Avaliação da experiência do telemonitoramento de enfermagem por mulheres com excesso de peso / Evaluación de la experiencia de la telemonitorización de enfermería por mujeres con exceso de peso / Assessment of the experience of nursing telemonitoring by overweight women

Resumo Objetivo Avaliar a experiência do monitoramento remoto de enfermagem na perspectiva de mulheres com excesso de peso. Método Estudo descritivo, de abordagem qualitativa, realizado em ambulatório de referência em obesidade em Salvador-Bahia, com 42 mulheres com excesso de peso, as quais haviam participado do grupo intervenção de um ensaio clínico randomizado. Realizaram-se entrevistas semiestruturadas entre janeiro a março de 2017 e os dados foram analisados através da técnica de análise de conteúdo temática. Resultados Dos depoimentos emergiu a categoria central "Aumentando a consciência do cuidado de si", a qual foi representada por três categorias temáticas: Vivenciando um feedback frequente e interativo com a enfermeira para o controle de peso, Melhorando o cuidado de si e Sentindo satisfação com os resultados alcançados. Conclusão e implicações para a prática As participantes vivenciaram e reconheceram a melhora do conhecimento para o controle do peso e mudanças positivas nos modos de viver ou conviver com o excesso de peso. Os resultados evidenciaram que atividades educativas por meio da telenfermagem, numa perspectiva dialógica, contribuem para potencializar o autocuidado.

Resumen Objetivo Evaluar la experiencia de la monitorización remota de enfermería en la perspectiva de las mujeres con exceso de peso. Método Estudio descriptivo, de enfoque cualitativo, realizado en ambulatorio de referencia en obesidad en Salvador-Bahia, con 42 mujeres con exceso de peso, las cuales habían participado del grupo de intervención de un ensayo clínico aleatorio. Se realizaron entrevistas semiestructuradas entre enero y marzo de 2017 y los datos fueron analizados mediante la técnica de análisis de contenido temático. Resultados De los testimonios surgió la categoría central " Aumentando la conciencia sobre el autocuidado", la cual estaba representada por tres categorías temáticas: Vivenciando un feedback frecuente e interactivo con la enfermera para el control del peso, Mejorando el autocuidado y Sintiendo satisfacción con los resultados logrados. Conclusión e implicaciones para la práctica Las participantes vivenciaron y reconocieron la mejora del conocimiento para el control del peso y cambios positivos en los modos de vivir o convivir con exceso de peso. Los resultados evidenciaron que actividades educativas por medio de la teleenfermería, en una perspectiva dialógica, contribuyen para potencializar el autocuidado.

Abstract Objective To evaluate the experience of remote nursing monitoring from the perspective of overweight women. Method Descriptive, qualitative approach study, carried out in a reference outpatient clinic in obesity in Salvador-Bahia, with 42 overweight women, who had participated in the intervention group of a randomized clinical trial. Semi-structured interviews were conducted between January and March 2017. The data were analyzed using the thematic content analysis technique. Semi-structured interviews were conducted between January and March 2017, with the data having been analyzed through thematic content analysis. Results From their statements the central category "Increasing awareness for self-care" was identified, which was represented by three thematic categories: Experiencing a frequent and interactive feedback with the nurse for weight control, Improving self-care and Feeling satisfaction with the results obtained. Conclusion and implications for practice The participants experienced and recognized improved knowledge for weight control and positive changes in ways of living or living with excess weight. The results evidenced that educational activities, through telenursing, in a dialogical perspective, contribute towards enhancing self-care.

Sobrepeso, obesidad y actividad física en estudiantes de enfermería pregrado de una universidad privada 2017 / Overweight, obesity and physical activity in undergraduate nursing students from a private university

INTRODUCCIÓN: La obesidad es un factor de riesgo directo para la aparición y desarrollo de patologías crónicas no transmisibles, como la diabetes, hipertensión, enfermedad renal y cardiovascular. El sobrepeso y obesidad están relacionados entre otros factores a la inactividad física en los diferentes grupos etáreos, lo cual genera un problema de salud pública que requiere atención oportuna y estrategias de prevención y control en la población. OBJETIVOS: Determinar el sobrepeso, obesidad y su relación con la actividad física, en los estudiantes de enfermería pre grado de la Universidad Peruana Cayetano Heredia, 2017. MATERIAL Y MÉTODO: Estudio descriptivo transversal y analítico, con una muestra aleatoria extraída de 198 alumnos, a quienes se les aplicó el instrumento validado Cuestionario Internacional de Actividad Física, previamente se tomaron medidas de peso, talla y calculó el Índice de Masa Corporal (IMC). Los estadísticos utilizados para medir la asociación fueron Tau-C de Kendall y coeficiente D de Somers. RESULTADOS: Del total de la muestra, el 14,1 % tienen obesidad, 31,7% sobrepeso, y el 52,8% están en condición normal. Respecto a la actividad física los estudiantes realizan actividad física baja y moderada con el 40,8% y 53,5% respectivamente, el 5,6% de los participantes realiza actividad física alta, destacando el sexo femenino en mayor proporción. CONCLUSIÓN: Existe una relación inversa entre la actividad física y las categorías de IMC, a mayor IMC se evidencia baja actividad física en la población de estudio

INTRODUCTION: Obesity is a direct risk factor for the appearance and development of chronic non-communicable diseases, such as diabetes, hypertension, renal and cardiovascular disease. Overweight and obesity are related among other factors to physical inactivity in the different age groups, which generates a public health problem that requires timely attention, and population prevention and control strategies. OBJECTIVES: To determine overweight, obesity and the relationship with physical activity in undergraduate nursing students at the Universidad Peruana Cayetano Heredia during 2017. MATERIAL AND METHOD: Descriptive, cross-sectional and analytical study, with a random sample of 198 students, to whom the validated International Physical Activity Questionnaire was applied, previously taking measurements of weight, height and calculating the Body Mass Index (BMI). The statistics used to measure the association were Kendall's Tau-C and Somers' D coefficient. RESULTS: Of the total sample, 14.1% are obese, 31.7% overweight, and 52.8% are in normal condition. Regarding physical activity, students carry out low and moderate physical activity with 40.8% and 53.5%, respectively. 5.6% of the participants perform high physical activity, having females a higher proportion. CONCLUSION: There is an inverse relationship between physical activity and BMI categories. The higher the BMI value, the lower the level of physical activity in the study population

Factores asociados con el sobrepeso de los niños y las niñas en el primer año de vida / Factors associated with overweight in children during their first year of life

OBJETIVO: identificar los factores asociados con la obesidad del niño o de la niña al año de vida, y determinar la relación entre el peso/talla de la madre con la presencia de sobrepeso del recién nacido al año de vida. MÉTODO: estudio observacional retrospectivo en recién nacidos (RN) de madres gestantes primíparas sin patología, atendidos en el Hospital de Verín (enero 2014-abril 2017). Se recogieron variables maternas; variables neonatales, así como el tipo de alimentación durante su primer año de vida y las características antropométricas de niños/as al mes, 3, 6 y 12 meses del nacimiento. Se llevaron a cabo análisis descriptivos, bivariantes y correlaciones entre características de la madre y valores antropométricos de menores. RESULTADOS: un 6,03% de los RN presentó sobrepeso u obesidad. Un 9,2% tenía sobrepeso al mes de vida, 3,1% a los 3 meses, 5,3% a los 6 meses y 16% al año. Los que presentaban sobrepeso al año eran aquellos que tenían mayor peso al nacimiento, no encontrándose relación entre el sobrepeso al nacimiento y a lo largo de su primer año con las características gestacionales de la madre. Los niños presentaron cifras ligeramente más elevadas de índice de masa corporal (IMC) que las niñas durante el primer año de vida, siendo significativo solo a los 3 meses. También existieron evidencias significativas de la asociación de la talla materna con el peso/talla del RN a lo largo de su primer año de vida. La alimentación recibida durante los tres primeros meses juega un papel importante al final de su primer año, observándose una reducción de la talla y del peso en los niños que a partir del tercer mes se alimentaban con lactancia artificial en comparación con las niñas, en las que su peso aumentó en casi 1 kg al prescindir de la lactancia materna a partir de ese tercer mes. CONCLUSIONES: las características gestacionales no se relacionaron con una presencia de obesidad durante el primer año de vida, siendo las características en el momento del nacimiento del niño y el tipo de alimentación las que se asociaron con un exceso de peso al año

OBJECTIVE: to identify those factors associated with obesity in boys or girls during their first year of life, and to determine the relationship between the weight/height of the mother and the presence of overweight in newborns on the first year of life. METHOD: an observational retrospective study in newborns (NBs) from primiparous mothers without any other condition, managed at the Hospital de Verín (January, 2014- April, 2017). Maternal variables were collected, as well as neonatal variables, type of feeding during their first year of life, and the anthropometric characteristics of the children at one month and 3, 6 and 12 months after birth. Descriptive, bivariate analysis was conducted, and correlations between characteristics of the mother and anthropometric values of the children. RESULTS: 6.03% of the NBs presented overweight or obesity; 9.2% had overweight at one month of life, 3.1% at 3 months, 5.3% at 6 months, and 16% at one year. Those who presented excess weight at one year were those with higher weight at birth; no relationship was found between overweight at birth and during their first year with the gestational characteristics of the mother. Boys presented slightly higher figures of body mass index (BMI) than girls during their first year of life, which was significant only at 3 months. There was also significant evidence regarding the association of maternal height with the weight/height of the NB over their first year of life. The type of feeding received during the first three months played an important role at the end of their first year: a reduction in their height and weight was observed in boys who were fed with formula in comparison with girls, whose weight increased in almost 1 kilo when breastfeeding was withdrawn from the third month onwards. CONCLUSIONS: gestational characteristics were not associated with the presence of obesity during the first year of life; on the other hand, the characteristics of the child at the time of birth and type of feeding were associated with an excess weight at one year

Addressing Food Insecurity and Overweight/Obesity in Hospitalized Low-Income Latino Patients.

Food insecurity (FI), the limited or unreliable availability of safe and nutritious food, is a pressing public health concern affecting millions of U.S. citizens. Unfortunately, FI tends to impact those who are most vulnerable (e.g., low-income minorities) and potentially increases obesity risks, diet-sensitive disease risks (e.g., hypertension and type 2 diabetes), and hospital utilization. Low-income Latino patients may be particularly sensitive to adverse outcomes based on unaddressed socioeconomic needs. Nurses are in a prime position to assess and address FI in these patients. Our article will discuss how nurses can be advocates in combating FI in Latino patients with overweight/obesity.

Effect of remote nursing monitoring on overweight in women: clinical trial.

OBJECTIVE: to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women. METHOD: controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study. RESULTS: in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group. CONCLUSION: the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv.

Factors influencing the adoption of health promoting behaviors in overweight pregnant women: a qualitative study.

BACKGROUND: The ability to adopt and implement health promotion behaviors is one of the most important determinants of health status. Various factors affect the successful changing of behaviors and choosing a healthy lifestyle. The present study aims at exploring the experiences of overweight pregnant women in terms of the factors influencing selection and adoption of health promoting behaviors during pregnancy. METHODS: This qualitative study reports the findings of individual and group in-depth interviews with 32 overweight pregnant women using semi-structured questions which was conducted in Tabriz-Iran in 2017 and lasted for 6 months. The data collection continued until the saturation of the data. Participants were selected using purposive sampling and study inclusion criteria. Interviews were recorded and transcribed. Thereafter, content analysis was made using MAXQDA v. 10. Strength of data was verified by both participants and external control. RESULTS: The reported effective factors led to identification of the two themes of two contextual perceived barriers and facilitators, which were classified into four main categories and nine subcategories: 1. Individual barriers (disabilities-additional needs in pregnancy and mental barriers) 2. Socio- environmental barriers (adverse effects of the environment, adverse effects of the relatives and financial pressures) 3. Individual facilitators (intrinsic incentives, abundance and individual skills) 4. Socio- environmental (social and family support, incentive environments, and raising awareness). CONCLUSION: The adoption of health behaviors and healthy lifestyle is under the mutual influence of individual characteristics and socio-environmental factors. What should be considered in planning and designing interventions is focused on removing barriers and strengthening facilitators, in particular by moderating social factors and taking into account individual needs and personal expectations.

The Effects of a Health Partner Program on Alleviating Depressive Symptoms Among Healthy Overweight/Obese Individuals.

Background and Purpose: Although lifestyle interventions have been shown to be effective in losing weight and increasing physical activity in community settings, little is known whether these programs may also ameliorate negative mood states in healthy overweight/obese adults when such programs are delivered in workplace settings. The aim of the study was to determine whether a health partner program may alleviate depressive symptoms among healthy overweight/obese individuals at 1 year. Methods: A secondary data analysis was performed using the Center for Health Discovery and Well Being database at Emory University in the United States. A total of 297 healthy overweight/obese university employees were recruited from the health partner program. Participants worked with health partners to establish an individualized health action plan, which might include changes in diet or exercise, modification of risk-related behaviors (e.g., tobacco use, alcohol use), and stress reduction strategies such as yoga. Depressive symptoms were measured by the Beck Depression Inventory-II at baseline and one-year follow-up. Results: At baseline, 9.7% of participants had depressive symptoms. At one-year follow-up, these participants had a small-to-moderate improvement in depressive symptoms (Cohen's d = 0.423), and the changes in depressive symptoms were statistically significant (p < 0.001). Implications for Practice: Since overweight/obese individuals are more likely to experience depressive symptoms than normal-weight individuals, early interventions to steer these individuals to better mental health are therefore essential. This study has demonstrated the potential benefits of a health partner program on alleviating depressive symptoms among overweight/obese individuals and this should be integrated into clinical practice.

Nursing care of overweight children: A concept analysis.

AIM: To report an analysis of the concept nursing care of overweight children. BACKGROUND: Patient care is the essence of nursing practice. Nursing professionals must define how to serve specific population groups, including overweight children, presenting real solutions to their problem. A clear conceptual analysis is necessary to unify nursing language and to contribute to nursing practice. DESIGN: Concept analysis. DATA SOURCES: The following databases were searched: COCHRANE, SCOPUS, LILACS, CINAHL, MEDLINE/PubMed, and CAPES Theses Library of Brazil. REVIEW METHODS: Walker and Avant's concept analysis methodology was adopted in this study. Twenty-two articles were analyzed, and the uses, attributes, antecedents, and outcomes of the concept were identified. The nursing care assumptions proposed by Virginia Henderson comprised the theoretical referential. RESULTS: The attributes of nursing care for overweight children included investigation, guidance, and monitoring of dietary, clinical, academic, and social aspects, along with evaluation of lifestyle and anthropometric data related to the affected children and their families. CONCLUSION: This study enabled the construction of a defined concept for nursing care of overweight children that may be useful in the construction of a medium-range theory. Further research is recommended to verify the usefulness of the nursing approach.

Sobrepeso y obesidad: eficacia de las intervenciones en adultos / Overweight and obesity: effectiveness of interventions in adults

Objetivo: Identificar las intervenciones más efectivas en adultos con sobrepeso y obesidad. Método: Revisión narrativa mediante búsqueda bibliográfica en bases de datos PubMed, Cochrane, Instituto Joanna Briggs, EMBASE, Cuiden y Cinahl con lenguaje libre y controlado (términos MeSH) utilizando los operadores booleanos AND y OR. La búsqueda se limitó a artículos publicados entre 2007-2015. Se seleccionaron 18 en función de los criterios de inclusión y exclusión establecidos. Resultados: Se identificaron distintos tipos de intervenciones basadas en la modificación de los estilos de vida, fundamentalmente dieta, actividad física y la esfera del comportamiento, encontrándose grandes diferencias en cuanto a contenidos específicos, grado de intensidad de las intervenciones, tiempo de seguimiento y elementos evaluados. En la mayoría de los estudios se consiguen pérdidas de peso estadísticamente significativas pero limitadas en cuanto a peso y número de personas. Las intervenciones que utilizan Internet no tienen un efecto uniforme en la pérdida de peso. En el mantenimiento logran niveles similares al de cara a cara. Conclusiones: La combinación de dieta, ejercicio y terapia cognitivo-conductual es la forma más eficaz de intervención en el sobrepeso y la obesidad. No existen datos suficientes para señalar la intervención grupal o individual como más efectivas. La intervención online permite una mayor accesibilidad y menor coste (AU)

Objective: To identify the most effective interventions in overweight and obese adults. Method: A narrative review through a search of the literature in databases PubMed, Cochrane, Joanna Briggs Institute, EMBASE, Cuiden y Cinahl with free and controlled language (MeSH terms) using Boolean operators AND and NOT. The research was limited to articles published between 2007 and 2015. Eighteen articles were selected based on the established inclusion and exclusion criteria. Results: Different types of interventions were identified based on the modification of lifestyles, mainly diet, physical activity and behavior. Major differences were found in specific content, degree of intensity of interventions, time tracking and elements evaluated. Most of studies found statistically significant weight loss but this was limited in terms of weight and number of people. Web-based interventions have no uniform effect on weight loss but achieve similar levels to face-to-face interventions in maintaining weight loss. Conclusions: The combination of personalised diet, exercise and cognitive behavioural therapy is the most effective form of intervention in overweight and obesity. There is insufficient data to indicate whether group or individual interventions are more effective. Online intervention allows greater accessibility and lower cost (AU)

[Analysis of clinical relevance applied to 3methods of reducing weight in overweight or obesity followed-up for one year]. / Análisis de relevancia clínica aplicado a 3métodos de reducción de peso en pacientes con sobrepeso u obesidad seguidos durante un año.

OBJECTIVE: To analyse the effect of the use/implementation of 3methods to reduce weight in overweight or obese patients during one year of follow up. MATERIAL AND METHODS: The design corresponds to a double-blind, randomised, controlled clinical trial with 3arms, and 12 months of follow-up. Patients were randomised into 3intervention groups: obesity motivational intervention, with a nurse previously trained in motivational intervention by expert psychologists (G1; n=60); lower intensity consultation, non-motivational group, with digital platform support (G2; N=61), and a third group that received recommendations for weight loss and follow-up in Primary Care Clinic (G3; n=59). Anthropometric variables (weight, height, and abdominal-waist circumference) were measured, and the percentage of patients who managed to reduce their weight ≥5% was considered as the main measurement of treatment effectiveness. RESULTS: All groups significantly decreased body weight at the end of the study, with a reduction in G1 (-5.6kg) followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean: -3.9kg. The indicators of clinical relevance were in G1/G3: relative risk (RR): 4.99 (95% CI: from 2.71 to 9.18); relative risk reduction (RRR): 399.1% (171.3 to 818.0); Absolute risk reduction (RAR): 65.3% (from 51.5 to 79.1) and NNT: 2 (from 2 to 2). In the G2/G3 groups: RR: 3.01 (from 1.57 to 5.76); RRR: 200.5% (from 57.0 to 475.5); RAR: 32.8% (from 16.9 to 48.7) and NNT: 4 (from 3 to 6). In the G1/G2 groups: RR: 1.66 (from 1.25 to 2.20); RRR: 66.1% (from 25.3 to 120.1); RAR: 32.5% (from 16.6 to 48.4) and NNT: 4 (from 3 to 7). CONCLUSIONS: All 3groups were able to reduce weight. Although the group with motivational intervention achieved the greatest decrease, as well as the most favourable clinical relevance indicators.

The Role of the Faith Community Nurse in Weight Management.

Over two thirds of U.S. adults are overweight or obese; many view long-term behavior change as unachievable. Faith community nurses are ideally positioned to help people learn strategies for successful weight management. This article discusses the role of faith in lifestyle modification, and the use of the 5 A's Model for weight management.

Factores asociados al sobrepeso y la obesidad infantil en España, según la última encuesta nacional de salud (2011) / Factors associated with overweight and childhood obesity in Spain according to the latest national health survey (2011)

Objective: To describe the factors associated with overweight/obesity in Spain according to the latest National Health Survey (2011). Method: Descriptive cross-sectional study with 3,752 children aged 2 to 15 years (boys=2,007; girls=1,745). Main variables: overweight; obesity; gender; level of education of the head of the family; monthly income; hours of sleep; physical exercise; hours of TV and/or computer use; daily breakfast; parents' weight perception. Diagnostic criterion was based on WHO growth patterns, defined overweight with +1SD and obesity, +2SD. Results: Boys more obese than girls. Children whose parents had a lower level of education, those who did not practice physical activity and whose parents had an income of less than 900€ per month showed a higher percentage of overweight/obesity. Conclusions: Children whose parents had a lower education and monthly income presented a higher percentage of obesity. Sleeping the recommended hours and doing some type of physical activity reduces obesity.

Objetivo: Descrever os fatores associados com sobrepeso/obesidade na Espanha, segundo dados da última Pesquisa Nacional de Saúde (2011). Método: Estudo descritivo transversal com 3.752 crianças de 2 a 15 anos (meninos=2007; meninas=1.745). Principais variáveis: excesso de peso; obesidade; sexo; nível de escolaridade do chefe da família; renda mensal; horas de sono; exercício; horas de utilização da televisão e/ou computador; desjejum diário; percepção de obesidade dos pais. O diagnóstico baseou-se em padrões de crescimento da OMS, sendo o excesso de peso +1DP e a obesidade +2DP. Resultados: Meninos mais obesos que meninas. Crianças cujos pais tinham menos anos de estudo, aquelas que não praticam atividade física e cujos pais possuíam uma renda menor de 900 € mensal mostraram maior percentual de obesidade. Conclusão: Menor nível de escolaridade e baixa renda contribuem mais para a obesidade. Dormir as horas recomendadas e fazer algum tipo de atividade física reduz a obesidade.

Objetivo: Describir los factores asociados al sobrepeso/obesidad en España según datos de la última Encuesta Nacional de Salud (2011). Métodos: Estudio descriptivo transversal en población infantil de 2 a 15 años. Participaron 3752 individuos (niños n=2007 y niñas n=1745). Muestreo aleatorio polietápico estratificado. Principales variables: sobrepeso; obesidad; sexo; nivel de estudios del progenitor; ingresos mensuales; horas de sueño; ejercicio físico; horas de uso de televisión y/u ordenador; desayuno diario; percepción ponderal de los progenitores. Los criterios diagnósticos fueron los estándares de OMS, definiéndose sobrepeso con +1SD y obesidad, +2SD. Resultados: Niños más obesos que niñas. Niños/as cuyos progenitores presentaban un nivel de estudios bajo, niños/as que no hicieron ningún ejercicio y cuyos progenitores ganaron menos que 900€ mensuales presentaron un mayor sobrepeso/obesidad. Conclusión: Niños/as con progenitores con bajo nivel de estudios y de ingresos presentaron mayor obesidad. Dormir las horas recomendadas y hacer actividad física disminuye la obesidad.

Video consultations as add-on to standard care among patients with type 2 diabetes not responding to standard regimens: a randomized controlled trial.

OBJECTIVE: To examine whether video consultations preceded by measurements of blood glucose, weight and blood pressure as add-on to standard care could contribute to achieving and maintaining good diabetes control among patients with poorly regulated type 2 diabetes (T2D). DESIGN: Randomized controlled trial. METHODS: 165 patients with T2D were randomized 1:1 to telemedicine intervention as add-on to clinic-based care or control (clinic-based care). The intervention consisted of monthly video conferences with a nurse via a tablet computer and lasted for 32 weeks. Regularly self-monitored measurements of blood sugar, blood pressure and weight were uploaded and visible to patient and nurse. Both groups were followed up six months after the end of the intervention period. PRIMARY ENDPOINT: HbA1c after eight months. RESULTS: Video conferences preceded by uploads of measurements as add-on to clinic-based care led to a significant reduction of HbA1c compared to that in standard care (0.69% vs 0.18%, P = 0.022). However, at six-month follow-up, the inter-group difference in HbA1c-reduction was no longer significant. Non-completers had higher HbA1c levels at baseline and a lower degree of education. CONCLUSION: Video consultations preceded by uploading relevant measurements can lead to clinically and statistically significant improvements in glycemic control among patients who have not responded to standard regimens. However, continuing effort and attention are essential as the effect does not persist when intervention ends. Furthermore, future studies should focus on differentiation as the most vulnerable patients are at greater risk of non-adherence.

Implementing guidelines for preventing, identifying and treating adolescent overweight and obesity-School nurses' perceptions of the challenges involved.

AIMS AND OBJECTIVES: To gain a better understanding of school nurses' perceptions of the challenges involved in implementing national guidelines on managing overweight and obesity in adolescents. BACKGROUND: National guidelines for the management of childhood overweight and obesity are developed in many countries to translate scientific knowledge into practice. However, several challenges are involved in their implementation. DESIGN AND METHODS: A qualitative design with focus group interviews was chosen for data collection. Six focus group interviews with 21 school nurses were conducted. Data were analysed by qualitative content analyses. RESULTS: National guidelines provided new directions for managing overweight and obesity in school health services. School nurses were assigned new tasks and responsibilities, which they felt they were not sufficiently prepared for, nor were they supported by extra resources. Challenges in implementation of the guidelines were identified at various levels: system level (implementation strategy, available resources, training and support, professional collaboration, referral options); individual school nurse level (perceived competence, burden of responsibility, attitudes and emotions); subject level (sensitivity of weight-related issues); and professional level (scepticism to a body mass index cut-off of 25 kg/m2 as the starting point for intervention). CONCLUSIONS: School nurses felt overwhelmed in terms of implementing the guidelines. This indicates barriers not being sufficiently identified or acted upon during implementation. Further, the nurses' scepticism about the body mass index cut-off for intervention, and their experience that measuring and follow-up of adolescents' weight development was their responsibility alone, indicates that important discussions are needed on this as an adequate measure as well as on the professional division of responsibilities. RELEVANCE TO CLINICAL PRACTICE: Having a proper strategy for implementation, and ensuring that necessary clinical structures and resources are available, is crucial. Including school nurses in developing and implementing such strategies is vital for success in implementing national guidelines.

Estudio en familias: factores ambientales y culturales asociados al sobrepeso y obesidad / Study of families: environmental and cultural factors associated with overweight and obesity

Objetivo: Determinar si el sobrepeso y la obesidad en los integrantes de la familia están relacionados con los factores ambientales y culturales relativos al funcionamiento de la familia. Método: Estudio descriptivo correlacional. La muestra fue constituida por 198 integrantes de familias. Se aplicaron una Cédula de Datos Generales, una Escala para Evaluar las Relaciones Intrafamiliares, el Cuestionario de Elección de Alimentos y el Cuestionario de Actividad Física. Resultados: El 8.6% de los participantes mayores de 18 años presentó sobrepeso y el 46.5% algún grado de obesidad. El índice de masa corporal de los adultos se relacionó con las kilocalorías totales producto de la actividad física (rs=.594; p<.01) y con las subescalas ecología de la alimentación (rs=.160; p<.05) y valor nutritivo (rs=.242; p<.01). Los factores culturales no se asociaron con el índice de masa corporal (rs=.242; p>.01). Conclusiones: En esta muestra el Sobrepeso/Obesidad se asoció con los factores ambientales (AU)

Objective: Determine whether overweight and obesity in family members are related to environmental and cultural factors regarding the functioning of families. Method: Descriptive Correlational Study. The sample consisted of 198 family members. A General Data Card, a Scale to Evaluate Intra-family Relations, the Food Selection Questionnaire, and the Physical Activity Questionnaire were used. Results: 8.6% of the participants 18 years old or older were overweight, and 46.5% had some degree of obesity. The Body Mass Index of adults was related to total kilocalories as a product of physical activity (rs=.594; p<.01) and with the subscales, eating ecology (rs=.160; p<.05) and nutritional value (rs=.242; p<.01). Cultural values were not associated with the Body Mass Index (rs=.242; p>.01). Conclusions: In this sample, Overweight/Obesity was associated with environmental factor (AU)

Dietary advice on prescription: experiences with a weight reduction programme.

AIMS AND OBJECTIVES: To describe overweight persons' experiences with weight reduction and participation in the dietary advice on prescription. BACKGROUND: Approximately 20% of overweight individuals are able to successfully lose weight. Experiences from earlier weight reduction programmes indicate that those who succeed typically manage to avoid overeating to handle stress and have high motivation to lose weight. Those who fail have low self-control and engage in negative health behaviours such as eating when experiencing negative emotions and stress. DESIGN: The study used a descriptive qualitative design and was conducted at a Primary Health Care Centre in south-west Sweden. METHODS: The first nineteen study participants who completed the weight reduction programme in two years responded in writing to five open questions about their experiences with the programme. Data were analysed using inductive content analysis. RESULTS: The participants appreciated the face-to-face meetings with the nurse because they felt seen and listened to during these sessions. They also felt their life situations and self-discipline had an impact on how well they were able to follow the programme. Dietary advice on prescription advice was considered to be helpful for achieving behavioural changes and losing weight. People who succeeded in sustainably losing weight described the importance of support from partners or close friends. CONCLUSIONS: To achieve sustainable weight reduction, it is important to individualise the programme in order to address each person's life situation and the unique difficulties they may encounter. RELEVANCE TO CLINICAL PRACTICE: Motivational interviewing appears to be a good technique for developing a successful relationship between the nurse and the patient. The dietary advice on prescription advice was perceived to be a good way to improve food habits and can easily be used at many Primary Health Care Centres. Patient's partners should also be offered the opportunity to participate in the programme.

Exceso de peso y factores asociados: un estudio de base poblacional / Excesso de peso e fatores associados: um estudo de base populacional / Overweight and associated factors: a population-based study

Este estudio tuvo como objetivo estimar el predominio del sobrepeso y factores asociados entre adultos y ancianos. Es un estudio transversal, de base poblacional, realizado en ciudad de tamaño medio del Norte de Minas Gerais, Brasil. Fueron entrevistadas personas de edad igual o superior a 18 años. Se realizó un análisis múltiple por regresión de Poisson, tomando, como variable dependiente, el sobrepeso (IMC ≥ 25kg/m2). El predominio del sobrepeso fue el 53,7%. Después del análisis múltiple, permanecieron asociados al sobrepeso: edad igual o superior a 40 años, estar casado/vivir en unión estable, el consumo de alcohol, el tabaquismo, la hipertensión y depresión. Los resultados ponen de manifiesto una preocupante prevalencia del sobrepeso. Entre las variables asociadas, en el modelo final, están las relacionadas con el estilo de vida. En este sentido las acciones de promoción de la salud son fundamentales para la prevención del sobrepeso entre los adultos y los ancianos (AU)

O objetivo do estudo foi estimar a prevalência de excesso de peso e fatores associados, entre adultos e idosos. Trata-se de estudo transversal, de base populacional, realizado em cidade de porte médio do norte de Minas Gerais, Brasil. Foram entrevistados indivíduos com idade igual ou superior a 18 anos. A análise múltipla foi realizada através da regressão de Poisson, adotando-se, como variável dependente, excesso de peso (IMC ≥ 25kg/m2). A prevalência de excesso de peso foi 53,7%. Após a análise múltipla, permaneceram associadas ao excesso de peso: idade igual ou superior a 40 anos, ser casado/viver em união estável, ingerir bebida alcoólica, fumar, apresentar hipertensão arterial e depressão. Os resultados destacam uma preocupante prevalência de excesso de peso. Entre as variáveis associadas, no modelo final, encontram-se as relacionadas com estilo de vida. Nesse sentido, as ações de promoção da saúde são fundamentais para prevenção do excesso de peso e obesidade entre adultos e idosos (AU)

The objective of the study was to estimate the prevalence of excess of weight and associated factors among adults and elders. It is a cross-sectional and population- based study, done in a medium size city of the north of Minas Gerais, Brazil. Interviewed people had 18 or over. The multiple analysis was done through regression of Poisson, adopting as a dependent variable, the overweight (IMC ≥ 25kg/m2). The prevalence of excess of weight was of 53.7%. After the multiple analysis, the factors that remained associated with excess of weight were: age 40 or over, being married/living together, drinking alcohol beverages, smoking, having high blood pressure and depression. The results show a preoccupant prevalence of overweight. Among the associated variables, in the final model, factors related to health style were found. By this, the action to promote health is fundamental to prevent the overweight and obesity among adults and elderly people (AU)

Validación de instrumento para la detección de adolescentes con sobrepeso en la escuela / Validação de instrumento para o screening de adolescentes com excesso de peso na escola / Instrument validation for screening of adolescents with overweight at school

El objetivo fue validar el contenido del instrumento de enfermería para la detección de adolescentes con sobrepeso en la escuela. Estudio metodológico llevado a cabo en tres etapas: creación del «Formulario para la detección de adolescentes con sobrepeso en la escuela»; evaluación psicométrica por especialistas; modificación del instrumento de acuerdo con las recomendaciones. Las pruebas estadísticas de Kappa y Chi-Quadrado fueron utilizadas en el análisis. Las frecuencias positivas de los criterios psicométricos fueron ≥80%, con algunas diferencias de concordancia entre los especialistas (p<0,001). Algunos criterios presentaron pobre concordancia (k=0,20-0,39) y otros sin concordancia (k=0). El ítem de evaluación física tuvo valor Kappa 1 em todos los criterios. Después de hacer las alteraciones, todos los criterios tuvieron alta concordancia (K=1), con exención del ítem «Perfil sociodemográfico y datos generales». El instrumento fue considerado de contenido válido y útil para la identificación del diagnóstico de enfermería de sobrepeso y para la implementación del proceso de enfermería en esa población (AU)

Objetivou-se validar o conteúdo de instrumento para uso do enfermeiro no screening de adolescentes com excesso de peso na escola. Estudo metodológico realizado em três etapas: construção do «Formulário para o screening de adolescentes com excesso de peso na escola»; avaliação do Formulário por especialistas, segundo critérios psicométricos; modificação do Formulário conforme os pareceres. Utilizaram-se os testes Kappa e Qui-Quadrado. Os critérios psicométricos atingiram frequências ≥80% de respostas positivas, com diferença entre os especialistas (p<0,001). Alguns critérios apresentaram fraca concordância (k=0,20-0,39) ou nenhuma concordância (k<0). O item sobre avaliação física obteve valor Kappa 1 em todos os critérios. Após as alterações no Formulário, todos os critérios atingiram alta concordância (k=1), exceto o item «Perfil sociodemográfico e dados gerais». O instrumento foi considerado válido quanto ao conteúdo e útil para a identificação do diagnóstico de enfermagem excesso de peso, podendo impactar na implementação do processo de enfermagem nessa população (AU)

The aim was to validate the content of a nursing instrument for the screening of overweight adolescents in schools. Methodological study conducted in three phases: construction of the «Overweight Screening Form for Adolescents in Schools»; psychometric evaluation by specialists; modification of instrument according to specialists’ suggestions. The Kappa and Chi Square tests were used in the analysis. The frequency of positive responses for the psychometric criteria was ≥80%, with some agreement differences among the specialists (p<0,001). Some criteria presented low agreement (k=0,20-0,39) or no agreement (k=0). The physical evaluation item obtained a Kappa 1 in all criteria. After Form alterations were made, all criteria reported high agreement (k=1), except for «Sociodemographic profile and general data». The instrument was considered to have content validity and useful for the identification of nursing diagnosis of overweight adolescents. It can serve as a tool in the implementation of the nursing process with this population (AU)

Prevalencia de obesidad infantil y hábitos alimentarios en educación primaria / Prevalence of childhood obesity & eating habbits in primary education

Introducción: En los países desarrollados la obesidad infantil se ha incrementado alarmantemente en los últimos años, convirtiéndose en un grave problema de salud pública. La obesidad es una enfermedad crónica de origen multifactorial que comienza durante la niñez y adolescencia. Se produce por un desequilibrio entre el consumo y el gasto energético. Como causas influyentes destacan: factores genéticos, biológicos, de comportamiento y culturales. Su tratamiento resulta muy complicado en esta etapa de crecimiento porque cualquier déficit nutricional puede repercutir negativamente en el desarrollo integral del niño. Objetivos: Clasificar a la población de estudio en función de su Indice de Masa Corporal (IMC), establecer la relación que existe entre obesidad infantil y el uso del servicio de comedor escolar y verificar que el menú del comedor escolar es adecuado en cuanto al contenido calórico y el porcentaje de principios inmediatos. Metodología: Se realizó un estudio observacional descriptivo transversal sobre obesidad en niños de 6 años. Para la recogida de datos, se utilizó una báscula para medir el peso y una cinta métrica para tallarlos, y con los datos de peso y estatura recogidos se calculó el IMC. Por otro lado, para poder comprobar el menú, el personal del comedor escolar nos facilitó un menú mensual. Resultados: Dentro de los porcentajes europeos, nuestra muestra reflejó niños con sobrepeso y obesidad y también un considerable porcentaje de niños con bajo peso. Conclusiones: Destacar el papel fundamental de la familia y cuidadores en los comedores escolares; fomentando hábitos saludables (ejercicio y dieta equilibrada) para poder prevenir patologías en la edad adulta secundarias a la obesidad, lo cual es una gran estrategia de seguridad para la salud pública y para la economía de los Sistemas Sanitarios (AU)

Introduction: In developed countries child obesity alarmingly in recent years, becoming in a serious problem of public health. Obesity is a chronic illness with multifactorial origin that begining in childhood and adolescence, produced it by an inbalance between intake and energy expenditure. Its causes could be genetic,biological, behavioral or cultural factors. Treatment is difficult in this growth stage because any nutritional deficit can negatively impact in children´s comprehensive development. Objectives: ClassifiedppilsBody Mass Index (BMI), observed relations between infant obesity and using school dining-room and checked that menu was appropriate in calories content and percentage of macronutrients. Methodology: It has implemented an observational, descriptive and cross study about obesity in children six years. For data collection, it used a scale to measure weight and a tape measure to carve, and weight data collected height and BMI was calculated. Furthermore, in order to check the menu, the staff cafeteria gave us a monthly menu. Results: Into europe percentages, our sample showed children with overweight and obesity and a considerable percentage with underweight. Conclusions: Family and carers play significant rol in school dining-room promoting healthy habits (with exercise and a balance diet) to prevent pathologies in adulthood secondaries to obesity, which is an security strategy in public health and for economy of health systems (AU)

New cardiovascular guidelines: Clinical practice evidence for the nurse practitioner.

PURPOSE: Guidelines for the prevention and treatment of cardiovascular disease (CVD) have recently changed. Goals of these guidelines have shifted to the promotion of health and control of risk rather than solely on treatment of CVD. This article summarizes the six new cardiovascular screening, prevention, and treatment guidelines for use in practice. DATA SOURCES: Published and peer-reviewed guidelines published jointly and in collaboration with the National Heart Lung and Blood Institute by the American Heart Association and the American College of Cardiology constitute the evidence base for this article. CONCLUSIONS: The potential for making lifestyle changes a way of life instead of a diet or program is an important point to make in clinical visits. If nurse practitioners (NPs) could promote a way-of-life lifestyle change to individuals in America, even change at a modest level, we could improve the health of the nation. IMPLICATIONS FOR PRACTICE: NPs need to be aware of new guidelines and best practices to improve the cardiovascular health of their patients. We summarized these new guidelines into an easy-to-interpret format for use in practice.