates of postoperative AKI compared with Ringer's solution. These findings support safety and efficacy of Custodiol in this specific setting, which is currently off-label.

Materials and methods From 1992 to 2015 we observed 326 patients (169 females and 157 males; age range 15-84; mean, 47 years) with OH from SIH according to the ICHD 2004 criteria. One hundred and sixteen performed a conservative treatment, while 210 underwent lumbar EBP with 15-50 ml (mean 28 ml) autologous blood. In 203 cases blood was mixed with contrast medium (1 ml of gadolinium [12 pts] and 5 ml of iopamidol [191 pts]), because about 30’ after EBP they underwent a spinal MRI or CT to document the blood spread into the epidural space. All patients were kept in a 30° Trendelenburg position for an hour before the procedure, during and for 24 h (52 pts) or 16 h (158 pts) after the procedure. Fifty-two patients were premedicated with acetazolamide (500 mg). The follow-up ranged from 6 months to 8 years.

In this paper we propose a new small area estimation methodology aimed at the estimation of Value Added, Labor Cost and related competitiveness indicators for subsets of the population of Italian small and medium sized manufacturing firms classified according to geographical region, industrial sector and firms size. This disaggregation is needed in regional comparisons in order to avoid the confounding effect of sectorial and firm size composition of a region's manufacturing industry. We use data on the Small and Medium Enterprises sample survey conducted by the Italian National Statistical Institute (year 2009) that provided us this information in the framework of the BLUE-ETS project. The estimates obtained with our method are more reliable than those that would have been obtained using standard survey weighted estimators, and offer therefore the basis for more sound economic analysis. The small area methods that we propose are model based and take into account the peculiarities of business such as the skewness of target variables' distributions. For this reason the model we propose is based on the log-normal distribution. We consider a multivariate model in which two different variables (Value Added and Labor Cost) and jointly modeled in order to exploit their correlation. We adopt a Bayesian approach to inference. The problem of prior specification is considered and two alternative solutions compared. Since we produce estimates for several variables and hundreds of subset of the target population results are difficult to summarize. A general conclusion may be that, for Italy, the North-South divide in productivity levels is more apparent in capital and knowledge intensive sectors, especially when industrial districts are present. The productivity gap tends to grow for larger firms, but there exists several exception to this rule. Many industries traditionally associated to the Italian productive system (furniture, clothing, textile) are characterized by low labor productivity levels: in these cases the productivity gap between Northern and Southern regions is less pronounced or absent. As the paper is mostly about the methodology needed to obtain the estimates, it is relevant not only for those interested in Italian economy. The same ideas may be applied to data from other countries. The relevance of the mentioned indicators is highlighted by the increasing divergences in economic competitiveness among regions within the different EU member states observed in these last years.

Linear Mixed Models used in small area estimation usually rely on normality for the estimation of the variance components and the Mean Square Error of predictions. Nevertheless, normality is often inadequate when the target variable is income. For this reason, in this paper we consider Linear Mixed Models for the log-transformed income (which require back-transformation for prediction of means and totals on the variable’s original scale) and a Generalized Linear Mixed Model based on the Gamma distribution. Various prediction methods are compared by means of a simulation study based on the ECHP data. Standard predictors obtained from Linear Mixed Model for the untrasformed income are shown to be preferable to the considered alternatives, confirming their robustness with respect to the failure of the normality assumption.