Orientações em alimentação e nutrição para adultos e idosos com COVID-19 em isolamento domiciliar e após alta hospitalar / Série Nutricionistas em Ação com a Ciência / Guidelines on food and nutrition for adults and the elderly with COVID-19 in home isolation and after hospital discharge / Nutritionists In Action Series with Science

Orientações em alimentação e nutrição para adultos e idosos com COVID-19 em isolamento domiciliar e após alta hospitalar, com suspeita ou diagnóstico do novo Coronavírus, também às pessoas que apresentam sintomas leves ou moderados e que não precisam ficar internadas em hospitais, direcionada também para os cuidadores e pessoas que convivem no mesmo ambiente e demais interessados no tema. Em uma linguagem acessível e usando ótimas ilustrações e tabelas, esclarece sobre os cuidados nutricionais e também sobre alguns alimentos e nutrientes importantes para a imunidade. Instrui como fazer em situações de falta de apetite, perda de paladar (Disgeusia), dificuldade para engolir (Disfagia), perda de olfato (Anosmia) e diarréia. Orienta sobre as compras dos alimentos, sobre os riscos de contaminação, tempo de validade e armazenagem na geladeira e freezer, bem como os cuidados no preparo dos mesmos. Apresenta instruções sobre a higienização das mãos com água e sabonete e como fazer a fricção anti-séptica das mãos com preparação alcoólicas, sobre o manuseio adequado na retirada do lixo e instruções para diluição da solução clorada para superfícies e para embalagens e alimentos. Por fim, apresenta sete passos para manter a alimentação saudável para adultos e idosos

Guidelines on food and nutrition for adults and the elderly with COVID-19 in home isolation and after hospital discharge, with suspicion or diagnosis of the new coronavirus, also those with mild or moderate symptoms and who do not need to be hospitalized, also directed to the caregivers and people who live in the same environment and others interested in the topic. In an accessible language and using great illustrations and tables, it clarifies about nutritional care and also about some foods and nutrients important for immunity. Instructs you how to do it in situations of poor appetite, loss of taste (dysgeusia), difficulty swallowing (dysphagia), loss of smell (anosmia) and diarrhea. It advises on food purchases, on the risks of contamination, expiration time and storage in the refrigerator and freezer, as well as care in preparing them. It presents instructions on hand hygiene with soap and water and how to rub hands with alcoholic preparations, on proper handling of waste removal and instructions for diluting the chlorinated solution to surfaces and to packaging and food. Finally, it presents seven steps to maintain healthy eating for adults and the elderly

Orientações em alimentação e nutrição para crianças e adolescentes com COVID-19 em isolamento domiciliar e após alta hospitalar / Série Nutricionistas em Ação com a Ciência / Guidelines on food and nutrition for children and adolescents with COVID-19 in home isolation and after hospital discharge / Nutritionists in Action with Science Series

Orientações em alimentação e nutrição para crianças e adolescentes com COVID-19 em isolamento domiciliar e após alta hospitalar, considerando que os cuidados com crianças e adolescentes em casa envolvem convivência harmoniosa na família, o distanciamento entre as pessoas, os cuidados com a casa, com a alimentação, cuidados estes que implicam em zelar para que a doença não comprometa o crescimento e desenvolvimento adequados deste grupo específico. Neste sentido, as orientações presentes no texto prestam sua contribuição com a saúde de crianças e adolescentes diagnosticados ou com suspeita de COVID-19

Guidelines on food and nutrition for children and adolescents with COVID-19 in home isolation and after hospital discharge, considering that care for children and adolescents at home involves harmonious coexistence in the family, the distance between people, care with the home, with food, care that implies ensuring that the disease does not compromise the proper growth and development of this specific group. In this sense, the guidelines present in the text contribute to the health of children and adolescents diagnosed or suspected of having COVID-19

Orientações para boas práticas em alimentação e nutrição hospitalar no enfrentamento da COVID-19 / Guidelines for good practices in hospital food and nutrition in coping with COVID-19

Baseado em informações oficiais já disponíveis, "Orientações para boas práticas em alimentação e nutrição hospitalar no enfrentamento da COVID-19" foi elaborado por um grupo de profissionais nutricionistas do Brasil, atuantes em diversas áreas (clínica, hospitalar, unidades de alimentação e nutrição, docência e pesquisa universitária, consultoria em gestão de qualidade e segurança de alimentos), com o objetivo de contribuir com as adaptações nos processos de trabalho de nutricionistas e gestores de unidades hospitalares. Apresenta orientações: quanto à higienização de ambientes e materiais específicos, quanto aos cuidados no transporte e distribuição de refeições, dicas também para profissionais de saúde que trabalham na área de isolamento, orientações para os pacientes hospitalizados e apresenta condutas de avaliação nutricional. O resultado do trabalho foi de reforçar a condutas adequadas e contribuir significativamente com a segurança alimentar e nutricional de pacientes e colaboradores

Based on official information already available, "Guidelines for good practices in food and hospital nutrition in coping with COVID-19" was prepared by a group of nutritionists from Brazil, working in several areas (clinic, hospital, food and nutrition units, teaching and university research, consultancy in quality management and food safety), in order to contribute to adaptations in the work processes of nutritionists and hospital unit managers. It presents guidelines: regarding the cleaning of specific environments and materials, regarding care in the transportation and distribution of meals, tips also for health professionals working in the isolation area, guidelines for hospitalized patients and presents nutritional assessment procedures. The result of the work was to reinforce adequate conduct and significantly contribute to the food and nutritional security of patients and employees

DIRECT COSTS OF TYPE 2 DIABETES: A BRAZILIAN COST-OF-ILLNESS STUDY.

OBJECTIVES: The aim of this study was to evaluate the direct costs of type 2 diabetes mellitus patients treated in a Brazilian public hospital. METHODS: This was an exploratory retrospective cost-of-illness study with quantitative approach, using medical records of patients treated in a public hospital (2012-14), with at least one consultation over a period of 12 months. Data on patient's profile, exams, number of consultations, medications, hospitalizations, and comorbidities were collected. The cost per patient per year (pppy) was calculated as well as the costs related to glycated hemoglobin (HbA1c) values, using thresholds of 7 and 8 percent. RESULTS: Data of 726 patients were collected with mean age of 62 ± 11 years (68.3 percent female). A total of 67.1 percent presented HbA1c > 7 percent and 44.9 percent > 8 percent. The median cost of diabetes was United States dollar (USD) 197 pppy. The median costs of medication were USD 152.49 pppy, while costs of exams and consultations were USD 40.57 pppy and 8.70 pppy, respectively. Thirty-eight patients (4 percent) were hospitalized and presented a median cost of 3,656 per patient per hospitalization with a cost equivalent to 53.1 percent of total expenses. Total costs of patients with HbA1c ≤ 7 percent were lower for this group and also costs of medications and consultations, whereas for patients with HbA1c ≤ 8 percent, only total costs and costs of medications were lower when compared with HbA1c > 8 percent patients. CONCLUSIONS: Medications and hospitalizations were the major contributor of diabetes expenses. Preventing T2DM, or reducing its complications through adequate control, may help avoid the substantial costs related to this disease.

Predominant learning styles among pharmacy students at the Federal University of Paraná, Brazil

Background: Learning styles are cognitive, emotional, and physiological traits, as well as indicators of how learners perceive, interact, and respond to their learning environments. According to Honey-Mumford, learning styles are classified as active, reflexive, theoretical, and pragmatic. Objective: The purpose of this study was to identify the predominant learning styles among pharmacy students at the Federal University of Paraná, Brazil. Methods: An observational, cross-sectional, and descriptive study was conducted using the Honey-Alonso Learning Style Questionnaire. Students in the Bachelor of Pharmacy program were invited to participate in this study. The questionnaire comprised 80 randomized questions, 20 for each of the four learning styles. The maximum possible score was 20 points for each learning style, and cumulative scores indicated the predominant learning styles among the participants. Honey-Mumford (1986) proposed five preference levels for each style (very low, low, moderate, high, and very high), called a general interpretation scale, to avoid student identification with one learning style and ignoring the characteristics of the other styles. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: This study included 297 students (70% of all pharmacy students at the time) with a median age of 21 years old. Women comprised 77.1% of participants. The predominant style among pharmacy students at the Federal University of Paraná was the pragmatist, with a median of 14 (high preference). The pragmatist style prevails in people who are able to discover techniques related to their daily learning because such people are curious to discover new strategies and attempt to verify whether the strategies are efficient and valid. Because these people are direct and objective in their actions, pragmatists prefer to focus on practical issues that are validated and on problem situations. There was no statistically significant difference between genders with regard to learning styles. Conclusion: The pragmatist style is the prevailing style among pharmacy students at the Federal University of Paraná. Although students may have a learning preference that preference is not the only manner in which students can learn, neither their preference is the only manner in which students can be taught. Awareness of students’ learning styles can be used to adapt the methodology used by teachers to render the teachinglearning process effective and long lasting. The content taught to students should be presented in different manners because varying teaching methods can develop learning skills in students (AU)

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The chronic care model for type 2 diabetes: a systematic review.

The chronic care model (CCM) uses a systematic approach to restructure health care systems. The aim of this systematic review was to examine studies that evaluated different elements of the CCM in patients with type 2 diabetes mellitus (T2DM) and to assess the influence of the CCM on different clinical outcomes. There view was performed in the Medline and Cochrane Library electronic databases. The search was limited to randomized controlled trials conducted with T2DM patients. Studies were eligible for inclusion if they compared usual care with interventions that use done or more elements of the CCM and assessed the impact on clinical outcomes. After applying the eligibility criteria, 12 studies were included for data extraction. Of these, six showed evidence of effectiveness of the CCM for T2DM management in primary care as well as significant improvements in clinical outcomes. In the other six studies, no improvements regarding clinical outcomes were observed when comparing the intervention and control groups. Some limitations, such as a short follow-up period and a low number of patients, were observed. Some studies showed that the reorganization of health systems can improveT2DM care. However, it is possible that greater benefits could be obtained through combing all 6 elements of CCM.

Proportion of Brazilian diabetes patients that achieve treatment goals: implications for better quality of care.

BACKGROUND: Diabetes and its complications are substantial causes of morbidity and mortality, and caused approximately 5.1 million deaths worldwide in 2013. Early detection and treatment of diabetes complications can prevent their progression. OBJECT: This study compared the proportions of patients with type 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) who achieved the goals of good clinical control. METHODS: Adults and elderly patients with T1DM and T2DM at a public outpatient endocrinology service in Brazil were retrospectively evaluated between 2012 and 2013. Clinical and socio demographic data were obtained from medical records and evaluated in accordance with the Brazilian Diabetes Society Guidelines. Care process measures, outcomes indicators, and supporting process measures were evaluated. RESULTS: A total of 1031 records were analyzed: 29 and 71 % of patients had T1DM and T2DM, respectively. T2DM patients had significantly higher BMI than T1DM patients (overweight and obesity in 85.1 vs. 47.5 %, p < 0.01). The follow-up periods for diabetes and number of clinical visits to the endocrinology service were significantly greater among T1DM patients than T2DM patients (p < 0.01). However, T2DM patients required significantly more other (i.e., non-endocrinological) healthcare services (p < 0.01). HbA1c was significantly lower in T2DM patients (p < 0.01). Moreover, blood pressure and triglycerides were significantly higher in T2DM patients (p < 0.01), whereas total cholesterol and low-density lipoprotein were significantly lower in T2DM patients (p < 0.01). Only 0.5 % of the patients achieved all targets, and 1.1 % did not achieve any. CONCLUSIONS: The achievement of goals of good clinical practice varies among the parameters evaluated. Almost no patients achieved all targets. Many patients are overweight and do not achieve targets for HbA1c, lipid profile, or blood pressure control.

Transcultural Diabetes Nutrition Algorithm: Brazilian Application.

The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D) is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy) and regular physical activity (structured exercise) represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA) is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.

Evaluation of food intake and excretion of metabolites in nephrolithiasis.

INTRODUCTION: Nephrolithiasis is a common condition with high prevalence and recurrence, occurring by a complex and multifactorial process. OBJECTIVE: To analyze the main dietary and metabolic characteristics of patients with nephrolithiasis and compare them with a control group. METHODS: A cross sectional study with 31 patients with nephrolithiasis (NE) and 18 healthy. By the dietary intake it were observed sodium, calcium, protein, potassium, vitamin C, oxalate and water intake in both groups. Metabolic assessment were analyzed in urinary excretion of oxalate and citrate. The presence of hypertension and body mass index (BMI) was also evaluated. RESULTS: In the NE group, it was found that 45.2% had a high intake of sodium and 100% a high intake of oxalate. It was also observed a low calcium, potassium and vitamin C intake by 93.5%, 100% and 94.9% respectively. Regarding protein, only 12.5% had normal protein intake. Concerning water intake, 12.9% had an ingestion less than 1 liter, 54.8% between 1 and 2 liters and 32.3% higher than 2 liters. Hypertension was observed in 64.5% of patients and adequate excretion of oxalate and citrate in 90.5% of them. There was no statistically difference in food intake, BMI and oxalate excretion between groups. However, the NE group showed higher urinary citrate. CONCLUSION: It was found in both groups a high prevalence of overweight patients, a high intake of oxalate and sodium, in addition to inadequate intakes of calcium, potassium and vitamin C. The NE group showed high protein intake and increased excretion of citrate.

Avaliação da ingestão alimentar e excreção de metabólitos na nefrolitíase / Evaluation of food intake and excretion of metabolites in nephrolithiasis

Introdução: A nefrolitíase é uma patologia frequente, com alta taxa de prevalência e recorrência, ocorrendo por processo multifatorial e complexo. Objetivo: Analisar as principais características dietéticas e metabólicas de pacientes com nefrolitíase e compará-los com grupo controle. Métodos: Estudo observacional, transversal, com 31 pacientes com nefrolitíase (NE) e 18 saudáveis. Na ingestão dietética, foram verificados sódio, cálcio, proteína, potássio, vitamina C, oxalato e a ingestão hídrica em ambos os grupos. Na avaliação metabólica, foi analisada excreção urinária de citrato e oxalato. Também foi avaliada presença de hipertensão arterial e Índice de Massa Corporal (IMC). Resultados: Quanto ao grupo NE, verificou-se que 45,2% apresentou alta ingestão de sódio e 100% de oxalato. Foi também observada baixa ingestão de cálcio em 93,5%, potássio em 100% e vitamina C em 94,9%. Com relação à proteína, apenas 12,5% apresentou ingestão normoproteica. Quanto à ingestão hídrica, 12,9% apresentou ingestão menor que 1 litro, 54,8% entre 1 a 2 litros, e 32,3% maior que 2 litros. Foi observada hipertensão arterial sistêmica em 64,5% desses pacientes e excreção adequada de citrato e oxalato em 90,5% deles. Não foi verificada diferença estatística significativa na ingestão alimentar, IMC, e excreção de oxalato entre os grupos. No entanto, o grupo NE apresentou maior excreção de citrato. Conclusão: Verificou-se nos dois grupos elevada prevalência de pacientes com sobrepeso, alta ingestão de oxalato e sódio, além de inadequação nas ingestões de cálcio, potássio e vitamina C. No grupo NE, foi observada ...

Introduction: Nephrolithiasis is a common condition with high prevalence and recurrence, occuring by a complex and multifactorial process. Objective: To analyze the main dietary and metabolic characteristics of patients with nephrolithiasis and compare them with a control group. Methods: A crosssectional study with 31 patients with nephrolithiasis (NE) and 18 healthy. By the dietary intake it were observed sodium, calcium, protein, potassium, vitamin C, oxalate and water intake in both groups. Metabolic assessment were analyzed in urinary excretion of oxalate and citrate. The presence of hypertension and body mass index (BMI) was also evaluated. Results: In the NE group, it was found that 45.2% had a high intake of sodium and 100% a high intake of oxalate. It was also observed a low calcium, potassium and vitamin C intake by 93.5%, 100% and 94.9% respectively. Regarding protein, only 12.5% had normal protein intake. Concerning water intake, 12.9% had an ingestion less than 1 liter, 54.8% between 1 and 2 liters and 32.3% higher than 2 liters. Hypertension was observed in 64.5% of patients and adequate excretion of oxalate and citrate in 90.5% of them. There was no statistically difference in food intake, BMI and oxalate excretion between groups. However, the NE group showed higher urinary citrate. Conclusion: It was found in both groups a high prevalence of overweight patients, a high intake of oxalate and sodium, in addition to inadequate intakes of calcium, potassium and vitamin C. The NE group showed high protein intake and increased excretion of citrate. .

Adequate dietary intake and nutritional status in patients with nephrolithiasis: new targets and objectives.

OBJECTIVES: Modifiable risk factors for kidney stones, such as diet and nutritional status, are targets in the treatment and prevention of nephrolithiasis. The aim of the present study was to assess the nutritional state and energy and nutrient adequacy of patients with nephrolithiasis via anthropometric evaluation, dietary inquiry, and urine biochemistry. DESIGN: The present observational cross-sectional study. SETTING: An outpatient, nephrolithiasis clinic of a tertiary care, university hospital. SUBJECTS: A total of 31 patients with nephrolithiasis and 25 controls were assessed. INTERVENTIONS: All patients were subjected to nutritional evaluation, including dietary inquiry and chemical tests of blood and 24-hour urine samples. MAIN OUTCOME MEASURE: Nutritional state and nutrient ingestion adequacy. RESULTS: The group of patients with nephrolithiasis exhibited high body mass index, abdominal circumference, and body fat percentage values. The protein, sodium, calcium, potassium, and oxalate intakes differed significantly from the recommended values in both the nephrolithiasis and control groups. The nephrolithiasis and control groups differed only in terms of oxalate intake (159 ± 119.27 vs. 112 ± 47.9, respectively, P = .042). Regarding urine biochemistry, 30% of the patients with nephrolithiasis exhibited hypercalciuria, versus 12% of the control group. CONCLUSIONS: The prevalence of individuals with overweight/obesity was high in both the nephrolithiasis and control groups. This finding indicates that in addition to orientation regarding nonlithogenic dietary habits, continuous education by a multidisciplinary staff must also address the prevention and treatment of obesity.

Avaliação do estado nutricional e do consumo alimentar de pacientes amputados e com úlceras de pressão atendidos em um centro hospitalar de reabilitação / Evaluation of the nutritional status and food consumption of amputated patients having pressure ulcers in a hospital rehabilitation center / Evaluación del estado nutricional e del consumo alimenticio y de pacientes amputados que tienen úlceras de presión en un centro de rehabilitación hospitalario

O objetivo deste trabalho foi avaliar o estado nutricional e a ingestão alimentar de pacientes amputados com úlceras de pressão (UP) atendidos no ambulatório de um Centro Hospitalar de Reabilitação em Curitiba por meio de um estudo retrospectivo. Os critérios de inclusão foram: idade acima de 18 anos, via de alimentação exclusivamente oral, diagnóstico médico de amputação, úlcera de pressão como problema associado e número de consultas com Nutricionista (no mínimo 3). Foram selecionadas para análise as fichasde cinco pacientes. O estudo mostrou que a maioria dos pacientes foi diagnosticada com sobrepeso e que a ingestão de proteínas energiae micronutrientes essenciais para cicatrização de UP (vitaminas A, C e E, cobre e zinco) foram insuficientes. Após a terapia nutricional,todos apresentaram melhoras no processo de cicatrização. Ainda faltam estudos que comprovem uma eficácia na suplementação de nutrientes em pacientes com esse diagnóstico, porém todos concordam que uma melhora no estado nutricional favorece a cura e prevenção de UP quando ainda existem outros fatores associados.

The aim of this work was to evaluate the nutritional status and food consumption patterns of patients amputated due topressure ulcers (PU) assisted in the clinic of a Hospital Rehabilitation Center in Curitiba by means of a retrospective study. Inclusion criteria were: age above 18 years, exclusively oral feeding, amputated, pressure ulcer as associated problem and at least 3 consultationswith a Nutritionist. The medical history of five patients was selected for analysis. The study has showed that most patients were diagnosedwith overweight and that the essential protein ingestion, energy and micronutrients for cicatrization of PU (vitamins C and E, copper and zinc) were insufficient. After the proposed nutritional therapy, all patients presented improvements in the cicatrization process. Stillthere is a lack of studies that prove the effectiveness of nutrients supplementation in patients with this diagnosis, although all agree thatan improvement in the nutritional status contributes to cure and prevention of PU in cases in which here are other associated factors.

La meta de este trabajo fue evaluar el estado nutricional y los patrones del consumo de alimentos de pacientes amputados debido a úlceras de presión (UP) ayudados en la clínica de un centro de rehabilitación hospitalario en Curitiba por medio de un estudioretrospectivo. Los criterios de inclusión fueran: tener más de 18 años, utilizar exclusivamente alimentación oral, ser amputado, tener úlcera de presión como problema asociado y por lo menos 3 consultas con un nutricionista. El historial médico de cinco pacientes fueseleccionado para el análisis. El estudio ha demostrado que la mayoría de los pacientes ha sido diagnosticada con exceso de peso y que laingestión de proteínas, la energía y los microalimentos esenciales para la cicatrización de UP (vitaminas C y E, cobre y cinc) eran escasos.Después de la terapia alimenticia propuesta, todos los pacientes presentaron mejorías en el proceso de cicatrización. Hay una carenciade estudios que prueben la eficacia de la suplementación nutricional en pacientes con esta diagnosis, aunque todos convengan que una mejoría en el estado alimenticio contribuye a la curación y a la prevención de la UP en los casos que presentan otros factores asociados.