Síndrome metabólica em profissionais de enfermagem que atuam na assistência oncológica: prevalência e fatores associados / Síndrome metabólico en profesionales de enfermería que actúan en la asistencia oncológica: prevalencia y factores asociados / Metabolic syndrome in nursing professionals working in oncology care: prevalence and associated factors

RESUMO Objetivo: avaliar a prevalência da síndrome metabólica e os fatores associados em profissionais de enfermagem que atuam em oncologia. Método: estudo transversal com 231 profissionais de enfermagem, de um centro de alta complexidade em oncologia do Estado do Rio de Janeiro, Brasil, entre junho de 2013 e junho de 2015. Realizou-se entrevista para coleta de dados sociodemográficos, profissionais, antecedentes pessoais, hábitos e estilos de vida e condições de saúde. Foram realizadas medida da circunferência da cintura, peso, altura, pressão arterial casual e Monitorização Ambulatorial da Pressão Arterial, além da glicemia plasmática de jejum, triglicerídeos e lipoproteína de alta densidade. Avaliou-se a síndrome metabólica de acordo com a I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. Regressão de Poisson com variância robusta foi realizada, sendo a presença da síndrome metabólica ou não o desfecho. Resultados: a prevalência da síndrome metabólica foi de 25,1% e esta condição se associou ao maior tempo de formação profissional (4,0%; IC95%:1,05-1,07), à maior pressão diastólica na Monitorização Ambulatorial da Pressão Arterial do período de sono (3,0%; IC95%:1,01-1,05), presença de sobrepeso (2,84%; IC95%:1,93-6,70) e obesidade (4,94%; IC95%:2,08-11,77). Conclusões: observou-se alta prevalência da síndrome metabólica nos profissionais avaliados, e associação com excesso de peso e alteração da pressão no período de sono. Os resultados apontam para necessidade de intervenções para controle de fatores de risco para doenças crônicas não transmissíveis na população estudada.

RESUMEN Objetivo: evaluar la prevalencia del síndrome metabólico y los factores asociados en profesionales de enfermería que actúan en oncología. Método: estudio transversal con 231 profesionales de enfermería, de un centro de alta complejidad en oncología del Estado de Rio de Janeiro, Brasil, entre junio de 2013 y junio de 2015. Se realizó entrevista para recolección de datos sociodemográficos, profesionales, antecedentes personales, hábitos y estilos de vida y condiciones de salud. Fueron realizadas medida de la circunferencia de la cintura, peso, altura, presión arterial casual y Monitoreo Ambulatorio de Presión Arterial, además de la glucemia plasmática de ayuno, triglicéridos y lipoproteína de alta densidad. Se evaluó el síndrome metabólico de acuerdo con la I Directriz Brasileña de Diagnóstico y Tratamiento del Síndrome Metabólico. Fue realizada Regresión de Poisson con varianza robusta, siendo la presencia del síndrome metabólico, o no, el resultado. Resultados: la prevalencia del síndrome metabólico fue de 25,1% y esta condición se asoció al mayor tiempo de formación profesional (4,0%; IC95%:1,05-1,07), a la mayor presión diastólica en elMonitoreo Ambulatorio de Presión Arterial del período de sueño (3,0%; IC95%:1,01-1,05); presencia de sobrepeso (2,84%; IC95%:1,93-6,70) y obesidad (4,94%; IC95%:2,08-11,77). Conclusiones: se observó alta prevalencia del síndrome metabólico en los profesionales evaluados, y asociación con exceso de peso y alteración de la presión en el período de sueño. Los resultados señalan la necesidad de intervenciones para el control de factores de riesgo para enfermedades crónicas no transmisibles en la población estudiada.

ABSTRACT Objective: to evaluate the prevalence of metabolic syndrome and associated factors in nursing professionals working in oncology. Method: cross-sectional study with 231 nursing professionals from a high complexity oncology center in the State of Rio de Janeiro, Brazil, between June 2013 and June 2015. An interview was carried out to collect sociodemographic, professional, personal history, habits and lifestyles, and health conditions data. Waist circumference, weight, height, casual blood pressure, and Ambulatory Blood Pressure Monitoring were performed, in addition to fasting plasma glucose, triglycerides, and high-density lipoprotein. Metabolic syndrome was evaluated according to the I Brazilian Guideline for the Diagnosis and Treatment of Metabolic Syndrome. Poisson regression with robust variance was performed, the outcome being the presence or not of metabolic syndrome. Results: there was a 25.1% prevalence of metabolic syndrome and this condition was associated with longer professional training (4.0%; 95%CI: 1.05-1.07), with higher diastolic pressure in Ambulatory Blood Pressure Monitoring during sleep (3.0%; 95%CI:1.01-1.05), overweight (2.84%; 95%CI:1.93-6.70), and obesity (4.94%; IC95%: 2.08-11.77). Conclusions: there was a high prevalence of metabolic syndrome among the evaluated professionals, and an association between excess weight and changes in pressure during sleep. The results point to the need for interventions to control risk factors for chronic non-communicable diseases in the studied population.

Oncology nurses' knowledge and awareness on metabolic syndrome in cancer survivors and the perceived barriers to the provision of related care: A mixed-method study.

OBJECTIVE: To identify oncology nurses' level of knowledge and awareness of metabolic syndrome (MetS) in cancer survivors and the perceived barriers to the provision of MetS-related care. METHODS: In this mixed-method study, 196 participants responded to a structured modified questionnaire that included items pertaining to MetS-related knowledge and awareness. Concurrently, 24 semi-structured interviews were conducted. A qualitative survey and quantitative interview were conducted between October 2018 and December 2018. RESULTS: While oncology nurses had a high level of knowledge of MetS in terms of its individual components, they failed to accurately differentiate MetS cases from non-MetS ones. Further, they showed a high level of awareness of MetS-related care for cancer survivors but did not apply their knowledge in clinical settings. In the qualitative survey, the nurses cited various factors pertaining to their perceived barriers to the provision of MetS-related care, including the fact that cancer survivors are distinguished by the specificity of the subject and inpatient environmental constraints. CONCLUSIONS: Oncology nurses had a high level of knowledge of MetS but failed to accurately identify MetS cases. Thus, their level of knowledge should be improved, and strategies are needed to overcome the perceived barriers to the provision of MetS-related care.

Terminologia especializada de enfermagem para o cuidado de pessoas com síndrome metabólica / Terminología especializada de enfermería para el cuidado a la persona con síndrome metabólica / Specialized nursing terminology for the care of people with metabolic syndrome

RESUMO Objetivo Construir uma terminologia especializada de enfermagem para o cuidado de pessoas com síndrome metabólica na Atenção Primária à Saúde. Método Estudo metodológico, realizado a partir da identificação dos conceitos de enfermagem para o cuidado à pessoa com a síndrome, validação dos conceitos com enfermeiros especialistas e mapeamento cruzado com os conceitos primitivos da CIPE® 2017. Resultados Dos conceitos extraídos, 489 envolveram as necessidades psicobiológicas, psicossociais e psicoespirituais. Destes, 441 conceitos foram validados e submetidos ao mapeamento e à análise de similaridade e abrangência, a qual possibilitou eliminação de conceitos considerados sinônimos, culminado em 389 conceitos relacionados às necessidades de pessoas com síndrome metabólica, em que 43,7% dos conceitos validados não constavam na versão 2017 da CIPE®. Do total de conceitos constantes e não constantes, 42,3% foram classificados no eixo Ação, seguido do eixo Foco (34,9%). Conclusão e implicações para a prática Com o alcance do objetivo, têm-se o avanço no conhecimento sobre a utilização da CIPE®, com uma proposta de uniformização da linguagem profissional para o cuidado de pessoas com síndrome metabólica, com potencial para incrementar sistemas de informação da Atenção Primária à Saúde com indicadores do cuidado de enfermagem para pessoas com agregação de fatores de risco cardiovascular.

RESUMEN Objetivo Construir una terminología especializada en enfermería para el cuidado de personas con síndrome metabólico en Atención Primaria de Salud Método Estudio metodológico, basado en la identificación de conceptos de enfermería para el cuidado de personas con síndrome, validación de conceptos con enfermeros expertos y mapeo cruzado con los primeros conceptos de CIPE® 2017. Resultados De los conceptos extraídos, 489 involucraron las necesidades psicobiológicas, psicosociales y espirituales. De estos, 441 conceptos fueron validados y sometidos a mapeo y análisis de similitud y exhaustividad, lo que permitió la eliminación de conceptos considerados sinónimos, que culminaron en 389 conceptos relacionados con las necesidades de las personas con síndrome metabólico, de los cuales el 43.7% de los conceptos validados no constaban en la versión 2017 de la CIPE®. Del total de conceptos constantes y no constantes, el 42,3% se clasificó en el eje Acción, seguido del eje Enfoque (34,9%). Conclusión e implicaciones para la práctica con el logro del objetivo, existe un avance en el conocimiento sobre el uso de CIPE®, con una propuesta para estandarizar el lenguaje profesional para la atención de personas con síndrome metabólico, con el potencial de mejorar los sistemas de información de Atención Primaria de Salud con indicadores de atención de enfermería para personas con agregación de factores de riesgo cardiovascular.

ABSTRACT Objective To build a specialized nursing terminology for the care of people with metabolic syndrome in Primary Health Care. Method Methodological study, based on the identification of nursing concepts for the care of people with the syndrome, validation of concepts with nurses experts, and cross-mapping with the early concepts of ICNP® 2017. Results Of the concepts extracted, 489 involved psychobiological, psychosocial, and psycho-spiritual needs. Of these, 441 concepts were validated and subjected to mapping and analysis of similarity and comprehensiveness, which allowed the elimination of concepts considered synonyms, culminating in 389 concepts related to the needs of people with metabolic syndrome, in which 43.7% of validated concepts were not contained in the 2017 version of the ICNP®. Of the constant and non-constant concepts, 42.3% were classified in the Action axis, followed by the Focus axis (34.9%). Conclusion and implications for practice With the achievement of the objective, there is the advance in knowledge about the use of ICNP®, with a proposal to standardize professional language for the care of people with metabolic syndrome, with the potential to increase Primary Health Care information systems with indicators of nursing care for people with aggregation of cardiovascular risk factors.

A Retrospective Chart Review of Screening on the Prevalence of Metabolic Syndrome (MetS) in an Irish Community Mental Health Service.

Individuals who are treated with antipsychotic medications are at risk of developing metabolic syndrome (MetS). The comorbidity of a severe mental illness (SMI) and a physical illness has a major impact on the quality of life of these individuals. We conducted a retrospective chart review (RCR) of 214 individuals with a diagnosis of schizophrenia who had been receiving antipsychotic medications for at least 6 months, in five clinical settings in an Irish community mental health service. The aim was to determine the presence of MetS to assist in improving screening practices and directing future practice. The National Cholesterol Education Program High Blood Cholesterol Adult Treatment Panel 111 (NCEP ATP 111) metabolic diagnostic criteria were utilised to determine prevalence. After examining 214 charts we observed that waist circumference varied from 68 to 142 cm, elevated waist circumference over the recommended parameters was recorded in 145 charts. Forty-five percent (n = 98) had blood pressure (BP) readings over 130/85. The range for body mass index (BMI)'s varied from 16 to 54, BMIs over 25 was recorded in 44% (n = 95) of charts. Elevated triglycerides (TG) were recorded in 37% (n = 80) and 45% (n = 97) had reduced HDL-C levels. Elevated glucose levels were found in 25% (n = 54) of the charts examined. The chart review found an overall prevalence rate of 44% (n = 94) for this sample. Regular audit of screening data used for the presence of MetS in individuals with SMI is essential in the detection of physical comorbidities and to improving the quality of life and prevention of premature deaths.

Síndrome metabólica: análise conceitual no contexto da enfermagem / Metabolic Syndrome: conceptual analysis in the nursing context / Síndrome metabólica: análisis conceptual en el contexto de la enfermería

Objetivo analisar o conceito síndrome metabólica e identificar respectivos atributos essenciais, antecedentes e consequentes no contexto da enfermagem. Método análise conceitual, a partir dos passos metodológicos de um modelo. Realizou-se revisão integrativa, por meio de acesso on-line a quatro bases de dados: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Literatura Latino-Americana em Ciências da Saúde e Índice Bibliográfico Español en Ciencias de la Salud. Resultados os atributos essenciais mais frequentes envolveram os critérios diagnósticos da síndrome metabólica. Alimentação inadequada e sedentarismo destacaram-se como antecedentes mais comuns da síndrome, e os consequentes foram ocorrências de doenças cardiovasculares e diabetes mellitus tipo 2. Como implicação, tem-se o destaque de relevantes dados empíricos para definição ampla do conceito. Conclusão foi possível analisar o conceito em estudo no que concerne aos atributos essenciais, antecedentes e consequentes, definindo-o operacionalmente como potencial fenômeno de enfermagem que demanda cuidados direcionados para redução do risco e da morbimortalidade por doenças cardiovasculares.

Objective to analyze the metabolic syndrome concept and to identify its essential features, antecedents, and outcomes within the context of nursing. Method conceptual analysis, based on the methodological steps of a model. We carried out an integrative review by accessing four databases online: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature, and Índice Bibliográfico Español en Ciencias de la Salud. Results the essential features most frequently involved the diagnostic criteria of metabolic syndrome. Inadequate nutrition and physical inactivity were highlighted as the most common antecedents of the syndrome, and the outcomes were occurrences of cardiovascular disease and diabetes mellitus type 2. As implication, we highlight relevant empirical data to the broad definition of the concept. Conclusion we could analyze the concept under study regarding essential features, antecedents, and outcomes, operationally defining it as a potential nursing phenomenon, which demands health care focusing on reducing risks and morbidity and mortality for cardiovascular diseases.

Objetivo analizar el concepto síndrome metabólica e identificar respectivos atributos esenciales, antecedentes y consecuentes en el contexto de la enfermería. Método análisis conceptual, desde los pasos metodológicos de un modelo. Se realizó la revisión integrativa, por medio de acceso online a cuatro bases de datos: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Literatura Latinoamericana en Ciencias de la Salud y Índice Bibliográfico Español en Ciencias de la Salud. Resultados los atributos esenciales más frecuentes involucraron los criterios diagnósticos del síndrome metabólica. Alimentación inadecuada y sedentarismo se destacaron como antecedentes más comunes del síndrome, y los consecuentes fueron ocurrencias de enfermedades cardiovasculares y diabetes mellitus tipo 2. Como implicación, se tiene el destaque de relevantes datos empíricos para la definición amplia del concepto. Conclusión ha sido posible analizar el concepto en estudio en el que concierne a los atributos esenciales, antecedentes y consecuentes, definiéndolo operacionalmente como potencial fenómeno de enfermería que demanda cuidados direccionados para la reducción del riesgo y de la morbimortalidad por enfermedades cardiovasculares.

Improving Metabolic Syndrome Screening on Patients on Second Generation Antipsychotic Medication.

AIM: This quality improvement project aims at stressing the importance of screening for metabolic syndrome (MS) on patients with serious mental illness (SMI) managed with second generation antipsychotic (SGA) medication. METHOD: One hundred charts of patients who were on SGA (n=100) were randomly selected from more than 1000 charts for the purpose of this project with (n=50) charts for pre-intervention and (n=50) charts for post intervention. A chi-square test of independence was calculated comparing the frequency of labs and vital done in pre-intervention and post-intervention period. RESULTS: A significant interaction was found [χ2(2)=32.67, p<.001] indicating that providers were more likely to order labs in postintervention (62%) than in pre-intervention (22%). No significant relationship was found for vital signs [χ2(1)=.542, p>.05]. The use of the screening and monitoring tool showed that gaps exist in the screening for MS among patients on SGA. IMPLICATION TO PRACTICE: Advanced health nurse practitioners are well placed to take the lead in screening, monitoring, and implementing the necessary measures to address MS among patients with serious mental illness.

Metabolic Syndrome Screening and Assertive Community Treatment: A Quality Improvement Study.

Metabolic syndrome defines a collection of cardiometabolic illnesses that predict risk for poor physical health and early death and is highly prevalent among those with serious mental illness. Despite recommendations for routine monitoring, those with serious mental illness frequently do not receive physical health screenings. We conducted a quality improvement (QI) project to increase rates of metabolic syndrome screening in three New York City Assertive Community Treatment (ACT) teams. The project, conducted from December 2010 to May 2011, involved educational sessions for staff and consumers and a systematic screening protocol. We collected complete metabolic syndrome screening measurements for 71% of participating ACT consumers. We found metabolic risk to be nearly universal among participants, with over half diagnosed with metabolic syndrome. We also found high rates of previously undiagnosed hypertension, diabetes, and dyslipidemia. We describe the resources and obstacles we encountered in our QI project to make systematic metabolic screening a routine part of ACT care. This QI project suggests that ACT teams can take a leadership role in screening their consumers for physical health issues, aligning with recent policy trends to better integrate behavioral health and primary care services.

Lifestyle modifications supported by regional health nurses lowered insulin resistance, oxidative stress and central blood pressure in subjects with metabolic syndrome.

BACKGROUND: This study was attempted to investigate whether lifestyle modifications supported by regional health nurses should improve cardio-metabolic factors--including adipocytokines, oxidative stress, and arterial stiffness--in subjects with metabolic syndrome. METHODS: Thirty-six subjects with metabolic syndrome were enrolled, 28 of whom completed the 6-month lifestyle modifications (male:female=19:9). Blood and urine test results were examined in relation to metabolic factors before and after 6-month nutritional and physical activity modifications. In addition, oral glucose tolerance tests were performed and arterial stiffness was measured by brachial-ankle pulse wave velocity and radial augmentation index before and after them. RESULTS: Six-month lifestyle modifications significantly reduced body weight, homeostasis model assessment index, and low-density lipoprotein cholesterol (LDL-C). They significantly attenuated oxidative stress measured by the urinary 8-hydroxy-2-deoxyguanosine/creatinine ratio. They also lowered brachial and central systolic blood pressure. They tended to decrease waist circumferences and the levels of C-reactive protein. However they did not significantly change the levels of adipocytokines, including tumour necrosis factor, soluble tumour necrosis factor receptors, and interleukin 6, or arterial stiffness measured by brachial-ankle pulse wave velocity and radial augmentation index. CONCLUSIONS: Six-month lifestyle modifications supported by regional health nurses lowered body weight, insulin resistance, LDL-C, oxidative stress, and peripheral and central blood pressure in subjects with metabolic syndrome.

Insulin Resistance, Metabolic Syndrome, and Polycystic Ovary Syndrome in Obese Youth.

School nurses are well aware of the childhood obesity epidemic in the United States, as one in three youth are overweight or obese. Co-morbidities found in overweight or obese adults were not commonly found in youth three decades ago but are now increasingly "normal" as the obesity epidemic continues to evolve. This article is the second of six related articles discussing the co-morbidities of childhood obesity and discusses the complex association between obesity and insulin resistance, metabolic syndrome, and polycystic ovary syndrome. Insulin resistance increases up to 50% during puberty, which may help to explain why youth are more likely to develop co-morbidities as teens. Treatment of these disorders is focused on changing lifestyle habits, as a child cannot change his or her pubertal progression, ethnicity, or family history. School nurses and other personnel can assist youth with insulin resistance, metabolic syndrome, and polycystic ovary syndrome by supporting their efforts to make changes, reinforcing that insulin resistance is not necessarily type 2 diabetes even if the child is taking medication, and intervening with negative peer pressure.

Androgen-deprivation therapy and metabolic syndrome in men with prostate cancer.

PURPOSE/OBJECTIVES: To examine the trajectory of changes in body composition and metabolic profile in men who receive androgen-deprivation therapy (ADT) for prostate cancer. DESIGN: Prospective longitudinal design with repeated measures. SETTING: Urban medical center in the southwestern United States. SAMPLE: 55 men starting radiation therapy for prostate cancer. METHODS: Changes in the parameters of metabolic syndrome were estimated with ADT (n=31) and non-ADT (n=24) groups by repeated-measures analysis of variance implemented by general linear mixed-effects models. Models included interactions between groups and follow-up time to test differences between the groups. MAIN RESEARCH VARIABLES: Body composition and metabolic variables. FINDINGS: The ADT group demonstrated a transient increase in waist circumference at the nine-month time point and significant changes in measures of insulin resistance were noted at the three month point. Values for diastolic and systolic blood pressure, plasma glucose, high-density lipoprotein, and triglycerides were not altered for either group. Differences in metabolic variables or measures of body composition did not differ significantly between the groups. CONCLUSIONS: The findings demonstrate the development of insulin resistance in men receiving ADT as early as three months after starting ADT. IMPLICATIONS FOR NURSING: Addressing survivorship concerns can lead to the development of nursing interventions designed to reduce adverse effects associated with ADT.

Preventing the development of metabolic syndrome in people with psychotic disorders--difficult, but possible: experiences of staff working in psychosis outpatient care in Sweden.

The aim of this study was to explore mental health staffs' experiences of assisting people with psychotic disorders to implement lifestyle changes in an effort to prevent metabolic syndrome. Qualitative interviews were conducted with 12 health care professionals working in psychosis outpatient care in Sweden. Data were analysed using a qualitative content analysis. The results illustrate that implementation of lifestyle changes among people with psychotic disorders was experienced as difficult, but possible. The greatest obstacles experienced in this work were difficulties due to the reduction of cognitive functions associated with the disease. Guidelines available to staff in order to help them identify and prevent physical health problems in the group were not always followed and the content was not always relevant. Staff further described feelings of uncertainty about having to motivate people to take anti-psychotic medication while simultaneously being aware of the risks of metabolic deviations. Nursing interventions focusing on organising daily routines before conducting a more active prevention of metabolic syndrome, including information and practical support, were experienced as necessary. The importance of healthy eating and physical activity needs to be communicated in such a way that it is adjusted to the person's cognitive ability, and should be repeated over time, both verbally and in writing. Such efforts, in combination with empathic and seriously committed community-based social support, were experienced as having the best effect over time. Permanent lifestyle changes were experienced as having to be carried out on the patient's terms and in his or her home environment.

Metabolic syndrome in African Americans: views on making lifestyle changes.

This study explores African American adults' understanding of metabolic syndrome (MetS) and their motivations for making lifestyle changes. African Americans have a greater risk for components of MetS, such as hypertension. Three focus groups were conducted with African American adults (n = 11) with MetS. Content analysis revealed five themes: Threat of Poor Health, Building Trust With Providers, Gaining Social Support, Seeking Culturally Acceptable Alternatives, and Getting on Track and Staying on Track. Lifestyle interventions for African Americans with MetS need to focus on building trust, developing self-monitoring skills, social support, and identifying low-cost/convenient opportunities for physical activity.

Lifestyles and cardiovascular risk in individuals with functional psychoses.

PURPOSE: This study aims to examine known determinants of cardiovascular risk in Italian patients with functional psychoses. DESIGN AND METHODS: A cross-sectional study design was used to examine cardiovascular risk factors and lifestyle behaviors of 123 individuals with functional psychosis and compare clinically relevant data with those of the general Italian population. FINDINGS: A significant proportion of patients manifested frank hypertension (6.9%), hypercholesterolemia (20.5%), diabetes (6.5%), or a body mass index of more than 30 (20.3%). Many also smoked (63.0%) or ingested alcohol every day (26.0%), did not eat fruits or vegetables (8.0%), or did not exercise on a daily basis (34.0%). PRACTICE IMPLICATIONS: Patients with psychosis manifest significant rates of potentially reversible risk factors for cardiovascular diseases. Mental health nurses should advocate for and implement well-resourced counseling programs to reduce the prevalence of smoking and metabolic syndrome in mental health populations.

Síndrome metabólica e estilo de vida / Metabolic syndrome and life style

Estudo exploratório-descritivo, com abordagem qualitativa, realizado no município de Vanini, Rio Grande do Sul, tendo como objetivo identificar a repercussão do diagnóstico de síndrome metabólica na vida de seus portadores. Foram selecionados 18 sujeitos de forma aleatória. Os dados foram coletados por meio de entrevista semi-estruturada no mês de abril de 2007. O conteúdo das entrevistas foi tratado com a técnica da análise temática. Foram construídas as seguintes categorias: significado do diagnóstico,reeducação alimentar, mudança no estilo de vida, integração em grupos, disposição e bem-estar. Este trabalho permitiu perceber que os portadores de síndrome metabólica precisam continuar tendo apoio, acompanhamento e orientação dos profissionais, fortalecendo a autonomia e estimulando a responsabilização de cada portador.