Asthma self-management model: randomized controlled trial.

Information for patients provided by the pharmacist is reflected in adhesion to treatment, clinical results and patient quality of life. The objective of this study was to assess an asthma self-management model for rational medicine use. This was a randomized controlled trial with 60 asthmatic patients assigned to attend five modules presented by a pharmacist (intervention group) and 59 patients in the control group. Data collection was performed before and after this 4-month intervention and included an evaluation of asthma knowledge, lifestyle, inhaler techniques, adhesion to treatment, pulmonary function and quality of life. An economic viability analysis was also performed. The intervention group obtained an increase in asthma knowledge scores of 58.3-79.5% (P < 0.001). In this group, there was also an increase in the number of individuals who practiced physical exercise (36-43%), in the number of correct replies regarding the use of inhalers, in the percentage of adherent patients, and in quality of life scores for all domains. We concluded that this asthma self-management model was effective in improving the quality of life of asthma patients.

Evaluation of pulmonary tuberculosis diagnostic tests in children and adolescents at a pediatric reference center.

INTRODUCTION: This study evaluates the performance of individual and combinations tests used for pediatric tuberculosis diagnosis at a reference center. MATERIALS AND METHODS: Diagnostic test outcomes from children with presumed pulmonary tuberculosis evaluated from January 2005 - July 2010 were compared to a standard diagnosis made by an expert panel of physicians. RESULTS: Presence of at least one sign/symptom, history of contact, or abnormal chest X-ray (aCXR) individually showed the highest sensitivity (85.7%). While the combination of history of contact, at least one sign/symptom, positive tuberculin skin test, and aCXR had low sensitivity of 20%, but the specificity and a positive predictive value were 100%, respectively. The combination of tests used in the International Union Against Tuberculosis and Lung Disease and the Brazilian Ministry of Health systems showed sensitivity of 28.6% and 71.4% and specificity of 95.8% and 97.0%, respectively. CONCLUSIONS: In the absence of a gold standard, the combination of clinical history, tuberculin skin test, and aCXR, as well as the Brazilian scoring system serve as simple, low-cost approach that can be used for pediatric TB diagnosis by first-contact care providers.

Aptidão física e nível habitual de atividade física associados à saúde cardiovascular em adultos e idosos / Physical fitness and habitual level of physical activity associated with cardiovascular health in adults and elderly

O nível habitual de atividade física (NHAF) vem sendo utilizado para estabelecer uma relação entre estilo de vida ativo e saúde cardiovascular. No entanto, a avaliação da aptidão física permitiria a avaliação real das condições físicas do indivíduo, podendo assim apresentar melhores relações com a saúde cardiovascular. Objetivos: Relacionar o NHAF e aptidão física com a saúde cardiovascular de adultos e idosos e verificar a associação da prática regular de exercícios físicos supervisionada com os diferentes níveis de aptidão física. Método: Foram avaliados 213 adultos e idosos (> 50 anos) participantes de projetos comunitários. Os participantes realizaram as seguintes avaliações: NHAF por meio do questionário IPAQ, aptidão física por meio de uma bateria de testes motores que permitiu o cálculo do Índice de Aptidão Funcional Geral (IAFG), pressão arterial, perfil lipídico e índice de massa corporal. Resultados: O modelo linear generalizado evidenciou um maior número de diferenças com relação às variáveis relacionadas à saúde cardiovascular quando os participantes foram subdivididos em grupos tendo o IAFG como variável independente, comparado ao NHAF. O teste exato de Fisher evidenciou que os grupos de IAFG classificados como “bom” e “muito bom” apresentaram maior proporção de indivíduos com prática regular de exercícios físicos superior a 6 meses, com destaque para um maior número realizando a prática com supervisão (p<0,0001). Conclusão: O IAFG apresenta melhor associação com a saúde cardiovascular do que o NHAF e o tempo de prática e a supervisão estão associados ao nível de aptidão física...

The habitual level of physical activity (HLPA) has been used to establish the relation between active lifestyle and cardiovascular health. However, the assessment of physical fitness would review the actual physical condition of the individual, and thus can have better relations with cardiovascular health. Objectives: Relate HLPA and physical fitness with cardiovascular health of adults and elderly and to verify the association of supervised regular physical exercise with different levels of fitness. Method: 213 adults and elderly (> 50 years) participating in community projects were evaluated. The HLPA were assessed by the IPAQ and physical fitness through a battery of motor tests that allowed the calculation of the General Functional Fitness Index (GFFI). Blood pressure, lipid profile and body mass index were considered as indicators of cardiovascular health. Results: The generalized linear model showed a greater number of differences with respect to variables related to cardiovascular health when participants were subdivided having GFFI as an independent variable, compared to HLPA. The Fisher exact test showed that the groups GFFI classified as “good” and “very good” showed a higher proportion of individuals with regular practice for more than 6 months exercise, especially for a larger number performing the practice under supervision (p <0.0001). Conclusion: The GFFI has better association with cardiovascular health than HLPA and time of practice and supervision are associated with the level of physical fitness...