Do the metrics matter? An experimental investigation of Instagram influencer effects on mood and body dissatisfaction.

Instagram is saturated with content from 'influencers', users who create high-quality idealised content, attain celebrity-level following, and often leverage their popularity to earn money through brand partnership/promotion. Although existing literature generally indicates the negative impact of idealised Instagram imagery on female psychological wellbeing, influencer imagery has yet to receive thorough attention. We investigated the impact of high versus low popularity influencer images on mood and body dissatisfaction. Adult women (N = 111, aged 17-40) were randomly allocated to one of three groups: either (1) the influencer-high group (idealised imagery alongside high 'like'/follow metrics); (2) the influencer-low group (the same idealised imagery adjusted for low popularity metrics); or (3) a nature control group with matched low-popularity metrics. Results revealed significantly higher negative mood and body dissatisfaction within the two influencer imagery groups compared with the control group. Interestingly, comparisons revealed no significant differences between the influencer-high and influencer-low groups on mood and body dissatisfaction. The findings suggest that users should be aware of the potentially negative impacts of viewing idealised influencer imagery, regardless of whether the content is high or low in popularity.

Developing a template matching algorithm for benchmarking hospital performance in a diverse, integrated healthcare system.

Template matching is a proposed approach for hospital benchmarking, which measures performance based on matching a subset of comparable patient hospitalizations from each hospital. We assessed the ability to create the required matched samples and thus the feasibility of template matching to benchmark hospital performance in a diverse healthcare system.Nationwide Veterans Affairs (VA) hospitals, 2017.Observational cohort study.We used administrative and clinical data from 668,592 hospitalizations at 134 VA hospitals in 2017. A standardized template of 300 hospitalizations was selected, and then 300 hospitalizations were matched to the template from each hospital.There was substantial case-mix variation across VA hospitals, which persisted after excluding small hospitals, hospitals with primarily psychiatric admissions, and hospitalizations for rare diagnoses. Median age ranged from 57 to 75 years across hospitals; percent surgical admissions ranged from 0.0% to 21.0%; percent of admissions through the emergency department, 0.1% to 98.7%; and percent Hispanic patients, 0.2% to 93.3%. Characteristics for which there was substantial variation across hospitals could not be balanced with any matching algorithm tested. Although most other variables could be balanced, we were unable to identify a matching algorithm that balanced more than ∼20 variables simultaneously.We were unable to identify a template matching approach that could balance hospitals on all measured characteristics potentially important to benchmarking. Given the magnitude of case-mix variation across VA hospitals, a single template is likely not feasible for general hospital benchmarking.

Variability and Delay in Telestroke Physician Alert among Spokes in a Telestroke Network: A Need for Metric Benchmarks.

INTRODUCTION: Telestroke has increased access to acute management of ischemic stroke in areas that lack stroke care expertise, yet delays persist in evaluation and treatment. We describe variation in time to alert a telestroke physician of suspected acute ischemic stroke patients potentially eligible for acute stroke therapies among community hospitals in our telestroke network, and explore demographic and spoke-related characteristics associated with delays. METHODS: From our telestroke registry, we identified suspected acute ischemic stroke patients who arrived within 6 hours of symptom onset and underwent video consultation at 1 of 17 community hospitals in our hub-and-spoke network. We compared time between patient arrival to telestroke alert (door-to-page-time) and to tissue plasminogen activator (tPA) administration for eligible patients (door-to-needle-time). We identified factors associated with prolonged metrics. RESULTS: Of 1020 cases between 9/2015 and 3/2017, 47% received tPA. Sixty percent had door-to-page-time more than 15 minutes (median 19.5; IQR, 11-34). Door-to-page-time more than 15 minutes was associated with an 8-fold increase in likelihood of door-to-needle-time more than 60 minutes. Patients with severe stroke experienced faster door-to-page-times. Hospitals with more beds had prolonged door-to-page-time. Full time in-house neurology presence, even when not covering emergent consultations, was associated with faster door-to-page-time over telestroke. Seventy-one percent of patients underwent CT brain prior to the telestroke physician alert; this scenario delayed door-to-page and door-to-needle times. CONCLUSIONS: Door-to-page-time varied considerably among spokes. Awaiting CT scan prior to alerting the telestroke consultant of a stroke code delayed metrics. Telestroke physician alert standards are needed, as are educational initiatives on acute ischemic stroke management and workflow.

Alternative approach to pediatric cardiac quality assessment for low-volume centers.

BACKGROUND: In pediatric cardiac care, many centers participate in multiple, national, domain-specific registries, as a major component of their quality assessment and improvement efforts. Small cardiac programs, whose clinical activities and scale may not be well-suited to this approach, need alternative methods to assess and track quality. METHODS: We conceived of and piloted a rapid-approach cardiac quality assessment, intended to encompass multiple aspects of the service line, in a low-volume program. The assessment incorporated previously identified measures, drawn from multiple sources, and ultimately relied on retrospective chart review. RESULTS: A collaborative, multidisciplinary team formed and came to consensus on quality metrics pertaining to 3 chosen areas of clinical activity in the program. Despite the use of multiple different data sources and the need for manual chart review in data collection, a rich assessment of these program components was completed for presentation in 6 weeks. CONCLUSIONS: While small programs may not participate in the spectrum of cardiac care registries available, these same centers can benefit from them by adapting some of their validated metrics for use in internal, self-maintained quality reports. Our pilot of this alternative approach revealed opportunities for improved quality assessment practices; the product can serve as a baseline for future prospective assessment and reporting, as well as longitudinal internal benchmarking.

Integrative hospital treatment in older patients to benchmark and improve outcome and length of stay - the In-HospiTOOL study.

BACKGROUND: A comprehensive in-hospital patient management with reasonable and economic resource allocation is arguably the major challenge of health-care systems worldwide, especially in elderly, frail, and polymorbid patients. The need for patient management tools to improve the transition process and allocation of health care resources in routine clinical care particularly for the inpatient setting is obvious. To address these issues, a large prospective trial is warranted. METHODS: The "Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay" (In-HospiTOOL) study is an investigator-initiated, multicenter effectiveness trial to compare the effects of a novel in-hospital management tool on length of hospital stay, readmission rate, quality of care, and other clinical outcomes using a time-series model. The study aims to include approximately 35`000 polymorbid medical patients over an 18-month period, divided in an observation, implementation, and intervention phase. Detailed data on treatment and outcome of polymorbid medical patients during the in-hospital stay and after 30 days will be gathered to investigate differences in resource use, inter-professional collaborations and to establish representative benchmarking data to promote measurement and display of quality of care data across seven Swiss hospitals. The trial will inform whether the "In-HospiTOOL" optimizes inter-professional collaboration and thereby reduces length of hospital stay without harming subjective and objective patient-oriented outcome markers. DISCUSSION: Many of the current quality-mirroring tools do not reflect the real need and use of resources, especially in polymorbid and elderly patients. In addition, a validated tool for optimization of patient transition and discharge processes is still missing. The proposed multicenter effectiveness trial has potential to improve interprofessional collaboration and optimizes resource allocation from hospital admission to discharge. The results will enable inter-hospital comparison of transition processes and accomplish a benchmarking for inpatient care quality.

Design and Implementation of Structured Clinical Documentation Support Tools for Treating Stroke Patients.

BACKGROUND AND PURPOSE: Standardized electronic medical record tools provide an opportunity to efficiently provide care that conforms to Best Practices and supports quality improvement and practice-based research initiatives. METHODS: We describe the development of a customized structured clinical documentation "toolkit" that standardizes patient data collection to conform to Best Practices for treating patients with stroke. The toolkit collects patients' demographic information, relevant score test measures, and captures information on disability, treatment, and outcomes. RESULTS: We describe here our creation and implementation of the toolkits and provide example screenshots. As of August 1, 2018, we have evaluated 2332 patients at an initial visit for a possible stroke. We provide basic descriptive data gathered from the use of the toolkits, demonstrating their utility in collecting patient data in a manner that supports both quality clinical care and research initiatives. CONCLUSIONS: We have developed an EMR toolkit to support Best Practices in the care of patients with stroke. We discuss quality improvement projects and current research initiatives using the toolkit. This toolkit is being shared with other Departments of Neurology as part of the Neurology Practice-Based Research Network.

A quality framework for the role of invasive, non-interventional cardiologists in the present-day cardiac catheterization laboratory: A multidisciplinary SCAI/HFSA expert consensus statement.

The present-day cardiac catheterization laboratory (CCL) is home to varied practitioners who perform both diagnostic, interventional, and complex invasive procedures. Invasive, non-interventional cardiologists are performing a significant proportion of the work as the CCL environment has evolved. This not only includes those who perform diagnostic-only cardiac catheterization but also heart failure specialists who may be involved in hemodynamic assessment and in mechanical circulatory support and pulmonary hypertension specialists and transplant cardiologists. As such, the training background of those who work in the CCL is varied. While most quality metrics in the CCL are directed towards evaluation of patients who undergo traditional interventional procedures, there has not been a focus upon providing these invasive, noninterventional cardiologists, hospital/CCL administrators, and CCL directors a platform for quality metrics. This document focuses on benchmarking quality for the invasive, noninterventional practice, providing this physician community with guidance towards a patient-centered approach to care, and offering tools to the invasive, noninterventionalists to help their professional growth. This consensus statement aims to establish a foundation upon which the invasive, noninterventional cardiologists can thrive in the CCL environment and work collaboratively with their interventional colleagues while ensuring that the highest quality of care is being delivered to all patients.

Failure of a Best Practice Alert to Reduce Antibiotic Prescribing Rates for Acute Sinusitis Across an Integrated Health System in the Midwest.

BACKGROUND: Antimicrobial resistance is a growing concern, and in recent years, there has been increased interest in ambulatory antimicrobial stewardship. Acute rhinosinusitis (ARS) is one of the most common outpatient diagnoses that results in an antibiotic prescription. OBJECTIVE: To determine if a best practice alert (BPA) will affect the percentage of oral antibiotic prescriptions for adults with ARS. METHODS: A prospective, pre/post study was initiated to evaluate the percentage of oral antibiotic prescriptions for ARS in 117 primary care clinics in the Midwest. Included in the study results were 16,570 adults who had an office visit for ARS: 8,106 patients from December 1, 2015, to February 28, 2016, were in the pre-intervention group without an active BPA, and 8,464 patients from December 1, 2016, to February 28, 2017, were in the post-intervention group when the BPA was active. The primary outcome was the number of oral antibiotic prescriptions for ARS compared with the number of office visits for ARS in the pre- and postintervention groups. RESULTS: The percentage of oral antibiotics prescribed for the pre- and postintervention groups were 94.8% and 94.3%, respectively (P = 0.152). The BPA displayed for 7,780 visits, prompting discontinuation of an antibiotic for 10 (0.1%) visits in the postintervention group. CONCLUSIONS: This study suggests that, although an electronic alert may be attractive to facilitate antimicrobial stewardship, it may be ineffective. These results warrant alternative measures to facilitate ambulatory antimicrobial stewardship. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to declare. Study concept and design were contributed by Hansen, D. Leedahl, and N. Leedahl. Hansen and N. Leedahl took the lead in data collection, with assistance from Carson and D. Leedahl. Data interpretation was performed by all the authors. The manuscript was written by Hansen, along with the other authors, and revised by all the authors.

Best Practice Update: Incorporating Psychogastroenterology Into Management of Digestive Disorders.

Chronic digestive diseases, including irritable bowel syndrome, gastroesophageal reflux disease, and inflammatory bowel diseases, cannot be disentangled from their psychological context-the substantial burden of these diseases is co-determined by symptom and disease severity and the ability of patients to cope with their symptoms without significant interruption to daily life. The growing field of psychogastroenterology focuses on the application of scientifically based psychological principles and techniques to the alleviation of digestive symptoms. In this Clinical Practice Update, we describe the structure and efficacy of 2 major classes of psychotherapy-cognitive behavior therapy and gut-directed hypnotherapy. We focus on the impact of these brain-gut psychotherapies on gastrointestinal symptoms, as well as their ability to facilitate improved coping, resilience, and self-regulation. The importance of the gastroenterologist in the promotion of integrated psychological care cannot be overstated, and recommendations are provided on how to address psychological issues and make an effective referral for brain-gut psychotherapy in routine practice.

Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi-center C3PO-QI study.

OBJECTIVES: This study sought to update benchmark values to use a quality measure prospectively. BACKGROUND: Congenital Cardiac Catheterization Outcomes Project - Quality Improvement (C3PO-QI), a multi-center registry, defined initial radiation dose benchmarks retrospectively across common interventional procedures. These data facilitated a dose metric endorsed by the American College of Cardiology in 2014. METHODS: Data was collected prospectively by 9 C3PO-QI institutions with complete case capture between 1/1/2014 and 6/30/2015. Radiation was measured in total air kerma (mGy), dose area product (DAP) (µGy*M2 ), DAP per body weight, and fluoroscopy time (min), and reported by age group as median, 75th and 95th %ile for the following six interventional procedures: (1) atrial septal defect closure; (2) aortic valvuloplasty; (3) treatment of coarctation of the aorta; (4) patent ductus arteriosus closure; (5) pulmonary valvuloplasty; and (6) transcatheter pulmonary valve implantation. RESULTS: The study was comprised of 1,680 unique cases meeting inclusion criteria. Radiation doses were lowest for pulmonary valvuloplasty (age <1 yrs, median mGy: 59, DAP: 249) and highest in transcatheter pulmonary valve implantation (age >15 yrs, median mGy: 1835, DAP: 17990). DAP/kg standardized outcome measures across weights within an age group and procedure type significantly more than DAP alone. Radiation doses decreased for all procedures compared to those reported previously by both median and median weight-based percentile curves. These differences in radiation exposure were observed without changes in median fluoroscopy time. CONCLUSIONS: This study updates previously established benchmarks to reflect QI efforts over time. These thresholds can be applied for quality measurement and comparison. © 2017 Wiley Periodicals, Inc.

Assessing Compliance With Established Pneumonia Core Measures at a Comprehensive Cancer Center.

Healthcare organizations use Pneumonia Core Measures (PCMs) to ensure delivery of high-quality care. In this study, a multidisciplinary team was organized to optimize care and enhance compliance in a comprehensive cancer emergency center. We performed a four-phase study, three of which were interventional: intense education regarding PCM; microbiologic analysis of the pathogens responsible for the pneumonias; development and implementation of an institutional pneumonia algorithm and order set. In phase 4, we analyzed five PCMs. The percentage of pneumonia patients from whom blood cultures were obtained increased from 73% to 91% after intervention (p < .001); sputum cultures increased from baseline 24.6% to 51% (p = .004) post order-set implementation, and order-set utilization increased from 40% to 77%. We achieved the benchmark for only one PCM, PN 3a. More than 80% of patients met clinical and microbiological criteria for healthcare-associated pneumonia. We identified a gap between our patient population and some PCMs that relates to antibiotics selection. The treatment of cancer patients and pneumonia falls outside established guidelines for treating community-acquired pneumonia. Although the algorithm and order set implemented optimized care and minimized variation, national benchmarks for four of the PCMs were not met. Our findings provide information for policymakers considering pneumonia measurements for antibiotic selection in a cancer care setting.

Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report.

Older people are majority users of health and social care services in the UK and internationally. Many older people who access these services have frailty, which is a state of vulnerability to adverse outcomes. The existing health care response to frailty is mainly secondary care-based and reactive to the acute health crises of falls, delirium and immobility. A more proactive, integrated, person-centred and community-based response to frailty is required. The British Geriatrics Society Fit for Frailty guideline is consensus best practice guidance for the management of frailty in community and outpatient settings. RECOGNITION OF FRAILTY: The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailty. A gait speed <0.8m/s; a timed-up-and-go test >10s; and a score of ≥3 on the PRISMA 7 questionnaire can indicate frailty. The common clinical presentations of frailty (falls, delirium, sudden immobility) can also be used to indicate the possible presence of frailty. MANAGEMENT OF FRAILTY: The BGS recommends an holistic medical review based on the principles of comprehensive geriatric assessment (CGA) for all older people identified with frailty. This will: diagnose medical illnesses to optimise treatment; apply evidence-based medication review checklists (e.g. STOPP/START criteria); include discussion with older people and carers to define the impact of illness; work with the older person to create an individualised care and support plan. SCREENING FOR FRAILTY: The BGS does not recommend population screening for frailty using currently available instruments.

Renal replacement therapy in Brunei Darussalam: comparing standards with international renal registries.

BACKGROUND AND AIM: Brunei Darussalam is a small South East Asian country with a high prevalence and incidence of end stage kidney disease (ESRD). This study aims to compare key performance indicators recorded in the Brunei Dialysis and Transplant Registry and department records against international practice. Registries from the USA (USRDS), UK (UK Renal Registry), Australasia (ANZDATA), Europe (ERA-EDTA Registry) and Malaysia (MDTR) were used for comparisons. METHODS AND RESULTS: Haemodialysis (83%) and renal transplantation (6%) were the most and least favoured modality of renal replacement therapy in Brunei. Diabetes mellitus as a cause of ESRD (57%) was high in Brunei but on par with other South East Asian countries. Dialysis death rates (11%) and living-related transplant survival rates (5 year graft and patient survival 91% and 96% respectively) were favourable compared with other registries. Anaemia and mineral bone disease management were similar to Malaysia but slightly inferior to the others, but generally in keeping with KDOQI and KDIGO targets. Haemodialysis adequacy (48% achieving urea reduction ratio of >65%) was relatively poorer due to poor dialysis flow rates and low fistula usage (71%). Peritoneal dialysis peritonitis (24.5 patient-month/episode) and adequacy (78% achieving kt/v of 1.7) were in keeping with ISPD targets and international registries' results. CONCLUSION: Brunei has achieved reasonable and commendable standards in many areas pertaining to the renal services. This report has identified several key areas for developments but this is to be expected for a service making its first foray into international benchmarked practice.

[Quality of documentation of intraoperative and postoperative complications : improvement of documentation for a nationwide quality assurance program and comparison with routine data]. / Dokumentationsqualität intra- und postoperativer Komplikationen : Verbesserung der Dokumentation für die verpflichtende Qualitätssicherung und Vergleich mit DRG-Routinedaten.

INTRODUCTION: Complications after cholecystectomy are continuously documented in a nationwide database in Germany. Recent studies demonstrated a lack of reliability of these data. The aim of the study was to evaluate the impact of a control algorithm on documentation quality and the use of routine diagnosis coding as an additional validation instrument. METHODS: Completeness and correctness of the documentation of complications after cholecystectomy was compared over a time interval of 12 months before and after implementation of an algorithm for faster and more accurate documentation. Furthermore, the coding of all diagnoses was screened to identify intraoperative and postoperative complications. RESULTS AND DISCUSSION: The sensitivity of the documentation for complications improved from 46 % to 70 % (p = 0.05, specificity 98 % in both time intervals). A prolonged time interval of more than 6 weeks between patient discharge and documentation was associated with inferior data quality (incorrect documentation in 1.5 % versus 15 %, p < 0.05). The rate of case documentation within the 6 weeks after hospital discharge was clearly improved after implementation of the control algorithm. Sensitivity and specificity of screening for complications by evaluating routine diagnoses coding were 70 % and 85 %, respectively. The quality of documentation was improved by implementation of a simple memory algorithm.

Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions.

There are well-established frameworks for comparing the performance of health systems cross-nationally on multiple dimensions. A sub-set of such comprehensive schema is taken up by criteria specifically applied to health service delivery, including hospital performance. We focus on evaluating hospital performance, using the New Zealand public hospital sector over the period 2001-2009 as a pragmatic and illustrative case study for cross-national application. We apply a broad three-dimensional matrix--efficiency, effectiveness, equity--each based on two measures, and we undertake ranking comparisons of 35 hospitals. On the efficiency dimension--relative stay, day surgery--we find coefficients of variation of 10.8% and 8.5% respectively in the pooled data, and a slight trend towards a narrowing of inter-hospital variation over time. The correlation between these indicators is low (.20). For effectiveness--post-admission mortality, unplanned readmission--the coefficient of variation is generally higher (24.1% and 12.2%), and the trend is flat. The correlation is again low (.21). The equity dimension is assessed by quantifying the degree of ethnic and socio-economic variation for each hospital. The coefficient of variation is much higher--40.7-66.5% for ethnicity, 55.8-84.4% for socio-economic position--the trend over time is mixed, and the correlation is moderate (.41). On averaging the rank of hospitals across all measures it is evident that there is limited consistency across the three constituent dimensions. While it is possible to assess hospital performance across three dimensions using an illustrative set of standard measures derived from routine data, there appears to be little consistency in hospital rankings on these New Zealand data for the period 2001-2009. However, the methodology of using rankings derived from readily available data--possibly allied with multiple or composite indicator models--has potential for the cross-national comparison of hospital profiles, and assessments in three dimensions provide a more holistic and rounded account of performance.

Avaliação comparativa do efeito dos ácidos graxos oléico, palmítico e esteárico sobre biomarcadores do processo aterosclerótico / Comparative evaluation of fatty acids, oleic, palmitic and stearic, effects on atherosclerosis biomarkers

A aterosclerose é classificada como enfermidade crônica não transmissível e é considerada uma das principais causas de morte e morbidade em vários países, incluindo o Brasil. Entre as possíveis causas de sua gênese está o hábito alimentar, especificamente o consumo de ácidos graxos, principalmente saturados e trans. Ácidos graxos saturados possuem características biológicas e fisico-químicas diferentes dos insaturados. Os mais abundantes na dieta humana são o palmítico e esteárico. Sua associação com acometimentos cardiovasculares vem sendo cada vez mais investigada, principalmente os que possuem mais de dez carbonos em sua cadeia interferindo no metabolismo de lipoproteínas podendo desencadear todo o processo aterosclerótico. A indústria de alimentos vem desenvolvendo algumas tecnologias opcionais para reduzir ou eliminar ácidos graxos trans, em especial, o elaídico, dentre elas a modificação no processo de hidrogenação que aumenta a quantidade de ácidos graxos saturados. Alguns alimentos industrializados necessitam de uma grande quantidade de ácidos graxos saturados promovendo um aumento no teor de ácido palmítico e esteárico, sendo este último considerado um ácido graxo saturado neutro, mas dependendo da concentração utilizada, pode contribuir no decréscimo da HDL-c (High Density Lipoprotein), dentre outras alterações deletérias. Desta forma, investigar as alterações de determinados parâmetros biológicos diante da mudança da proporção de ácidos graxos saturados, respeitando o teor total de lipídios de uma dieta é a base deste estudo. Foram realizados ensaios em material biológico para a determinação dos seguintes parâmetros: 1) Atividade de enzimas antioxidantes; 2) Peroxidação lipídica em tecidos; 3) Lipidograma; 4) Determinação do perfil de ácidos graxos de tecidos e rações e 5) Expressão de genes relacionados com o processo aterosclerótico (ICAM-1, VCAM-1, CD36 e MCP-1). A determinação da atividade de enzimas antioxidantes foi realizada considerando somente as enzimas Catalase (CAT) e Superóxido Dismutase (SOD), por se tratarem de enzimas com alteração expressiva no processo aterogênico, na ocorrência de disfunção endotelial. Neste trabalho, foi analisada a atividade das referidas enzimas no tecido hepático e cardíaco, onde não foram constatadas alterações. O mesmo processo biológico que estimula a produção excessiva de espécies reativas pode levar ao aumento da peroxidação lipídica, principalmente de ácidos graxos polinsaturados das membranas celulares, em tecidos como fígado, cérebro e coração. A peroxidação lipídica apresentou diferenças significativas no tecido hepático. O grupo alimentado com ração enriquecida com tripalmitato apresentou peroxidação lipídica aumentada em relação ao grupo controle. Correlacionando com o perfil de ácidos graxos do tecido hepático, notamos que houve maior incorporação de ácido palmítico nesse tecido, que por apresentar configuração linear, quando incorporado à membrana celular, pode levar à disfunção e possível suscetibilidade a danos, como a peroxidação. No tecido cardíaco e no tecido cerebral não foram observadas alterações e diferenças entre os tratamentos. O lipidograma consiste na quantificação de lipoproteínas e frações lipídicas, compondo o perfil lipídico no plasma sanguíneo. Os resultados obtidos mostraram que o colesterol total foi significativamente menor no grupo controle, assim como triacilglicerol e LDL colesterol (LDL-c). Já HDL colesterol (HDL-c) está reduzida no grupo que recebeu ração suplementada com ácido palmítico, assim como este grupo apresentou parâmetros aumentados nas dosagens de triacilglicerol e colesterol total. Os grupos alimentados com ração suplementada com triestearato e trioleato apresentaram resultados intermediários para a dosagem de HDL-c, com valores tendendo ao grupo suplementado com tripalmitato. Em relação à dosagem de LDL-c, foi constatada diferença entre os grupos suplementados e o grupo controle. Destaca-se que não houve diferença entre a dosagem entre os grupos suplementados. Portanto, o grupo alimentado com dieta enriquecida com ácido oleico (monoinsaturado) equipara-se aos grupos alimentados com dietas enriquecidas com ácido esteárico e palmítico (saturados). O perfil de ácidos graxos do tecido hepático mostrou uma porcentagem elevada de ácido palmítico no grupo alimentado com ração enriquecida com o mesmo ácido graxo, com diferença estatística em relação aos demais grupos. Já em relação ao ácido esteárico, não houve diferenças significativas entre os grupos. Em compensação, o teor de ácido oleico no grupo suplementado com este mesmo ácido graxo e com ácido palmítico foi significativamente diferente em relação aos demais, com valores superiores. Este resultado demonstra que não houve dessaturação do ácido esteárico a oleico, ao menos neste modelo. No tecido cardíaco, foi observado o mesmo comportamento. No tecido cardíaco não houve diferença estatística significativa da concentração de ácidos graxos, indicando que não houve incorporação ou dessaturação. Ressalta-se que de acordo com determinação realizada utilizando a técnica de cromatografia gasosa, as rações apresentavam em sua composição o teor de lipídios adequado ao modelo animal e as proporções de ácidos graxos alteradas como proposto no objetivo deste trabalho. Em relação às moléculas de adesão e quimiocinas (VCAM-1, ICAM-1, CD-36 e MCP-1) relacionadas com o processo aterosclerótico, houve somente alteração na molécula CD-36 no grupo alimentado com ração enriquecida com trioleato, com redução em relação aos demais. Mas, as moléculas de adesão relacionadas com o processo inicial da aterogênese, a expressão gênica realizada através da técnica de q-RT-PCR não foi relevante, não apresentando diferença entre os tratamentos. Conclui-se, portanto, que os tratamentos aplicados ao modelo animal selecionado possui o potencial de alterar lipoproteínas plasmáticas, mas não de manter a continuidade e desencadear o processo inflamatório relacionado à aterogênese

Atherosclerosis is chronic a non-communicable disease considered one of a major cause of morbidity and mortality in several countries, including Brazil. Among all the possible causes of their genesis the dietary habit of high fatty acid intake, especially saturated and trans fatty acids is the most important. Saturated and unsaturated fatty acids possess different biological and physicochemical characteristics. The most abundant fatty acid in the human diet are palmitic and stearic and they association with cardiovascular events has been increasingly investigated, especially those one with more than ten carbons in its chain which interfers in the lipoproteins metabolism and can initiate the atherosclerotic process. The food industry has developed some optional technologies to reduce or eliminate the presence of trans fatty acids in foods, in particular elaidic, which after the hydrogenation process increases the saturated fatty acids content. Some industrialized foods requires a large amount of saturated fatty acids that promote an increase of palmitic and stearic content, the last fatty acid mentioned is considered a neutral saturated fatty acid that can contribute to the decrease in HDL-c (High Density lipoprotein), depending on the concentration used, among other deleterious changes. Thus, investigate changes of specifics biological parameters in response to consumption of different saturated fatty acids, respecting the total content of lipids in a normolipidic diet is the aim of this study. Assays were conducted to determine the following parameters in the tissues: 1) Activity of antioxidant enzymes, 2) Lipid peroxidation, 3) Lipidogram; 4) Fatty acid composition 5) Expression of genes related the atherosclerotic process (ICAM-1, VCAM-1, CD36 and MCP- 1). The determination of the activity of antioxidant enzymes was carried out considering only the enzymes Catalase (CAT) and Superoxide Dismutase (SOD), because they are enzymes more sensitive and readily available in changes resulted of an atherosclerotic process with endothelial dysfunction. In the study, no changes were observed in activity of these enzymes in the liver and heart. The same biological process that stimulates the overproduction of reactive species can lead to increased lipid peroxidation, especially of polyunsaturated fatty acids present in cell membranes of tissues such as liver, brain and heart. The group fed with diet enriched with tripalmitate showed increased lipid peroxidation compared to control group. Correlating this information with the fatty acid profile in liver tissue, we noted that there was a greater incorporation of palmitic acid, which exhibit linear configuration when incorporated into the cell membrane and can lead to dysfunction and higher susceptibility to damages such as oxidation. No differences were observed in the others tissues analyzed. The lipidogram is the quantification of lipoprotein and lipid fractions, composing the lipid profile in blood plasma. The results showed that total cholesterol was significantly lower in the control group, as well triglyceride and LDL cholesterol (LDL-c). HDL cholesterol (HDL-C) concentration is reduced and triacylglycerol and cholesterol increased n the group fed with diet supplemented with palmitic. The groups fed with diets supplemented with tristearate and trioleate presented intermediate results for the measurement of HDL-c, with values tending to the group supplemented with tripalmitate. Regarding LDL-c levels, significant differences were observed between the supplemented groups and the control group. Emphasis that there was no difference between the dosage between the supplemented groups. Therefore, the group fed with oleic acid (monounsaturated) supplemented diet equates to the groups fed with diets enriched with stearic and palmitic acid (saturated). The fatty acid profile of liver tissue showed a high percentage of palmitic acid in the group fed with diet enriched with the same fatty acid, with a statistical difference compared to the other groups. In relation to stearic acid, there were no significant differences between groups. As compensation, the oleic acid content in the group supplemented with the same fatty acid and palmitic acid was significantly higher when compared to the others. This result demonstrates that no desaturation of stearic acid to oleic happened in this experimental model. In cardiac tissue there was no statistically significant difference in the concentration of fatty acids, indicating no incorporation or desaturation. Regarding adhesion molecules and chemokines (VCAM-1, ICAM- 1, CD-36 and MCP-1) related to the atherosclerotic process, there was only change in the gene expression of CD-36 molecule in the group fed diet enriched with trioleate, with reduction in relation to others. No other alterations were observed. In conclusion, we verified that the consumption of the different fatty acids in this experimental model has potential to alter lipoproteins levels but not to iniciate or maintain the inflammatory process associated with atherogenesis