Cost-Effectiveness of Passion Fruit Albedo versus Turmeric in the Glycemic and Lipaemic Control of People with Type 2 Diabetes: Randomized Clinical Trial.

BACKGROUND: Robust evidence has related yellow passion fruit albedo and long turmeric to the metabolic and glycemic control of diabetes. AIM: To analyze the incremental cost-effectiveness of the flour made from yellow passion fruit albedo versus long turmeric merged with piperine in the glycemic and lipid control of individuals with type 2 diabetes. METHOD: Eighty-nine patients were enrolled in this randomized, placebo-controlled, clinical trial for 120 days. The first group was prescribed 500 mg capsules, three times a day, of yellow passion fruit albedo flour (FAMA). The second group was prescribed long turmeric capsules (500 mg), merged with piperine (5 mg) (CURPI), at fasting. The third group followed the standard advice recommendations, and ingested a placebo of carboxymethyl cellulose (500 mg) at fasting. RESULTS: The group using FAMA showed a higher reduction (-5.9%) of glycemia after fasting, compared to placebo (+9%), and CURPI (-3.2%) (p < 0.05). Regarding HbA1c, the study observed a significant and similar statistical reduction (-0.8%) in the intervention groups, in contrast with the placebo group (p < 0.05). The reduction in HOMA-IR in the CURPI group (-9.4%) was higher than the other groups (p < 0.05). The CURPI group also showed a higher reduction of serum triglyceride levels (-20.8%) compared to the placebo (-0.09%) and FAMA (+1.8%) (p < 0.05) groups. CONCLUSION: It was concluded that turmeric is the most cost-effective in comparison with yellow passion fruit albedo, because of its decrease in the levels of triglycerides and HOMA-IR, even when adjusted for confounding variables. On the other hand, HbA1c cost-effectiveness relation was similar.

Effectiveness of the piperine-supplemented Curcuma longa L. in metabolic control of patients with type 2 diabetes: a randomised double-blind placebo-controlled clinical trial.

There is robust evidence of using Curcuma longa L. in reducing metabolic levels in people with diabetes. This study analysed the effectiveness of Curcuma longa L. in the metabolic control of patients with type 2 diabetes in Brazil. A randomised double-blind placebo-controlled clinical trial was conducted with 71 participants divided into a Curcuma longa L. group (500 mg/day with piperine 5 mg) and a placebo group, for 120 days. Anthropometric, clinical and biochemical variables were evaluated at baseline, 60 and 120 days after the beginning of the intervention. Paired and independent Student's t-test and chi-square test were used for statistical analysis. The curcuma group presented a significantly decreased glycaemia (p=.013), glycated haemoglobin (p=.015), HOMA index (p=.037) and triglycerides (TGs) (p=.002). The use of piperine-added Curcuma longa L. was effective in the glycaemic and TG control of patients with type 2 diabetes.

Telecoaching programme for type 2 diabetes control: a randomised clinical trial.

BACKGROUND:: People with diabetes have a high risk of developing micro and macrovascular complications that increase treatment costs and shorten life expectancy. Telecoaching programmes can improve short-term control of diabetes and reduce disease burden. AIMS:: To analyse the effect of a health telecoaching programme in the control of type 2 diabetes. METHODS:: A pragmatic clinical trial was carried out. Thirty-one patients with type 2 diabetes were divided into control and intervention groups. The control group received usual nursing care, and those in the intervention group received usual care and telecoaching for 24 weeks. FINDINGS:: The intervention group improved: measurements of abdominal circumference, systolic and diastolic blood pressure and body mass index; variables related to glycaemic control (fasting venous glucose and glycated haemoglobin/HbA1c); and high-density lipoprotein levels. CONCLUSION:: The data indicate that telecoaching is an effective tool for diabetes management. It is recommended that the study should be developed to include more people and run over the long term.

[Health indicators associated with poor sleep quality among university students]. / Indicadores de saúde associados com a má qualidade do sono de universitários.

OBJECTIVE: To associate the sleep quality of Brazilian undergraduate students with health indicators. METHOD: A cross-sectional study was developed with a random sample of 662 undergraduate students from Fortaleza, Brazil. The demographic data, Pittsburgh Sleep Quality Index and health data indicators (smoking, alcoholism, sedentary lifestyle, nutritional condition and serum cholesterol) were collected through a self-administered questionnaire. Blood was collected at a clinical laboratory. In order to estimate the size of the associations, a Poisson Regression was used. RESULTS: For students who are daily smokers, the occurrence of poor sleep was higher than in non-smokers (p<0.001). Prevalence rate values were nevertheless close to 1. CONCLUSION: The likelihood of poor sleep is almost the same in smokers and in alcoholics.


Consumption of food markers of a healthy diet according to racial groups of women in Brazil. / Consumo de alimentos marcadores de uma alimentação saudável, segundo os grupos raciais de mulheres no Brasil.

This article aims to analyze the consumption of healthy food consumption markers, according to racial groups of Brazilian women interviewed in the 2019 National Health Survey (NHS). This work was a cross-sectional study with data from 45,148 white and black women, aged ≥ 20 years. The variables used were the consumption of fruits, vegetables and legumes, beans, and fish. The association between color/race and the dietary intake indicators was tested using crude Poisson regression and adjusted to estimate prevalence ratios and 95% confidence intervals (95%CI). The prevalence of the consumption of fruits and vegetables was statistically higher among white women, while fish and beans was higher among black women. After adjusting for socioeconomic and demographic variables, it was found that black women remained only less likely to consume fruit (PR = 0.91; 95% CI: 0.88-0.95) and only more likely to consume beans (PR = 1.07; 95% CI: 1.04-1.10) than whites. There were racial inequalities for the consumption of healthy foods among Brazilian women, indicating that color/race defined a dietary pattern for black women that put them in vulnerable conditions in terms of fruit consumption.

O objetivo do artigo é analisar o consumo de alimentos marcadores de uma alimentação saudável, segundo os grupos raciais de mulheres brasileiras entrevistadas na Pesquisa Nacional de Saúde 2019. Estudo transversal com dados de 45.148 mulheres brancas e negras de ≥ 20 anos de idade. Os marcadores utilizados foram o consumo de frutas, verduras e legumes e feijão e peixe. A associação de cor/raça com os indicadores de consumo alimentar foi testada por regressão de Poisson bruta e ajustada para estimar razões de prevalência e intervalo de confiança de 95%. A prevalência do consumo de frutas, verduras e legumes foi estatisticamente maior nas brancas, e o de peixes e feijão foi maior nas negras. Após o ajuste pelas variáveis socioeconômicas e demográficas, verificou-se que mulheres negras permaneceram apresentando menores chances apenas de consumir frutas (RP = 0,91; IC95%: 0,88-0,95) e maior somente de consumir feijão (RP = 1,07; IC95%: 1,04-1,10) do que as brancas. Verificaram-se desigualdades raciais para o consumo de alimentos saudáveis entre mulheres brasileiras, indicando que a cor/raça definiu um padrão alimentar para as mulheres negras que as colocam em condições vulneráveis em grande parte do consumo de frutas.

Drug interactions in Brazilian type 2 diabetes patients.

The aim of this paper is to identify the prevalence of the most frequent drug interactions in patients using oral antidiabéticos and their association with capillary glucose and medication adherence. In total, 579 type 2 diabetes mellitus patients from 12 health institutions in Fortaleza, Brazil were interviewed in 2009. A form was applied, including questions on medication use, comorbidities, lifestyle, body mass index and random capillary glucose. Results revealed that 26.7% used five or more different drugs simultaneously and daily. Statistically significant drug interactions occurred between antidiabéticos and diuretics, angiotensin-converting enzyme inhibitors, anti-lipidaemics and corticoids. No significant association was found between polypharmacy, medication adherence and glucose. It is important for nurses, in consensus with other health professionals, to consider the possibility of other drugs that mean less risk for diabetes patients' glucose control or of increased antidiabetics doses.

[Correlation between anthropometric indicators and sleep quality among Brazilian university students]. / Correlação entre indicadores antropométricos e a qualidade do sono de universitários brasileiros.

The current study investigated the correlation between anthropometric indicators and sleep quality among Brazilian university students using the Pittsburgh Sleep Quality Index. A cross-sectional assessment with 702 university students was conducted between March 2010 and June 2011. Results showed that cases of obesity were more frequent among students who were good sleepers. On the other hand, overweight and high cervical and abdominal circumference was most prominent among poor sleepers. Thus, apart from the damage caused by sleep disorders alone, additional risks due to the association between poor sleep quality and being overweight, central obesity, and increased cervical perimeter are highlighted.

Effectiveness of cinnamon in the reduction of lipid levels in people with diabetes: a randomized clinical trial.

OBJECTIVE: To evaluate the effectiveness of cinnamon in reducing lipid levels in people with diabetes. METHOD: Randomized clinical trial of parallel groups, triple-blind, conducted in Basic Health Units in the state of Piauí in 2019. People with Type 2 Diabetes Mellitus, between 18 and 80 years old, using oral antidiabetics, were included, and divided into two groups. The experimental group tested 3g of cinnamon for 90 days. RESULTS: 140 people participated in the study. From these, the experimental group (n= 71) showed a reduction in mean levels of total cholesterol (p= 0.316 | CI 95% -24.9-8.1), LDL (p= 0.024 | CI 95% -29.3 -2.1) and triglycerides (p= 0.969 | 95% CI -28.6-27.5), and increased HDL (p= 0.001 | 95% CI 4.2-10.2). CONCLUSION: The use of 3g of cinnamon per day, for 90 days, seems to help reduce LDL values and increase HDL levels in patients with diabetes.

Glycemic outcomes of people with diabetes mellitus in Brazilian primary health care.

Background: The capillary blood glucose monitoring program at home a challenge in primary health care. Therefore, it is fundamental to identify the glycemic control of people with diabetes mellitus through HBA1c and to analyze its associated factors. Objective: To identify the glycemic profile of people with Diabetes Mellitus (DM) through HbA1c and analyze factors associated. Materials & methods: Cross-sectional study developed in Ribeirão Preto, São Paulo, Brazil. Secondary data from the electronic health record of people registered in the Primary Health Care system were used. A sample of 3181 participants was obtained. People with HbA1c < 7.0% (53 mmol/mol) were considered to have adequate glycemic control. For people aged ≥ 55 years, a less stringent target, < 8.0% (64 mmol/mol), was also considered. The odds ratio was the measure of effect analyzed with their respective 95% Confidence Intervals (95% CI). Results: Adequate glycemic control with HbA1c < 7.0% (53 mmol/mol) was found in 44.8% of people and, when using the less rigid target, HbA1c < 8.0% (64 mmol/mol) for people aged ≥ 55 years-old, 70.6% had adequate glycemic control. Age and drug therapy were associated with adequate glycemic control (p < 0.001), which was more frequent among older people and those who used only metformin. Conclusion: The study shows that the achievement of adequate glycemic control is still a challenge, especially with regard to younger people and those who use insulin.

Bolus versus continuous insulin infusion in immediate postoperative blood glucose control in liver transplantation: pragmatic clinical trial.

OBJECTIVE: To analyze the effectiveness and safety of two insulin therapy techniques (continuous and intermittent infusion) in the blood glucose control of people who have undergone liver transplantation, in the immediate postoperative period. METHODS: The study was a prospective, open, pragmatic clinical trial with 42 participants, divided into two groups of 21 patients each, in the immediate postoperative period following liver transplantation. Participants in the Experimental Group and Control Group received continuous infusion and bolus insulin, respectively, starting at capillary blood glucose ≥150mg/dL. RESULTS: There were no statistically significant differences in the blood glucose reduction time to reach the target range between the Experimental Group and Control Group in the transplanted patients (p=0.919). No statistically significant differences regarding the presence of low blood glucose (p=0.500) and in the initial blood glucose value (p=0.345) were found. The study identified the final blood glucose value in postoperative intensive care unit lower and statistically significant in the continuous infusion pump group in relation to the Bolus Group (p<0.001). Additionally, the variation of blood glucose reduction was higher and statistically significant in the continuous method group (p<0.05). CONCLUSION: The continuous infusion method was more effective in the blood glucose control of patients in the postoperative period following liver transplantation. BRAZILIAN REGISTRY OF CLINICAL TRIALS: RBR-9Y5tbp.

Efficacy of Cinnamon as an Adjuvant in Reducing the Glycemic Biomarkers of Type 2 Diabetes Mellitus: A Three-Month, Randomized, Triple-Blind, Placebo-Controlled Clinical Trial.

The major aim of this randomized, placebo-controlled, triple-blind clinical trial was to evaluate the efficacy of cinnamon as an adjuvant treatment in reducing glycemic levels in people with type 2 diabetes, compared to a placebo. The study was conducted between August and December 2019, with 160 people with type 2 diabetes, in five Primary Health Units, in Parnaíba, Brazil. Inclusion criteria were: persons of both genders using oral antidiabetic agents, with glycated hemoglobin ≥ 6.0%, and between 18 and 80 years of age. The primary outcome was change in glycated hemoglobin levels after 90 days of intervention. Other biomarkers evaluated were fasting blood glucose, insulin level, and HOMA-IR index. Participants were divided equally into two groups of 80 individuals each, and were given 3 g capsules of either cinnamon or placebo to be taken in combination with their usual oral antidiabetic agents. After 90 days, participants in the cinnamon group had statistically significant reductions of 0.2% of glycated hemoglobin and 0.55 mmol/L of fasting venous glucose, when compared with the placebo group. Cinnamon reduced the glycemic measures of persons with type 2 diabetes, albeit with modest reductions. TRIAL: RBR-2KKB6D.

[Nursing interventions for stroke patients: an integrative literature review]. / Intervenções de enfermagem aos pacientes com acidente vascular encefálico: uma revisão integrativa de literatura.

The objective of this study was to analyze the knowledge on nursing interventions for hospitalized stroke patients. An integrative literature review was performed by accessing five online databases, in September 2009. The descriptors used in the search were nursing care and stoke, in Portuguese, English and Spanish. A total 223 articles were found, and 12 were selected. It was found in the articles that there was a greater number of clinical nursing interventions, followed by educational, managerial and research interventions. Clinical interventions are more related to the biological aspects of patients. As to the educational interventions, the articles point at the fundamental role of nurses, as well as that of relatives and caregivers. The main managerial intervention was the coordination of health care. As for research interventions, only one was identified and described as the development and improvement of health care practice through clinical evidence.

Development and validation of a MHEALTH technology for the promotion of self-care for adolescents with diabetes. / Desenvolvimento e validação de uma tecnologia MHEALTH para a promoção do autocuidado de adolescentes com diabetes.

Self-care is encouraged in the type 1 Diabetes Mellitus (DM1) setting. Thus, this research aimed to develop and validate a mobile application (APP) to promote self-care for adolescents with DM1. The method was divided into two stages: development and validation, ranging from literature review, benchmarking, prototype construction to validation by specialists. The APP construction was subsidized by the seven steps proposed by the American Association of Diabetes Educators. The screens were designed and possible functions were selected. After the design, the APP prototype was developed and named "DM Agendinha". The content validation process was mediated by the Suitability Assessment of Materials tool, where the percentage obtained was 85.3%, characterizing the APP as "Superior Material". The Smartphone Usability questionnaire was employed for technical validation, and the APP reached a global Content Validity Index of 0.96. We concluded, therefore, that the use of this material by adolescents will favor the acquisition of new knowledge and adherence to healthy practices, considering that it is a highly intelligible electronic technology.

No cenário do Diabetes Mellitus tipo 1 (DM1), uma prática incentivada é o autocuidado. Dessa forma, objetivou-se elaborar e validar um aplicativo móvel (APP) para a promoção do autocuidado em adolescentes com DM1. O método foi divido em duas etapas: elaboração e validação, que vão desde a revisão de literatura, benchmarking, construção do protótipo e validação por especialistas. A construção do APP foi subsidiada pelos sete passos propostos pela American Association of Diabetes Educators. Foram desenhadas as telas e selecionaram-se as possíveis funções; após o desenho, o protótipo do APP foi desenvolvido e nomeado como "DM Agendinha". O processo de validação de conteúdo foi mediado pelo instrumento Suitability Assessment of Materials, por meio do qual o percentual obtido foi de 85,3%, caracterizando o APP como "Material Superior". Para a validação técnica, empregou-se o questionário Smartphone Usability questionnaire, que obteve um Índice de Validade de Conteúdo global de 0,96. Conclui-se, portanto, que o uso desse material por parte dos adolescentes favorecerá a aquisição de novos conhecimentos e a adesão de práticas saudáveis, tendo em vista que se trata de uma tecnologia de caráter eletrônico e de fácil compreensão.

Risk factors for type 2 diabetes mellitus in children.

This study investigates risk factors for type 2 diabetes mellitus in a population of children in public schools, Fortaleza, CE, Brazil. A total of 727 children aged 6 to 11 years old from 12 schools were evaluated between March and June 2008. A form addressing socio-demographic data, body mass index, blood pressure, capillary blood glucose and waist circumference was applied. A total of 54.1% of the children were female, 21.7% were overweight, 6.6% were obese, 27% had central obesity, 6.2% showed altered capillary glucose, and 17% high blood pressure. In relation to risk factors, 53.4% presented no risk factors; 24.3% had at least one factor and 18.8% two risk factors. Nurses can intervene in schools through educational health programs encouraging the adoption of healthy habits and identifying children at risk of type 2 diabetes mellitus.

[Scales to preventive behavior measures in adolescent girls in the face of STD/HIV: an integrative review]. / Escalas para medida de comportamento preventivo em meninas adolescentes frente às DST/HIV: revisão integrativa.

Since the dawn of the AIDS epidemic in the international epidemiological scenario, prevention of transmission of HIV among women and adolescents has been one of the biggest challenges in controlling the disease. Through integrative review, this study aims to describe the studies that used validated scales in order to access behaviors of female adolescents facing the prevention of sexually transmitted diseases. Two databases were used for the selection of articles: PubMed, a digital file produced by the National Library of Medicine and the Cumulative Index to Nursing and Allied Health Literature (CINAHL); the sample consisted of seven items. The scales indicate that health professionals must recognize the interactions among peers, partners and parents to assess the vulnerability of adolescents and encourage the use of reliable tools for nursing practice in the prevention of these diseases.

[Risk factors for type 2 diabetes mellitus among adolescents]. / Fatores de risco para diabetes mellitus tipo 2 entre adolescentes.

The objective of this study was to identify risk factors for type 2 diabetes (DM2) in a population of private schools adolescents of Fortaleza-Brazil. A total 794 students aged 12 to 17 years, from 12 schools, were evaluated in the months of May, June, August and September 2007. A form was applied approaching sociodemographics aspects, BMI, blood pressure, capillary glycemia and sedentary lifestyle. Approximately 24% of the participants had high BMI, 65% were sedentary and 51% had family history of DM2. In those with larger income, 73.5% had family history of DM2 (p = 0.04). About 39% of the adolescents had at least two risk factors for DM2. Most of the risk factors for DM2 identified in this study are changeable, therefore, susceptible to preventive interventions in the school setting.

[Overweight among adolescents from private schools in Fortaleza, CE, Brazil]. / Sobrepeso entre adolescentes de escolas particulares de Fortaleza, CE, Brasil.

The purpose of the study was to identify cases of overweight among adolescents in private schools in Fortaleza, Brazil. We investigated 794 students between 12 and 17 years old from 12 private schools, in the months March to June and August-September 2007. The prevalence of overweight and obesity was 20% and 4%, respectively. Among the young people who watch TV while eat, the weight accumulated was higher and the cases of obesity was the double (p = 0, 000). About 28% of people who practiced regular physical activity were overweight (p <0, 001). In the fight against adolescent adiposity, to the nursing is primarily the preventive actions, because attenuate various pathological effects related to the accumulation of body weight.

[Physical activity practice by adolescents from Fortaleza, CE, Brazil]. / Prática de atividade física por adolescentes de Fortaleza, CE, Brasil.

It aimed to learn the daily habits related to the physical activity practice among private state schools adolescents in Fortaleza-Brazil. We investigated 307 students between 12 and 17 years old from six private schools, in the months March to June 2007. We applied a form which recorded sedentarism, BMI, blood pressure and blood glucose. The chi-squared test was used for to analysis the proportions. About 68% of young people were sedentary. The sedentarism was higher in females surveyed (p=0, 000) and those with over-weight (p=0,001). Among adolescents active exercise was the most practiced football (42%) and weights (19%). The health education in schools can assist in combating the sedentarism of the adolescents.

Effectiveness of ginger in reducing metabolic levels in people with diabetes: a randomized clinical trial.

OBJECTIVE: to evaluate the effectiveness of ginge (Zingiber officinale) in reducing blood sugar and lipid levels in people with type 2 diabetes. METHOD: a randomized and double-blind clinical trial conducted with people with type 2 diabetes in primary care facilities. The study included individuals aged between 20 and 80 years old, using oral antidiabetic drugs and with HbA1c levels between 6.0% and 10%. The participants were paired 1:1, allocated in two distinct groups, and randomized in blocks, based on their HbA1c levels. In the experimental group, the participants used 1.2g of ginger and, in the control group, 1.2g of placebo, daily for 90 days. The primary outcome was a reduction in fasting blood sugar and HbA1c, and the secondary outcome was a reduction in lipids and HOMA-IR. 103 individuals completed the study, 47 in the experimental group and 56 in the control group. RESULTS: the participants in the experimental group showed a greater reduction in the blood glucose and total cholesterol values compared to the control group. CONCLUSION: the use of ginger can help in the treatment of people with diabetes, and data support the inclusion of this herbal drug in the clinical practice of nurses. RBR-2rt2wy.

Assessment of access to first contact in the perspective of professionals.

OBJECTIVES: to evaluate the "access to first contact" attribute, from the perspective of Primary Care Health professionals. METHODS: an evaluative and cross-sectional study, carried out from February to March 2017. The sample consisted of 163 health professionals, of both genders, who worked in the basic care of the Municipality of Juazeiro do Norte, Ceará. Access to first contact was evaluated by the Primary Care Assessment Tool (PCATool). The 6.60 mark was used as the cut-off point for the evaluated attribute. RESULTS: access to first contact reached a score of 3.3, denoting a low degree of orientation for Primary Health Care. Nurses were the ones who evaluated the attribute more negatively (p=3.2). CONCLUSIONS: access to first contact obtained a low score, pointing to the fragility of the Family Health Strategy as a gateway to the Brazilian Unified Health System (Sistema Único de Saúde).