Serum Cortisol and Clinical Response to a Single Session of Whole-Body Vibration in Healthy Adult Dogs.

This study evaluated the serum cortisol response to a single session of whole-body vibration (WBV) in healthy adult dogs. Ten healthy adult medium dogs, females and males, aged between 24 and 48 months and with body weight between 10.1 and 17.9 kg were used. A single WBV session at a frequency of 30 Hz for 5 min (3.10 mm peak displacement, 11.16 m/s2 peak acceleration, and 0.29 m/s velocity), then 50 Hz for 5 min (3.98 mm peak displacement, 39.75 m/s2 peak acceleration, and 0.62 m/s velocity), and finishing with 30 Hz for 5 min (3.10 mm peak displacement, 11.16 m/s2 peak acceleration, and 0.29 m/s velocity) was performed. Serum cortisol, heart and respiratory rate, and systolic blood pressure were evaluated at different time points: 1 min before WBV (1PRE) and 1 min (1POST), 60 min (60POST), and 360 min (360POST) after the WBV session. An increase (P = 0.0417) of the serum cortisol values was observed between 1PRE and 1POST and a decrease (P = 0.0417) between 1POST and 60POST and between 60POST and 360POST. However, the values remained within the reference range. The heart and respiratory rate and the systolic blood pressure remained unchanged. Our findings suggest that a single bout of WBV (5 min of 30 and 50 Hz) using a vibrating platform that delivered a vortex wave circulation does not modify the serum cortisol levels and clinical parameters of healthy adult dogs.

Aprendizagem baseada em problemas no ensino remoto: vivências de estudantes de enfermagem na pandemia covid-19 / Aprendizaje basado en problemas en educación remota: experiencias de estudiantes de enfermería en la pandemia covid-19 / Problem-based learning in remote education: experiences of nursing students during covid-19 pandemic

RESUMO Objetivo: compreender a percepção dos estudantes de Enfermagem frente ao processo tutorial remoto no período de isolamento social decorrente da COVID-19. Método: trata-se de pesquisa qualitativa na modalidade compreensiva e interpretativa, fundamentada nos pressupostos da hermenêutica dialética, a qual busca contextualizar o discurso dos atores, as suas compreensões e autenticidades. O estudo foi realizado a partir de entrevistas com 22 estudantes da segunda série do curso de Enfermagem de uma instituição pública do interior de São Paulo, Brasil, de setembro a dezembro de 2020. Resultados: dos 22 estudantes entrevistados, 21 se identificaram como sendo do sexo feminino, com idades entre 19 e 24 anos e, em sua maioria, residindo com familiares no período da pandemia. Identificaram-se quatro temáticas na análise da percepção desses estudantes frente ao processo tutorial remoto: a dinâmica do processo tutorial remoto; as limitações impostas às atividades no domicílio; os incômodos da pandemia; e a falta de recursos institucionais e de momentos de convivência. Conclusão: o processo tutorial remoto configura-se como essencial para a continuidade da aprendizagem dos estudantes de Enfermagem. Identificou-se, porém, a falta de efetiva integração com a prática profissional e entre os integrantes do processo e a inadequação dos recursos do domicílio. Depreende-se que a repentina alteração da ordem estabelecida levou ao enfrentamento dos desafios e contribuiu para novas aprendizagens.

RESUMEN Objetivo: comprender la percepción de los estudiantes de enfermería frente al proceso de tutoría remota en el período de aislamiento social derivado del COVID-19. Método: se trata de una investigación cualitativa de forma comprensiva e interpretativa, basada en los supuestos de la hermenéutica dialéctica, que busca contextualizar el discurso de los actores, sus entendimientos y autenticidades. El estudio se realizó a través de entrevistas a 22 estudiantes del segundo grado del curso de Enfermería en una institución pública del interior de São Paulo, Brasil, de septiembre a diciembre de 2020. Resultados: de los 22 estudiantes entrevistados, 21 se identificaron como siendo del sexo femenino, con edades comprendidas entre 19 y 24 años y en su mayoría viviendo con familiares durante el período pandémico. Se identificaron cuatro temas en el análisis de la percepción de estos estudiantes sobre el proceso de tutoría a distancia: la dinámica del proceso de tutoría a distancia; las limitaciones impuestas a las actividades en el hogar; las molestias pandémicas; y la falta de recursos institucionales y momentos de convivencia. Conclusión: el proceso de tutoría a distancia es fundamental para la continuidad del aprendizaje de los estudiantes de enfermería. Se identificó, sin embargo, la falta de integración efectiva con la práctica profesional y entre los integrantes del proceso y la inadecuación de los recursos del hogar. Parece que el cambio repentino en el orden establecido llevó a enfrentar desafíos y contribuyó a nuevos aprendizajes.

ABSTRACT Objective: to understand the perception of Nursing students facing the remote tutorial process in the period of social isolation resulting from COVID-19. Method: this is qualitative research in a comprehensive and interpretive mode, based on the assumptions of dialectical hermeneutics, which seeks to contextualize the actors' discourse, their understandings, and authenticities. The study was conducted through interviews with 22 students from the second grade of the Nursing course of a public institution in the interior of São Paulo, Brazil, from September to December 2020. Results: twenty-one of the 22 students interviewed were female, between 19 and 24 years old, and mostly living with family members during the pandemic period. Four themes were identified in the analysis of the perception of these students regarding the remote tutorial process: the dynamics of the remote tutorial process; the limitations imposed on activities at home; the pandemic annoyances; and the lack of institutional resources and moments of coexistence. Conclusion: the remote tutorial process is essential for the continuity of learning for Nursing students. However, we identified the lack of effective integration with professional practice and among the members of the process and the inadequacy of the household resources. It appears that the sudden change in the established order led to facing challenges and contributed to new learning.

Estado Nutricional e Sintomas Gastrointestinais em Pacientes Oncológicos Submetidos à Quimioterapia / Nutritional Status and Gastrointestinal Symptoms in Oncology Patients Receiving Chemotherapy / Estado Nutricional y Síntomas Gastrointestinales en Pacientes con Cáncer Sometidos a Quimioterapia

Introdução: O estado nutricional do paciente oncológico apresenta grande variação ao longo da doença, além de efeitos adversos relacionados ao trato gastrointestinal serem comuns durante o tratamento quimioterápico. Objetivo: Avaliar o estado nutricional e a presença de sintomas gastrointestinais em pacientes oncológicos submetidos à quimioterapia. Método: Estudo transversal com pacientes em tratamento no setor de Quimioterapia do Hospital Escola da Universidade Federal de Pelotas (UFPel), RS, no período de abril a julho de 2019. Dados sociodemográficos e questões relacionadas à doença foram obtidos por meio de um questionário. Para avaliação do estado nutricional e dos sintomas gastrointestinais, utilizou-se a avaliação subjetiva global produzida pelo paciente. A análise dos dados foi realizada por meio de análise descritiva, e a associação entre variáveis categóricas, verificada pelo teste qui-quadrado de Pearson (p<0,05). Resultados:Foram avaliados 101 pacientes, com média de idade de 58,6 anos e maior prevalência de indivíduos do sexo feminino (58,4%), de cor branca (77,2%), casados (53,0%), pertencentes à classe C (50,4%). Encontrou-se maior prevalência dos cânceres do trato gastrointestinal (34,6%) e mama (27,8%). A maioria dos pacientes foi classificada como bem nutrido (66,3%), enquanto saciedade precoce (56,0%), xerostomia (54,0%), inapetência (42,0%) e náusea (37,0%) foram os sintomas mais citados. Não foi encontrada associação estatística entre o estado nutricional e qualquer um dos sintomas gastrointestinais. Conclusão: O estado nutricional da maioria dos pacientes foi classificado como bem nutrido, mas necessitando de atenção para a ocorrência dos sintomas gastrointestinais.

Introduction: The nutritional status of oncologic patients varies greatly throughout the disease, further to gastrointestinal tract related adverse effects that are common during chemotherapy treatment. Objective: Evaluate the nutritional status and the presence of gastrointestinal symptoms in oncologic patients undergoing chemotherapy. Method: Cross-sectional study with patients in treatment in the Chemotherapy Unit of the Hospital School of Pelotas Federal University (UFPel), RS, from April to July 2019. Sociodemographic data and questions related to the disease were obtained through a questionnaire. To assess the nutritional status and gastrointestinal symptoms the Patient-Generated Subjective Global Assessment was utilized. Data analysis was performed through descriptive analysis, and the association between categorical variables was verified by Pearson's chi-square test (p<0.05). Results: A total of one hundred one patients was evaluated, mean age of 58.6 years, with higher prevalence of females (58.4%), Caucasian (77.2%), married (53.0%), belonging to class C (50.4%). Higher prevalence of gastrointestinal tract (34.6%) and breast (27.8%) cancer was found. Most patients were classified as well-nourished (66.3%), while early satiety (56.0%), xerostomia (54.0%), loss of apetite (42.0%), and nausea (37.0%) were the symptoms most cited. No statistical association was encountered between nutritional status and any of the gastrointestinal symptoms. Conclusion: The nutritional status of most patients was classified as well nourished, but attention is needed for the occurrence of gastrointestinal symptoms.

Introducción: El estado nutricional del paciente oncológico presenta variacones durante la enfermedad, además de los efectos adversos relacionados con el tracto gastrointestinal comunes durante la quimioterapia. Objetivo: Evaluar el estado nutricional y la presencia de síntomas gastrointestinales en pacientes con cáncer sometidos a quimioterapia. Método: Estudio transversal con pacientes tratados en el sector de quimioterapia del Hospital Escuela de la Universidad Federal de Pelotas (UFPel), RS, de abril a julio de 2019. Se obtuvieron datos sociodemográficos y relacionados con la enfermedad a través de un cuestionario. Para evaluar el estado nutricional y los síntomas gastrointestinales se utilizó la Evaluación Subjetiva Global Producida por el Paciente. Las análisis de los datos se realizó mediante análisis descriptiva, y la asociación entre variables categóricas se verificó mediante la prueba de chi-cuadrado de Pearson (p<0,05). Resultados: Se evaluaron 101 pacientes, con edad media de 58,6 años, mayor prevalencia de mujeres (58,4%), blancos (77,2%), casados (53,0%), pertenecientes a la clase C (50,4%). Se encontró una mayor prevalencia de cánceres del tracto gastrointestinal (34,6%) y de mama (27,8%). La mayoría de los pacientes se clasificó como bien nutrido (66,3%), mientras que saciedad temprana (56,0%), boca seca (54,0%), falta de apetito (42,0%) y náuseas (37,0%) fueron los síntomas más frecuentemente. No se encontró asociación estadística entre el estado nutricional y los síntomas gastrointestinales. Conclusión: El estado nutricional de la mayoría de los pacientes se clasificó como bien nutrido, pero necesita la atención a presencia de síntomas gastrointestinales.

Effects of dietary counseling on sodium restriction in patients with chronic kidney disease on hemodialysis: A randomized clinical trial.

Reducing dietary sodium has the potential to benefit patients with chronic kidney disease on hemodialysis (HD). This study was aimed to evaluate the effects of dietary counseling on sodium restriction and its relationship with clinical, dietary, and quality of life parameters in patients on HD treatment. This study was designed as a randomized clinical trial. The study included 87 patients on HD, divided into intervention (n = 47) and control (n = 40) groups. Anthropometric, clinical, sodium intake, and quality of life data were evaluated in both groups at four-time points: baseline (T0), 90 days (T3), 180 days (T6), and 365 days (T12). The intervention group received dietary counseling at the beginning and throughout the study. There were no between-group differences regarding anthropometric, clinical, and quality of life data at any of the time points. The mean age was 59 ± 14 years, and most of the patients were men (61%) and had hypertension (90%). Total sodium (g) and processed meat (mg sodium) intake significantly decreased in both groups [intervention: T0 = 3.5 (2.3-4.7); T12 = 2.0 (0.7-2.5); P <0.0001; control: T0 = 3 (1.5-4.9); T12 = 2.0 (0.8-3.3); P = 0.001; and intervention: T0 = 78 (25-196); T12 = 21 (0-78); P = 0.003; control: T0 = 97 (31-406); T12 = 44 (0-152); P = 0.004, respectively] . There was a significant decrease in the consumption of packaged seasonings (mg sodium) [T0 = 130 (0-854); T12 = 0 (0-0); P = 0.015] and instant noodles [T0 = 19 (0-91); T12 = 0 (0-0); P = 0.017] in the intervention group. Dietary counseling was effective in changing dietary habits. In both groups, there was a reduction in total sodium intake, which was greater in the intervention group. Moreover, a decrease in the intake of salty foods, such as packaged seasonings and instant noodles, was only observed in the intervention group.

Cut-Point for Satisfactory Adherence of the Dietary Sodium Restriction Questionnaire for Patients with Heart Failure.

BACKGROUND: The low or non-adherence to reduction of sodium intake has been identified as one of the main precipitating factors of heart failure (HF). The Dietary Sodium Restriction Questionnaire (DSRQ) identifies factors that can interfere with adherence to this recommendation. However, there is still no cut-point to define adherence for this questionnaire. OBJECTIVES: To identify the cut-point for satisfactory adherence to the Brazilian version of the DSRQ, (the Questionário de Restrição de Sódio na Dieta, QRSD). METHODS: Multicenter study. Patients with HF in outpatient treatment (compensated) and those treated in emergency departments due to acute HF (decompensated) were included. For the cut-point definition, the DSRQ scores were compared between groups. A ROC curve was constructed for each subscale to determine the best point of sensitivity and specificity regarding adherence. A 5% significance level was adopted. RESULTS: A total of 206 compensated patients and 225 decompensated were included. Compensated patients exhibited scores that showed higher adhesion in all subscales (all p <0.05). Scores ≥ 40 points of a total of 45 for the subscale of Attitude and Subjective Norm; scores ≤ eight of a total of 20 for Perceived Behavioral Control; and ≤ three of a total of 15 for Dependent Behavior Control were indicative of satisfactory adherence. CONCLUSIONS: Based on the evaluation of patients in these two scenarios, it was possible to determine the cut-point for satisfactory adherence to the reduction of sodium in the diet of patients with HF. Countries with similar culture could use this cut-point, as other researchers could also use the results as a reference for further studies.

Cut-Point for Satisfactory Adherence of the Dietary Sodium Restriction Questionnaire for Patients with Heart Failure / Ponto de Corte para Adesão Satisfatória do Questionário de Restrição de Sódio na Dieta em Pacientes com Insuficiência Cardíaca

Abstract Background: The low or non-adherence to reduction of sodium intake has been identified as one of the main precipitating factors of heart failure (HF). The Dietary Sodium Restriction Questionnaire (DSRQ) identifies factors that can interfere with adherence to this recommendation. However, there is still no cut-point to define adherence for this questionnaire. Objectives: To identify the cut-point for satisfactory adherence to the Brazilian version of the DSRQ, (the Questionário de Restrição de Sódio na Dieta, QRSD). Methods: Multicenter study. Patients with HF in outpatient treatment (compensated) and those treated in emergency departments due to acute HF (decompensated) were included. For the cut-point definition, the DSRQ scores were compared between groups. A ROC curve was constructed for each subscale to determine the best point of sensitivity and specificity regarding adherence. A 5% significance level was adopted. Results: A total of 206 compensated patients and 225 decompensated were included. Compensated patients exhibited scores that showed higher adhesion in all subscales (all p <0.05). Scores ≥ 40 points of a total of 45 for the subscale of Attitude and Subjective Norm; scores ≤ eight of a total of 20 for Perceived Behavioral Control; and ≤ three of a total of 15 for Dependent Behavior Control were indicative of satisfactory adherence. Conclusions: Based on the evaluation of patients in these two scenarios, it was possible to determine the cut-point for satisfactory adherence to the reduction of sodium in the diet of patients with HF. Countries with similar culture could use this cut-point, as other researchers could also use the results as a reference for further studies.

Resumo Fundamento: A baixa ou a não adesão à redução de sódio na dieta foi identificada como um dos principais fatores causais da insuficiência cardíaca (IC). O Questionário de Restrição de Sódio na Dieta (QRSD) do inglês Dietary Sodium Restriction Questionnaire (DSRQ) identifica fatores que possam interferir na adesão a essa recomendação. No entanto, anda não existe um ponto de corte que estabelece adesão segundo o QRSD. Objetivos: Identificar o ponto de corte para adesão satisfatória ao QRSD, versão brasileira do DSRQ. Métodos: Estudo multicêntrico. Foram incluídos pacientes com IC em tratamento ambulatorial (compensados) e aqueles tratados em serviços de emergência por IC aguda (descompensados). Para a definição do ponto de corte, os escores do QRSD foram comparados entre os grupos. A curva ROC foi construída para cada subescala para determinar o melhor ponto de sensibilidade e especificidade em relação à adesão. Adotou-se um nível de significância de 5%. Resultados: Foram incluídos 206 pacientes compensados e 225 pacientes descompensados. Os pacientes compensados apresentaram escores que indicaram maior adesão em todas as subescalas (p < 0,05). Escores ≥ 40 pontos de um total de 45 para a subescala "atitude e norma subjetiva"; escores ≤ 8 de um total de 20 para a subescala "controle comportamental percebido"; e escores 3 de um total de 15 para "comportamento dependente" foram indicativos de adesão satisfatória. Conclusões: A avaliação de pacientes com IC atendidos no ambulatório ou na emergência permitiu a determinação dos pontos de corte para adesão satisfatória à restrição dietética de sódio. Países de culturas similares poderiam usar esse mesmo ponto de corte, bem como outros pesquisadores poderiam utilizá-lo como referência para outros estudos.

Dietary Patterns in Secondary Prevention of Heart Failure: A Systematic Review.

BACKGROUND: Diet is an important factor in secondary prevention of heart failure (HF) but there is still no consensus as to which dietary model should be adopted by this population. This systematic review aims to clarify the relationship between dietary patterns and secondary prevention in HF. METHODS: We searched the Medline, Embase and Cochrane databases for studies with different dietary patterns and outcomes of secondary prevention in HF. No limitation was used in the search. RESULTS: 1119 articles were identified, 12 met the inclusion criteria. Studies with Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Hyperproteic and Low-carb diets were found. The DASH pattern showed improvement in cardiac function, functional capacity, blood pressure, oxidative stress and mortality. The Mediterranean diet had a correlation with inflammation, quality of life and cardiac function but just on cross-sectional studies. Regarding the Hyperproteic and Low-carb diets only one study was found with each pattern and both were able to improve functional capacity in patients with HF. CONCLUSIONS: DASH pattern may have benefits in the secondary prevention of HF. The Mediterranean diet demonstrated positive correlation with factors of secondary prevention of HF but need more RCTs and cohort studies to confirm these effects. In addition, the Hyperproteic and Low-carb diets, despite the lack of studies, also demonstrated positive effects on the functional capacity in patients with HF.

Aggressive fluid and sodium restriction in decompensated heart failure with preserved ejection fraction: Results from a randomized clinical trial.

OBJECTIVES: Sodium and fluid restriction is commonly prescribed for heart failure patients. However, its role in the treatment of heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the effect of a diet with sodium and fluid restriction with an unrestricted diet in patients admitted for decompensated HFpEF. METHODS: Patients were randomized to a diet with sodium (0.8 g/d) and fluid (800 mL/d) restriction (intervention group [IG]) or an unrestricted diet (control group [CG]) and followed for 7 d or hospital discharge. The primary outcome was weight loss. Secondary outcomes included clinical stability, perception of thirst, neurohormonal activation, nutrient intake, readmission, and mortality rate after 30 d. RESULTS: Fifty-three patients were included (30, IG; 23, CG). The mean ejection fraction was 62% ± 8% for IG and 60% ± 7% for CG (P = 0.44). Weight loss was similar in both groups, being 1.6 ± 2.2 kg in the IG and 1.8 ± 2.1 kg in CG (P = 0.49) as well as the reduction in the congestion score (IG = 3.4 ± 3.5; CG = 3.8 ± 3.4; P = 0.70). The daily perception of thirst was higher in the IG (P = 0.03). Lower energy consumption was seen in the IG (P <0.001). No significant between-group differences at 30 d were found. CONCLUSIONS: Aggressive sodium and fluid restriction does not provide symptomatic or prognosis benefits, but does produce greater perception of thirst, may impair the patient's food intake, and does not seem to have an important neurohormonal effect in patients admitted for decompensated HFpEF.

Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review.

BACKGROUND: Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. METHODS: We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. RESULTS: A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. CONCLUSIONS: It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence.

Qualidade da dieta e consumo de sódio por pacientes em hemodiálise de uma clínica renal da fronteira oeste do Rio Grande do Sul / Quality of diet and sodium consumption by hemodialysis patients in a renal clinic of the border west of Rio Grande do Sul

Objetivo: Avaliar a qualidade da dieta e estado nutricional de pacientes submetidos à hemo- diálise em Clínica Renal de um município do sul do Brasil. Método: Neste estudo descritivo, observacional foram incluídos 15 pacientes. Dados sociodemográficos, clínicos e laboratoriais foram coletados dos prontuários de cada paciente. Para avaliação dos dados antropométricos, foram aferidas medidas de peso seco, peso pré e pós-diálise, altura e circunferência da cintura. Dados dietéticos foram coletados por meio de um recordatório de 24h e avaliados pelo Índice de Qualidade da Dieta Revisado. O consumo de alimentos ricos em sódio foi avaliado por meio de questionário de frequência específico. Resultados: Na população estudada, a média de idade foi de 57,3 anos, sendo a maioria dos pacientes do sexo masculino (60%). A classificação do índice de massa corporal foi de eutrofia para metade dos pacientes (53,3%). A média da circunferência da cintura foi de 89,67 cm, sendo que 73,3% dos pacientes apresentaram valores adequados. Conforme avaliação dos dados dietéticos, o consumo de sódio diário foi de 3,98 g e a pontuação média do Índice de Qualidade da Dieta foi de 63,33 pontos; 66,7% da população apresentaram necessidade de modificação da dieta. Conclusões: Os pacientes apresentaram hábitos alimentares que necessitam de modificações, principalmente no que diz respeito ao consumo de frutas, verduras e cereais integrais. Também se destaca o elevado consumo de sódio, sendo o sódio adicional o mais prevalente entre o consumo total diário. Desta maneira, tornam-se necessárias estratégias de educação nutricional para uma mudança efetiva dos hábitos alimentares destes pacientes.(AU)

Objective: To evaluate dietary quality and nutritional status of hemodialysis patients in a Renal Clinic of southern Brazil. Methods: Fifteen patients were included in the study. Sociodemo- graphic, clinical and laboratory data were collected from medical records. To evaluate the anthropometric measurements were measured dry weight, weight pre and post-dialysis, height, and waist circumference. Dietary data were collected using 24-hour recalls and evaluated by the Diet Quality Index - Revised. The consumption of foods high in sodium was assessed by a food frequency questionnaire. Results: In this study the mean age was 57.3 years and most patients were male (60%). Body mass index classification was eutrophic to half of patients (53.3%). The average waist circumference was 89.67 cm, and 73.3% of patients had appro- priate values. According to the assessment of dietary data, daily sodium intake was 3.98 g and the mean score of the Diet Quality Index was 63.33 points; 66.7% of the population was classified as "need a diet modification". Conclusions: Patients of the renal clinic need dietary changes, especially regarding to the consumption of fruits, vegetables and whole grains. Also highlights the high sodium intake, being the added sodium the most prevalent among total daily consumption. Therefore, become necessary nutritional education strategies for effective change in eating habits of these patients.(AU)

Consumo de alimentos ricos em sódio e alteração dos níveis pressóricos em adolescentes de Itaqui/RS / Intake of high-sodium foods and change of pressure levels in adolescents living in Itaqui/RS, Brazil

Introdução: O elevado consumo de alimentos do tipo fast food por adolescentes está diretamente associado à maior prevalência de doenças crônicas não transmissíveis nesta população. O objetivo deste trabalho foi avaliar o consumo de alimentos ricos em sódio, o estado nutricional e os níveis pressóricos em escolares adolescentes de Itaqui. Métodos: Tratou-se de um estudo transversal, de base escolar, com adolescentes residentes no município, os quais forneceram, por meio de um questionário autoaplicado, informações sociodemográficas, sobre o consumo habitual de alimentos ricos em sódio e sal e sobre hipertensão. Foram aferidos ainda peso e altura (para a obtenção do estado nutricional), circunferência abdominal e as pressões sistólica e diastólica, com posterior classificação de acordo com os valores de referência para a idade. Resultados: Participaram do estudo 645 adolescentes, entre 13 e 19 anos de idade, matriculados no ensino médio, período diurno, da rede pública no município. Foi observado consumo adequado de cinco dos sete alimentos ricos em sódio, assim como a não utilização de sal adicional pela maioria dos adolescentes. A prevalência de sobrepeso e obesidade foi de 18,3% e 2,8%, respectivamente, e de pressão arterial limítrofe ou aumentada foi de 20,2%. Houve associação positiva da pressão arterial aumentada com sobrepeso (p< 0,001) circunferência abdominal aumentada (p< 0,001) e consumo de biscoitos doces (p= 0,014). Conclusão: Tais informações poderão nortear o desenvolvimento de estratégias educativas quanto ao consumo de alimentos ricos em sódio, o controle da pressão arterial, bem como alertar esses jovens quanto às consequências da hipertensão(AU)

Introduction: The high consumption of fast-food type food by teens is directly associated with a higher prevalence of chronic diseases in this population. The aim of this study was to evaluate the consumption of high-sodium foods, nutritional status, and blood pressure among adolescent students from Itaqui. Methods: This was a school-based cross-sectional study with adolescents living in the city, who provided, through a self-administered questionnaire, social demographic information on their usual consumption of high-sodium foods and salt and on hypertension. Student height and weight (to obtain their nutritional status), waist circumference, and systolic and diastolic pressures were also measured, with subsequent classification according to reference values for age. Results: The study included 645 adolescents between 13 and 19 years of age, enrolled in the public daytime high school network. We found adequate intake of five of the seven sodium-rich foods and no use of additional salt by most adolescents. The prevalence of overweight and obesity was 18.3% and 2.8%, respectively, and of increased blood pressure 20.2%. There was a positive association between increased blood pressure and overweight (p<0.001) , increased waist circumference (p<0.001), and consumption of sweet cookies (p = .014). Conclusion: Such information can guide the development of educational strategies regarding the consumption of high-sodium foods and blood pressure control, as well as to warn these young people about the consequences of high blood pressure(AU)

Membrane adsorber for endotoxin removal

ABSTRACT The surface of flat-sheet nylon membranes was modified using bisoxirane as the spacer and polyvinyl alcohol as the coating polymer. The amino acid histidine was explored as a ligand for endotoxins, aiming at its application for endotoxin removal from aqueous solutions. Characterization of the membrane adsorber, analysis of the depyrogenation procedures and the evaluation of endotoxin removal efficiency in static mode are discussed. Ligand density of the membranes was around 7 mg/g dry membrane, allowing removal of up to 65% of the endotoxins. The performance of the membrane adsorber prepared using nylon coated with polyvinyl alcohol and containing histidine as the ligand proved superior to other membrane adsorbers reported in the literature. The lack of endotoxin adsorption on nylon membranes without histidine confirmed that endotoxin removal was due to the presence of the ligand at the membrane surface. Modified membranes were highly stable, exhibiting a lifespan of approximately thirty months.

RESUMO A superfície de membranas planas de nylon foi modificada utilizando-se bisoxirano como espaçador e poli(álcool vinílico) para recobrimento das membranas. O aminoácido histidina foi utilizado como ligante para endotoxinas, visando à sua aplicação na remoção de endotoxinas a partir de soluções aquosas. São discutidas as etapas de caracterização do adsorvedor com membranas, análise do procedimento de despirogenização e avaliação da eficiência de remoção em modo estático. A densidade de ligantes nas membranas foi em torno de 7 mg/g membrana (massa seca), permitindo uma remoção de endotoxinas de até 65%. O desempenho das membranas preparadas com nylon e recobertas com poli(álcool vinílico) contendo histidina como ligante foi superior ao de outros adsorvedores com membranas descritos na literatura. A ausência de adsorção de endotoxinas em membranas sem histidina confirma que a remoção das endotoxinas deve-se exclusivamente à presença do ligante na superfície da membrana. As membranas modificadas mostraram-se bastante estáveis, exibindo um tempo de vida superior a 30 dias.

Adequacy of energy and nutrient intake in patients with heart failure.

BACKGROUND: Nutritional factors have a significant influence on the prognosis of patients with heart failure (HF). OBJECTIVE: The goal of the present study was to assess the food intake of stable patients with HF. METHODS: Patients of both genders aged over 18 years with a confirmed diagnosis of HF were recruited and matched with healthy individuals for age, sex and BMI. Food records and weighing were used to assess participant nutritional intake. DRIs and NCEP-ATP III recommendations were used to evaluate the adequacy of nutritional intake. RESULTS: Sixty-five percent of the 40 patients in the sample and 48% of the 25 control subjects were men. The mean age in both groups was 54±8 years and mean BMI was categorized as overweight. Carbohydrate, trans fatty acid and sodium intake were higher in the HF group as compared to control subjects (p=0.006, p.

Introducción: Factores nutricionales tienen una influencia significativa en el pronóstico de pacientes con insuficiencia cardíaca (IC). Objetivos: Evaluar la ingesta de alimentos de pacientes con IC estable. Métodos: Pacientes de ambos sexos, mayores de 18 años, con diagnóstico confirmado de IC fueron reclutados y emparejados por edad, sexo y IMC con individuos sanos. La ingesta nutricional fue evaluada mediante el registro alimentario y pesaje de acuerdo con las recomendaciones de las DRIs y NCEP-ATP III para la evaluación de la adecuación de la ingesta nutricional. Resultados: El 65% de los 40 pacientes con IC y el 48% de los 25 individuos control eran hombres. La edad media en los grupos fue de 54±8 años y los valores del IMC fueron indicativos de sobrepeso. La ingesta de carbohidratos, ácidos grasos trans y sodio fue mayor en el grupo IC que en el grupo control (p=0,006, p.

Effect of fluid and dietary sodium restriction in the management of patients with heart failure and preserved ejection fraction: study protocol for a randomized controlled trial.

BACKGROUND: Although half of all patients with heart failure (HF) have a normal or near-normal ejection fraction and their prognosis differs little from that of patients with a reduced ejection fraction, the pathophysiology of HF with preserved ejection fraction (HF-PEF) is still poorly understood, and its management poorly supported by clinical trials. Sodium and fluid restriction is the most common self-care measure prescribed to HF patients for management of congestive episodes. However, its role in the treatment of HF-PEF remains unclear. This trial seeks to compare the effects of a sodium- and fluid-restricted diet versus an unrestricted diet on weight loss, neurohormonal activation, and clinical stability in patients admitted for decompensated HF-PEF. METHODS/DESIGN: This is a randomized, parallel trial with blinded outcome assessment. The sample will include adult patients (aged ≥18 years) with a diagnosis of HF-PEF admitted for HF decompensation. The patients will be randomized to receive a diet with sodium and fluid intake restricted to 0.8 g/day and 800 mL/day respectively (intervention group) or an unrestricted diet, with 4 g/day sodium and unlimited fluid intake (control group), and followed for 7 days or until hospital discharge. The primary outcome shall consist of weight loss at 7 days or discharge. The secondary outcome includes assessment of clinical stability, neurohormonal activation, daily perception of thirst and readmission rate at 30 days. DISCUSSION: Assessment of the effects of sodium and fluid restriction on neurohormonal activation and clinical course of HF-PEF can promote a deeper understanding of the pathophysiology and progression of this complex syndrome. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT01896908 (date of registration: 8 August 2013).

Prega cutânea tricipital como preditor prognóstico na insuficiência cardíaca ambulatorial / Triceps skinfold as a prognostic predictor in outpatient heart failure

FUNDAMENTO: A maioria dos estudos relatando o paradoxo da obesidade utiliza índice de massa corporal (IMC) para classificar obesidade. Dados avaliando o valor prognóstico de outras medidas indiretas de composição corporal são pouco explorados na insuficiência cardíaca (IC). OBJETIVO: Avaliar a associação entre IMC e outras medidas de composição corporal indiretas com risco de morte por todas as causas na IC. MÉTODOS: Parâmetros antropométricos de composição corporal foram avaliados em 344 pacientes ambulatoriais com fração de ejeção do ventrículo esquerdo (FEVE) < 50%, de uma coorte prospectiva seguida durante 30 ± 8,2 meses. A sobrevida foi avaliada por curvas de Kaplan-Meier e análise de regressão de risco proporcional de Cox. RESULTADOS: Os pacientes eram predominantemente do sexo masculino, de etiologia não-isquêmica e com disfunção sistólica do VE moderada a grave (FEVE média de 32 ± 9%). Prega cutânea tricipital (PCT) foi o único parâmetro antropométrico associado com prognóstico, com valores significativamente menores nos pacientes que morreram (p = 0,047). Uma PCT > 20 mm estava presente em 9% dos pacientes que morreram e em 22% dos vivos (p = 0,027). Na análise univariada, creatinina sérica, FEVE e classe funcional foram associadas ao risco de morte. Na regressão de Cox, PCT > 20 mm foi o preditor independente mais forte de mortalidade por qualquer causa (hazard ratio: 0,36; IC 95%: 0,13-0,97; p = 0,03). CONCLUSÃO: Embora IMC seja o parâmetro antropométrico mais utilizado na prática clínica, nossos resultados sugerem que PCT pode ser um melhor preditor de mortalidade em pacientes ambulatoriais com IC.

BACKGROUND: Most reports regarding the obesity paradox have focused on body mass index (BMI) to classify obesity and the prognostic values of other indirect measurements of body composition remain poorly examined in heart failure (HF). Objective: To evaluate the association between BMI and other indirect, but easily accessible, body composition measurements associated with the risk of all-cause mortality in HF. METHODS: Anthropometric parameters of body composition were assessed in 344 outpatients with a left ventricular ejection fraction (LVEF) of <50% from a prospective HF cohort that was followed-up for 30 ± 8.2 months. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis. RESULTS: HF patients were predominantly male, of non-ischemic etiology, and had moderate to severe LV systolic dysfunction (mean LVEF = 32 ± 9%). Triceps skinfold (TSF) was the only anthropometric index that was associated with HF prognosis and had significantly lower values in patients who died (p = 0.047). A TSF > 20 mm was present in 9% of patients that died and 22% of those who survived (p = 0.027). Univariate analysis showed that serum creatinine level, LVEF, and NYHA class were associated with the risk of death, while Cox proportional hazard regression analysis showed that TSF > 20 was a strong independent predictor of all-cause mortality (hazard ratio = 0.36; 95% confidence interval = 0.13-0.97, p = 0.03). CONCLUSION: Although BMI is the most widely used anthropometric parameter in clinical practice, our results suggested that TSF is a better predictive marker of mortality in HF outpatients.

Validity and reliability of the Dietary Sodium Restriction Questionnaire (DSRQ).

INTRODUCTION: The Dietary Sodium Restriction Questionnaire (DSRQ) was designed to assess attitudes and behaviors of patients with heart failure (HF) related to following a low-sodium diet. Recently, it has been translated and culturally adapted for use in Brazil. However, further validation of the instrument is required before it can be used in the management of patients with HF in Brazil. OBJECTIVE: To test the reliability and validity of the Brazilian version of the DSRQ. METHODS: Face and content validity were assessed by a panel of experts. Construct validity was tested using exploratory and confirmatory factor analysis. Reliability was tested using Cronbach's alpha to assess the internal consistency of the instrument. RESULTS: A total of 206 systolic HF outpatients were assessed (mean age, 60.4 ± 11.9 years). Face and content validity analysis showed equivalence between the Brazilian version and the original instrument. In the exploratory factor analysis, the principal component analysis (PCA) yielded four factors with eigenvalues greater than 1. Three models were tested in the confirmatory factor analysis, and the three-factor model resulting from the PCA showed the best fit, accounting for 49% of the variance. Alpha values obtained for the attitude/subjective norm, perceived behavioral control, and dependent behavior subscales were 0.71, 0.67, and 0.79, respectively. CONCLUSIONS: Our results suggest that the final validated Brazilian version of the DSRQ is a valid and reliable tool for measuring attitudes and behaviors related to following a low-sodium diet in Brazilian patients with HF.

Introducción: El Dietary Sodium Restriction Questionnaire (DSRQ) evalúa actitudes y comportamientos de pacientes con insuficiencia cardiaca (IC) relacionados con el cumplimiento de la restricción de sodio. Recientemente, ha sido traducido y adaptado culturalmente para uso en Brasil. No obstante, una validación adicional del instrumento se requiere para que pueda ser utilizado en el manejo de pacientes con IC en Brasil. Objetivo: Probar la fiabilidad y validez de la versión brasileña del DSRQ. Métodos: Validez aparente y de contenido fueron evaluados por un grupo de especialistas. Validez de constructo se evaluó mediante análisis factorial exploratoria y confirmatoria. La fiabilidad y consistencia interna del cuestionario fue evaluada mediante el coeficiente alfa de Cronbach. Resultados: Un total de 206 pacientes ambulatorios con IC fueron evaluados (edad media, 60,4 ± 11,9 años). Los resultados de la validez aparente y de contenido demostró la equivalencia entre la versión brasileña y de la versión original. En el análisis factorial exploratorio, el análisis de componentes principales (PCA) se obtuvieron cuatro factores con valores superiores a 1. Tres modelos fueron probados en el análisis factorial confirmatoria, y el modelo de tres factores resultantes del PCA mostró el mejor ajuste, representando 49% de la varianza. El alfa obtenido para las escalas de actitud/norma subjetiva, control de la conducta percibido y comportamiento dependiente fueron 0,71, 0,67 y 0,79, respectivamente. Conclusiones: Nuestros resultados sugieren que la versión brasileña del DSRQ es un instrumento válido y fiable para medir las actitudes y comportamientos relacionados con una dieta baja en sodio en pacientes brasileños con IC.

Triceps skinfold as a prognostic predictor in outpatient heart failure.

BACKGROUND: Most reports regarding the obesity paradox have focused on body mass index (BMI) to classify obesity and the prognostic values of other indirect measurements of body composition remain poorly examined in heart failure (HF). OBJECTIVE: To evaluate the association between BMI and other indirect, but easily accessible, body composition measurements associated with the risk of all-cause mortality in HF. METHODS: Anthropometric parameters of body composition were assessed in 344 outpatients with a left ventricular ejection fraction (LVEF) of <50% from a prospective HF cohort that was followed-up for 30 ± 8.2 months. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis. RESULTS: HF patients were predominantly male, of non-ischemic etiology, and had moderate to severe LV systolic dysfunction (mean LVEF = 32 ± 9%). Triceps skinfold (TSF) was the only anthropometric index that was associated with HF prognosis and had significantly lower values in patients who died (p = 0.047). A TSF > 20 mm was present in 9% of patients that died and 22% of those who survived (p = 0.027). Univariate analysis showed that serum creatinine level, LVEF, and NYHA class were associated with the risk of death, while Cox proportional hazard regression analysis showed that TSF > 20 was a strong independent predictor of all-cause mortality (hazard ratio = 0.36; 95% confidence interval = 0.13-0.97, p = 0.03). CONCLUSION: Although BMI is the most widely used anthropometric parameter in clinical practice, our results suggested that TSF is a better predictive marker of mortality in HF outpatients.

Manejo de pragas em cultivo de roseira de sistema de produção integrada e sistema convencional / Pest management in rose crop in integrated production system and conventional system

A cultura da roseira é suscetível ao ataque de várias pragas e o uso de práticas agrícolas menos agressivas à natureza têm sido incentivadas como alternativa ao controle químico. O objetivo do trabalho foi avaliar o uso de agentes de controle biológico e defensivos alternativos no manejo de pragas na produção integrada de rosas e comparálo com o uso de defensivos químicos no sistema convencional. O experimento foi conduzido de fevereiro de 2010 a janeiro de 2011 em cultivo de roseira em casa de vegetação (18 x 6 m) em São João Del Rei (MG). Foram utilizadas mudas de rosas da cultivar 'Carolla' (espaçamento de 1,20 m x 0,20 m). Foram separadas duas áreas na casa de vegetação, sendo uma com controle químico convencional e outra de produção integrada. Cada área continha quatro linhas com 50 plantas por linha. Foram feitas amostragens semanais através da contagem dos artrópodes fitófagos e inimigos naturais presentes nas plantas. Os principais artrópodes fitófagos encontrados foram ácaros, pulgões, moscas brancas e tripes. Não foi constatado dano nas plantas em ambas as áreas avaliadas. Não foram utilizados defensivos químicos na área de produção integrada. Na área de produção integrada foram encontrados 84,2% dos inimigos naturais quantificados. Os resultados obtidos nesse estudo permitem concluir que o cultivo de rosas em sistema de produção integrada possibilita a redução da aplicação de defensivos químicos e o aumento da população de inimigos naturais na área.

The culture of the rose is susceptible to attack by various pests and the use of agricultural practices less aggressive to nature has been encouraged as an alternative to chemical control. The objective was to evaluate the use of biological control agents and alternative pesticides in pest management in integrated production of roses and compare it with the use of pesticides in the conventional system. The experiment was conducted from february 2010 to january 2011 rose cultivation in greenhouse (18 x 6 m) in São João Del Rei (MG). Was used rose variety 'Carolla' (1.20 m x 0.20 m). Two areas were separated in a greenhouse, one with conventional chemical control and other integrated production. Each area contained four lines with 50 plants per row. Samples were collected weekly by counting the insects present in plants. The mains phytophagous arthropods were found mites, aphids, whiteflies and thrips. Damage was not observed in plants in both areas studied. No pesticides were used in the area of Integrated Production. In the area of integrated production found 84.2% of natural enemies quantified. The results of this study support the conclusion that the cultivation of roses in an integrated production system allows the reduction of the application of pesticides and increased population of natural enemies in the area.

Aplicação das boas práticas por manipuladores de alimentos em lanchonetes da Universidade Federal do Tocantins / Applying best practices for food handlers in cafeterias University of Tocantins

Para obter alimentos de qualidade e que não ofereçam risco à saúde do consumidor é imprescindível que os mesmos tenham sido processados obedecendo às boas práticas (BP). A ausência das BP, durante a manipulação dos alimentos pode agravar a ocorrência de doenças veiculadas por alimentos, causando prejuízos financeiros ao consumidor e ao estabelecimento envolvido. Diante disto, três lanchonetes e um restaurante, localizados na Universidade Federal do Tocantins (UFT), Campus Palmas, foram alvos de estudo para verificar a aplicação das BP, cujo objetivo foi realizar um diagnóstico e capacitar os manipuladores de alimentos. Foi aplicado um questionário aos manipuladores e um checklist ambos baseados na RDC nº 216 da Agência Nacional de Vigilância Sanitária, para avaliar os seus conhecimentos e as condições dos estabelecimentos, respectivamente.

Adaptação transcultural para o Brasil do Dietary Sodium Restriction Questionnaire (Questionário Restritivo da Dieta de Sódio) (DSRQ) / Cross-cultural adaptation into Brazilian portuguese of the Dietary Sodium Restriction Questionnaire (DSRQ) / Adaptación transcultural para Brasil del dietary sodium restriction questionnaire (Cuestionario Restrictivo de la Dieta de Sodio) (DSRQ)

FUNDAMENTO: A restrição de sódio é uma medida não farmacológica frequentemente orientada aos pacientes com Insuficiência Cardíaca (IC). No entanto, a adesão é de baixa prevalência, ficando entre as causas mais frequentes de descompensação da IC. O Dietary Sodium Restriction Questionnaire (DSRQ) tem como objetivo identificar fatores que afetam a adesão à restrição dietética de sódio para pacientes com IC. No Brasil, não existem instrumentos que avaliem tais fatores. OBJETIVO: Realizar a adaptação transcultural do DSRQ. MÉTODOS: Estudo metodológico que envolveu as seguintes etapas: tradução, síntese, retrotradução, revisão por um comitê de especialistas, pré-teste da versão final e análise de concordância interobservador. No pré-teste foram avaliados os itens e sua compreensão, além da consistência interna pelo coeficiente alfa de Cronbach. O instrumento foi aplicado por dois pesquisadores simultânea e independentemente, sendo utilizado o teste Kappa para análise da concordância. RESULTADOS: Apenas uma questão sofreu alterações semânticas e/ou culturais maiores. No pré-teste, o alfa de Cronbach obtido para o total foi de 0,77, e para as escalas de Atitude, Norma subjetiva e Controle Comportamental obtiveram-se, respectivamente, 0,66, 0,50 e 0,85. Na etapa de concordância, o Kappa foi calculado para 12 das 16 questões, com valores que variaram de 0,62 a 1,00. Nos itens em que o cálculo não foi possível, a incidência de respostas iguais variou de 95 por cento a 97,5 por cento. CONCLUSÃO: A partir da adaptação transcultural do DSRQ foi possível propor uma versão do questionário para posterior avaliação das propriedades psicométricas.

BACKGROUND: Sodium restriction is a non-pharmacological measure often recommended to patients with heart failure (HF). However, adherence is low, being among the most common causes of HF decompensation. The Dietary Sodium Restriction Questionnaire (DSRQ) aims at identifying factors that affect adherence to dietary sodium restriction by patients with HF. In Brazil, there are no instruments to assess these factors. OBJECTIVE: Perform the transcultural adaptation of DSRQ. METHODS: Methodological study that involved the following steps: translation, synthesis, back-translation, review by an expert committee, pretest of the final version and analysis of interobserver agreement. In the pretest, items and their understanding were evaluated, as well as internal consistency by Cronbach's alpha. The instrument was simultaneously and independently administered by two researchers and the kappa test was used for agreement analysis. RESULTS: Only one question underwent major semantic and/or cultural alteration. At the pretest, Cronbach's alpha for the total obtained was 0.77; for the Attitude, Subjective Norm and Behavioral Control scales were obtained, respectively: 0.66, 0.50 and 0.85. At the agreement step, the Kappa was calculated for 12 of the 16 questions, with values ranging from 0.62 to 1.00. In items for which the calculation was not possible, the incidence of equal responses ranged from 95 percent to 97.5 percent. CONCLUSION: Based on the transcultural adaptation of DSRQ, it was possible to propose a version of the questionnaire for further evaluation of psychometric properties.

FUNDAMENTO: La restricción de sodio es una medida no farmacológica a menudo dirigida a los pacientes con Insuficiencia Cardíaca (IC). Sin embargo, la adhesión es de baja prevalencia, y queda entre las causas más comunes de descompensación de la IC. El Dietary Sodium Restriction Questionnaire (DSRQ) tiene como objetivo, identificar los factores que afectan la adhesión a la restricción dietética de sodio para pacientes con IC. En Brasil, no existen instrumentos que evalúen tales factores. OBJETIVOS: Realizar la adaptación transcultural del DSRQ. MÉTODOS: Estudio metodológico que contó con las siguientes etapas: traducción, síntesis, versión, revisión por parte de un comité de expertos, test previo de la versión final y análisis de concordancia interobservador. En el test anterior se evaluaron los ítems y su comprensión, además de la consistencia interna por el coeficiente alfa de Cronbach. El instrumento lo aplicaron dos investigadores de forma simultánea e independiente, siendo utilizado el test Kappa para el análisis de la concordancia. RESULTADOS: Solamente una pregunta tuvo alteraciones semánticas y/o culturales relevantes. En el test anterior, el alfa de Cronbach obtenido para el total fue de 0,77 y para las escalas de Actitud, Norma subjetiva y Control Comportamental obtuvimos, respectivamente, 0,66, 0,50 y 0,85. En la etapa de concordancia el Kappa fue calculado para 12 de las 16 preguntas, con valores que variaron de 0,62 a 1,00. En los ítems en que el cálculo no fue posible, el aparecimiento de las respuestas iguales varió de un 95 por ciento a un 97,5 por ciento. CONCLUSIONES: A partir de la adaptación transcultural del DSRQ se pudo proponer una versión del cuestionario para una posterior evaluación de las propiedades psicométricas.