Presence of Self-Reported Sleep Alterations After Stroke and Their Relationship With Disability: A Longitudinal Study.

BACKGROUND: Sleep disorders have a prevalence of 30% to 70% in post-stroke individuals. The presence of sleep disorders and poor sleep quality after stroke can affect important functions and lead to worse outcomes. However, most studies are restricted to the acute post-stroke stage only. OBJECTIVE: To investigate the frequency of self-reported sleep alterations in a sample of chronic stroke individuals and to identify which self-reported sleep alterations were associated with disability. METHODS: Prospective exploratory study. Self-reported sleep alterations were measured by the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, and STOP-Bang Questionnaire. The dependent variable was measured 3 years after the first contact by the Modified Rankin Scale (mRS). Step-wise multiple linear regression analysis was employed to identify which sleep alterations were associated with disability. RESULTS: Sixty-five individuals with stroke participated. About 67.7% of participants had poor sleep quality, 52.4% reported insomnia symptoms, 33.9% reported excessive daytime sleepiness, and 80.0% were classified as intermediate or high risk for obstructive sleep apnea. Only risk for obstructive sleep apnea was significantly associated with disability and explained 5% of the variance in the mRS scores. CONCLUSION: Self-reported sleep alterations had a considerable frequency in a sample of chronic stroke individuals. The risk of obstructive sleep apnea was associated with disability in the chronic stage of stroke. Sleep alterations must be considered and evaluated in the rehabilitation process even after a long period since the stroke onset.

Hábitos e práticas alimentares de uma comunidade paraense e prevenção de hipertensão e diabetes / Eating habits and practices of a community from Pará and prevention of hypertension and diabetes

Trata-se de um relato de experiência que objetivou descrever a vivência de acadêmicos de enfermagem na utilização de uma tecnologia educativa para abordagem da alimentação de hipertensos e diabéticos paraenses. Utilizou-se um painel interativo com figuras de alimentos presentes no cotidiano da população, algumas relacionadas a alimentos capazes de contribuir para o descontrole das doenças e outras com alimentos substitutivos, mais saudáveis e capazes de exercer papel positivo e efeito protetor. Observou-se que a ação centrada na adaptação e nas sugestões de substituições mais saudáveis com diminuição da quantidade ou substituições por alimentos regionais mostrou-se positiva, uma vez que estimulou o senso de pertencimento cultural e a autonomia do participante e que a elaboração de planos de cuidado devem ser personalizados em respeito às diferenças regionais e culturais.

This is an experience report that aimed to describe the experience of nursing students in the use of educational technology to approach the feeding of hypertensive and diabetic patients from Pará. An interactive panel was used with pictures of foods present in the population's daily life, some related to foods capable of contributing to the lack of control of diseases, and others with substitute foods, healthier and capable of exerting a positive role and protective effect. It was observed that the action centered on adaptation and suggestions for healthier replacements, with a reduction in the quantity or substitutions for regional foods, proved to be positive, as it stimulated the participant's sense of cultural belonging and autonomy and the development of care plans must be personalized with respect for regional and cultural differences.

Improved quality of life (EHP-30) in patients with endometriosis after surgical treatment

SUMMARY OBJECTIVE: This study aimed to evaluate the quality of life of patients with endometriosis before and after surgical treatment. METHODS: An observational, longitudinal, and prospective study was conducted with 102 women with pelvic pain and endometriosis that was unimproved by clinical treatment and indicated for surgical treatment. The patients' quality of life was assessed using the 30-item Endometriosis Health Profile (EHP-30) questionnaire before and 3 and 6 months after surgery. The statistical tests were analyzed using the Statistical Package for Social Sciences version 17.0, and the Friedman test was used. RESULTS: There was a reduction in EHP-30 scores 3 and 6 months after surgery compared to before surgery, as well as 6 months after surgery compared to 3 months after surgery, in the central questionnaire (PART 1) and in Sections A, B, C, E, and F (p<0.0001). For Section D, there was a reduction in scores 6 months after surgery compared to before surgery (p<0.0001). CONCLUSION: Surgical treatment of endometriosis improves quality of life in several areas assessed by the EHP-30 questionnaire.

Acolhimento ao parto em estabelecimentos de saúde vinculados à Rede Cegonha no Brasil: a perspectiva das usuárias / Childbirth care in health services affiliated with the Stork Network in Brazil: the users' perspective / Acogida al parto en establecimientos de salud vinculados a la Red Cegonha en Brasil: la perspectiva de las usuarias

Este estudo objetivou analisar os fatores sociodemográficos e reprodutivos associados ao acolhimento ao parto em estabelecimentos de saúde vinculados à Rede Cegonha no Brasil, na perspectiva das usuárias. Foram selecionados 606 serviços com amostra de 10.540 puérperas. O desfecho foi a variável latente acolhimento da puérpera, composta por cinco indicadores: apresentação dos profissionais com nome e função, chamar a gestante pelo nome, compreensão das informações dadas, se sentir bem tratada e respeitada e ter as necessidades respondidas pela equipe. As variáveis explicativas foram: idade, escolaridade, cor da pele, situação conjugal, tipo de parto, paridade e peregrinação. Foi utilizada modelagem de equações estruturais. Observaram-se maiores percentuais de mulheres com idade de 20 a 34 anos (68,31%), que se autodeclararam como pardas (56,3%), com escolaridade entre 9 e 11 anos de estudo (56,1%) e que tinham companheiro (78,8%). Houve predominância de puérperas que tiveram parto vaginal (56,6%), com um a dois filhos (46%) e que relataram não peregrinar (91,9%). Apresentaram efeito direto positivo sobre o acolhimento mulheres com maior idade (CP = 0,094; p < 0,001) e maior escolaridade (CP = 0,096; p < 0,001). O parto cesáreo apresentou efeito direto negativo (CP = -0,059; p < 0,002) e cor da pele preta e parda apresentou efeitos direto e indireto negativos (CP = -0,081; p < 0,001 e CP = -0,014; p < 0,001). Puérpera com maior idade, maior escolaridade e que tiveram parto vaginal tiveram percepção mais positiva do acolhimento nos serviços de saúde.

This study aimed to analyze sociodemographic and reproductive factors associated with childbirth care in health services affiliated with the Stork Network in Brazil, from the users' perspective. The sample included 10,540 postpartum women from 606 services. The outcome was the latent variable reception of the patient, consisting of five indicators: healthcare staff members introducing themselves stating their names and roles, calling the pregnant woman by her name, the patient's understanding of the information provided, the patient feeling well treated and respected, and the patient having her needs met by the staff. The explanatory variables were maternal age, schooling, skin color, marital status, type of delivery, parity, and number of services visited before admission for childbirth. Most of the women were 20 to 34 years of age (68.31%), self-identified as brown (56.3%), had 9 to 11 years of schooling (56.1%), and were married or lived with the partner (78.8%). There was a predominance of vaginal delivery (56.6%), with one or two previous children (46%), and reports of not having gone to more than one maternity service to be admitted (91.9%). There was a direct positive effect on reception for childbirth from patient´s higher age (SC = 0.094; p < 0.001) and more schooling (SC = 0.096; p < 0.001). Cesarean delivery had a direct negative effect (SC = -0.059; p < 0.002), and black and brown skin color had direct and indirect negative effects (SC = -0.081; p < 0.001 and SC = -0.014; p < 0.001). Older postpartum women and those with more schooling and vaginal delivery had a more positive perception of their reception by maternity services.

El objetivo de este estudio fue analizar los factores sociodemográficos y reproductivos, asociados a la acogida en el parto, en establecimientos de salud vinculados a la Red Cegonha en Brasil, desde la perspectiva de las usuarias. Se seleccionaron 606 servicios en una muestra de 10.540 puérperas. El resultado fue la variable latente de acogida de la puérpera, compuesta por cinco indicadores: presentación de los profesionales con nombre y función, llamar a la gestante por el nombre, comprensión de la información proporcionada, sentirse bien tratada y respetada y contar con las necesidades cubiertas por el equipo. Las variables explicativas fueron: edad, escolaridad, color de piel, situación conyugal, tipo de parto, paridad y desplazamientos largos. Se utilizó un modelado de ecuaciones estructurales. Se observaron mayores porcentajes de mujeres con una edad comprendida entre los 20 a los 34 años (68,31%), que se autodeclararon mestizas (56,3%), con una escolaridad entre 9 y 11 años de estudio (56,1%) y que tenían compañero (78,8%). Hubo una predominancia de puérperas que tuvieron un parto vaginal (56,6%), con de 1 a 2 hijos (46%) y que informaron no realizar grandes desplazamientos (91,9%). Presentaron un efecto directo positivo sobre la acogida mujeres con mayor edad (CP = 0,094; p < 0,001) y mayor escolaridad (CP = 0,096; p < 0,001). El parto por cesárea presentó un efecto directo negativo (CP = -0,059; p < 0,002) y color de la piel negra y mestiza presentó efectos directo e indirecto negativos (CP = -0,081; p < 0,001 e CP = -0,014; p < 0,001). Puérperas con mayor edad, mayor escolaridad y que tuvieran parto vaginal tuvieron una percepción más positiva de acogida en los servicios de salud.

Alterações histopatológicas pancreáticas, placentárias e na matriz extracelular hipofisária durante a diabetes mellitus gestacional / Pancreatic histopathological changes, placental and the pituitary extracellular matrix during gestational diabetes mellitus

A Diabetes Mellitus Gestacional (DMG) pode ser definida como intolerância a carboidrato durante a gravidez e estima-se que pode afetar 10-22% de todas as pacientes grávidas. Durante a gravidez podem surgir diversas complicações para o feto como risco elevado de aborto espontâneo, anormalidades congênitas e morbidade e mortalidade neonatal. Entretanto, podem surgir também alterações morfofuncionais em diversos órgãos da mãe diabética, porém isso não é bem estabelecido. Investigar se haverá ou não alterações bioquímicas e histopatológicas em diversos órgãos, como hipófise, útero, placenta e pâncreas de ratas grávidas com diabetes mellitus durante e no final da gravidez e compará-las . Além disso, investigar se há alteração na matriz extracelular (MEC) da hipófise desses animais. No 5º dia de vida, ratas Wistar foram divididas em dois grupos: um tratado com estreptozotocina (Grupo Diabético / DIAB), na dose de 90 mg/kg, subcutâneo e outro grupo, que foi tratado com veículo (tampão citrato/CTR). Aos 90 dias de vidas, foram submetidas ao cruzamento. Após isso, foram sacrificadas no 11º e 21º dia de gravidez. Foram avaliados glicemia e bioquímica maternal e número de implantes .O pâncreas, útero, placenta e hipófises foram coradas com Hematoxilina e Eosina e somente as hipófises foram coradas com Massom e Picrosirius, para avaliação da MEC.Os animais diabéticos tanto do 11º quanto do 21º dia apresentaram uma redução no número de implantes, menor peso e maior glicemia e colesterol total, em relação aos animais controle independente do dia da gravidez. Não foi verificada diferença dos níveis de triglicerídeos entre os grupos não diabéticos e diabéticos, independente dos dias. Entretanto, os animais diabéticos que finalizaram o período de gestação apresentaram uma maior glicemia maternal em relação ao grupo diabético do 11º dia. Pâncreas de ratas diabéticas do 21º dia apresentaram vacuolização intracitoplasmática das ilhotas, insulite,migração de células ...

Gestational Diabetes Mellitus (GDM) can be defined as carbohidrat intolerance during pregnancy and it may affect 10-22% off all pregnant pacients. During pregnancy can surge lots of complications to the fetus such as high risk of spontaneous abortion, congenital abnormalities and neonatal morbity and mortality. However, it can also surge morphofunctional alterations in several organs of the diabetic mother, but it has not been well established .To investigate if there is going to be biochemical and histopathological alterations in several organs, such as pituitary, uterus, placenta and pancreas of pregnant diabetics rats during and in the end of pregnancy and compared them. Furthermore, to investigate if there is pituitary alteration of the extracellular matrix (ECM) in these animals. On the 5th day of life, Wistar rats were divided in two groups: one treated with streptozotocin (Diabetic Group/DIAB) , with the dose of 90 mg/kg, subcutaneous and another group , treated with vehicle (citrate buffer/CTR). At 90 days of life, they were mated . After, they were sacrified at 11o e 21o days of pregnancy. Were evaluated maternal glicemia and biochemistry and implant numbers. The pancreas, uterus,placenta e pituitary were stained with Hematoxilin and Eosin and only the pituitary were stained with Masson and Picrosirius, for ECM evaluation. Diabetic animals of 11o day as well as 21o days during pregnancy showed a reduced implant numbers, reduced weight and higher glicemia and total cholesterol , compared with control animals independent of pregnancy day. It was not verified difference in triglycerides levels between non diabetic and diabetic animals, independent of the day. However, diabetic animals that concluded the gestational period showed a higher maternal glicemia compared with 11o day diabetic group. Pancreas of 21o days diabetic animals showed islets intracitoplasmatic vacuolization, insulitis, inflammatory cell migration, thickness of wall vessel ...