Poststroke consequences upon optimization properties of postural sway during upright stance: a cross-sectional study

BACKGROUND

The understanding of human postural control has advanced with the introduction of optimization process modeling. These models, however, only provide control parameters, rather than analytical descriptors of optimization processes. Here, we use a newly developed direct (pattern) search algorithm to investigate changes in postural optimization process in poststroke individuals.

OBJECTIVE

This cross-sectional study investigated the optimization properties of postural stability during upright standing in poststroke individuals.

METHODS

Twenty-nine poststroke and 15 healthy age-matched individuals underwent posturography with a force platform while standing for 60 s for acquisition of center-of-pressure data. Poststroke individuals were grouped depending on their weight-bearing (WB) pattern and their balance capability assessed through Berg Balance Scale (BBS). The optimization properties of postural stability were computed assuming the minimization of postural sway as cost function.

RESULTS

The asymmetric WB poststroke group showed larger convergence rate toward the local minimum of postural sway than the symmetric WB group. Additionally, the low-balance capability group exhibited smaller values for averaged local minima and global minimum of postural sway coordinates compared with high-balance capability group. Significant correlations were found for BBS and the local minima and global minimum (Pearson's r ranged 0.378-0.424, P < 0.05).

CONCLUSIONS

In summary, the optimization properties describing postural dynamic stability, steadiness, and global reference are altered in poststroke individuals with asymmetric WB pattern and low-balance capability.

Neurovascular and hemodynamic responses to mental stress and exercise in severe COVID-19 survivors

Previous studies show that COVID-19 survivors have elevated muscle sympathetic nerve activity (MSNA), endothelial dysfunction, and aortic stiffening. However, the neurovascular responses to mental stress and exercise are still unexplored. We hypothesized that COVID-19 survivors, compared with age- and body mass index (BMI)-matched control subjects, exhibit abnormal neurovascular responses to mental stress and physical exercise. Fifteen severe COVID-19 survivors (aged: 49 ± 2 yr, BMI: 30 ± 1 kg/m2) and 15 well-matched control subjects (aged: 46 ± 3 yr, BMI: 29 ± 1 kg/m2) were studied. MSNA (microneurography), forearm blood flow (FBF), and forearm vascular conductance (FVC, venous occlusion plethysmography), mean arterial pressure (MAP, Finometer), and heart rate (HR, ECG) were measured during a 3-min mental stress (Stroop Color-Word Test) and during a 3-min isometric handgrip exercise (30% of maximal voluntary contraction). During mental stress, MSNA (frequency and incidence) responses were higher in COVID-19 survivors than in controls (P < 0.001), and FBF and FVC responses were attenuated (P < 0.05). MAP was similar between the groups (P > 0.05). In contrast, the MSNA (frequency and incidence) and FBF and FVC responses to handgrip exercise were similar between the groups (P > 0.05). MAP was lower in COVID-19 survivors (P < 0.05). COVID-19 survivors exhibit an exaggerated MSNA and blunted vasodilatory response to mental challenge compared with healthy adults. However, the neurovascular response to handgrip exercise is preserved in COVID-19 survivors. Overall, the abnormal neurovascular control in response to mental stress suggests that COVID-19 survivors may have an increased risk to cardiovascular events during mental challenge.

Sympathetic Neural Overdrive, Aortic Stiffening, Endothelial Dysfunction, and Impaired Exercise Capacity in Severe COVID-19 Survivors: A Mid-Term Study of Cardiovascular Sequelae

BACKGROUND

COVID-19 has become a dramatic health problem during this century. In addition to high mortality rate, COVID-19 survivors are at increased risk for cardiovascular diseases 1-year after infection. Explanations for these manifestations are still unclear but can involve a constellation of biological alterations. We hypothesized that COVID-19 survivors compared with controls exhibit sympathetic overdrive, vascular dysfunction, cardiac morpho-functional changes, impaired exercise capacity, and increased oxidative stress.

METHODS

Nineteen severe COVID-19 survivors and 19 well-matched controls completed the study. Muscle sympathetic nerve activity (microneurography), brachial artery flow-mediated dilation and blood flow (Doppler-Ultrasound), carotid-femoral pulse wave velocity (Complior), cardiac morpho-functional parameters (echocardiography), peak oxygen uptake (cardiopulmonary exercise testing), and oxidative stress were measured ~3 months after hospital discharge. Complementary experiments were conducted on human umbilical vein endothelial cells cultured with plasma samples from subjects.

RESULTS

Muscle sympathetic nerve activity and carotid-femoral pulse wave velocity were greater and brachial artery flow-mediated dilation, brachial artery blood flow, E/e' ratio, and peak oxygen uptake were lower in COVID-19 survivors than in controls. COVID-19 survivors had lower circulating antioxidant markers compared with controls, but there were no differences in plasma-treated human umbilical vein endothelial cells nitric oxide production and reactive oxygen species bioactivity. Diminished peak oxygen uptake was associated with sympathetic overdrive, vascular dysfunction, and reduced diastolic function in COVID-19 survivors.

CONCLUSIONS

Our study revealed that COVID-19 survivors have sympathetic overactivation, vascular dysfunction, cardiac morpho-functional changes, and reduced exercise capacity. These findings indicate the need for further investigation to determine whether these manifestations are persistent longer-term and their impact on the cardiovascular health of COVID-19 survivors.

Reorganization of thalamocortical connections in congenitally blind humans

Cross-modal plasticity in blind individuals has been reported over the past decades showing that nonvisual information is carried and processed by "visual" brain structures. However, despite multiple efforts, the structural underpinnings of cross-modal plasticity in congenitally blind individuals remain unclear. We mapped thalamocortical connectivity and assessed the integrity of white matter of 10 congenitally blind individuals and 10 sighted controls. We hypothesized an aberrant thalamocortical pattern of connectivity taking place in the absence of visual stimuli from birth as a potential mechanism of cross-modal plasticity. In addition to the impaired microstructure of visual white matter bundles, we observed structural connectivity changes between the thalamus and occipital and temporal cortices. Specifically, the thalamic territory dedicated to connections with the occipital cortex was smaller and displayed weaker connectivity in congenitally blind individuals, whereas those connecting with the temporal cortex showed greater volume and increased connectivity. The abnormal pattern of thalamocortical connectivity included the lateral and medial geniculate nuclei and the pulvinar nucleus. For the first time in humans, a remapping of structural thalamocortical connections involving both unimodal and multimodal thalamic nuclei has been demonstrated, shedding light on the possible mechanisms of cross-modal plasticity in humans. The present findings may help understand the functional adaptations commonly observed in congenitally blind individuals.

Discrimination of Meat Produced by Bos taurus and Bos indicus Finished under an Intensive or Extensive System

Simple Summary

This research was carried out to investigate the usefulness and reliability of meat quality traits such as physicochemical properties and fatty acid profiles to discriminate between meat produced by taurine and zebu cattle, finished on pasture or grain. This approach is of utmost importance to assess the authenticity of meat products, particularly when beef is certified based on criteria such as breed and finishing system. Our results using discriminant analyses indicate that meats originating from pasture- or grain-finishing can be discriminated with high reliability, essentially on the basis of their fatty acid profile. The global distinction of meat from the two genetic groups is somewhat more difficult to achieve reliably. Still, prior knowledge of the finishing system used to produce meat from a given genetic group enhances the trustworthiness of the assignment procedure, allowing the reliable allocation of meat samples originating from Bos indicus and Bos taurus finished on pasture or grain, with fatty acid profiles being better discriminating factors than physicochemical properties. These results can be adopted as tools to be used in meat certification programs.

Abstract

Meat obtained under commercial conditions shows considerable variability, mostly due to genetic background and production system. In this study, meat physicochemical properties and fatty acid profiles were analysed to investigate the feasibility of using them as tools to discriminate between meats produced by different genetic groups and finishing systems. Samples of the Longissimus thoracis were collected from 160 commercial bulls of the B. taurus (n = 75) and B. indicus (n = 85) groups, finished either on pasture (n = 46) or with grain supplementation (n = 114) and analysed by standard procedures. Data were analysed by discriminant analysis using a stepwise procedure, to select the meat characteristics that better contribute to discriminate the various groups. Our results indicate that fatty acid profiles of meat had better discriminating ability than physicochemical properties, especially to identify meat from animals finished on grain or pasture. The overall discrimination of meat from different genetic groups was achieved with a slightly lower reliability. Nonetheless, our results show that reliability of allocation to genetic group can be improved if prior information on finishing system is considered. These results are of high importance because they can be incorporated as tools to assess the authenticity of beef, particularly in meat certification programs.

Breastfeeding self-efficacy and associated factors in the context of primary health care, Brazil

Introduction

Exclusive breastfeeding is essential to reduce infant morbidity and mortality, as it meets the entire child's nutritional and immunological needs, strengthens the emotional bond between the mother-baby pair and protects against chronic and infectious diseases. Several factors interfere in this practice, among which the woman's self-efficacy stands out because such attitude represents maternal confidence in her ability to breastfeed her child.

Objectives

Evaluating self-efficacy of breastfeeding among women assisted in primary health care units and; verifying the association between socioeconomic and obstetric factors, and between the duration of exclusive breastfeeding and breastfeeding self-efficacy.

Methods

Cross-sectional study carried out with 216 mothers of children under six months, registered in four basic health units in the city of Rio de Janeiro, Brazil. The research was approved by the Ethics and Research Committees of the participating institutions. The Breastfeeding Self-Efficacy Scale - Short Form was used to measure the self-efficacy scores, and the Statistical Package for the Social Science Program was used to analyze such data.

Results

high levels of breastfeeding self-efficacy were associated with six or more prenatal consultations (OR = 0.92, 95% CI 0.84-1.01, p = 0.07), normal birth (OR = 1,25, 95% CI 1.07-1.45, p &lt; 0.001), breastfeeding in the first half hour after delivery (OR = 1,17, 95% CI 1.08 - 1.27, p &lt; 0.001) and the practice of exclusive breastfeeding for 6 months (OR = 1,86, 95% CI 1.27-2.27, p &lt; 0.001).

Conclusions

prenatal care, vaginal delivery, breastfeeding in the first half hour of life and the practice of exclusive breastfeeding were related to the high and medium level of breastfeeding self-efficacy. The knowledge of the self-efficacy degree and the determining factors for the breastfeeding enable health professionals to implement effective interventions for promoting, protecting and supporting breastfeeding

Key messages

Maternal self-efficacy contributes to prevent early weaning and, thus, to reduce infant morbidity and mortality. Awareness of the determining factors of breastfeeding enables the implementation of effective interventions to promote and support breastfeeding.

Postural Muscle Unit Plasticity in Stroke Survivors: Altered Distribution of Gastrocnemius' Action Potentials

Neuromuscular adaptations are well-reported in stroke survivors. The death of motor neurons and the reinnervation of residual muscle fibers by surviving motor neurons, for example, seem to explain the increased density of muscle units after stroke. It is, however, unknown whether reinnervation takes place locally or extensively within the muscle. Here we combine intramuscular and surface electromyograms (EMGs) to address this issue for medial gastrocnemius (MG); a key postural muscle. While seven stroke survivors stood upright, two intramuscular and 15 surface EMGs were recorded from the paretic and non-paretic gastrocnemius. Surface EMGs were triggered with the firing instants of motor units identified through the decomposition of both intramuscular and surface EMGs. The standard deviation of Gaussian curves fitting the root mean square amplitude distribution of surface potentials was considered to assess differences in the spatial distribution of motor unit action potentials and, thus, in the distribution of muscle units between limbs. The median number of motor units identified per subject in the paretic and non-paretic sides was, respectively, 2 (range: 1–3) and 3 (1–4). Action potentials in the paretic gastrocnemius were represented at a 33% wider skin region when compared to the non-paretic muscle (Mann-Whitney; P = 0.014). Side differences in the representation of motor unit were not associated with differences in subcutaneous thickness (skipped-Spearman r = −0.53; confidence interval for r: −1.00 to 0.63). Current results suggest stroke may lead to the enlargement of the gastrocnemius muscle units recruited during standing. The enlargement of muscle units, as assessed from the skin surface, may constitute a new marker of neuromuscular plasticity following stroke.

Structural and functional connectivity changes in response to short-term neurofeedback training with motor imagery

Recent findings have been challenging current understanding of how fast the human brain change its structural and functional connections in response to training. One powerful way to deepen the inner workings of human brain plasticity is using neurofeedback (NFB) by fMRI, a technique that allows self-induced brain plasticity by means of modulating brain activity in real time. In the present randomized, double-blind and sham-controlled study, we use NFB to train healthy individuals to reinforce brain patterns related to motor execution while performing a motor imagery task, with no overt movement. After 1 h of NFB training, participants displayed increased fractional anisotropy (FA) in the sensorimotor segment of corpus callosum and increased functional connectivity of the sensorimotor resting state network. Increased functional connectivity was also observed in the default mode network. These results were not observed in the control group, which was trained with sham feedback. To our knowledge, this is the first demonstration of white matter FA changes following a very short training schedule (<1 h). Our results suggest that NFB by fMRI can be an interesting tool to explore dynamic aspects of brain plasticity and open new venues for investigating brain plasticity in healthy individuals and in neurological conditions.

Lower limb amputees undergo long-distance plasticity in sensorimotor functional connectivity

Amputation in adults is associated with an extensive remapping of cortical topography in primary and secondary sensorimotor areas. Here, we used tactile residual limb stimulation and 3T functional magnetic resonance imaging in humans to investigate functional connectivity changes in the sensorimotor network of patients with long-term lower limb traumatic amputations with phantom sensation, but without pain. We found a pronounced reduction of inter-hemispheric functional connectivity between homologous sensorimotor cortical regions in amputees, including the primary (S1) and secondary (S2) somatosensory areas, and primary (M1) and secondary (M2) motor areas. We additionally observed an intra-hemispheric increased functional connectivity between primary and secondary somatosensory regions, and between the primary and premotor areas, contralateral to amputation. These functional connectivity changes in specialized small-scale sensory-motor networks improve our understanding of the functional impact of lower limb amputation in the brain. Our findings in a selective group of patients with phantom limb sensations, but without pain suggest that disinhibition of neural inputs following traumatic limb amputation disrupts sensorimotor topology, unbalancing functional brain network organization. These findings step up the description of brain plasticity related with phantom sensations by showing that pain is not critical for sensorimotor network changes after peripheral injury.

Observing Grasping Actions Directed to Emotion-Laden Objects: Effects upon Corticospinal Excitability

The motor system is recruited whenever one executes an action as well as when one observes the same action being executed by others. Although it is well established that emotion modulates the motor system, the effect of observing other individuals acting in an emotional context is particularly elusive. The main aim of this study was to investigate the effect induced by the observation of grasping directed to emotion-laden objects upon corticospinal excitability (CSE). Participants classified video-clips depicting the right-hand of an actor grasping emotion-laden objects. Twenty video-clips differing in terms of valence but balanced in arousal level were selected. Motor evoked potentials (MEPs) were then recorded from the first dorsal interosseous using transcranial magnetic stimulation (TMS) while the participants observed the selected emotional video-clips. During the video-clip presentation, TMS pulses were randomly applied at one of two different time points of grasping: (1) maximum grip aperture, and (2) object contact time. CSE was higher during the observation of grasping directed to unpleasant objects compared to pleasant ones. These results indicate that when someone observes an action of grasping directed to emotion-laden objects, the effect of the object valence promotes a specific modulation over the motor system.

Motor planning of goal-directed action is tuned by the emotional valence of the stimulus: a kinematic study

The basic underpinnings of homeostatic behavior include interacting with positive items and avoiding negative ones. As the planning aspects of goal-directed actions can be inferred from their movement features, we investigated the kinematics of interacting with emotion-laden stimuli. Participants were instructed to grasp emotion-laden stimuli and bring them toward their bodies while the kinematics of their wrist movement was measured. The results showed that the time to peak velocity increased for bringing pleasant stimuli towards the body compared to unpleasant and neutral ones, suggesting higher easiness in undertaking the task with pleasant stimuli. Furthermore, bringing unpleasant stimuli towards the body increased movement time in comparison with both pleasant and neutral ones while the time to peak velocity for unpleasant stimuli was the same as for that of neutral stimuli. There was no change in the trajectory length among emotional categories. We conclude that during the “reach-to-grasp” and “bring-to-the-body” movements, the valence of the stimuli affects the temporal but not the spatial kinematic features of motion. To the best of our knowledge, we show for the first time that the kinematic features of a goal-directed action are tuned by the emotional valence of the stimuli.

Balance Impairments after Brachial Plexus Injury as Assessed through Clinical and Posturographic Evaluation

Objective: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance.

Design: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment included the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60 s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60 s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions.

Results: BPI patients presented lower BBS scores (p = 0.048) and a higher frequency of feet touches during the single-leg stance (p = 0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was shown by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p = 0.020), but not for lateral direction (p = 0.818).

Conclusions: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition.

Enhancing Motor Network Activity Using Real-Time Functional MRI Neurofeedback of Left Premotor Cortex

Neurofeedback by functional magnetic resonance imaging (fMRI) is a technique of potential therapeutic relevance that allows individuals to be aware of their own neurophysiological responses and to voluntarily modulate the activity of specific brain regions, such as the premotor cortex (PMC), important for motor recovery after brain injury. We investigated (i) whether healthy human volunteers are able to up-regulate the activity of the left PMC during a right hand finger tapping motor imagery (MI) task while receiving continuous fMRI-neurofeedback, and (ii) whether successful modulation of brain activity influenced non-targeted motor control regions. During the MI task, participants of the neurofeedback group (NFB) received ongoing visual feedback representing the level of fMRI responses within their left PMC. Control (CTL) group participants were shown similar visual stimuli, but these were non-contingent on brain activity. Both groups showed equivalent levels of behavioral ratings on arousal and MI, before and during the fMRI protocol. In the NFB, but not in CLT group, brain activation during the last run compared to the first run revealed increased activation in the left PMC. In addition, the NFB group showed increased activation in motor control regions extending beyond the left PMC target area, including the supplementary motor area, basal ganglia and cerebellum. Moreover, in the last run, the NFB group showed stronger activation in the left PMC/inferior frontal gyrus when compared to the CTL group. Our results indicate that modulation of PMC and associated motor control areas can be achieved during a single neurofeedback-fMRI session. These results contribute to a better understanding of the underlying mechanisms of MI-based neurofeedback training, with direct implications for rehabilitation strategies in severe brain disorders, such as stroke.

Electroconvulsive therapy in obsessive-compulsive disorder: a chart review and evaluation of its potential therapeutic effects

In a chart review of patients with obsessive-compulsive disorder (OCD) attending a university clinic, ECT was prescribed for five subjects (1.2%), only because of severe intervening manic (N=1) or depressive episodes (N=4). Although affective symptoms improved in four of the five patients, OCD symptoms remained unchanged (N=3) or transiently worsened (N=2).

Motor imagery modulation of body sway is task-dependent and relies on imagery ability

In this study we investigate to what extent the effects of motor imagery on postural sway are constrained by movement features and the subject's imagery ability. Twenty-three subjects were asked to imagine three movements using the kinesthetic modality: rising on tiptoes, whole-body forward reaching, and whole-body lateral reaching. After each task, subjects reported the level of imagery vividness and were subsequently grouped into a HIGH group (scores ≥3, “moderately intense” imagery) or a LOW group (scores ≤2, “mildly intense” imagery). An eyes closed trial was used as a control task. Center of gravity (COG) coordinates were collected, along with surface EMG of the deltoid (medial and anterior portion) and lateral gastrocnemius muscles. COG variability was quantified as the amount of fluctuations in position and velocity in the forward-backward and lateral directions. Changes in COG variability during motor imagery were observed only for the HIGH group. COG variability in the forward-backward direction was increased during the rising on tiptoes imagery, compared with the control task (p = 0.01) and the lateral reaching imagery (p = 0.02). Conversely, COG variability in the lateral direction was higher in rising on tiptoes and lateral reaching imagery than during the control task (p < 0.01); in addition, COG variability was higher during the lateral reaching imagery than in the forward reaching imagery (p = 0.02). EMG analysis revealed no effects of group (p > 0.08) or task (p > 0.46) for any of the tested muscles. In summary, motor imagery influences body sway dynamics in a task-dependent manner, and relies on the subject' imagery ability.

Genotype x environment interactions for fatty acid profiles in Bos indicus and Bos taurus finished on pasture or grain

A study was conducted to characterize lipid profiles in the M. longissimus thoracis of commercial Brazilian beef and to assess how those profiles are influenced by finishing system, genetic group, and their interaction. Intramuscular fat (IMF) and fatty acid (FA) profiles were determined in 160 bulls of the Bos taurus (n = 75) and Bos indicus (n = 85) genetic groups, finished on pasture (n = 46) or with grain supplementation (n = 114) and slaughtered in a commercial abattoir. Finishing system had a major impact on the deposition of IMF, as well as on the concentration of SFA, PUFA, and their ratio, but genetic groups showed important differences in the ability to convert SFA into cis-9 MUFA and to convert 16:0 into 18:0. When compared with pasture-finished animals, those finished with grain had greater content of IMF and SFA (P < 0.01), similar amounts of MUFA (P > 0.05), and about one-half the amount of PUFA (P < 0.01). Except for MUFA, differences in FA profiles among finishing systems were mostly mediated through their effect on IMF, even though the relationship of IMF with groups of FA differed among finishing systems. Under grain finishing, B. taurus had less SFA and greater MUFA than B. indicus (P < 0.01), but no differences were observed in PUFA (P > 0.05). With pasture-finishing, no differences were observed among the 2 genetic groups in SFA and MUFA (P > 0.05), but PUFA were decreased in B. taurus (P < 0.01). When genetic groups were compared in grain-finishing, B. taurus had a decreased ability for elongation and B. indicus had a decreased aptitude for desaturation of FA. On the other hand, with pasture-finishing a greater deposition of intermediate FA from ruminal biohydrogenation was observed in B. indicus than in B. taurus. Overall, FA profiles were affected more by finishing system in B. indicus than in B. taurus.

A freezing-like posture to pictures of mutilation

Postural sway and heart rate were recorded in young men viewing emotionally engaging pictures. It was hypothesized that they would show a human analog of "freezing" behavior (i.e., immobility and heart rate deceleration) when confronted with a sustained block of unpleasant (mutilation) images, relative to their response to pleasant/arousing (sport action) or neutral (objects) pictures. Volunteers stood on a stabilometric platform during picture viewing. Significantly reduced body sway was recorded during the unpleasant pictures, along with increased mean power frequency (indexing muscle stiffness). Heart rate during unpleasant pictures also showed the expected greater deceleration. This pattern resembles the "freezing" and "fear bradycardia" seen in many species when confronted with threatening stimuli, mediated by neural circuits that promote defensive survival.

[Food borne disease outbreaks caused by Salmonella enteritidis]

OBJECTIVE

It is to describe outbreaks of salmonellosis reported from July 1993 through June 1997 in the Northwest region of S. Paulo State, Brazil, one of the areas where several foodborne outbreaks of salmonellosis have been recently detected.

METHOD

Data of 19 epidemiological investigations were analysed; 87 stool specimens and 38 food samples (including 12 of shell eggs) were processed for microbiological analysis. Salmonella strains were identified by serotyping, phagetyping and antimicrobial susceptibility testing.

RESULTS

There were 906 ill persons including 295 hospitalized patients. Phage type 4 (PT 4) Salmonella Enteritidis strains were isolated from 80.5% of stool samples, from all food samples and from 41.7% of eggs. Of the outbreaks, 95.7% were associated with the consumption of food containing raw or undercooked eggs. All strains were susceptible to the 13 antimicrobials, except the strains from the nosocomial outbreak.

CONCLUSIONS

The results obtained show the need for the implementation of control measures regarding egg and storage, as well as for guidance to the public as to the risks involved in the consumption of inadequately prepared eggs.

[Prevalence of virus B infection in a hospital community]

The authors studied the prevalence of HBV markers among health care personnel of the University Hospital of the Federal University of Rio de Janeiro. The aim of study was to identify the high risk groups, in order to counsel vaccination of those groups, in order to counsel vaccination of those groups at risk as a routine. As a control group, a group of office workers of the hospital were chosen. A significant difference of incidence of HBV markers, mainly in surgeons (40%) and hemodialysis unit personnel (36.4%) when compared to the control group, was observed (p less than 0.05). The incidence increased with age and the time spent in the profession. The authors concluded that vaccination is indicated in surgeons hemodialysis personnel, dentists and laboratory personnel.

[Hemoglobin levels in school children of São Paulo, Brazil]

Com o objetivo de obter dados para avaliação do estado nutritivo dos escolares, o Serviço de Saúde Escolar da Secretaria da Educação do Estado de São Paulo, Brasil, realizou um inquérito laboratorial, usando como parâmetro a determinação da taxa hemoglobínica numa amostra de 20% dos 2.440 alunos do Grupo Escolar "Leonor Quadros", localizado em um bairro periférico da cidade de São Paulo. O método de exame utilizado constituiu na dosagem fotocolorimétrica da hemoglobina, empregando-se para isto um fotocolorímetro fabricado pelo Laboratório Ames do Brasil S/A. A taxa hemoglobínica média encontrada foi de 13,0 g%, sendo a média masculina de 13,09 g% e a feminina de 12,99g%. As taxas mínimas e máximas foram de 7,5 g% e 17,09 g%. Para melhor ordenação dos resultados, e de acordo com o nível hemoglobínico obtido, os escolares foram divididos em três grupos: o 1.° compreendendo escolares com nível hemoglobínico até 10,99 g%; o 2.º, entre 11,0 g% e 12,99g%, e o 3.°, acima de 13,0%. No primeiro grupo foram encontrados 2,3% dos alunos; no segundo, 36,2%, e no terceiro, 61,4%, verificando-se que 96% dos escolares apresentam nível hemoglobínico na faixa de 11,0 g% e mais. À vista dos resultados obtidos, considerou-se de razoável para bom o estado nutritivo dos escolares examinados.