Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services.

Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.

Food Patterns of Hospitalized Patients with Heart Failure and Their Relationship with Demographic, Economic and Clinical Factors in Sergipe, Brazil.

Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)" of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System­SUS (67.5%). Three dietary patterns were identified, labeled "traditional" (typical foods of the Brazilian northeastern population added to ultra-processed foods), "Mediterranean" (foods recommended by the Mediterranean diet) and "dual" (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the "traditional" pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The "Mediterranean" was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The "dual" diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the "traditional" pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the "dual" pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.

Fatores de risco para acidentes com materiais perfurocortantes / Risk factors of accidents with sharp instruments

Os profissionais de saúde estão expostos a uma série de riscos no ambiente hospitalar, dentre os quais merece destaqueo risco biológico. Esta pesquisa teve como objetivo identificar os fatores de risco para acidentes com material perfurocortantese analisar as principais causas referidas. Trata-se de estudo exploratório de caráter retrospectivo, com uma amostracomposta por 100 acadêmicos de enfermagem, que já exerciam a profissão no nível técnico e tivessem sofrido algumtipo de acidente com materiais perfurocortantes. Constatou-se que 41% dos acidentes ocorreram em hospitais de grandeporte, no turno matutino, sendo a UTI o ambiente com maior prevalência de acidentes, e os objetos que mais causaramacidentes foram as agulhas de seringas. As causas apontadas como possíveis fatores de risco para os acidentes indicam aimportância da implementação da Política Nacional de Educação Permanente em Saúde (PNEPS), a utilização de EPIs eas precauções-padrão.(AU)

Health care professionals are exposed to a number of risks in hospital environment among which biological risk should behighlighted. This research aimed to identify risk factors of accidents with sharp instruments and analyze the main causesmentioned. This is a retrospective exploratory study with a sample of one hundred nursing students already working at atechnical level and who had already suffered some sort of accident with sharp instruments. The analysis of the results showedthat 41% of the accidents occurred in large hospitals and in the morning shift, the ICU environment was the one withgreater prevalence of accidents and the objects that caused most accidents were syringe needles. The causes identified aspossible risk factors of accidents indicate the importance of implementing the National Policy on Permanent Education inHealth (PNEPS), of using PPE and of the standard precautions.(AU)

[Family Health Strategy in tuberculosis control in Curitiba, State of Paraná]. / A Estratégia de Saúde da Família no controle da tuberculose em Curitiba (PR).

Tuberculosis defined by some as the 'neglected calamity' is still an important public health problem. To try to improve results in tackling the disease, actions have been decentralized to the level of Primary Health Care (PHC), which has been demanding a new direction in the Family Health Strategy (FHS). This research sought to analyze the evolution of the FHS in the municipality of Curitiba between the years 2000 and 2009 and its impact on incidence rates of tuberculosis. The aggregate-type ecological study with a longitudinal territorial time-series base was the methodology used. Data collection was conducted from October 2010 to July 2011. The main results revealed a marked increase of 127.63% in the number of Family Health Teams, with a 76.28% increase of coverage. There was also concern about the ongoing training of these teams, which reflected positively in increasing the number of diagnostic tests performed, reducing the number of new cases, the proportion of individuals abandoning treatment and the mortality rate related to tuberculosis. From the research conducted it can be seen that there has been a correction in the direction of actions to control the incidence of tuberculosis in the municipality of Curitiba.

A Estratégia de Saúde da Família no controle da tuberculose em Curitiba (PR) / Family Health Strategy in tuberculosis control in Curitiba, State of Paraná

A tuberculose, definida por alguns como a 'calamidade negligenciada, é ainda um importante problema de saúde pública. Para tentar melhorar os resultados no seu enfrentamento, as ações foram descentralizadas para a Atenção Primária à Saúde (APS), o que vem demandando uma nova orientação na Estratégia de Saúde da Família (ESF). Esta pesquisa teve como objetivo analisar a evolução da Estratégia de Saúde da Família (ESF) no município de Curitiba entre os anos de 2000 a 2009 e seus reflexos sobre os casos de Tuberculose. Como metodologia utilizou-se o estudo Ecológico tipo agregado de base territorial longitudinal de séries temporais. A coleta de dados foi realizada no período de outubro de 2010 a julho de 2011. Como principais resultados verificou-se um aumento expressivo de 127,63% no número de Equipes de Saúde da Família, com um aumento da cobertura em 76,28%. Existiu também uma preocupação com relação à capacitação continuada destas equipes o que repercutiu de forma positiva no aumento de exames para diagnóstico realizado, redução do número de casos novos, redução da proporção de abandono do tratamento e da taxa de mortalidade relacionada a tuberculose. Pelo estudo realizado percebe-se uma correção no direcionamento das ações de controle da Tuberculose no município de Curitiba.

Tuberculosis defined by some as the 'neglected calamity' is still an important public health problem. To try to improve results in tackling the disease, actions have been decentralized to the level of Primary Health Care (PHC), which has been demanding a new direction in the Family Health Strategy (FHS). This research sought to analyze the evolution of the FHS in the municipality of Curitiba between the years 2000 and 2009 and its impact on incidence rates of tuberculosis. The aggregate-type ecological study with a longitudinal territorial time-series base was the methodology used. Data collection was conducted from October 2010 to July 2011. The main results revealed a marked increase of 127.63% in the number of Family Health Teams, with a 76.28% increase of coverage. There was also concern about the ongoing training of these teams, which reflected positively in increasing the number of diagnostic tests performed, reducing the number of new cases, the proportion of individuals abandoning treatment and the mortality rate related to tuberculosis. From the research conducted it can be seen that there has been a correction in the direction of actions to control the incidence of tuberculosis in the municipality of Curitiba.

Utilização da biofotogrametria para a avaliação da flexibilidade de tronco / Use of biophotogrammetry for assessment of trunk flexibility

INTRODUÇÃO: a ginástica rítmica (GR) é uma modalidade de ginástica que requer alto grau de flexibilidade, em virtude dos movimentos complexos que são requeridos. OBJETIVO: esta pesquisa objetivou comparar o teste de sentar e alcançar (TSA) e a técnica de biofotogrametria como indicadores de flexibilidade de tronco, em praticantes iniciantes de GR. METODOLOGIA: a amostra contou com 60 meninas (de cinco a 11 anos de idade) de um universo de 110, todas matriculadas em um centro de iniciação esportiva no estado do Paraná. A coleta de dados foi realizada no mês de novembro do ano de 2009. Para a comparação TSA com a biofotogrametria, foram traçados os ângulos de flexão da pelve (WP), flexão da coluna lombar (WC) e flexão do total do tronco (WT). RESULTADOS: o resultado médio atingido pelas participantes na escala do TSA foi de 27,75cm. Encontrou-se forte correlação do ângulo WT com o TSA. Por ser uma composição de WC e WP, o WT possibilita uma visualização global da distância do tronco até os membros inferiores quando ocorre a flexão durante o teste. Por isso, as correlações entre os ângulos são boas e significativas. CONCLUSÃO: uma vez que o TSA apresenta alguns fatores intervenientes que podem mascarar o seu resultado, a biofotogrametria é discutida como um teste que permite observar, através de imagens fotográficas e cálculos angulares, dados fidedignos para a mensuração de flexibilidade e compensações musculares não identificadas normalmente.

INTRODUCTION: Rhythmic Gymnastics (RG) is a type of gymnastics that requires a high degree of flexibility due to the complexity of the required movements. OBJECTIVE: this study aimed to compare the sit and reach test (SRT) and the Biophotogrammetry technique as indicators of trunk flexibility in beginning GR practitioners. METHODS: the sample included 60 girls (5-11 years old) from a universe of 110, all enrolled in a Center for Sports Initiation in Parana State. Data collection was performed in November, 2009. IN order to compare the TSA and biophotogrammetry, angles of the pelvis (WP), spinal flexion (WC) and total trunk flexion (WT) were drawn. RESULTS: the average score achieved by the participants on theTSA scale was 27.75 cm. A strong correlation was found between WT angle and the TSA values. Since it is a combination of the WC and WP, the WT provides a global view of the distance from the trunk to the legs when bending occurs during the test. Therefore, the correlations between the angles are good and meaningful. CONCLUSION: since the TSA has some intervening factors that may mask the result, biophotogrammetry is discussed as a test that allows the observation of reliable data for measuring flexibility and muscle compensation which are not usually identified, through photographs and angular calculations.

Knee bioelectric impedance assessment in healthy/with osteoarthritis subjects.

The present study analyzes parameters estimated by bioelectric impedance spectroscopy (BIS) in subjects with healthy and with osteoarthritis (OA) knees. Thirty-two male volunteers, members of the Parachute Military Infantry Brigade of Rio de Janeiro, Brazil, participated in the study (62 knee joints). Clinical specialists used the Dejour scale for OA classification and divided the subjects into a control (without OA) and a pathological group (with different degrees of OA). BIS data were obtained in a standing position using a BIS technique based on the current response to a step voltage excitation. Differences between groups were measured by means of a Wilcoxon-Mann-Whitney test. Results indicate that raw bioimpedance parameters seem to be sensitive to the physiological changes associated with OA. Thus, data indicate that extra-cellular resistance (Re) and reactance of the equivalent capacitance (Xcx) increase according to the disease intensity (p < 0.001). In conclusion, the BIS technique seems to be able to provide the objective and non-invasive basis for helping the diagnosis of knee OA.

Avaliação da exposição a metais numa oficina de recuperação de armamento de uma organização militar / Exposure assessment to metals in an armament repair shop of a military organization

O objetivo deste estudo foi a avaliação da exposição ocupacional ao chumbo e manganês dos trabalhadores de uma oficina de recuperação de armamento de uma organização militar. O ar do ambiente de trabalho foi avaliado no monitoramento ambiental e os indicadores biológicos de dose interna, para chumbo e manganês, em sangue e na urina, foram utilizados no monitoramento biológico. A concentração de manganês e chumbo nos filtros e fluidos biológicos foi determinada por espectrometria de absorção atômica eletrotérmica. Os resultados do monitoramento ambiental indicaram níveis de Pb e Mn acima do TLV-TWA durante o processo de pintura (313,33 μg m-3) e solda (951 μg m-3). Os indicadores biológicos revelaram que cinco dos nove trabalhadores apresentam níveis de Pb-S que sugerem exposição ambiental ao chumbo (valores entre 5 e 10 μg dL-1). Pode-se concluir que existe uma pequena exposição ocupacional ao chumbo e ao manganês na oficina de tratamento superficial. Tal exposição é influenciada pelas condições meteorológicas e pela demanda variável de trabalho.

The aim of this study was the occupational exposure assessment to lead and manganese of workers in an armament repair shop of a military organization. The air of the working environment was assessed in the environmental monitoring while the internal dose biological indicators for lead and manganese, in blood and urine, were used in biological monitoring. Metals concentration in filters and biological fluids were determined by electrothermal atomic absorption spectrometry. The results of the environmental monitoring showed lead and manganese levels above the TLV-TWA during the process of painting (313.33 g m-3) and solder (951 μg m-3). The biological indicators revealed that five of the nine employees presented Pb-S levels that suggested an environmental exposure to lead (values between 5 and 10 μg dL-1). It can be concluded that there is a small occupational exposure to lead and manganese in the superficial treatment repair shop. This exposure is influenced by weather conditions and the variable demand of work.

[Exposure assessment to metals in an armament repair shop of a military organization]. / Avaliação da exposição a metais numa oficina de recuperação de armamento de uma organização militar.

The aim of this study was the occupational exposure assessment to lead and manganese of workers in an armament repair shop of a military organization. The air of the working environment was assessed in the environmental monitoring while the internal dose biological indicators for lead and manganese, in blood and urine, were used in biological monitoring. Metals concentration in filters and biological fluids were determined by electrothermal atomic absorption spectrometry. The results of the environmental monitoring showed lead and manganese levels above the TLV-TWA during the process of painting (313.33 g m-3) and solder (951 microg m-3). The biological indicators revealed that five of the nine employees presented Pb-S levels that suggested an environmental exposure to lead (values between 5 and 10 microg dL-1). It can be concluded that there is a small occupational exposure to lead and manganese in the superficial treatment repair shop. This exposure is influenced by weather conditions and the variable demand of work.

Avaliação da hidratação dos alunos do curso de formação de Pára-quedistas Militares do Exército Brasileiro / Assessment of hydration among Brazilian army parachuting training program rookies

Este estudo teve como objetivo avaliar a hidratação dos alunos do Curso Básico Páraquedista (C Bas Pqdt - Curso de Formação dos Pára-quedistas Militares Brasileiros) de acordo com a variação da massa corporal e do calculo do total de líquidos corporais a partir do método de bioimpedância elétrica. A coleta de dados ocorreu durante as três semanas da 1ª fase do Curso Básico Pára-quedista, de 7 a 25 de janeiro de 2008. A amostra foi selecionada de forma aleatória entre os 422 alunos que iniciaram o curso. Participaram do estudo 90 militares do sexo masculino, voluntários, que podem ser caracterizados pelos seguintes dados antropométricos médios: idade(25,08 ± 3,96 anos); peso (76,53 ± 7,39 kg); altura (174,53 ± 5,85 cm) e percentual de gordura (14,07 ± 4,09). A perda hídrica percentual média foi de 3% do peso corporal e 46,7% dos sujeitos apresentaram níveis de desidratação superiores a essa média. Os resultados sugerem que a exposição ao estresse térmico e a relação volume X intensidadedo treinamento estão inadequadas, provocando uma acentuada velocidade de perda hídrica nos alunos do curso.

The aim of the present study was to evaluate hydration levels in the Basic Parachutist Course (BPC - the main program for Brazilian military parachutists training) students according to their body mass and total body water variations. To this end, a bio-impedance method was used in order to assess the subject?s fat percents. The data were collected during the 3 weeks of the first phase of the training course, January 7 - 25, 2008. The sample was randomly selected from the 422 volunteers who started the course. 90 male subjects participated in the study, and they can be characterized by the following anthropometric data: age (25.08 ± 3.96 years); weight (76.53 ± 7.39 kg); height (174.53 ± 5.85 cm) and fat percent (14.07 ± 4.09). The water loss average was 3% of the body weight and 46.7% of the subjects had higher levels of dehydration than the average. The results suggest that the course stress levels are not adequate, implying in an excessive water loss by its subjects.

Gerenciamento do risco ocupacional no Exército Brasileiro: aspectos normativos e práticos / Occupational risk management in the Brazilian army: normative and practical aspects

Neste estudo procurou-se descrever o método de gerenciamento do risco que o Exército Brasileiro utiliza em suas atividades, desde a parte normativo-documental até a execução das atividades nos quartéis de tropa e confrontá-lo, de maneira sucinta, com alguns aspectos de segurança ocupacional previstos pelo Ministério do Trabalho e Emprego. Foi utilizada uma abordagem qualitativa, com base em uma triangulação de técnicas de coleta de dados, a saber: coleta documental; observação sistemática e entrevista semi-estruturada, na qual selecionou-se 24 informantes militares, os quais foram divididos em três grupos, visando a coletar informações dos grandes círculos hierárquicos: oficiais, sargentos, cabos e soldados. Constatou-se que o método de gerenciamento do risco do Exército Brasileiro apóia-se em três documentos principais: o Caderno de Instrução 32/1, o Caderno de Instrução 32/2 e o Programa de Instrução Militar. Observou-se, ainda, que esse método faz referência apenas aos riscos de acidentes, desconsiderando alguns aspectos importantes previstos nas Normas Regulamentadoras do Ministério do Trabalho e Emprego e os demais tipos de riscos.

This study aims to describe the risk management method used by the Brazilian Army, ranging from the guidelines, norms, and standards to the implementation of activities in the barracks, providing a brief comparison with key occupational safety provisions by the Ministry of Labor and Employment. A qualitative approach was used, based on triangulation of data collection techniques: document collection; systematic observation; and a semi-structured interview with 24 key informants among the military, divided into three groups, aimed at collecting information on the main hierarchical levels: officers, sergeants, corporals, and privates. We found that the Brazilian Army's risk management method is based on three main documents: Instruction Booklet 32/1, Instruction Booklet 32/2, and the Military Instruction Program. The method only refers to accident risks, overlooking other important aspects covered in the Regulatory Standards of the Ministry of Labor and Employment and other types of risks.

[Occupational risk management in the Brazilian army: normative and practical aspects]. / Gerenciamento do risco ocupacional no Exército Brasileiro: aspectos normativos e práticos.

This study aims to describe the risk management method used by the Brazilian Army, ranging from the guidelines, norms, and standards to the implementation of activities in the barracks, providing a brief comparison with key occupational safety provisions by the Ministry of Labor and Employment. A qualitative approach was used, based on triangulation of data collection techniques: document collection; systematic observation; and a semi-structured interview with 24 key informants among the military, divided into three groups, aimed at collecting information on the main hierarchical levels: officers, sergeants, corporals, and privates. We found that the Brazilian Army's risk management method is based on three main documents: Instruction Booklet 32/1, Instruction Booklet 32/2, and the Military Instruction Program. The method only refers to accident risks, overlooking other important aspects covered in the Regulatory Standards of the Ministry of Labor and Employment and other types of risks.