Synthesis of TiO2 graphene oxide-based material for textile effluent decontamination: characterization, kinetic, and mechanism studies.

In this work, a hydrothermal method was proposed to fabricate a nanomaterial composed of titanium dioxide and graphene oxide (10 wt%) (TiO2-GO). The GO was synthesized according to the modified Hummers and Offeman method, followed by exfoliation. Several characterization analyses were performed in order to investigate the structure, functional groups, and elemental composition of the nanomaterial. XRD analysis showed that the presence of GO does not change the crystalline structure of TiO2. FTIR evidenced the characteristic peaks present in both precursor materials (TiO2 and GO) and EDX confirmed the presence of GO on the TiO2-GO material. The nanomaterial was used as a photocatalyst in the TWW treatment, where the color and COD removal and the decrease of the characteristic peaks presented in the UV-Vis spectrum were investigated. The dosages of TiO2-GO and pH were studied to find the optimum operating condition. The results revealed that 0.5 g of photocatalyst with an initial pH of 3 achieve the best results under UV-A radiation. The kinetic test shows a COD removal of 87% after 90 min. The reuse test shows a decrease in COD removal after four cycles attributed to the deposition of some oxidized compounds on the catalyst surface. Finally, the efficiency of the photocatalyst was evaluated under solar radiation and it was shown that despite the good results, the performance of the TiO2-GO was better under UV-A radiation.

The effect of probiotics on the clinical status of adult patients with atopic dermatitis: a systematic review.

OBJECTIVES: To describe, through a literature review, the results and benefits of oral and topical probiotics for adult patients with atopic dermatitis. DESIGN: A systematic review of articles published over a 13-year period was conducted to answer the following questions: (1) what information is given in the scientific literature concerning the use of probiotics in adult patients with atopic dermatitis? (2) Was there an improvement in the clinical status of the patients? (3) Was there a change in the microbial profile in patients after using such approaches? (4) Among the probiotics used, which was the most used in adult AD patients? (5) What was the average time of these interventions? (6) What were the outcomes? RESULTS: Seven studies with different sample sizes, ranging from 16 to 109 patients, were included in this review. These studies were all clinical trials (7/7), and probiotics (7/7) was the model of intervention chosen. Probiotics showed a potential to relieve the symptoms of the study groups with a reduction of pruritus and SCORAD when compared to the placebo groups. However, their effectiveness varied according to the strain, period, and form of administration. CONCLUSIONS: Many studies have demonstrated that probiotics improve the symptoms of atopic dermatitis and even its prevention. However, there is still much controversy and divergence concerning the real benefits. Despite this, probiotics have demonstrated a fair ability in improving AD adult patients' symptoms in terms of decreasing pruritus and severity related to SCORAD.

O consumo de substâncias psicoativas entre pessoas idosas: um olhar complexo / The consumption of psychoactive substances among older adults: a complex perspective / El consumo de sustancias psicoactivas en personas mayores: una mirada compleja

OBJETIVO: descrever o padrão de consumo de substâncias psicoativas entre pessoas idosas sob a ótica da complexidade. Método: qualitativo do tipo estudo de caso múltiplo, realizado com onze pessoas idosas no domicílio/serviço de saúde; os dados foram coletados através de documentos, observação assistemática e entrevista semiestruturada; foram analisados de forma geral, analítica e teórica por meio da comparação dos casos; teve como eixo teórico a complexidade, sendo aprovado pelo comitê de ética em pesquisa. RESULTADOS: quanto ao padrão de consumo de substâncias psicoativas foram achados dois temas: encontro com a substância, que identificou pessoas idosas utilizando substâncias lícitas e ilícitas, e formas de consumo; consequências e motivações do consumo e/ou abandono das drogas. São consequências as perdas materiais/econômicas e criminalidade e motivações a socialização e fuga do estresse/ansiedade. Os idosos que pararam ou diminuíram o consumo aderiram à estratégia de redução de danos. CONCLUSÃO: evidenciou-se o consumo de substâncias psicoativas por pessoas idosas, verificando-se espaço para o sucesso de intervenções de saúde/enfermagem com a criação de ações/programas de abordagem específica para redução de danos.

OBJECTIVE: to describe the pattern of consumption of psychoactive substances among older adults from the perspective of complexity. METHOD: a qualitative survey of the multiple-case study type, carried out with eleven older adults at their homes and/or at a health service; data was collected through documents, unsystematic observation and semi-structured interview; they were analyzed in a general, analytical and theoretical way by comparing the cases; its theoretical axis was complexity, being approved by the research ethics committee. RESULTS: regarding the pattern of consumption of psychoactive substances, two themes were found: encounter with the substance, which identified older adults using legal and illegal substances, and forms of consumption; consequences and motivations of drug use and/or abandonment. Consequences are material/economic losses and crime, and motivations for socialization and escape from stress/anxiety. The older adults who stopped or reduced their consumption adhered to the harm reduction strategy. CONCLUSION: the consumption of psychoactive substances by older adults was evidenced, with space for the success of health/nursing interventions, with the creation of actions/programs with a specific approach to harm reduction.

OBJETIVO: describir el patrón de consumo de sustancias psicoactivas en personas mayores desde la perspectiva de la complejidad. MÉTODO: estudio cualitativo, de tipo caso múltiple, realizado con once ancianos en el domicilio/servicio de salud; los datos se recopilaron a través de documentos, observación no sistemática y entrevista semiestructurada; se analizaron de forma general, analítica y teórica comparando los casos; su eje teórico fue la complejidad, siendo aprobado por el comité de ética en investigación. RESULTADOS: en cuanto al patrón de consumo de sustancias psicoactivas, se encontraron dos temas: contacto con la sustancia, que identificó a personas mayores que consumen sustancias legales e ilegales, y formas de consumo; consecuencias y motivaciones del consumo y/o abandono de las drogas. Las consecuencias son pérdidas materiales/económicas y delitos, y motivaciones para socializar y escapar del estrés/ansiedad. Las personas mayores que suspendieron o disminuyeron su consumo se adhirieron a la estrategia de reducción de daños. CONCLUSIÓN: se evidenció el consumo de sustancias psicoactivas por los adultos mayores, con espacio para el éxito de las intervenciones de salud/enfermería, con la creación de acciones/programas con un enfoque específico de reducción de daños.

Perfil de crianças atendidas em um serviço de urgência e emergência no sul do Brasil / Perfil de niños atendidos en un servicio urgencias y de emergencias en sur de Brasil / Profile of children treated at an urgent and emergency service in southern Brazil

Objetivo: investigar o perfil e os principais motivos de atendimento de crianças até 12 anos incompletos em um serviço de Urgência e Emergência. Método: pesquisa quantitativa, realizada em 1.800 fichas de protocolo de Classificação de Risco de crianças atendidas por um serviço de urgência e emergência. Os dados foram coletados por meio de um instrumento estruturado, digitados no programa Excel® e analisados por meio de estatística descritiva. Resultados: a maioria das crianças atendidas era do sexo masculino (53,5%) e tinham entre zero e dois anos (39,3%). A Classificação de Risco mais prevalente foi a verde (81,1%), seguida da amarela (15,8%) e vermelha (3,1%). Os motivos de busca por atendimento mais frequentes foram febre (45,1%) e tosse (13,9%). Conclusões: é imprescindível orientar a população e organizar os serviços de atenção básica para que as condições passíveis de tratamento nestes serviços não gerem sobrecarga aos serviços de urgência e emergência.(AU)

Objective: to investigate the profile and the main reasons for attending children up to 12 years old in an Urgency and Emergency service. Method: quantitative approach, carried out on 1,800 risk classification protocol sheets of children attended by an urgent and emergency service. The data were collected using a structured instrument, typed in the Excel® program and analyzed using descriptive statistics. Results: most of the children attended were male (53,5%) and were between zero and two years old (39,3%). The most prevalent Risk Rating was green (81,1%), followed by yellow (15,8%) and red (3,1%). The most frequent reasons for seeking care were fever (45,1%) and cough (13,9%). Conclusions: it is essential to guide the population and organize primary care services so that the conditions that can be treated in these services do not create an overload on urgent and emergency services.(AU)

Objetivo: investigar el perfil y las principales razones para atender a niños de hasta 12 años en un servicio de Urgencia y Emergencia. Método: investigación cuantitativa, realizada en 1800 fichas de protocolo de clasificación de riesgo de niños atendidos por un servicio de urgencia y emergencia. Los datos fueron recolectados usando un instrumento estructurado, ingresados en el programa Excel® y analizados usando estadísticas descriptivas. Resultados: la mayoría de los niños atendidos eran varones (53,5%) y tenían entre cero y dos años (39,3%). La calificación de riesgo más prevalente fue la verde (81,1%), seguida de la amarilla (15,8%) y la roja (3,1%). Los motivos más frecuentes de consulta fueron fiebre (45,1%) y tos (13,9%). Conclusiones: es fundamental orientar a la población y organizar los servicios de atención primaria para que las condiciones que se puedan tratar en estos servicios no generen una sobrecarga en los servicios de urgencia y emergencia.(AU)

Coronavirus Disease 2019: Quick Diet and Nutrition Guide for Patients With Chronic Kidney Disease.

Considering the Covid-19 pandemic and that patients with CKD are included in a high-risk group, a quick nutrition guide for patients with CKD in all stages was developed, and it is available in Portuguese at https://bit.ly/2zfSjl0, in English at https://bit.ly/covid19ckd, in Spanish at https://bit.ly/guia enfermedad renal and in French at https://bit.ly/covid19maladierenale.

Agreement between self-assessment of body image and measured body mass index in the Brazilian adult population.

Silhouettes are used in the self-assessment of one's body size, shape and satisfaction. This technique can be helpful in intervention studies and in household studies in which body size measurements are not feasible. Despite its popularity, few studies have validated the Stunkard Figure Rating Scale (SFRS) to assess body image (BI) or nutritional status (NS). The present study assessed the agreement between self-assessment of BI by SFRS and measured BMI in adults from a national household survey in Brazil (n = 11247; 57.2% women, aged 20-99y). The subjects were asked to choose a silhouette from the SFRS that most resembled their current status prior to measures of body mass and stature. BMI-derived NS was then matched to the SFRS. The prevalence of overweight and obesity (OB) was 34.4 and 19.0%, respectively. Weighted kappa between SFRS and BMI was 0.45 and 0.43 and Spearman's correlation coefficient was 0.64 and 0.59 for women and men, respectively. Sex-specific receiver operating curves indicated that the silhouettes correctly (area under the curve > 0.80) identified OB and underweight (UW). In conclusion, SFRS provides only reasonable results when estimating the BMI distribution but it works well to identify OB and UW in the Brazilian adult population.

Red meat intake in chronic kidney disease patients: Two sides of the coin.

Red meat is an important dietary source of high biological value protein and micronutrients such as vitamins, iron, and zinc that exert many beneficial functions. However, high consumption of animal protein sources, especially red meat, results in an increased intake of saturated fat, cholesterol, iron, and salt, as well as an excessive acid load. Red meat intake may lead to an elevated production of uremic toxins by the gut microbiota, such as trimethylamine n-oxide (TMAO), indoxyl sulfate, and p-cresyl sulfate. These uremic toxins are associated with increased risk for cardiovascular (CV) mortality. Limiting the intake of red meat in patients with chronic kidney disease (CKD) thus may be a good strategy to reduce CV risk, and may slow the progression of kidney disease. In the present review, we discuss the role of red meat in the diet of patients with CKD. Additionally, we report on a pilot study that focused on the effect of a low-protein diet on TMAO plasma levels in nondialysis CKD patients.

Evaluation of microscopic protocols for somatic cell counts in milk of dairy sheep / Avaliação de protocolos do método microscópico para contagem de células somáticas no leite de ovelhas leiteiras

The somatic cell count (SCC) is a diagnostic tool that indicates the mammary gland health and can be determined by the counting of cells in the microscope. There are discussions regarding appropriate staining method to the ewes' milk. The present study aimed to identify a methodology of microscopic SCC proper to the milk of the ovine species. Therefore, glass slides for smear were manufactured with 10 µL of ewe's milk in 1 cm2, and the fixers xylol and Carnoy's solution were tested, as well as and May-Grünwald, Broadhurst-Paley, Wrigth and Panoptic stainings. Carnoy's solution was elected, because it allowed a better fixation of the dairy film to the microscope slides, and Broadhurst-Paley staining, due to its good coloration and visualization of cells, as well as the differentiation of cytoplasmic corpuscles in ewe's milk. Broadhurst-Paley coloration is a tool applicable to the somatic cell count in ovine specie's milk.(AU)

A contagem de células somáticas é uma ferramenta de diagnóstico indicativa da saúde da glândula mamária e pode ser determinada em microscópio. Sobre ela, existem discussões quanto à coloração adequada ao leite de ovelhas. O presente estudo objetivou identificar uma metodologia de preparação de lâminas para a contagem microscópica de células somáticas do leite da espécie ovina. Para tanto, confeccionaram-se lâminas de esfregaços de 10 µL de leite de ovelha em 1 cm2, testaram-se os fixadores de xilol e solução de Carnoy e as colorações de May-Grünwald, Broadhurst-Paley, Wrigth e Panótico. Elegeram-se a solução de Carnoy, pois esta permitiu melhor fixação do filme lácteo às lâminas de microscopia, e o corante Broadhurst-Paley, que propiciou boa coloração e visualização das células, bem como a diferenciação dos corpúsculos citoplasmáticos presentes no leite ovino. A coloração é uma ferramenta aplicável à contagem de células somáticas no leite da espécie ovina.(AU)

Proportional mortality ratio due to chagas disease is five times higher for the state of Goias than the rest of Brazil

Mortality data due to Chagas disease for the endemic State of Goias, Brazil, was retrieved from the National System of Information on Mortality, between 2006 and 2011. A total of 29,041 deaths were attributed to Chagas disease in the country, of which 4,293 (14.8%) occurred in the State of Goias. The proportion of deaths attributable to Chagas disease was 0,4% for the country overall and 2.4% for State of Goias. Seventy-two percent of the records were from individuals over 60 years of age, and heart disease was the main cause of death in 80.3%. Chagas disease is a major cause of death in Goias and, proportionally, 5.3 times higher than for the rest of the country.

Resistant starch for modulation of gut microbiota: Promising adjuvant therapy for chronic kidney disease patients?

The gut microbiota has been extensively studied in all health science fields because its imbalance is linked to many disorders, such as inflammation and oxidative stress, thereby contributing to cardiovascular disease, obesity, diabetes and chronic kidney disease (CKD) complications. Novel therapeutic strategies that aim to reduce the complications caused by this imbalance have increased in recent years. Studies have shown that prebiotic supplementation can beneficially modulate the gut microbiota in CKD patients. Prebiotics consist of non-digestible dietary soluble fiber, which acts as a substrate for the gut microbiota. Resistant starch (RS) is a type of dietary fiber that can reach the large bowel and act as a substrate for microbial fermentation; for these reasons, it has been considered to be a prebiotic. Few studies have analyzed the effects of RS on the gut microbiota in CKD patients. This review discusses recent information about RS and the potential role of the gut microbiota, with a particular emphasis on CKD patients.

Exercise Training Alters the Bone Mineral Density of Hemodialysis Patients.

Marinho, SM, Moraes, C, Barbosa, JEdSM, Eduardo, JCC, Fouqe, D, Pelletier, S, and Mafra, D. Exercise training alters the bone mineral density of hemodialysis patients. J Strength Cond Res 30(10): 2918-2923, 2016-Patients with chronic kidney disease undergoing hemodialysis (HD) frequently present low bone mineral density (BMD), and exercise may be useful for treating bone loss. This study aimed to assess the effects of an intradialytic resistance exercise training program (RETP) on BMD in HD patients. Twenty-one patients were enrolled into 2 groups; 10 patients performed exercise (80.0% men; 46.9 ± 12.1 years; 27.0 ± 3.4 kg·m) and 11 patients were in the control group (54.5% men; 50.5 ± 11.5 years; 24.1 ± 8.7 kg·m). Dual-energy x-ray absorptiometry was used to measure the BMD, lean mass, and body fat before and after the supervised RETP (performed with elastic bands and ankle cuffs in both lower limbs 3 times a week for 24 weeks-72 sessions). In the exercise group, 30.0% of patients presented with osteopenia and 20.0% osteoporosis and in the control group, 45.5% osteopenia and 36.4% osteoporosis. Only in the exercise group, the osteoporosis percentage was reduced to 10.0% and the femoral neck BMD and T-score improved from 0.89 ± 0.1 to 0.93 ± 0.1 g·cm and from -1.3 ± 0.8 to -1.0 ± 0.8 g·cm (p ≤ 0.05), respectively, after the intervention. In contrast, these parameters were reduced in the control group. The results suggest that resistance exercise may be useful for improving the BMD in HD patients. In summary, 24 weeks of the supervised RETP played a role in improving the BMD of HD patients.

Effects of acute resistance exercise on acyl-ghrelin and obestatin levels in hemodialysis patients: a pilot study.

Chronic physical exercises may be beneficial to modulate appetite hormones as acyl-ghrelin (orexigenic) and obestatin (anorexigenic) in chronic kidney disease (CKD) patients; however, there are no data about the effects of acute exercises on these hormones. Thus, the aim of the present study was to assess the effect of acute resistance exercise on appetite hormones (acyl-ghrelin and obestatin) of patients undergoing hemodialysis (HD). Twenty-five patients (44.7 ± 12.9 years, 68% women) on regular HD program were enrolled into two groups, 16 patients performed exercises and 9 patients comprised the control group. The patients performed the exercises in both lower limbs with ankle-cuffs and elastic bands, 30 min after the initiation of hemodialysis session. Blood samples of both the groups were drawn in the morning before and after 30 min with exercise session (exercise group) and, before and after the same time without exercise (control group). Acyl-ghrelin and obestatin plasma levels were measured using an enzyme immunometric assay. Acyl-ghrelin plasma levels did not change in both the groups. However, when stratified by gender the acyl-ghrelin increased significantly right after exercise in men [32.1 pg/mL (25.6-41.2) to 46.0 pg/mL (39.0-59.5)] (p = 0.04). Obestatin plasma levels reduced after a single bout of exercise and changes remained significantly when the sample was stratified by gender. There was no change in obestatin plasma levels in control group. A single bout of resistance exercise seems to modulate the levels of appetite hormones in HD patients.

Trimethylamine N-Oxide From Gut Microbiota in Chronic Kidney Disease Patients: Focus on Diet.

Low-protein diet is the recommended nutritional intervention for nondialysis chronic kidney disease (CKD) patients because excess protein intake can damage kidney function and produce uremic toxins. Some of these toxins are generated from amino acids breakdown by gut microbiota as p-cresyl sulfate and indoxyl sulfate that have been clearly associated with cardiovascular mortality in CKD patients. Another uremic toxin, trimethylamine N-oxide (TMAO), a degradation product of choline and L-carnitine (which come mainly from animal protein such as red meat and eggs) is now considered as a proatherogenic metabolite. In the present review, we will highlight the relationship between TMAO, diet and cardiovascular aspects, and the potential concerns about TMAO in nondialysis CKD patients.

Cardiovascular Mortality in Chronic Kidney Patients: the Role of Uremic Toxins / Mortalidade Cardiovascular em Pacientes Renais Crônicos: o Papel das Toxinas Urêmicas

A doença cardiovascular (DCV) é a maior causa de morte nos pacientes com doença renal crônica (DRC) nomundo. Vários fatores estão associados a essa elevada mortalidade e, recentemente, as toxinas urêmicas produzidas pela microbiota intestinal têm recebido bastante atenção, já que a falência renal cursa com o acúmulo dessas toxinas no plasma. Essas toxinas têm relação com estresse oxidativo, inflamação, disfunção endotelial e induçãoda aterosclerose e, recentes estudos têm observado que pacientes com elevados níveis de tais toxinas têm aumento na mortalidade por DCV. Assim, o objetivo da presente revisão foi discutir o papel das toxinas urêmicasprovenientes da microbiota intestinal e seu impacto na mortalidade cardiovascular em pacientes renais crônicos, bem como as possíveis perspectivas terapêuticas que podem ser elucidadas a partir do conhecimento aprofundado do tema...

The cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD) in the world. Several factors are associated with this high mortality. Recently, the uremic toxins produced by intestinal microbiota have received extensiveattention from researchers, since kidney failure evolves with the accumulation of these toxins in the plasma. These toxins are related to oxidative stress, inflammation, endothelial dysfunction, and induction of atherosclerosis, and recent studies have noted thatpatients with high levels of these toxins have increased mortality due to CVD. Therefore, the purpose of this review was to discuss the role of uremic toxins from the intestinal microbiota and their impact on cardiovascular mortality in CKD patients, as well as the possible therapeutic perspectives that can be explained based on an in-depth understanding of the subject...

Effects of resistance exercise training on acyl-ghrelin and obestatin levels in hemodialysis patients.

BACKGROUND: Patients undergoing hemodialysis (HD) present altered levels of appetite hormones such as acyl-ghrelin (orexigenic) and obestatin (anorexigenic), which may contribute to anorexia. Physical exercise may affect these hormones and improve appetite in these patients. OBJECTIVES: The objective of this study is to evaluate the effects of a resistance exercise program in appetite hormones, body composition, and nutritional status in HD patients. DESIGN: Intervention study with the control group. SUBJECTS: Fifty-two patients on regular HD program were enrolled into two groups: 37 patients performed exercises (56.7% male, 45 ± 12.8 years, 57 (9-192) months on HD) and 15 patients comprised the control group (66.7% men, 50 ± 10.6 years, 57 (11-153) months on HD). MEASUREMENTS: Exercise program (performed with elastic bands and ankle cuffs in both lower limbs) was supervised three times a week during 6 months (72 sessions). Patients had their blood drawn in a regular HD day after overnight fasting, before and after 6 months of exercise program. Obestatin, acyl-ghrelin, routine biochemical parameters, quality of life, and anthropometric data were collected and analyzed before and after 6 months. RESULTS: After 6 months of exercise, obestatin levels reduced [from 3.0 ng/mL (2.3-3.4) to 1.9 ng/mL (0.6-3.4)] and acyl-ghrelin levels increased [from 21.5 pg/mL (1.3-77.7) to 37.2 pg/mL (16.7-94.1)] and the control group presented no significant differences in both plasma levels of hormones. Body composition and physical functional assessed by SF-36 and albumin levels (3.7 ± 0.3 to 3.9 ± 0.2, p < 0.05) improved after exercises. CONCLUSION: Six months of resistance exercises contributed to changes in plasma appetite hormones, body composition, and nutritional status in hemodialysis patients.

Escala de avaliação da dor: percepção dos enfermeiros em uma unidade de terapia intensiva neonatal / Escala de evaluación del dolor: percepción de los enfermeros en una unidad de terapia intensiva neonatal / Scale of pain evaluation: perception of nurses in a neonatal intensive care unit

Objetivo: conhecer a percepção de enfermeiros com relação à utilização de um instrumento para avaliação da dor em neonatos prematuros. Método: pesquisa qualitativa,exploratória e descritiva, realizada em uma Unidade de Terapia Intensiva Pediátrica e Neonatal, de um Hospital Universitário de Pelotas, Rio Grande do Sul. Participaram doestudo quatro enfermeiros, no período de outubro e novembro de 2010. Os dados foram coletados por meio de entrevista semiestruturada e analisados de acordo com a análisetemática. Resultados: foram abordadas as seguintes categorias: Escala para avaliação da dor nos RNs prematuros: percepção dos enfermeiros e Escala de dor e o prematuro: suaimplementação. Conclusão: enfermeiros desconhecem as novas tecnologias utilizadas para mensurar a dor; contudo, todos se mostraram comprometidos com uma assistênciahumanizada, uma vez que relataram interesse pela inserção deste instrumento de avaliação.

Aim: to identify the perceptions of nurses in relation to the use of an instrument to assess pain in preterm infants. Method: qualitative, exploratory and descriptive research conducted in a Neonatal Intensive Care Unit, in a University Hospitalin Pelotas, Rio Grande do Sul. The study included four nurses, in the period of October to November 2010. Data were collected through semi-structured interviews and analyzedaccording to thematic analysis. Results: the following categories were addressed: Scale to assess pain in premature newborns: perception of nurses, and Pain Scale and prematurenewborns: implementation. Conclusion: nurses do not know the new technologies used to measure pain; however, all nurses demonstrated committment to a humanized assistance,as they reported being interested in the inclusion of this instrument of assessment.

Objetivo: investigar la percepción entre los enfermeros sobre el uso de un instrumento para evaluar el dolor en recién nacidos prematuros. Método: investigacióncualitativa, exploratoria y descriptiva, realizada en una Unidad de Cuidados Intensivos Pediátricos y Neonatales del Hospital de Pelotas (RS, Brasil). Cuatro enfermerasparticiparon en el estudio, entre octubre y noviembre de 2010. Los datos fueron recogidos por entrevistas semi-estructurada y analizados según el análisis temático. Resultados: seestudiaron las siguientes categorías: Escala para evaluar el dolor en los recién nacidos prematuros: percepción de los enfermeros y La escala de dolor y el prematuro: suaplicación. Conclusión: los enfermeros desconocen las nuevas tecnologías utilizadas para medir el dolor, sin embargo, todos estaban comprometidos con una atención humanizada,mostrando interés por la inserción de este instrumento de evaluación.

Efficacy and effectiveness trials have different goals, use different tools, and generate different messages.

The discussion about the optimal design of clinical trials reflects the perspectives of theory-based scientists and practice-based clinicians. Scientists compare the theory with published results. They observe a continuum from explanatory to pragmatic trials. Clinicians compare the problem they want to solve by completing a clinical trial with the results they can read in the literature. They observe a mixture of what they want and what they get. None of them can solve the problem without the support of the other. Here, we summarize the results of discussions with scientists and clinicians. All participants were interested to understand and analyze the arguments of the other side. As a result of this process, we conclude that scientists tell what they see, a continuum from clear explanatory to clear pragmatic trials. Clinicians tell what they want to see, a clear explanatory trial to describe the expected effects under ideal study conditions and a clear pragmatic trial to describe the observed effects under real-world conditions. Following this discussion, the solution was not too difficult. When we accept what we see, we will not get what we want. If we discuss a necessary change of management, we will end up with the conclusion that two types of studies are necessary to demonstrate efficacy and effectiveness. Efficacy can be demonstrated in an explanatory, ie, a randomized controlled trial (RCT) completed under ideal study conditions. Effectiveness can be demonstrated in an observational, ie, a pragmatic controlled trial (PCT) completed under real-world conditions. It is impossible to design a trial which can detect efficacy and effectiveness simultaneously. The RCTs describe what we may expect in health care, while the PCTs describe what we really observe.

Resistance training in hemodialysis patients: a review.

PURPOSE: Few studies have examined the role of resistance training (RT) in chronic kidney patients on hemodialysis (HD). This study reviews the literature about resistance exercise for patients on HD and describes protocols and clinical outcomes. METHODS: A search of the MEDLINE database found 21 eligible publications, of which 14 studies applied only RT and 7 combined RT and aerobic training. FINDINGS: Regarding the period of exercise training, 14 studies applied intradialytic exercise. The main outcome reported was muscle strength, which was assessed through knee strength and handgrip measures. CONCLUSIONS: All studies reviewed presented at least one significant result in relation to biochemical parameters, physical capacity, strength, body composition, or quality of life. CLINICAL RELEVANCE: This review demonstrates that RT improves muscle strength, some biochemical parameters, and quality of life of the HD patients.

Resistance exercise: a strategy to attenuate inflammation and protein-energy wasting in hemodialysis patients?

PURPOSE: Patients undergoing hemodialysis (HD) present persistent inflammation and protein-energy wasting (PEW), which contributes to high rates of mortality. This study aimed to assess the effects of a resistance exercise training program (RETP) on inflammation and PEW in HD patients. METHODS: Thirty-seven patients (56.7 % men, 45.9 ± 14.1 years, 23.5 ± 3.9 kg/m(2)) performed 6 months of intradialytic RETP. Plasma adhesion molecules levels (ICAM-1 and VCAM-1) were measured using the enzyme immunometric assay, and interleukin-6 (IL-6), C-reactive protein, and tumor necrosis factor-alpha by ELISA. Anthropometric, physical capacity, and PEW (simultaneously presence of: BMI <23 kg/m(2), serum albumin <3.8 g/dL, and reduced arm muscle area) were analyzed. RESULTS: There was a reduction of ICAM-1 [(1,934.1 pg/mL (1,031.8-2,875.0) vs. 1,571.1 pg/mL (447.1-2,985.5), p < 0.05], VCAM-1 [5,259.51 pg/mL (3,967.4-6,682.4) vs. 3,062.11 pg/mL (2,034.0-5,034.4), p < 0.05], and CRP levels (2.3 ± 0.9 to 1.6 ± 0.6 pg/mL, p < 0.001) after 6 months of RETP. Body composition improved, albumin increased (3.7 ± 0.3 to 3.9 ± 0.2, p < 0.05), and the number of patients presenting PEW was decreased (p = 0.005). CONCLUSIONS: Resistance exercise program for 6 months seems to be effective in reducing inflammation and PEW of HD patients. The universal trial number of this study is U1111-1139-1326.

Brazil nut (Bertholletia excelsa, H.B.K.) improves oxidative stress and inflammation biomarkers in hemodialysis patients.

Cumulative evidence indicates that oxidative stress and inflammation frequently occurs in patients undergoing maintenance hemodialysis (HD) and as a result of overproduction of reactive oxygen species (ROS) and a decrease of antioxidant defenses such as selenium (Se). Previous studies in our laboratory showed that the supplementation of 1 unit of Brazil nut (the richest known food source of Se) a day during 3 months is effective to improve Se status and increase glutathione peroxidase (GPx) levels in HD patients. The aim of this study was to evaluate the effect of Brazil nut supplementation on oxidative stress and inflammation markers in HD patients. Forty HD patients from Rio de Janeiro, Brazil were studied. All patients received one nut per day for 3 months. The Se plasma levels and GPx, 8-isoprostane, 8-hydroxy-2-deoxyguanosine (8-OHdG), and cytokine (TNF-α and IL-6) levels and lipid profile were determined before and after 3 months of supplementation. The plasma Se and GPx activity increased, while cytokines, 8-OHdG, and 8-isoprostane plasma levels decreased significantly after 3 months supplementation. HDL-c levels increased and LDL-c levels decreased significantly. These data suggest that the consumption of only one Brazil nut per day during 3 months was effective to reduce the inflammation, oxidative stress markers, and the atherogenic risk, thereby increasing the antioxidant defenses in HD patients. Our results indicate that Brazil nut as Se source plays an important role as an anti-inflammatory and antioxidant agent in HD patients.