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Data on multidisciplinary programs dedicated to home parenteral nutrition (HPN) in Latin America are limited. This study describes the results of the first multidisciplinary pediatric intestinal rehabilitation program for HPN at a public tertiary hospital in Brazil.We retrospectively reviewed patients aged 0-18 years with intestinal failure (IF) who required parenteral nutrition (PN) for60 days between January/2014 and December/2020.Fifty-four patients were discharged on HPN (15 achieved enteral autonomy, 34 continued on HPN at the end of the study, 1 underwent intestinal transplantation, and 4 died). The median (IQR) age at the study endpoint of patients who achieved enteral autonomy was 14.1 (9.7-19) versus 34.7 (20.4-53.9) months in those who did not achieve enteral autonomy. Overall prevalence of catheter-related thrombosis was 66.7% and catheter-related bloodstream infection rate was 0.39/1000 catheter-days. Intestinal failure-associated liver disease (IFALD) was present in 24% of all patients; none of the patients who achieved enteral autonomy had IFALD. All patients showed significant improvement in anthropometric parameters during the HPN period. The sociodemographic characteristics of the patients' family members were mothers less than 20 years old (7.5%), schooling time more than 10 years (55.5%), and household income between 1 and 3 times the minimum wage (64.8%). The 5-year survival rate for HPN is 90%, and 27.7% of patients achieve enteral autonomy.The treatment of pediatric patients with IF followed by a multidisciplinary pediatric intestinal rehabilitation program with HPN is feasible and safe in the Brazilian public health system.

OBJECTIVE: To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22–26 months corrected gestational age (cGA) compared with those randomized to placebo. STUDY DESIGN: We performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs. RESULTS: The prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs. placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine [SCr]/ cystatin C values at days 0, 7, 9 and 14). At 22–26 months cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) 30 mg/g, 23% had a systolic blood pressure (SBP) >95(th) percentile for age, and 40% had a diastolic blood pressure (DBP) >95(th) percentile for age. SBP >90(th) percentile occurred less often among recipients of erythropoietin (p95(th) percentile or DBP >90(th) or >95(th) percentiles. CONCLUSIONS: ELGANs have high rates of in-hospital AKI and kidney-related problems at 22–26 months cGA. Recombinant erythropoietin (rhEpo) may protect ELGANs against long-term elevated SBP, but does not appear to protect from AKI, low eGFR, albuminuria or elevated DBP at 22–26 months cGA.

Purpose: to understand the effects that dialogical practices can have on the social participation and autonomy of people over 60 years old, as well as the way they face their own aging. Methods: this qualitative study was based on the dialogical discourse analysis, which considers language as the practice that organizes and signifies human actions. Thus, after dialogical practices developed during weekly meetings of 90 minutes, focused on oral, reading and writing activities related to elderly people´s life stories, the aged participants responded to a semi-structured interview. Results: the results allowed verifying that dialogical activities had positive effects on elderly people´s social participation and autonomy, so, they could have: a) more confidence and freedom to use the language; b) strength and reassurance to make decisions; c) more possibility to cope with aging; d) enhancement of their self-esteem and self-worth. Conclusion: it can be concluded that activities based on dialogical practices can promote an active, participatory aging, with a better quality of life. RESUMO Objetivo: compreender os efeitos que práticas dialógicas têm na participação social e autonomia de pessoas com mais de 60 anos, bem como na maneira que enfrentam a própria velhice. Métodos: fundamentado na análise dialógica do discurso, esse estudo, de caráter qualitativo, considera a linguagem como trabalho que organiza e dá sentido às ações humanas. Assim, durante um ano, após promover encontros semanais de 90 minutos, voltados a práticas orais, de leitura e de escrita, relacionadas às histórias de vida, participantes idosos responderam a uma entrevista semiestruturada. Resultados: os seus enunciados permitem afirmar que as atividades dialógicas tiveram efeitos positivos sobre a participação social e a autonomia, gerando-lhes: a) mais confiança e liberdade para usar a linguagem; b) fortalecimento e segurança para tomadas de decisões; c) mais possibilidade para o enfrentamento da velhice; d) além do aumento da autoestima. Conclusão: pôde-se concluir, sem generalizações, que um trabalho pautado em práticas dialógicas viabiliza a promoção de uma velhice ativa, participativa e com qualidade de vida.

Little is known about the extent of physical limitations and chronic illness within the US farm and ranch population or even the general health of farmers and ranchers on a national scale. With the farmer and rancher numbers declining, the average age of the farmer/rancher is steadily rising and the occupational hazards/risks are increasing. We expect to see a higher prevalence of physical limitations and chronic incidence of disease in this population. The focus of this paper is to examine the health and physical limitations of the working age farm and ranch population, age 20 and above. Since farming and ranching is a lifestyle, not just a job, farmers and ranchers may still farm full-time or part-time even though they have reached retirement age. This national study compares the farm and ranch population with the general population.We use National Health and Nutrition Examination Surveys (NHANES), the most detailed annual health surveys in the US that combine personal interviews and physical examinations of a nationally representative sample. Three NHANES waves from 1999 through 2004 are combined in a pooled cross-section to answer the following questions: What is the prevalence of physical limitations in the farm and ranch population? How does the farm and ranch population fare against the general population in terms of physical limitations and general health?