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Leisure plays a key role in supporting psychological, social and emotional well-being in later life. This paper aims to explore the relationship between leisure, place and income from the perspectives of older adults in the UK and Brazil and how older adults’ participation in leisure supports the development of sense of place within their communities. The data presented in the paper was gathered through a case study approach involving three cities in Brazil (Pelotas, Belo Horizonte e Brasília) and three in the UK (Edinburgh, Manchester and Glasgow). The findings draw upon qualitative data collected through the following research methods: face-to-face interviews, go-along interviews and photo diaries. The results have shown the low-income neighbourhoods studied both in Brazil and the UK are likely to have less leisure opportunities which tend to be provided by facilities such as CRAS (Reference Centre for Social Assistance) and communities centres. The lack of leisure opportunities particularly in low-income areas can negatively impact on the way older adults experience the sense of place within their neighbourhoods.

Oesophageal cancer is among the ten most common types of cancer worldwide. More than 80% of the cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of oesophageal and oesophagogastric junction (OGJ) carcinomas. The Brazilian Group of Gastrointestinal Tumours invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy (including checkpoint inhibitors) and follow-up, which was followed by presentation, discussion and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of oesophageal and OGJ carcinomas in several scenarios and clinical settings.

Spontaneous coronary artery dissection is an uncommon cause of myocardial ischemia. Although the first description dates from 1931, its diagnosis is sometimes made late and/or erroneously due to the lack of knowledge of its non-pathognomonic angiographic variations. Additionally, the proper management of this condition is not yet well established. Here we present a rare case of in-hospital recurrence of spontaneous dissection affecting both the left anterior descending and circumflex coronary arteries, with distinct clinical presentations. In-hospital recurrent spontaneous coronary [...]

RESUMO Introducao: A intervencao coronaria percutânea (ICP) em arterias de fino calibre corresponde a 30 a 40% dos procedimentos terapeuticos invasivos, e exibe taxas elevadas e persistentes de reestenose, a despeito da evolucao dos dispositivos empregados. O objetivo deste estudo foi avaliar a evolucao do perfil desta modalidade terapeutica no Brasil nos ultimos 10 anos. Metodos: Foram incluidos 24.895 pacientes do registro da Central Nacional de Intervencoes Cardiovasculares (CENIC) submetidos a 25.892 procedimentos com pelo menos um stent com diâmetro [...]

Background Risk stratification using scores is a valuable tool in cardiogenic shock after ST elevation myocardial infarction (STEMI). During pharmacoinvasive therapy (PIT) their use is unexplored in the literature. Objective: To validate the IABP-SHOCK II (Intra-aortic Balloon Pump in Cardiogenic Shock) score in patients treated with PIT and to analyze the influence of ischemia time on the different risk strata. Methods and results Of 2,143 STEMI patients seen between May 2010 and April 2017, 212 (9.9%) developed cardiogenic shock. Thirty-one patients (14.6%) with incomplete data were excluded from the analysis and the validation cohort included the remaining 181. Mortality rates were similar between the analyzed and excluded patients (42.5% and 45.1% respectively, p=0.77). The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62), and 76% for high-risk (n=25) (p 30-day mortality in scored strata Conclusion In patients with cardiogenic shock after STEMI treated with PIT, risk stratification using the IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterization times on the ability to the score model stratification.

Our goal was evaluate if cardiologists and their team are compromising with radiation protection. This survey intends to support a study about eyes lens opacity, also realized at SOLACI/2016-RJ-Brazil. An questionary about work conditions in cathlab, individual and colletive radioprotection, was applied for 127 professionals, being 95 cardiologists from several regions of Brazil, by means of personal interview. Among the responses, 38% said performed 50 procedures mensally while 43.7% between 50 and 100. Among them, 33.9% perform catheterims (CAT) and percutaneous coronary intervention (PCI), and 37% CAT, Ventriculography and Coronary Artery Bypass Graft. Around 70% of professionals reported that they have been working for more than 10 years and most have answered that they routinely use protective tools such as lead apron and thyroid shield. Cardiologists answered that they did not routinely wear lead glasses (46%) and a suspended ceiling shield (33%). In general, they justified that the glasses do not fit perfectly on face. Around 27.6% answered that the radiologic equipment don’t have protective side shields. We verify that 39.4% have never received a formal training in radioprotection. We estimated that 63.8% wear dosimeters over the apron at chest level for personal doses control. The professionals reported that they work in public and private institutions and 28.6% reported working in more than two services. About 52.8% associate the use of lead aprons with acquired ergonomic diseases. We conclude that strategies should be established to reinforce radiological protection practice and to guarantee better protection conditions for Cathlab professionals.

Introduction Atherosclerotic disease accounts for one-third of deaths annually, as it often leads to complications such as ST-elevation myocardial infarction (STEMI). Rescue percutaneous coronary intervention (PCI) is indicated in case of thrombolytic therapy failure administered in this scenario. However, the benefits regarding mortality rate reduction and the amount of myocardium that is actually salvaged are not well established. The development of new tools, including cardiac magnetic resonance imaging, to identify the myocardium at risk and the infarcted area has increased diagnostic accuracy. Differently from the context of primary PCI, little is known about the association between epicardial and microvascular coronary flow following rescue PCI and the salvaged myocardial area. The aim of this study is to evaluate whether there is an association between coronary flow and the salvaged myocardial area identified by magnetic resonance imaging. Methods This will be a prospective, open, single-center, intervention study. A total of 72 patients with STEMI who underwent rescue PCI after documented failure of the fibrinolytic therapy, and were transferred to our institution, will be selected, observing a pharmacoinvasive strategy. Conclusions At the end of this study, the authors expect to contribute to the knowledge about coronary flow and its association with the amount of salvaged cardiac muscle after rescue PCI. This type of information that can help to understand which cases can benefit the most from rescue PCI.

RESUMO Introducao A doenca aterosclerotica e responsavel por um terco dos obitos ocorridos anualmente, pois frequentemente leva a complicacoes como infarto do miocardio com supradesnivelamento do segmento ST (IMCST). A intervencao coronaria percutânea (ICP) de resgate e indicada caso ocorra falha da terapia trombolitica administrada neste cenario. No entanto, os beneficios, em termos de reducao da taxa de mortalidade e da quantidade de miocardio efetivamente salvo, nao sao bem estabelecidos. O desenvolvimento de novas ferramentas, entre elas a ressonância magnetica cardiaca, para identificar a area miocardica em risco e infartada, elevou a acuracia diagnostica. Diferentemente do contexto da ICP primaria, pouco se sabe sobre a relacao entre o fluxo coronario epicardico e microvascular apos a ICP de resgate e a area de miocardio salva. O objetivo deste estudo e avaliar se existe relacao entre tais fluxos e a area de miocardio salva identificada pela ressonância magnetica. Metodos Estudo prospectivo, aberto, unicentrico, de intervencao. Serao selecionados 72 pacientes com IMCST que tiverem realizado ICP de resgate apos falha documentada da terapia fibrinolitica transferidos para este servico, obedecendo uma estrategia farmaco‐invasiva. Conclusoes Ao termino desta pesquisa, esperamos contribuir para o conhecimento sobre o fluxo coronariano e sua relacao com a quantidade de musculo cardiaco salvo apos a ICP de resgate. Esta e uma informacao que pode ajudar a entender quais casos mais se beneficiam da ICP de resgate.

Pharmacoinvasive strategy in STEMI pts is an acceptable approach in situations in which primary percutaneous coronary intervention (pPCI) is not available. Nonetheless, fibrinolysis failure occurs in approximately 1/3 of pts. The mechanisms underlying fibrinolysis failure are poorly understood but

Data regarding operator radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study sought to compare operator and patient radiation exposure during PCI with radial versus femoral access. This

ST elevation acute myocardial infarction (STEMI) and recent use of thrombolytics are risk factors for complications related to catheterism, especially in the femoral access. Our goal is to analyze predictors of major complications due to this invasive procedure in patients with STEMI undergoing

The pharmaco-invasive therapy (PIT) is an effective alternative in patients with acute ST-segment elevation myocardial infarction (STEMI), when primary percutaneous coronary intervention (PCI) is not available in a timely manner. One of the most feared complications of the use of fibrinolytics prior

Auto antigens such as oxidized LDL have been implicated as atherogenic agents found in atheromatous lesions. It has not been observed whether percutaneous coronary intervention (PCI) can modulate the natural or adaptive humoral immune response to auto antigens according to the degree of