Chronic kidney disease prevention campaign: relationship between proteinuria and elderly people / Campanha de prevenção de doença renal crônica: relação entre proteinúria e idosos

ABSTRACT Objective: To verify the relationship between the presence of proteinuria as a renal injury marker in elderly without history of systemic arterial hypertension and cardiovascular diseases. A cross-sectional study was developed from January 2014 to December 2019, through kidney disease prevention campaigns promoted by the Federal University of Ceará in the city of Fortaleza. Methods: The sample consisted of 417 elderlies. A questionnaire was used to characterize individuals and assess previous diseases, and urinalysis reagent strips were used to assess proteinuria. Results: Statistically significant differences (p < 0.05) and moderate effect sizes were found for blood pressure levels (CI 0.53-0.93), systolic blood pressure, and diastolic blood pressure (CI 0.21-0.61). Significant differences in capillary glycemia were also found between groups (p = 0.033), but with a low effect size (0.02-0.42). The group with comorbidities was 2.94 times more likely to have proteinuria than those without comorbidities (OR 2.94, CI 1.55-4.01; p < 0.05). In the group without cardiovascular disease/high blood pressure, a statistically significant association was found for previous diabetes and proteinuria (p = 0.037), presenting 2.68 times higher risk of proteinuria in those with diabetes mellitus (OR 2.68, CI 1.05-6.85). Significant association was also found between age groups, with the older group having 2.69 times higher risk of developing proteinuria (75 to 90 compared to 60 to 74 years) (CI 1.01-7.16; p = 0.045). Conclusion: Even without systemic arterial hypertension or cardiovascular disease, diabetes and older age can be considered high risk factors for proteinuria.

Resumo Objetivo: Verificar a relação entre a presença de proteinúria como marcador de lesão renal em idosos sem histórico de hipertensão arterial sistêmica e doenças cardiovasculares. Um estudo transversal foi desenvolvido de Janeiro de 2014 a Dezembro de 2019, por meio de campanhas de prevenção a doenças renais promovidas pela Universidade Federal do Ceará, na cidade de Fortaleza. Métodos: A amostra foi composta por 417 idosos. Um questionário foi usado para caracterizar indivíduos e avaliar doenças prévias, e foram utilizadas tiras reagentes de urinálise para avaliar proteinúria. Resultados: Diferenças estatisticamente significativas (p < 0,05) e tamanhos de efeito moderados foram encontrados para níveis de pressão arterial (IC 0,53-0,93), pressão arterial sistólica e pressão arterial diastólica (IC 0,21-0,61). Também foram encontradas diferenças significativas na glicemia capilar entre grupos (p = 0,033), mas com um tamanho de efeito baixo (0,02-0,42). O grupo com comorbidades apresentou 2,94 vezes mais probabilidade de ter proteinúria do que aqueles sem comorbidades (OR 2,94; IC 1,55-4,01; p < 0,05). No grupo sem doença cardiovascular/hipertensão, foi encontrada uma associação estatisticamente significativa para diabetes anterior e proteinúria (p = 0,037), apresentando risco 2,68 vezes maior de proteinúria naqueles com diabetes mellitus (OR 2,68; IC 1,05-6,85). Também foi encontrada uma associação significativa entre faixas etárias, com o grupo mais velho apresentando risco 2,69 vezes maior de desenvolver proteinúria (75 a 90 em comparação com 60 a 74 anos) (IC 1,01-7,16; p = 0,045). Conclusão: Mesmo sem hipertensão arterial sistêmica ou doença cardiovascular, o diabetes e a idade avançada podem ser considerados fatores de alto risco para proteinúria.

Chronic kidney disease prevention campaign: relationship between proteinuria and elderly people.

OBJECTIVE: To verify the relationship between the presence of proteinuria as a renal injury marker in elderly without history of systemic arterial hypertension and cardiovascular diseases. A cross-sectional study was developed from January 2014 to December 2019, through kidney disease prevention campaigns promoted by the Federal University of Ceará in the city of Fortaleza. METHODS: The sample consisted of 417 elderlies. A questionnaire was used to characterize individuals and assess previous diseases, and urinalysis reagent strips were used to assess proteinuria. RESULTS: Statistically significant differences (p < 0.05) and moderate effect sizes were found for blood pressure levels (CI 0.53-0.93), systolic blood pressure, and diastolic blood pressure (CI 0.21-0.61). Significant differences in capillary glycemia were also found between groups (p = 0.033), but with a low effect size (0.02-0.42). The group with comorbidities was 2.94 times more likely to have proteinuria than those without comorbidities (OR 2.94, CI 1.55-4.01; p < 0.05). In the group without cardiovascular disease/high blood pressure, a statistically significant association was found for previous diabetes and proteinuria (p = 0.037), presenting 2.68 times higher risk of proteinuria in those with diabetes mellitus (OR 2.68, CI 1.05-6.85). Significant association was also found between age groups, with the older group having 2.69 times higher risk of developing proteinuria (75 to 90 compared to 60 to 74 years) (CI 1.01-7.16; p = 0.045). CONCLUSION: Even without systemic arterial hypertension or cardiovascular disease, diabetes and older age can be considered high risk factors for proteinuria.

Theoretical-practical evidence in the prevention and promotion of workers' mental health.

Mental health is an important conditioning factor of health in prevention, promotion, and surveillance practices in the intersectoral activity of workers' health. The goal of this study is to identify, in the scientific literature, risk factors and the promotion of wellbeing, both regarding workers' mental health. We approached workers' health in the field of management and research that provide the foundation, through a theoretical-methodological framework, for assistance and intersectoral policies applied to prevention and promotion of workers' wellbeing. We conducted a systematic review in May 2020 using the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) scientific journal database, with studies published from 2009 to 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for including and excluding variables and performed a fruitful analysis of a final sample of 14 scientific articles. For analyzing our results, we initially described the elements constituting the studies using a form; after this stage, we evidenced 3 axes for discussing the analytical data: a) interconnections of mental health and workers' health; b) risk factors and workers' mental health; and c) workers' mental health education. Studies show the strengthening of workers' mental health as an element for prevention and promotion in the psychosocial domain, reduction of morbidity and mortality, coping with precarious employment, the assistance and understanding of occupational psychopathologies, and not individualizing occupational illness.

A saúde mental é uma condicionante de saúde importante para as práticas de prevenção, promoção e vigilância na atuação intersetorial em saúde do trabalhador. O objetivo deste artigo é identificar na literatura de artigos científicos os fatores de risco e a promoção do bem-estar, ambos no campo da saúde mental em saúde do trabalhador. Problematizamos a saúde do trabalhador no campo da gestão e de pesquisas que embasam, por meio de aparato teórico-metodológico, políticas assistenciais e intersetoriais aplicadas à prevenção e promoção do bem-estar de trabalhadores e trabalhadoras. Operamos uma revisão sistemática no mês de maio de 2020 no Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), no período de 2009 a 2019. Orientados pelo método Preferred Reporting Items for Systematic Reviews and Meta-Analyses de inclusão e exclusão de variáveis, realizamos uma análise profícua de uma amostra final de 14 artigos incluídos. Na análise dos resultados, inicialmente foi realizada uma descrição de elementos de composição dos estudos através de um formulário-apêndice; após essa etapa, foram evidenciados três eixos de discussão dos dados analíticos: a) Tessituras sobre Saúde Mental e Saúde do Trabalhador; b) Fatores de Risco e Saúde Mental do Trabalhador; e c) Educação em Saúde Mental do Trabalhador. Os estudos evidenciam o fortalecimento de saúde mental do trabalhador como elemento de prevenção e promoção no campo psicossocial, redução da morbimortalidade, enfrentamento da precarização, de assistência e compreensão das psicopatologias do trabalho e não individualização do adoecimento ocupacional.

Risk Factors and Diagnosis of Diabetic Foot Ulceration in Users of the Brazilian Public Health System.

BACKGROUND: An individual with diabetes mellitus (DM) has an approximately 25% risk of developing ulcerations and/or destruction of the feet's soft tissues. These wounds represent approximately 20% of all causes of hospitalizations due to DM. OBJECTIVE: To identify the factors for the development of diabetic foot ulceration (DFU) among individuals treated by the Brazilian public health system. METHODS: This cross-sectional study was conducted on individuals with diabetes mellitus, aged above 18 years, of both sexes, and during July-October 2018 within a public healthcare unit in Brazil. All participants were assessed based on their socioeconomic, behavioral, and clinical characteristics, along with vascular and neurological evaluations. All participants were also classified according to the classification of risk of developing DFU, in accordance with the International Working Group on the Diabetic Foot (IWGDF). Statistical analyses were conducted using the chi-squared test, chi-squared test for trend, and Fisher's exact test, with a significance level of 5% (p < 0.05). RESULTS: The study consisted of 85 individuals. The DFU condition was prevalent in 10.6% of the participants. Adopting the classification proposed by IWGDF, observed risks for stratification categories 0, 1, 2, and 3 were 28.2%, 29.4%, 23.5%, and 8.2%, respectively. A statistically significant (p < 0.05) association was observed between the development of DFU and the following variables: time since the diagnosis of diabetes and the appearance of the nails, humidity, and deformations on the feet. CONCLUSION: The present study found an elevated predominance of DM patients in the Brazilian public health system (SUS) featuring cutaneous alterations that may lead to ulcers; these individuals had elevated risks of developing DFU. Furthermore, it was revealed that the feet of patients were not physically examined during treatment.