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1.
Front Med (Lausanne) ; 11: 1368661, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38737756

RESUMO

Background: Volunteering positively affects overall health of both volunteers and recipients through social interaction, support and physical activity. Health professionals' volunteering has considerable potential to improve health outcomes in communities. Objectives: This study aimed to summarize published scientific literature regarding volunteering by health professionals. Method: Medine, Embase, Scopus, PsycINFO and CINAHLdatabases were searched to identify eligible studies published between 2010 and 2023. Data on study methods and findings were extracted and synthesized. Results: Of the 144 eligible studies, 80 (56%) used quantitative methods, 46 (32%) used qualitative, 18 (12%) used mixed methods and 8 (6%) were interventional. Doctors (74 studies, 51%) and nurses (n = 40, 28%) were the professions with most reports of volunteering. Half the studies were from USA (n = 77, 53%), followed by UK (n = 19, 13%), Canada (n = 12, 8%), and Australia/New Zealand (n = 11, 8%). International volunteering in low-to-middle-income countries was reported in 64 studies (44%). Providing service and training were the dominant types of activities (n = 90, 62.5%), with health promotion reported in only 4 studies (3%). Studies reported positive impact from volunteering, both professionally and personally. Time and family commitments were the main barriers. Enablers, barriers and impact were summarized in a socio-ecological map. Conclusion: Health professionals volunteer in diverse activities and report multifaceted benefits. Studies of volunteering interventions could enable new, sustainable approaches to health promotion.

2.
Rev Bras Epidemiol ; 27: e240018, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38695431

RESUMO

OBJECTIVE: To assess the social, metabolic, and lifestyle determinants of consumption of fruits, vegetables, and greens (FVG) and ultra-processed food (ULT) in adults from Pernambuco. METHODS: Cross-sectional and analytical study, conducted in 2015/2016. In addition to sociodemographic variables, the determinants of lifestyle were level of physical activity, alcohol consumption, tobacco use, and metabolic variables were self-reported hypertension, blood glucose, and Body Mass Index (BMI). Consumption was measured by the Food Frequency Questionnaire, then created the Frequency of Consumption Index (SFI) of the mean intake of ULT and FVG foods. The indices of FVG and ULT consumption were transformed into quartiles and these variables were included in the multinomial logistic regression, considering their determinants when p<0.05. RESULTS: The sample was representative of the state, with 1,067 people being interviewed, whose intake of ULT was higher than that of FVG in the lowest and highest quartile of the consumption index. Consumption of fruit and vegetables was higher in higher consumption of alcoholic beverages (p=0.031) and BMI>25 kg/m2 (p=0.047); and lower in the lowest income (p=0.001). ULT intake was higher in young adults (p=0.005), lower income (p=0.044), and controlled blood glucose (p=0.021). Rural areas were 52% less exposed to medium-high ULT consumption (p<0.006). CONCLUSION: Higher rate of ULT consumption in relation to fresh foods, with income as a common determinant, inversely associated with ULT intake and directly related to FVG, which demands structuring policies.


Assuntos
Fast Foods , Estilo de Vida , Fatores Socioeconômicos , Humanos , Estudos Transversais , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Fast Foods/estatística & dados numéricos , Frutas , Brasil , Verduras , Comportamento Alimentar , Adolescente , Índice de Massa Corporal , Dieta/estatística & dados numéricos , Fatores Sociodemográficos , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Alimento Processado
3.
Rev Assoc Med Bras (1992) ; 70(4): e20231136, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38716938

RESUMO

OBJECTIVE: The objective was to analyze the implementation and use of the electronic patient record in the health services of the Brazilian Air Force. METHODS: This is a cross-sectional study carried out with 234 physicians, between March and May 2021. The data collection instrument was sent by email. The electronic patient record was implemented in the Air Force approximately 3 years ago (64.5%), and about 81% of the physicians received training to operate it. RESULTS: The most common records involve data related to consultations (90.1%) and interviews with physical examination (67.1%). Physicians cited that information storage (75.6%), agility, and feasibility of recording (55.1%) were the main advantages of the electronic patient record. As disadvantages, problems in electronic equipment (69.7%) and system errors (65%) were reported. Most participants considered that the implementation had a positive impact on work dynamics (75.6%) and productivity (66.7%), mainly regarding the components "Work processes" (57.3%) and "Amount of carried out activities" (21.4%). Keeping records was significantly associated with the job position (p<0.001), type of unit (p=0.008), time of implementation (p<0.001), and participation in training (p=0.028). CONCLUSION: The implementation of the electronic patient record in the Air Force was recently done, and just over half of the physicians were trained prior to the implementation. The tool is considered compatible with work processes and has a positive effect on productivity.


Assuntos
Registros Eletrônicos de Saúde , Humanos , Estudos Transversais , Brasil , Registros Eletrônicos de Saúde/estatística & dados numéricos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Médicos/estatística & dados numéricos , Atitude do Pessoal de Saúde
4.
J. Am. Coll. Cardiol ; 83(13 Suppl. A)Apr. 2024. tab.
Artigo em Inglês | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1551808

RESUMO

BACKGROUND: Randomized studies support complete over culprit-only revascularization for patients with acute coronary syndrome (ACS) However,whether these findings extend to elderly patients has not been thoroughly explored. METHODS: We conducted a systematic review and meta-analysis comparing clinical outcomes of elderly individuals (defined as age > 75 years) with ACS and multivessel coronary artery disease submitted to complete vs. culprit-only percutaneous coronary intervention (PCI). PubMed, Embase, and Cochrane were searched. We computed pooled hazard ratios (HRs) with 95% confidence intervals (CI) to preserve time-to-event data RESULTS: We included 7 studies, of which 2 were randomized controlled trials (RCTs), comprising 7,409 patients, of whom 3225 (43.5%) underwent complete revascularization. As compared with culprit lesion only PCI, complete revascularization was associated with a lower risk of all-cause mortality (HR 0.76; 95% CI 0.68-0.85; p<0.001), cardiovascular mortality (HR 0.67; 95% CI 0.54-0.82; p<0.001), and recurrent myocardial infarction (MI) (HR 0.65; 95% CI 0.50-0.85; p=0.002). There was no significant difference between the groups regarding the risk of recurrent revascularizations (HR 0.79; 95% CI 0.54-1.16; p=0.23). CONCLUSION: Among elderly patients with ACS and multivessel CAD, complete revascularization is associated with a lower risk of all-cause mortality, cardiovascular mortality, and recurrent MI.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão , Síndrome Coronariana Aguda , Revascularização Miocárdica
5.
Trop Anim Health Prod ; 56(4): 126, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38625501

RESUMO

The objective of this study was to compare the indirect methods of obtaining digestibility with the direct method of total fecal collection to estimate the apparent digestibility of nutrients in sheep and goats supplemented with non-protein nitrogen. Five goats and five sheep with no defined racial pattern were used, distributed in two 5 × 5 Latin squares, with split plots, considering the diets as plots and the apparent digestibility determination methodologies as subplots. The diets were composed of buffelgrass hay and the addition, via ruminal infusion, of increasing amounts of nitrogen supplementation in order to gradually raise the CP level of the basal diet in intervals of 2% points, that is, + 2, +4, + 6 and + 8%. Samples of the feeds offered, and the leftovers were collected daily during the five days of collection to determine the nutrient intake, as well as the total collection of feces to determine the apparent digestibility of the nutrients. The amount of fecal dry matter excreted was estimated by the concentration of Indigestible Acid Detergent Fiber (ADFi), Indigestible Neutral Detergent Fiber (NDFi), Indigestible Dry Matter at 244 h (DMi 244 h) and Indigestible Dry Matter at 264 h (DMi 264 h). Among the evaluated markers, DMi 264 h had the lowest accuracy in estimating fecal excretion and nutrient digestibility. For the goat species, the markers ADFi and DMi 244 h proved to be able to adequately predict fecal excretion and digestibility indices, while NDFi stood out for both species. Among the evaluated markers, NDFi is the one that most accurately estimates the nutrient digestibility of the diet for goats and sheep.


Assuntos
Detergentes , Cabras , Animais , Ovinos , Nutrientes , Suplementos Nutricionais , Nitrogênio
6.
Contraception ; : 110450, 2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38614274

RESUMO

OBJECTIVES: Inherited bleeding disorders may cause heavy menstrual bleeding in women, impacting quality of life and impairing daily and social activities. The levonorgestrel-releasing intrauterine system is a potential treatment for these women, which might reduce menstrual blood loss. STUDY DESIGN: We performed a systematic review and single-arm meta-analysis to examine the levonorgestrel-releasing intrauterine system in women with inherited bleeding disorders and heavy menstrual bleeding. RESULTS: A systematic search on PubMed, Embase and Cochrane yielded 583 results, of which six observational studies (n = 156) met inclusion criteria. Levonorgestrel-releasing intrauterine system use in patients with inherited bleeding disorders and heavy menstrual bleeding was associated with amenorrhea in 60% of patients and a significant increase of 1.40 g/dL in hemoglobin and of 19.75 ng/mL in ferritin levels when comparing post- and pre-treatment levels. The post-treatment mean hemoglobin was 13.32 g/dL and the mean ferritin was 43.22 ng/dL. The rate of intrauterine device expulsion or removal due to mal position was low (13%), as was the need for intrauterine device removal due to lack of efficacy (14%). CONCLUSION: The levonorgestrel-releasing intrauterine system may improve bleeding patterns and quality of life in patients with inherited bleeding disorders and heavy menstrual bleeding. IMPLICATIONS: Women with inherited bleeding disorders could benefit from levonorgestrel-releasing intrauterine system, so its use should be an option for this women.

7.
J Mech Behav Biomed Mater ; 153: 106497, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38458078

RESUMO

OBJECTIVE: To evaluate whether coating enamel with a polymeric primer (PPol) containing titanium tetrafluoride (TiF4) before applying a bleaching gel with 35% H2O2 (35% BG) increases esthetic efficacy, prevents changes in morphology and hardness of enamel, as well as reduces the cytotoxicity from conventional in-office bleaching. MATERIALS AND METHODS: Standardized enamel/dentin discs were stained and bleached for 45 min (one session) with 35% BG. Groups 2TiF4, 6TiF4, and 10TiF4 received the gel on the enamel previously coated with PPol containing 2 mg/mL, 6 mg/mL, or 10 mg/mL, respectively. No treatment or application of 35% BG directly on enamel were used as negative control (NC), and positive control (PC), respectively. UV-reflectance spectrophotometry (CIE L*a*b* system, ΔE00, and ΔWI, n = 8) determined the bleaching efficacy of treatments. Enamel microhardness (Knoop, n = 8), morphology, and composition (SEM/EDS, n = 4) were also evaluated. Enamel/dentin discs adapted to artificial pulp chambers (n = 8) were used for trans-amelodentinal cytotoxicity tests. Following the treatments, the extracts (culture medium + bleaching gel components diffused through the discs) were collected and applied to odontoblast-like MDPC-23 cells, which were assessed concerning their viability (alamarBlue, n = 8; Live/Dead, n = 4), oxidative stress (n = 8), and morphology (SEM). The amount of H2O2 in the extracts was also determined (leuco crystal violet/peroxidase, n = 8). The numerical data underwent one-criterion variance analysis (one-way ANOVA), followed by Tukey's test, at a 5% significance level. RESULTS: Regarding the ΔE00, no difference was observed among groups 2TiF4, 6TiF4, and PC (p > 0.05). The ΔWI was similar between groups 2TiF4 and PC (p > 0.05). The ΔWI of group 6TiF4 was superior to PC (p < 0.05), and group 10TiF4 achieved the highest ΔE00 and ΔWI values (p < 0.05). Besides limiting enamel microstructural changes compared to PC, group 10TiF4 significantly increased the hardness of this mineralized dental tissue. The highest cellular viability occurred in 10TiF4 compared to the other bleached groups (p < 0.05). Trans-amelodentinal H2O2 diffusion decreased in groups 2TiF4, 6TiF4, and 10TiF4 in comparison with PC (p < 0.05). CONCLUSION: Coating enamel with a PPol containing TiF4 before applying a 35% BG may increase enamel microhardness and esthetic efficacy and reduce the trans-amelodentinal cytotoxicity of conventional in-office tooth bleaching. The PPol containing 10 mg/mL of TiF4 promoted the best outcomes.


Assuntos
Clareadores Dentários , Clareamento Dental , Peróxido de Hidrogênio/química , Clareadores Dentários/farmacologia , Dentina , Clareamento Dental/efeitos adversos , Esmalte Dentário
8.
J Anal Toxicol ; 2024 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-38502105

RESUMO

New psychoactive substances (NPS) are often synthesized via small changes in the molecular structure, producing drugs whose effect and potency are not yet fully known. Ketamine is one of the oldest NPS, with therapeutic use in human and veterinary medicine authorized in several countries, being metabolized mainly into norketamine and 6-hydroxy-norketamine. Furthermore, two structural analogues of ketamine have recently been identified, deschloroketamine and 2-fluorodeschloroketamine, marketed as drugs of abuse. To comply with Green Analytical Toxicology (GAT) fundamentals, miniaturized techniques such as dispersive liquid-liquid microextraction (DLLME) were employed to determine toxicants in biological fluids. An analytical method for determining ketamine, its metabolites and its analogues in oral fluid was fully developed and validated by using DLLME and liquid chromatography-tandem mass spectrometry (LC-MS-MS). The extraction parameters were optimized by multivariate analysis, obtaining the best conditions with 200 µL of sample, 100 µL of methanol as dispersive solvent and 50 µL of chloroform as extractor solvent. Linearity was obtained from 10 to 1,000 ng/mL, with limit of detection (LOD) and lower limit of quantification (LLOQ) at 10 ng/mL. Imprecision (% relative standard deviation) and bias (%) were less than 8.2% and 9.5%, respectively. The matrix effect did not exceed 10.6%, and the recovery values varied from 24% to 42%. No matrix interference and good selectivity in the evaluation of 10 different sources of oral fluid and 42 drugs at 500 ng/mL, respectively, were observed. The method was applied in the analysis of 29 authentic oral fluid samples and had its green characteristic evaluated by three different tools: the Green Analytical Procedure Index (GAPI), the Analytical Eco-Scale and the Analytical GREEnness (AGREE) metrics.

9.
J Physiother ; 70(2): 115-123, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38494402

RESUMO

QUESTION: What is the effect of health coaching on physical activity, disability, pain and quality of life compared with a non-active control in adults with chronic non-cancer pain? DESIGN: Systematic review and meta-analysis of randomised controlled trials. Evidence was synthesised as standardised mean differences with 95% confidence intervals using random-effects models. Risk of bias was assessed using the revised Cochrane risk of bias tool. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine evidence certainty. DATA SOURCES: MEDLINE, Embase, CENTRAL, CINAHL, Scopus and PEDro were searched from inception to November 2023. PARTICIPANTS: Adults with chronic non-cancer pain. INTERVENTION: Health coaching to increase physical activity. OUTCOME MEASURES: Measures of physical activity, disability, pain and quality of life. RESULTS: Twenty-six randomised trials (n = 4,403) were included. Trials had moderate to high risk of bias. Health coaching had a trivial to small effect on improving physical activity compared with control (15 trials; SMD 0.21, 95% CI 0.07 to 0.35; low certainty evidence). Health coaching had a small effect on improving disability (19 trials; SMD 0.25, 95% CI 0.17 to 0.32; moderate certainty evidence) and pain (19 trials; SMD 0.31, 95% CI 0.18 to 0.43; very low certainty evidence) compared with control. The effect of health coaching on quality of life was unclear due to significant imprecision in the effect estimate (five trials; SMD 0.19, 95% CI -0.14 to 0.53; moderate certainty evidence). CONCLUSION: Health coaching promotes a trivial to small improvement in physical activity and small improvements in disability and pain in adults with chronic non-cancer pain. The effect of health coaching on quality of life remains unclear. REGISTRATION: PROSPERO CRD42020182740.


Assuntos
Dor Crônica , Tutoria , Adulto , Humanos , Dor Crônica/terapia , Qualidade de Vida , Analgésicos Opioides , Exercício Físico
10.
J Am Coll Cardiol ; 83(6): 637-648, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38325988

RESUMO

BACKGROUND: Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. OBJECTIVES: The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. METHODS: We conducted a randomized clinical trial with subjects with obesity grade 1 or 2 plus hypertension using at least 2 medications. We excluded subjects with previous cardiovascular events and poorly controlled type 2 diabetes. Subjects were assigned to Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) or MT alone. We reassessed the original primary outcome (reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg) at 5 years. The main analysis followed the intention-to-treat principle. RESULTS: A total of 100 subjects were included (76% women, age 43.8 ± 9.2 years, body mass index: 36.9 ± 2.7 kg/m2). At 5 years, body mass index was 36.40 kg/m2 (95% CI: 35.28-37.52 kg/m2) for MT and 28.01 kg/m2 (95% CI: 26.95-29.08 kg/m2) for RYGB (P < 0.001). Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (80.7% vs 13.7%; relative risk: 5.91; 95% CI: 2.58-13.52; P < 0.001) and the mean number of antihypertensive medications was 2.97 (95% CI: 2.33-3.60) for MT and 0.80 (95% CI: 0.51-1.09) for RYGB (P < 0.001). The rates of hypertension remission were 2.4% vs 46.9% (relative risk: 19.66; 95% CI: 2.74-141.09; P < 0.001). Sensitivity analysis considering only completed cases revealed consistent results. Interestingly, the rate of apparent resistant hypertension was lower after RYGB (0% vs 15.2%). CONCLUSIONS: Bariatric surgery represents an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. (GAstric bypass to Treat obEse Patients With steAdy hYpertension [GATEWAY]; NCT01784848).


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Derivação Gástrica , Hipertensão , Obesidade Mórbida , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Masculino , Pressão Sanguínea , Anti-Hipertensivos/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Obesidade/complicações , Obesidade/cirurgia , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Fatores de Risco , Resultado do Tratamento , Obesidade Mórbida/cirurgia
11.
Trop Anim Health Prod ; 56(2): 72, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38326674

RESUMO

This study aimed to assess the impact of adding forage cactus as an additive to the production of corn silage without the cob on the performance of feedlot sheep and subsequent silage losses. The experimental design was completely randomized, consisting of three treatments: corn silage without cob; 0% = 100% corn plant without the cob; 10% = 90% corn plant without cob + 10% forage cactus; 20% = 80% corn plant without cob + 20% forage cactus. Significant effects were observed for dry matter intake (P = 0.0201), organic matter (P = 0.0152), ether extract (P = 0.0001), non-fiber carbohydrates (P = 0.0007). Notably, nutrient digestibility showed significant differences in organic matter (P = 0.0187), ether extract (P = 0.0095), neutral detergent fiber (P = 0.0005), non-fiber carbohydrates (P = 0.0001), and metabolizable energy (P = 0.0001). Performance variables, including total weight gain (P = 0.0148), average daily weight gain (P = 0.0148), feeding efficiency, and rumination efficiency of dry matter (P = 0.0113), also exhibited significant effects. Consequently, it is recommended to include 20% forage cactus in corn silage, which, based on natural matter, helps meet animals' water needs through feed. This inclusion is especially vital in semi-arid regions and aids in reducing silage losses during post-opening silo disposal.


Assuntos
Cactaceae , Zea mays , Animais , Feminino , Dieta/veterinária , Fibras na Dieta , Digestão , Éteres , Lactação , Leite , Extratos Vegetais , Rúmen , Ovinos , Silagem/análise , Aumento de Peso
12.
Nursing (Ed. bras., Impr.) ; 27(308): 10125-10130, fev.2024.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1537501

RESUMO

O objetivo desse trabalho é descrever a sistematização da Assistência de Enfermagem a pessoas com agravos endócrinos e metabólicos pautado na teoria de Calista Roy. Metodologia: Trata-se de um relato de experiência através da aplicação da Sistematização da Assistência de Enfermagem (SAE), voltado para pessoas com agravos endócrinos e metabólicos no contexto hospitalar. Resultados e discussão: Foi aplicado a teoria da adaptação nas seis fases da Teoria de Calista Roy e foi elaborado diagnósticos de enfermagem para os quatro modos de adaptação: fisiológico, interdependência, autoconceito e função de papel. Considerações finais: Ao aplicar a SAE no indivíduo com agravos endócrinos e metabólicos a enfermeira deve realizá-lo em todas as suas etapas, e utilizar os protocolos para oferecer um cuidado holístico e integral, visando a promoção da saúde, prevenção de risco potencial e adaptação diante das necessidades em saúde.(AU)


The aim of this study is to describe the systematization of nursing care for people with endocrine and metabolic disorders, based on Calista Roy's theory. Methodology: This is an experience report on the application of the Systematization of Nursing Care (SNC) to people with endocrine and metabolic disorders in a hospital setting. Results and discussion: The theory of adaptation was applied in the six phases of Calista Roy's theory and nursing diagnoses were drawn up for the four modes of adaptation: physiological, interdependence, self-concept and role function. Final considerations: When applying the SNC to individuals with endocrine and metabolic disorders, the nurse must carry it out in all its stages, and use the protocols to offer holistic and comprehensive care, aimed at promoting health, preventing potential risks and adapting to health needs.(AU)


El objetivo de este estudio es describir la sistematización de los cuidados de enfermería a personas con trastornos endocrinos y metabólicos, basándose en la teoría de Calista Roy. Metodología: Se trata de un informe de experiencia sobre la aplicación de la Sistematización de los Cuidados de Enfermería (SNC) a personas con trastornos endocrinos y metabólicos en un entorno hospitalario. Resultados y discusión: Se aplicó la teoría de la adaptación en las seis fases de la teoría de Calista Roy y se elaboraron diagnósticos de enfermería para los cuatro modos de adaptación: fisiológica, interdependencia, autoconcepto y función de rol. Consideraciones finales: Al aplicar el SNC a individuos con trastornos endocrinos y metabólicos, la enfermera debe llevarlo a cabo en todas sus fases, y utilizar los protocolos para ofrecer cuidados holísticos e integrales, dirigidos a promover la salud, prevenir riesgos potenciales y adaptarse a las necesidades de salud.(AU)


Assuntos
Equipe de Assistência ao Paciente , Família , Empatia , Sistema Endócrino
13.
Ann Behav Med ; 58(3): 216-226, 2024 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-38300788

RESUMO

BACKGROUND: Understanding behavior change techniques (BCTs) used in randomized controlled trials (RCTs) of physical activity programs/services for older adults can help us to guide their implementation in real-world settings. PURPOSE: This study aims to: (a) identify the number and type of BCTs used in physical activity programs/services for older adults evaluated in large, good quality RCTs and (b) explore the impact of different BCTs on different outcome domains. METHODS: This is a secondary data analysis of a WHO-commissioned rapid review of physical activity programs/services for older adults. Fifty-six trials testing 70 interventions were coded for the type and number of BCTs present using a published BCT taxonomy. The proportion of positive effects found from physical activity interventions using the most common BCTs was calculated for the outcomes of physical activity, intrinsic capacity, functional ability, social domain, cognitive and emotional functioning, and well-being and quality of life. RESULTS: Thirty-nine of the 93 possible BCTs were identified in the included trials and 529 BCTs in total (mean 7.6, range 2-17). The most common BCTs were "action planning" (68/70 interventions), "instructions on how to perform a behavior" (60/70), "graded tasks" (53/70), "demonstration of behavior" (44/70), and "behavioral practice/rehearsal" (43/70). Interventions that used any of the most common BCTs showed overwhelmingly positive impacts on physical activity and social domain outcomes. CONCLUSION: Consideration of which BCTs are included in interventions and their impact on outcomes can improve the effectiveness and implementation of future interventions. To enable this, providers can design, implement, and evaluate interventions using a BCT taxonomy.


Interventions aimed at modifying health-related behaviors, such as physical activity, are often complex, with numerous components. To better understand interventions' "active ingredients," we conducted a secondary analysis of a World Health Organization (WHO)-commissioned rapid review, using a behavior change technique (BCT) taxonomy. We aimed to classify the number and types of BCTs in physical activity programs for older adults, as identified in randomized controlled trials (RCTs), and examine their impact on outcomes, including physical activity, intrinsic capacity, functional ability, social domain, cognitive and emotional functioning, and well-being. Examining 56 trials testing 70 interventions, we identified 39 out of 93 possible BCTs, totaling 529 instances across interventions. Common BCTs included "action planning," "instructions on how to perform a behavior," "graded tasks," "demonstration of behavior," and "behavioral practice/rehearsal." Interventions using the 10 most common BCTs demonstrated overwhelmingly positive impacts on physical activity and social domain outcomes. However, these BCTs were not consistently present in interventions yielding positive outcomes in other domains, with greater variation in effects. Our study highlights the significance of identifying both BCTs and desired outcomes when designing physical activity interventions. We advocate for the use of a taxonomy in designing and implementing future programs to maximize effectiveness.


Assuntos
Terapia Comportamental , Exercício Físico , Idoso , Humanos , Terapia Comportamental/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
J. Am. Coll. Cardiol ; 83(6): 637-648, fev.2024. ilus
Artigo em Inglês | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1530662

RESUMO

BACKGROUND: Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. OBJECTIVES: The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. METHODS: We conducted a randomized clinical trial with subjects with obesity grade 1 or 2 plus hypertension using at least 2 medications. We excluded subjects with previous cardiovascular events and poorly controlled type 2 diabetes. Subjects were assigned to Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) or MT alone. We reassessed the original primary outcome (reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg) at 5 years. The main analysis followed the intention-to-treat principle. RESULTS: A total of 100 subjects were included (76% women, age 43.8 ± 9.2 years, body mass index: 36.9 ± 2.7 kg/m2). At 5 years, body mass index was 36.40 kg/m2 (95% CI: 35.28-37.52 kg/m2) for MT and 28.01 kg/m2 (95% CI: 26.95-29.08 kg/m2) for RYGB (P < 0.001). Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (80.7% vs 13.7%; relative risk: 5.91; 95% CI: 2.58-13.52; P < 0.001) and the mean number of antihypertensive medications was 2.97 (95% CI: 2.33-3.60) for MT and 0.80 (95% CI: 0.51-1.09) for RYGB (P < 0.001). The rates of hypertension remission were 2.4% vs 46.9% (relative risk: 19.66; 95% CI: 2.74-141.09; P < 0.001). Sensitivity analysis considering only completed cases revealed consistent results. Interestingly, the rate of apparent resistant hypertension was lower after RYGB (0% vs 15.2%). CONCLUSIONS: Bariatric surgery represents an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. (GAstric bypass to Treat obEse Patients With steAdy hYpertension [GATEWAY]; NCT01784848).

15.
J Biosoc Sci ; 56(3): 493-503, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38415307

RESUMO

This study identified food deserts and swamps, investigating their associations with socioeconomic and demographic conditions. This ecological study was conducted using data from urban census tracts in the city of Recife, which were considered the unit of analysis. Information on food retail was obtained from government sources in 2019. Census tracts below the 25th percentile in the density of healthy food retail (i.e., those that predominantly sell natural or minimally processed foods, mixed businesses, and super- and hypermarkets) were classified as food deserts. Census tracts above the 25th percentile in the density of unhealthy food retail (i.e., those selling primarily ultra-processed foods) were considered food swamps. The socioeconomic and demographic conditions of the census tracts were evaluated using variables from the 2010 census (per capita income, average income, race, literacy of the head of household, and the availability of essential services) and the Health Vulnerability Index. Census tracts considered food deserts (28.5%) were more vulnerable, characterized by lower income and access to essential services, more illiterate residents and more minorities (Black/Indigenous/mixed race). Food swamps (73.47%) were more prevalent in less vulnerable neighbourhoods characterized by higher percentages of literate residents and Whites, greater purchasing power, and better basic sanitation. The characteristics of Recife's food deserts and swamps demonstrate social inequalities in the food environment. Public facilities could play a vital role in promoting healthy eating within food deserts. Additionally, future implementation of taxes on ultra-processed foods and the provision of tax subsidies to natural or minimally processed food sellers might contribute to fostering healthier dietary choices.


Assuntos
Desertos Alimentares , Áreas Alagadas , Humanos , Brasil , Abastecimento de Alimentos , Fatores Socioeconômicos , Características de Residência , Alimentos
16.
Animals (Basel) ; 14(4)2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38396518

RESUMO

The aim was to evaluate the chemical composition, carbohydrates, protein fractionation and in vitro gas production of silages composed of spineless cactus and tropical forages and their effect on sheep performance. Treatments consisted of silages: corn silage (CS), spineless cactus silage (SCS), spineless cactus + gliricidia (SCG), spineless cactus + buffel grass silage (SCBG) and spineless cactus + pornunça (SCP). Silos were opened 60 days after ensiling, and analyses were carried out. The digestibility test lasted for 36 days, with eight animals per treatment. A completely randomized design was adopted. Considering carbohydrate fractionation, CS, SCS and SCBG silages had higher total carbohydrate content (p = 0.001). The SCS silage presented a higher A + B1 fraction (p = 0.001). The SCBG and SCG silages showed a higher B2 fraction (p < 0.0001) compared to the CS and SCS silages. The SCBG and SCP silages presented a higher C fraction (p = 0.001). For protein fractionation, the SCP and SCG silages showed higher crude protein contents (p = 0.001). The CS and SCS silages showed a higher A fraction (p = 0.001). The SCBG silage presented a higher B1 + B2 fraction (p = 0.001). The SCG silage showed a higher B3 fraction (p = 0.006) compared to SCBG silage. The SCS and SCP silages showed a higher C fraction (p = 0.001). Exclusive SCS silage showed higher in vitro dry matter digestibility (p = 0.001), dry matter degradability (p = 0.001) and total gas production (p = 0.001). The use of the SCBG, SCP and SCG silages to feed sheep increased the dry matter intake (p < 0.001). Sheep fed the SCG silage showed greater dry matter and crude protein digestibility compared to the sheep fed the CS, SCS and SCP silages (p = 0.002). There was a higher water intake (p < 0.001) with the use of the SCS and SCG silages to feed the sheep. The SCP and SCG silages provided a greater intake (p < 0.001) and excretion (p < 0.001) of nitrogen by the animals. Although there were no differences between the treatments for daily gains, lambs that received the spineless cactus-based silage associated with tropical forages showed higher gains (160-190 g/day) than lambs that received CS silage (130 g/day). Thus, the use of spineless cactus associated with buffelgrass, pornunça and gliricidia to prepare mixed silages (60:40) to feed sheep has potential use to feed sheep, with positive effects on nutrient degradation and increases in dry matter intake. Under experimental conditions, we recommend the exclusive use of spineless cactus silage associated with buffel grass, pornunça and gliricidia in feeding sheep in semi-arid regions, as it provides nutrients, water and greater daily gains compared to corn silage.

17.
Australas J Ageing ; 43(1): 205-210, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38217881

RESUMO

OBJECTIVES: Accurate fall reporting is essential for assessing the effectiveness of fall prevention strategies. This study aimed to investigate the level of agreement between incident reports and resident progress notes as data sources for falls monitoring in residential aged care facilities. METHODS: A retrospective observational study was conducted involving 46 older people from six residential aged care facilities who had consented to join the broader TOP UP trial. Fall events documented in the incident report system and resident progress notes over 12 months before randomisation were extracted by two independent reviewers using a standardised Excel form. Agreement between the two data collection methods was calculated using Cohen's kappa coefficient. RESULTS: A total of 75 falls were recorded from 27 (59%) of the 46 participants who were 65% female, with an average age of 83 [SD 9] years. The incident reports captured 68 (90.7%) falls, while the progress notes captured 73 (97.3%) falls. Overall, there was a 75% agreement between falls recorded in progress notes and incident reports. Perfect agreement was identified for five facilities (n = 35), while one facility had a lower agreement rate of 29% (n = 11), which appeared to be attributable to staff shortages linked to the COVID-19 pandemic. CONCLUSIONS: There was substantial agreement between incident reports and progress records. These findings support the use of incident reports for identifying falls in research or to investigate the effectiveness of fall prevention strategies in residential aged care facilities.


Assuntos
Instituição de Longa Permanência para Idosos , Pandemias , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Instituições Residenciais , Gestão de Riscos , Estudos Retrospectivos
18.
J Cachexia Sarcopenia Muscle ; 15(2): 501-512, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38263952

RESUMO

Sarcopenia is a risk factor for adverse clinical outcomes in chronic kidney disease (CKD) patients, including mortality. Diagnosis depends on adopted consensus definition and cutoff values; thus, prevalence rates are generally heterogeneous. We conducted a systematic review and meta-analysis to investigate the global prevalence of sarcopenia and its traits across the wide spectrum of CKD. A systematic search was conducted using databases, including MEDLINE and EMBASE, for observational studies reporting the prevalence of sarcopenia. We considered sarcopenia according to the consensus definition of the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia, the Foundation for the National Institutes of Health Sarcopenia Project, and the International Working Group on Sarcopenia (IWGS). Subgroup analyses by CKD stages, consensus, and gender were performed. Pooled prevalence was obtained from random-effect models. A total of 140 studies (42 041 patients) across 25 countries were included in this systematic review and meta-analyses. Global prevalence of sarcopenia was 24.5% [95% confidence interval (CI): 20.9-28.3) and did not differ among stages (P = 0.33). Prevalence varied according to the consensus definition from 11% to 30%, with no significant difference (P = 0.42). Prevalence of severe sarcopenia was 21.0% (95% CI: 11.7-32.0), with higher rates for patients on dialysis (26.2%, 95% CI: 16.6-37.1) compared to non-dialysis (3.0%, 95% CI: 0-11.1; P < 0.01). Sarcopenic obesity was observed in 10.8% (95% CI: 3.5-21.2). Regarding sarcopenia traits, low muscle strength was found in 43.4% (95%CI: 35.0-51.9), low muscle mass in 29.1% (95% CI: 23.9-34.5), and low physical performance in 38.6 (95% CI: 30.9-46.6) for overall CKD. Prevalence was only higher in patients on dialysis (50.0%, 95% CI: 41.7-57.4) compared to non-dialysis (19.6%, 95% CI: 12.8-27.3; P < 0.01) for low muscle strength. We found a high global prevalence of sarcopenia in the wide spectrum of CKD. Low muscle strength, the primary sarcopenia trait, was found in almost half of the overall population with CKD. Patients on dialysis were more prevalent to low muscle strength and severe sarcopenia. Nephrology professionals should be aware of regularly assessing sarcopenia and its traits in patients with CKD, especially those on dialysis.


Assuntos
Insuficiência Renal Crônica , Sarcopenia , Estados Unidos , Humanos , Idoso , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Sarcopenia/etiologia , Prevalência , Força Muscular , Obesidade/diagnóstico , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-38285003

RESUMO

BACKGROUND: Falls and physical inactivity increase with age. However, physical activity, falls and their associations in older people born at different times are unclear. METHODS: Women born 1921-26 and 1946-51 who completed follow-up questionnaires in 1999 (n = 8 403, mean (SD) age: 75 (1) years) and 2019 (n = 7 555; 71 (1) years) in the Australian Longitudinal Study on Women's Health. Self-reported noninjurious and injurious falls in the previous 12 months and weekly amounts and types of physical activity (brisk walking, moderate- and vigorous-intensity) were compared between the cohorts using Chi-square tests. Associations between physical activity, and noninjurious and injurious falls were estimated using multinomial logistic regressions informed by a directed acyclic graph. RESULTS: A greater proportion of the later (1946-51) cohort (59%) reached 150-300 minutes of weekly physical activity, as recommended by the World Health Organization, compared to the earlier (1921-26) cohort (43%, p < .001). A greater proportion of the later cohort reported noninjurious falls (14% vs 8%). Both cohorts reported similar proportions of injurious falls (1946-51:15%, 1921-26:14%). In both cohorts, participation in 150-300 minutes of physical activity was associated with lower odds of noninjurious falls (adjusted Odds Ratio, 95% CI: 1921-26: 0.66, 0.52-0.84; 1946-51: 0.78, 0.63-0.97) and injurious falls (1921-26: 0.72, 0.60-0.87; 1946-51: 0.78, 0.64-0.96). CONCLUSIONS: Participation in recommended levels of physical activity was associated with reduced falls in both cohorts. However, generational differences were found with more falls and more physical activities in the women born later. Future studies could examine the reasons contributing to the generational differences.


Assuntos
Exercício Físico , Saúde da Mulher , Humanos , Feminino , Idoso , Estudos Longitudinais , Austrália/epidemiologia , Fatores de Risco
20.
Br J Sports Med ; 58(7): 382-391, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38253435

RESUMO

OBJECTIVES: To evaluate the effect of a coaching intervention compared with control on physical activity and falls rate at 12 months in community-dwelling people aged 60+ years. DESIGN: Cluster randomised controlled trial. SETTING: Community-dwelling older people. PARTICIPANTS: 72 clusters (605 participants): 37 clusters (290 participants) randomised to the intervention and 35 (315 participants) to control. INTERVENTION: Intervention group received written information, fall risk assessment and prevention advice by a physiotherapist, activity tracker and telephone-based coaching from a physiotherapist focused on safe physical activity. Control group received written information and telephone-based dietary coaching. Both groups received up to 19 sessions of telephone coaching over 12 months. OUTCOMES: The co-primary outcomes were device-measured physical activity expressed in counts per minute at 12 months and falls rate over 12 months. Secondary outcomes included the proportion of fallers, device-measured daily steps and moderate-to-vigorous physical activity (MVPA), self-reported hours per week of physical activity, body mass index, eating habits, goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being and disability. RESULTS: The mean age of participants was 74 (SD 8) years, and 70% (n=425) were women. There was no significant effect of the intervention on device-measured physical activity counts per minute (mean difference 5 counts/min/day, 95% CI -21 to 31), or falls at 12 months (0.71 falls/person/year in intervention group and 0.87 falls/person/year in control group; incidence rate ratio 0.86, 95% CI 0.65 to 1.14). The intervention had a positive significant effect on device-measured daily steps and MVPA, and self-reported hours per week of walking, well-being, quality of life, and disability. No significant between-group differences were identified in other secondary outcomes. CONCLUSION: A physical activity and fall prevention programme including fall risk assessment and prevention advice, plus telephone-based health coaching, did not lead to significant differences in physical activity counts per minute or falls rate at 12 months. However, this programme improved other physical activity measures (ie, daily steps, MVPA, hours per week of walking), overall well-being, quality of life and disability. TRIAL REGISTRATION NUMBER: ACTRN12615001190594.


Assuntos
Vida Independente , Tutoria , Humanos , Feminino , Idoso , Masculino , Qualidade de Vida , Medo , Exercício Físico
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