El profesional de enfermería en la promoción de salud en el segundo nivel de atención / The nursing professional in health promotion at the second level of care

La promoción de la salud se concibe como el proceso que permite el control de la salubridad, mediante acciones que desarrollan potencialidades comunitarias, habilidades, destrezas y capacidades personales, modificando las condiciones ambientales y socioeconómicas que impactan en los determinantes de salud. Se desarrolló una investigación con el objetivo de realizar una revisión bibliográfica acerca del accionar de enfermería en la promoción de la salud en el segundo nivel de atención. Los autores indagaron en 213 fuentes de bases de datos científicas: Redalyc, Elsevier, Scopus, ProQuest, PubMed y Enfermería Global, durante el período 2019- 2020. Los hallazgos permitieron concluir que las acciones de enfermería más comunes se dirigen hacia las conductas modificables como: automotivación, autoestima, alimentación saludable y actividad física. Los correspondientes planes de cuidados deben fomentar el autocuidado y la prevención de enfermedades, con una tendencia a la estandarización.

Health promotion is conceived as the process that allows the control of health through actions that develop community potentialities, abilities, skills and personal capacities, modifying the environmental and socioeconomic conditions that impact the determinants of health. This study aimed to conduct a bibliographic review about nursing actions in health promotion at the second level of care. The authors investigated 213 sources of scientific databases: Redalyc, Elsevier, Scopus, ProQuest, PubMed, and Global Nursing, during the period 2019-2020. The findings allowed to conclude that the most common nursing actions are directed towards modifiable behaviors such as: self-motivation, self-esteem, healthy eating, and physical activity. The corresponding care plans should promote self-care and disease prevention, with a trend towards standardization.

Effects of an interdisciplinary weight loss program on fibroblast growth factor 21 and inflammatory biomarkers in women with overweight and obesity

ABSTRACT Objective: To investigate the effects of an interdisciplinary intervention on biomarkers of inflammation and their relationship with fibroblast growth factor 21 (FGF21) concentrations in women with overweight and obesity. Subjects and methods: Thirty-one women were enrolled in a 12-week interdisciplinary weight loss program delivered by a team comprising an endocrinologist, nutritionist and exercise physiologist. Body composition; anthropometric measures; metabolic and inflammatory markers including adiponectin, leptin, and atrial natriuretic peptide (ANP) were assessed at baseline and post-therapy. The homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of adiponectin (HOMA-AD) were calculated. The participants were divided into two groups: those with increased FGF21, and those with decreased FGF21. Results: The sample comprised women aged 32 ± 5 years with a body mass index of 33.64 ± 3.49 kg/m2. Body weight, waist circumference and leptin concentration were decreased in the whole sample after therapy. However, only the group with an increase in FGF21 concentration presented significant improvements in adiponectin concentration and adiponectin/leptin ratio. Moreover, although there was a reduction of leptin in both groups, it was greater in the increased FGF21 groups. There was a reduction in ANP in the decreased FGF21 group. Conclusions: Changes in FGF21 concentrations were different among the women participating in the weight loss program, with some having increased levels and some reduced levels. Furthermore, improvements in adiponectin and the adiponectin/leptin ratio were found only in the group with increased FGF21 concentration.

Effects of an interdisciplinary weight loss program on fibroblast growth factor 21 and inflammatory biomarkers in women with overweight and obesity.

OBJECTIVE: To investigate the effects of an interdisciplinary intervention on biomarkers of inflammation and their relationship with fibroblast growth factor 21 (FGF21) concentrations in women with overweight and obesity. METHODS: Thirty-one women were enrolled in a 12-week interdisciplinary weight loss program delivered by a team comprising an endocrinologist, nutritionist and exercise physiologist. Body composition; anthropometric measures; metabolic and inflammatory markers including adiponectin, leptin, and atrial natriuretic peptide (ANP) were assessed at baseline and post-therapy. The homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of adiponectin (HOMA-AD) were calculated. The participants were divided into two groups: those with increased FGF21, and those with decreased FGF21. RESULTS: The sample comprised women aged 32 ± 5 years with a body mass index of 33.64 ± 3.49 kg/m2. Body weight, waist circumference and leptin concentration were decreased in the whole sample after therapy. However, only the group with an increase in FGF21 concentration presented significant improvements in adiponectin concentration and adiponectin/leptin ratio. Moreover, although there was a reduction of leptin in both groups, it was greater in the increased FGF21 groups. There was a reduction in ANP in the decreased FGF21 group. CONCLUSION: Changes in FGF21 concentrations were different among the women participating in the weight loss program, with some having increased levels and some reduced levels. Furthermore, improvements in adiponectin and the adiponectin/leptin ratio were found only in the group with increased FGF21 concentration.

Esquema de cuidados de enfermería ante posibles afecciones psicológicas en pacientes con enfermedad renal crónica / Nursing care scheme for possible psychological conditions in patients with chronic kidney disease

La enfermedad renal crónica afecta progresivamente la función de los correspondientes órganos, provocando una pérdida de la capacidad de eliminar toxinas y control del volumen de líquido del organismo; lo que repercute en el estado general del paciente en sus dimensiones bio-psico-so-ciales. Se realizó una búsqueda de fuentes acerca de la satisfacción de las necesidades del usua-rio en relación con los cuidados de salud en el ámbito psicológico, para plantear actividades de enfermería utilizando la taxonomía NIC desde los fundamentos de la teoría de las relaciones interpersonales de Hildegard Peplau. El estudio abarcó la revisión del contenido de 57 artículos recopilados de las bases de datos: Google Académico, Biblioteca Virtual en Salud, SciELO, Redalyc, Elsiever, MedLine, Scopus, Proquest, Pubmed, Enfermería Global, entre otras. La información fue procesada empleando la técnica de triangulación de fuentes.

Chronic kidney disease progressively affects the function of the corresponding organs, causing a loss of the ability to eliminate toxins and control the volume of fluid in the body, which affects the general state of the patient in its bio-psycho-social dimensions. An academic source about the satisfaction of the user's needs in relation to health care in the psychological field was carried out to propose nursing activities using the NIC taxonomy from the foundations of Hildegard Peplau's theory of interpersonal relationships. The study included a review of the content of 57 articles collected from the databases: Google Scholar, Virtual Health Library, SciELO, Redalyc, Elsiever, MedLine, Scopus, Proquest, Pubmed, Global Nursing, among others. The information was processed using the source triangulation technique.

Valoración de enfermería en gestantes con ruptura prematura de membranas / Nursing assessment in pregnant women with premature rupture of membranes

El proyecto se realizó con el objetivo de describir la valoración de Enfermería por dominios según NANDA-Internacional, en gestantes con diagnóstico de RPM, ingresadas en el Servicio de Ginecología y Obstetricia del Hospital Provincial General Docente Riobamba, Ecuador, durante el periodo octubre 2018 - enero 2019. Se realizó un estudio descriptivo, con enfoque cuantitativo, de corte transversal; cuya población de estudio quedó constituida por 61 individuos. Los datos fueron recolectados mediante la aplicación de una entrevista estructurada a cada paciente y de la revisión de documentos (historias clínicas). Se observaron 8 dominios alterados. El 63% de las mujeres participantes tuvo insuficientes controles prenatales. En el 78.7% de los partos se reportó líquido amniótico de aspecto claro. El 73.7% de las gestantes presentó antecedentes de infección. Las mayores afectaciones fueron en los dominios referidos a sexualidad/reproducción y promoción de la salud. La mayoría presentó RPM entre las 39 y 40.6 semanas y la FCF normal. Predominaron las madres adolescentes que declararon no planificar su embarazo.

This research was carried out in order to describe the assessment of Nursing by domains according to NANDA-International in pregnant women with a diagnosis of PROM admitted to the Gynecology and Obstetrics Service of the Provincial General Hospital of Riobamba-Ecuador, during the period October 2018 - January 2019. A cross-sectional and descriptive study was carried out with a quantitative approach; whose study population was made up of 61 individuals. The data were collected by applying a structured interview to each patient and reviewing documents (medical records). 8 altered domains were observed. 63% of the participating women had insufficient prenatal controls. Clear-looking amniotic fluid was reported in 78.7% of deliveries. 73.7% of pregnant women presented a history of infection. The greatest affectations were in the domains referring to sexuality / reproduction and health promotion. The majority presented PROM between 39 and 40.6 weeks and normal FHR. Adolescent mothers who declared not planning their pregnancy predominated.

Interdisciplinary therapy had positive effects on inflammatory state, mediated by leptin, adiponectin, and quality of diet in obese women / La terapia interdisciplinaria tuvo efectos positivos en el estado inflamatorio, mediado por la leptina, la adiponectina y la calidad de la dieta en mujeres obesas

BACKGROUND: obesity is a chronic disease associated with inadequate eating habits and reduced levels of physical activity. Because of obesity, the risk for comorbidities is increased, especially for cardiovascular diseases, insulin resistance, and increased pro-inflammatory factors. The aim of the present investigation was to analyze potential correlations between pro/anti-inflammatory adipokines, glycemic index, and other markers of diet quality using a metabolic profile in women undergoing interdisciplinary weight loss therapy. METHODS: thirty-two women with obesity were enrolled in a 12-week program of interdisciplinary therapy combining a clinical, nutritional, and physical exercise approach. Body composition, quality of diet, metabolic profile, and pro/anti-inflammatory adipokines were analyzed. RESULTS: the therapy showed to be effective in reducing body weight (from 93.16 ± 16.96 to 88.36 ± 16.23; p = 0.0000001), body mass index (from 34.01 ± 4.00 to 32.29 ± 3.96; p = 0.0000001), and body fat (from 38.25 ± 5.05 to 36.13 ± 5; p = 0.0000001). There was also an improvement in lipid profile, including total cholesterol (from 196.16 ± 34.78 to 183.53 ± 43.15; p = 0.001), non-HDL-cholesterol (from 142 ± 30.05 to 1333.69 ± 35.41; p = 0.01), VLDL-cholesterol (from 27.13 ± 12.4 to 22.06 ± 8.55; p = 0.002), triglycerides (from 135.88 ± 61.21 to 110.75 ± 43.09; p = 0.002) and glucose metabolism, including glucose (from 97.13 ± 10.43 to 92.6 ± 6.6; p = 0.004), and insulin (from 13.05 ± 5.54 to 11.29 ± 4.85; p = 0.03). As for food intake, there was a decrease in calorie consumption (from 1991.45 ± 677.78 to 1468.88 ± 390.56; p = 0.002), carbohydrates (from 50.37 ± 6 to 47.04 ± 8.67; p = 0.04), lipids (from 31.83 ± 5.53 to 30.37 ± 7.04; p = 0.3), and glycemic load (from 80.53 ± 39.88 to 54.79 ± 23.69; p = 0.02), and an increased consumption of proteins (from 18.3 ± 2.39 to 22.89 ± 4.9; p = 0.002). Positive correlations were demonstrated between insulin concentration and waist circumference (r = 0.82; p = 0.003); leptin and body fat and abdominal circumference (r = 0.74; p = 0.01); and LDL-cholesterol fraction and total cholesterol consumption (r = 0.69; p = 0.027). Negative correlations were demonstrated between leptin and monosaturated fat consumption (r = -0.71; p = 0.02); and adiponectin and liver enzyme GGT levels (r = -0.65; p = 0.04). CONCLUSIONS: interdisciplinary therapy had positive effects on inflammatory state, mediated by leptin, adiponectin, and quality of diet. Our findings suggest the effectiveness and clinical relevance of the interdisciplinary clinical therapy applied for obesity

INTRODUCCIÓN: la obesidad es una enfermedad crónica asociada con hábitos alimentarios inadecuados y niveles reducidos de actividad física. Debido a la obesidad, el riesgo de comorbilidad aumenta, especialmente el de las enfermedades cardiovasculares, la resistencia a la insulina y el aumento de los factores proinflamatorios. El objetivo de la presente investigación fue analizar las posibles correlaciones entre las adipocinas pro/antiinflamatorias, el índice glucémico y otros marcadores de calidad de la dieta con el perfil metabólico en mujeres sometidas a terapia interdisciplinaria para perder peso. MÉTODOS: treinta y dos mujeres con obesidad participaron en 12 semanas de terapia interdisciplinaria en la que se combinaron los enfoques clínico, nutricional y de ejercicio físico. Se analizaron la composición corporal, la calidad de la dieta, el perfil metabólico y las adipocinas pro/antiinflamatorias. RESULTADOS: la terapia demostró ser efectiva para reducir el peso corporal (de 93,16 ± 16,96 a 88,36 ± 16,23; p = 0,0000001), el índice de masa corporal (de 34,01 ± 4,00 a 32,29 ± 3,96; p = 0,0000001) y la grasa corporal (de 38,25 ± 5,05 a 36,13 ± 5,00; p = 0,0000001). También hubo una mejora del perfil lipídico, incluidos el colesterol total (de 196,16 ± 34,78 a 183,53 ± 43,15; p = 0,001), el colesterol no HDL (de 142,00 ± 30,05 a 1333,69 ± 35,41; p = 0,01), el VLDL-colesterol (de 27,13 ± 12,4 a 22,06 ± 8,55; p = 0,002), y el metabolismo de la glucosa, incluyendo la glucosa (de 97,13 ± 10,43 a 92,6 ± 6,6; p = 0,004) y la insulina (de 13,05 ± 5,54 a 11,29 ± 4,85; p = 0,03). En cuanto a la ingesta de alimentos, hubo disminución en el consumo de calorías (de 1991,45 ± 677,78 a 1468,88 ± 390,56; p = 0,002), carbohidratos (de 50,37 ± 6,00 a 47,04 ± 8,67; p = 0,04), lípidos (de 31,83 ± 5,53 a 30,37 ± 7,04; p = 0,3) y carga glucémica (de 80,53 ± 39,88 a 54,79 ± 23,69; p = 0,02), y aumento del consumo de proteínas (de 18,3 ± 2,39 a 22,89 ± 4,90; p = 0,002). Se demostraron correlaciones positivas entre la concentración de insulina y la circunferencia de la cintura (r = 0,82; p = 0,003); la leptina, la grasa corporal y la circunferencia abdominal (r = 0,74; p = 0,01), y la fracción de colesterol LDL y el consumo total de colesterol (r = 0,69; p = 0,027). Se demostraron correlaciones negativas entre la leptina y el consumo de grasa monosaturada (r = -0,71; p = 0,02), y la adiponectina y la enzima hepática GGT (r = -0,65; p = 0,04). CONCLUSIONES: la terapia interdisciplinaria tuvo efectos positivos sobre el estado inflamatorio, mediado por la leptina, la adiponectina, y la calidad de la dieta. Nuestros hallazgos sugieren la efectividad y la relevancia clínica de la terapia clínica interdisciplinaria aplicada a la obesidad

Interdisciplinary therapy had positive effects on inflammatory state, mediated by leptin, adiponectin, and quality of diet in obese women.

INTRODUCTION: Background: obesity is a chronic disease associated with inadequate eating habits and reduced levels of physical activity. Because of obesity, the risk for comorbidities is increased, especially for cardiovascular diseases, insulin resistance, and increased pro-inflammatory factors. The aim of the present investigation was to analyze potential correlations between pro/anti-inflammatory adipokines, glycemic index, and other markers of diet quality using a metabolic profile in women undergoing interdisciplinary weight loss therapy. Methods: thirty-two women with obesity were enrolled in a 12-week program of interdisciplinary therapy combining a clinical, nutritional, and physical exercise approach. Body composition, quality of diet, metabolic profile, and pro/anti-inflammatory adipokines were analyzed. Results: the therapy showed to be effective in reducing body weight, body mass index, and body fat. There was also an improvement in lipid profile, including total cholesterol, non-HDL-cholesterol, VLDL-cholesterol, triglycerides and glucose metabolism, including glucose, and insulin. As for food intake, there was a decrease in calorie consumption, carbohydrates, lipids, and glycemic load, and an increased consumption of proteins. Positive correlations were demonstrated between insulin concentration and waist circumference; leptin and body fat and abdominal circumference; and LDL-cholesterol fraction and total cholesterol consumption. Negative correlations were demonstrated between leptin and monosaturated fat consumption; and adiponectin and liver enzyme GGT levels. Conclusions: interdisciplinary therapy had positive effects on inflammatory state, mediated by leptin, adiponectin, and quality of diet. Our findings suggest the effectiveness and clinical relevance of the interdisciplinary clinical therapy applied for obesity.

INTRODUCCIÓN: Introducción: la obesidad es una enfermedad crónica asociada con hábitos alimentarios inadecuados y niveles reducidos de actividad física. Debido a la obesidad, el riesgo de comorbilidad aumenta, especialmente el de las enfermedades cardiovasculares, la resistencia a la insulina y el aumento de los factores proinflamatorios. El objetivo investigación fue analizar las posibles correlaciones entre las adipocinas pro/antiinflamatorias, el índice glucémico y otros marcadores de calidad de la dieta con el perfil metabólico en mujeres sometidas a terapia interdisciplinaria para perder peso. Métodos: treinta y dos mujeres con obesidad participaron en 12 semanas de terapia interdisciplinaria en la que se combinaron los enfoques clínico, nutricional y de ejercicio físico. Se analizaron la composición corporal, la calidad de la dieta, el perfil metabólico y las adipocinas pro/antiinflamatorias. Resultados: la terapia demostró ser efectiva para reducir el peso corporal, el índice de masa corporal y la grasa corporal. También hubo una mejora del perfil lipídico, incluidos el colesterol total, el colesterol no HDL, el VLDL-colesterol , y el metabolismo de la glucosa, incluyendo la glucosa y la insulina. En cuanto a la ingesta de alimentos, hubo disminución en el consumo de calorías, carbohidratos, lípidos y carga glucémica, y aumento del consumo de proteínas. Se demostraron correlaciones positivas entre la concentración de insulina y la circunferencia de la cintura ; la leptina, la grasa corporal y la circunferencia abdominal, y la fracción de colesterol LDL y el consumo total de colesterol. Se demostraron correlaciones negativas entre la leptina y el consumo de grasa monosaturada, y la adiponectina y la enzima hepática GGT. Conclusiones: la terapia interdisciplinaria tuvo efectos positivos sobre el estado inflamatorio, mediado por la leptina, la adiponectina, y la calidad de la dieta. Nuestros hallazgos sugieren la efectividad y la relevancia clínica de la terapia clínica interdisciplinaria aplicada a la obesidad.

Moderate exercise increases endotoxin concentration in hypoxia but not in normoxia: A controlled clinical trial.

BACKGROUND: Hypoxia and high altitudes affect various organs, which impairs important physiological functions, such as a disruption of the intestinal barrier mediated by increased translocation of bacteria and increased circulating endotoxin levels. Physical exercise can alter endotoxin concentration in normoxia. The aim of this study is to evaluate the effects of moderate exercise on endotoxin concentration in normobaric hypoxia. METHODS: Nine healthy male volunteers exercised on a treadmill for 60 minutes at an intensity of 50% VO2peak in normoxic or hypoxic conditions (4200 m). Blood was collected at rest, immediately after exercise and 1 hour after exercise to evaluate serum endotoxin levels. RESULTS: Under hypoxic exercise conditions, SaO2% saturation was lower after exercise compared with resting levels (P < 0.05) and returned to the resting level during recovery in normoxia (P < 0.05). Endotoxin concentration increased after exercise in hypoxia (P < 0.05); it remained high 1 hour after exercise in hypoxia compared with normoxia (P < 0.05) and was higher after exercise and recovery compared with resting levels (P < 0.05). HR was higher during exercise in relation basal in both conditions (P < 0.05) and RPR increase after 60 minutes in comparison to 20 minutes in hypoxia (P < 0.05). CONCLUSION: Moderate exercise performed in hypoxia equivalent to 4200 m increased endotoxin plasma concentration after exercise. One hour of rest in normoxic conditions was insufficient for the recovery of circulating endotoxins.