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1.
Curr Opin Clin Nutr Metab Care ; 23(4): 288-293, 2020 07.
Artigo em Inglês | MEDLINE | ID: covidwho-530053

RESUMO

PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.


Assuntos
Infecções por Coronavirus , Transtornos Nutricionais , Terapia Nutricional/normas , Fenômenos Fisiológicos da Nutrição , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Transtornos Nutricionais/epidemiologia , Transtornos Nutricionais/etiologia , Transtornos Nutricionais/terapia , Terapia Nutricional/métodos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Fatores de Risco
2.
Curr Opin Clin Nutr Metab Care ; 23(4): 288-293, 2020 07.
Artigo em Inglês | MEDLINE | ID: covidwho-605619

RESUMO

PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.


Assuntos
Infecções por Coronavirus , Transtornos Nutricionais , Terapia Nutricional/normas , Fenômenos Fisiológicos da Nutrição , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Transtornos Nutricionais/epidemiologia , Transtornos Nutricionais/etiologia , Transtornos Nutricionais/terapia , Terapia Nutricional/métodos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Fatores de Risco
3.
Curr Opin Clin Nutr Metab Care ; 23(4): 288-293, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32487876

RESUMO

PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.


Assuntos
Infecções por Coronavirus , Transtornos Nutricionais , Terapia Nutricional/normas , Fenômenos Fisiológicos da Nutrição , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Transtornos Nutricionais/epidemiologia , Transtornos Nutricionais/etiologia , Transtornos Nutricionais/terapia , Terapia Nutricional/métodos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Fatores de Risco
5.
Nutr. hosp ; 36(extr.3): 49-52, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184435

RESUMO

Introducción: la fragilidad y la sarcopenia son dos condiciones altamente prevalentes en el adulto mayor que se solapan en diferentes vertientes del diagnóstico y del tratamiento. Objetivos: analizar la problemática nutricional relacionada con la fragilidad y la sarcopenia en personas de edad avanzada. Métodos: se ha realizado una revisión bibliográfica de las particularidades de la fragilidad y de la sarcopenia, así como del diagnóstico y del tratamiento nutricional. Resultados: la fragilidad es un síndrome geriátrico que puede identificarse si se tienen al menos tres de los siguientes criterios: pérdida de peso, fuerza de presión de la mano disminuida, velocidad de la marcha lenta, actividad física reducida y agotamiento. La sarcopenia es una enfermedad muscular que se caracteriza por una masa muscular baja y una fuerza muscular reducida como determinantes principales. Ambas condiciones pueden verse beneficiadas por un consumo adecuado de proteínas (1-1,5 g/kg/día) y una actividad física de resistencia regular. Conclusión: la identificación, prevención, seguimiento y tratamiento nutricional de la fragilidad y la sarcopenia en adultos mayores es de vital importancia dada su elevada prevalencia. El objetivo es mantener la integridad y minimizar la pérdida muscular en los adultos mayores. Un envejecimiento saludable incluye la realización de actividad física regular y el cumplimiento de los requerimientos proteicos de esta población


Introduction: frailty and sarcopenia are prevalent conditions in older adults which diagnosis and treatment often overlap. Objective: to analyze the nutritional problematic related to frailty and sarcopenia in older adults. Methods: a literature review, about particularities of frailty and sarcopenia, diagnosis and nutritional treatment, has been carried out. Results: frailty is a geriatric syndrome that can be identified by at least three of the following criteria: weight loss, exhaustion, reduced physical activity, increased walk time, low grip strength. Sarcopenia is a muscular disease characterized by low muscle mass and reduced muscle strength as the main determinant. Both conditions can benefit from adequate protein intake (1-1.5 g/kg/day) and regular physical activity. Conclusion: identification, prevention, monitoring and nutritional treatment of frailty and sarcopenia in older adults is important because of its high prevalence. The main goal is to maintain the muscular integrity and minimize muscle loss in older adults. A healthy aging includes regular physical activity and the fulfillment of the protein requirements of this population


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Idoso Fragilizado , Sarcopenia/dietoterapia , Transtornos Nutricionais/diagnóstico , Transtornos Nutricionais/terapia , Proteínas/administração & dosagem , Sarcopenia/diagnóstico , Sarcopenia/terapia , Atividade Motora , Suplementos Nutricionais
6.
Rev. esp. nutr. comunitaria ; 25(2): 0-0, abr.-jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-191444

RESUMO

FUNDAMENTOS: El papel de la nutrición en los entornos hospitalarios, es de suma relevancia para la salud comunitaria, dada por la carga impuesta por la desnutrición asociada a la enfermedad en los pacientes que conlleva a la necesidad de optimizar el uso de los recursos disponibles en los sistemas de salud. El objetivo fue identificar las tendencias de análisis en la evaluación económica de las tecnologías en soporte nutricional enteral en pacientes hospitalizados. MÉTODOS: Se realizó una revisión de la literatura, basada en un rastreo bibliográfico teniendo en cuenta elementos de la metodología establecidos por el Centro de Revisiones y Difusión (CRD), de la Universidad de York, desde enero de 2005 hasta julio de 2017. Se incluyeron reportes en inglés y español. RESULTADOS: Se identificaron 21 reportes, en la tipificación de las publicaciones, predominaron los artículos relacionados con análisis de costo efectividad, minimización de costos y revisiones sistemáticas en el tema, mientras que los artículos relacionados con análisis de costo beneficio y costo utilidad representaron la menor proporción. CONCLUSIONES: Las tendencias en los análisis económicos de las tecnologías en soporte nutricional enteral en pacientes hospitalizados se focalizan en análisis de costo efectividad del soporte nutricional y rentabilidad de las fórmulas nutricionales especializadas


BACKGROUND: The role of nutrition in hospital settings is of paramount relevance to community health, given the burden imposed by malnutrition associated with disease on patients that leads to the need to optimize the use of resources available in health systems. The objective was to identify analysis trends in the economic evaluation of enteral nutritional support technologies in hospitalized patients. METHODS: A review of the literature was conducted, based on a bibliographic crawl taking into account elements of the methodology established by the Review and Dissemination Centre (CRD) of the University of York, from January 2005 to July 2017. Reports were included in English and Spanishindex (BMI) was calculated at the time of admission to the program and on different rehabilitation stages. RESULTS: 21 reports were identified, in the classification of the publications, articles related to cost effectiveness analysis, cost minimization and systematic reviews on the subject predominated, while articles related to cost benefit and cost utility analysis represented the lowest proportion. CONCLUSIONS: Trends in economic analysis of enteral nutritional support technologies in hospitalized patients focus on cost-effectiveness analysis of nutritional support and cost-effectiveness of specialized nutritional formulas


Assuntos
Humanos , Hospitalização/estatística & dados numéricos , Transtornos Nutricionais/terapia , Nutrição Enteral/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Apoio Nutricional/estatística & dados numéricos , Terapia Nutricional/estatística & dados numéricos
7.
J Med Syst ; 43(5): 135, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30949846

RESUMO

This study conducts a mapping study to survey the landscape of health chatbots along three research questions: What illnesses are chatbots tackling? What patient competences are chatbots aimed at? Which chatbot technical enablers are of most interest in the health domain? We identify 30 articles related to health chatbots from 2014 to 2018. We analyze the selected articles qualitatively and extract a triplet for each of them. This data serves to provide a first overview of chatbot-mediated behavior change on the health domain. Main insights include: nutritional disorders and neurological disorders as the main illness areas being tackled; "affect" as the human competence most pursued by chatbots to attain change behavior; and "personalization" and "consumability" as the most appreciated technical enablers. On the other hand, main limitations include lack of adherence to good practices to case-study reporting, and a deeper look at the broader sociological implications brought by this technology.


Assuntos
Comportamentos Relacionados com a Saúde , Aprendizado de Máquina , Telemedicina/métodos , Envio de Mensagens de Texto , Interface Usuário-Computador , Comportamento Aditivo/diagnóstico , Comportamento Aditivo/terapia , Comunicação , Nível de Saúde , Humanos , Internet , Saúde Mental , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/terapia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Transtornos Nutricionais/diagnóstico , Transtornos Nutricionais/terapia
8.
J Health Organ Manag ; 33(1): 78-92, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30859913

RESUMO

PURPOSE: The purpose of this paper is to advance understanding about the facilitation process used in complex implementation projects, by describing the function of novice clinician facilitators, and the barriers and enablers they experience, while implementing a new model of care for managing hospital malnutrition. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were undertaken with local facilitators ( n=7) involved in implementing The SIMPLE Approach (Systematised Interdisciplinary Malnutrition Pathway Implementation and Evaluation) in six hospitals in Queensland, Australia. Facilitator networks and training supported the clinicians acting as novice facilitators. FINDINGS: Key functions of the facilitator role were building relationships and trust; understanding the problem and stimulating change through data; negotiating and implementing the change; and measuring, sharing and reflecting on success. "Dedicated role, time and support" was identified as a theme encompassing the key barriers and enablers to successful facilitation. PRACTICAL IMPLICATIONS: When implementing complex interventions within short project timelines, it is critical that novice clinician facilitators are given adequate and protected time within their role, and have access to regular support from peers and experienced facilitators. With these structures in place, facilitators can support iterative improvements through building trust and relationships, co-designing strategies with champions and teams and developing internal capacity for change. ORIGINALITY/VALUE: This case study extends the knowledge about how facilitation works in action, the barriers faced by clinicians new to working in facilitator roles, and highlights the need for an adapt-to-fit approach for the facilitation process, as well as the innovation itself.


Assuntos
Implementação de Plano de Saúde/métodos , Hospitalização , Transtornos Nutricionais/terapia , Papel Profissional , Pesquisa sobre Serviços de Saúde , Humanos , Relações Interprofissionais , Entrevistas como Assunto , Inovação Organizacional , Equipe de Assistência ao Paciente , Desenvolvimento de Programas , Queensland
9.
Eur J Oncol Nurs ; 38: 76-84, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30717940

RESUMO

PURPOSE: Nutrition-related problems are common in patients with advanced cancer. They can disrupt daily life and routines. This study aimed to explore how couples cope with this source of distress. METHODS: A qualitative descriptive study design was adopted using semi-structured interviews. Seven couples, each consisting of an advanced cancer patient and his or her co-habiting life partner, participated. The Qualitative Analysis Guide of Leuven (QUAGOL) was used as a guide to facilitate the analysis process. RESULTS: When a patient communicates nutrition-related problems to the partner, individual coping is often complemented by interactive couple-coping pathways, serving two resilient coping strategies: maintaining normality and creating a new normality. These pathways can have either a practical, an emotional or a distant orientation. Different couple-coping pathways can be observed in the same couple when they are dealing with either one or multiple nutrition-related problems. Some couples, however, seem to cope more rigidly, often those with less observed 'we-ness'. CONCLUSIONS: Nutrition-related problems are inherent to advanced cancer and are perceived as health-threatening. Couple-coping with nutrition-related problems is a dynamic and interactive process leaning on different coping pathways. There is no evidence that one pathway is superior to another, as they all serve a resilient coping strategy. Our findings can assist homecare nurses and other professional caregivers in providing psychological support and advice to couples confronted with nutrition-related problems in advanced cancer. Future research should shed light on whether an unsuitable match in coping styles within a couple is one of the precursors of non-resilient outcomes.


Assuntos
Adaptação Psicológica , Neoplasias/complicações , Neoplasias/psicologia , Transtornos Nutricionais/psicologia , Atenção Primária à Saúde , Cônjuges/psicologia , Adulto , Idoso , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Transtornos Nutricionais/etiologia , Transtornos Nutricionais/terapia , Pesquisa Qualitativa
10.
BMC Health Serv Res ; 19(1): 89, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709375

RESUMO

BACKGROUND: Under- and over nutrition as well as nutrition risk factors such as communicable and non-communicable diseases are a common and major cause of morbidity and mortality in correctional facilities. Consequently, medical nutrition therapy (MNT), a spectrum of nutrition services aimed at optimizing individual well-being, is being recognized as integral to the health of people who experience incarceration. However, there is a paucity of research that explores the delivery of MNT in correctional facilities. METHODS: A scoping review combined with secondary analysis of qualitative data (field notes, in-depth stakeholder interviews) from a 2-year ethnographic study about food insecurity and incarceration was undertaken to gain insights about the delivery of corrections-based MNT in Canada. Thematic analysis of all documents was done using an interpretive framework. RESULTS: An understanding about MNT was developed within three themes: 1) specialized service provision in a unique environment; 2) challenges with the provision of MNT; and 3) consideration of corrections-based MNT alternatives. An incarcerated individual's nutritional health was conceptualized as culminating from various factors that included dietary intake and health status, enabling environments, access to quality health services, and clinical nutrition services. Nutrition care practices, which range from health promotion to rehabilitation, are challenged by issues of access, visibility, adequacy, and environmental barriers. Their success is dependent on demand (e.g., ability of recipient to act) and factors that enable quality health and food services. Advancing corrections-based MNT will require policies that provide supportive food and health environments and creating sustainable services by integrating alternatives such as peer approaches and telehealth. CONCLUSIONS: Professional associations, government, researchers and other stakeholders can help to strengthen corrections-based MNT by fostering shifts in thinking about the role of health practitioners in these contexts, preparing future health professionals with the specialized skills needed to work in these environments, generating evidence that can best inform practice, and cultivating collaborations aimed at crime prevention, successful societal reintegration, and the reduction of recidivism.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Transtornos Nutricionais/terapia , Terapia Nutricional/estatística & dados numéricos , Prisões/estatística & dados numéricos , Canadá , Promoção da Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Morbidade , Utilização de Procedimentos e Técnicas
11.
Artigo em Inglês | MEDLINE | ID: mdl-30217770

RESUMO

BACKGROUND: Intent-to-treat analyses from a randomized controlled trial showed significant between-group differences favouring micronutrient treatment on the Clinical Global Impression-Improvement, but no group differences on clinician, parent and teacher ratings of overall ADHD symptoms. There was an advantage of micronutrients over placebo in improving overall function, emotional regulation, aggression, and reducing impairment as well as improving inattention based on clinician but not parent observation. No group differences were observed on hyperactive-impulsive symptoms. We investigated predictors of response defined by pre-treatment variables. METHOD: We conducted analyses of data from a clinical trial of children (7-12 years) with ADHD, whereby participants were randomized to receive micronutrients or placebo for 10 weeks followed by a 10 week open-label (OL) phase. We included only children who had been exposed to micronutrients for a full 10 week period and demonstrated satisfactory adherence, either in RCT phase (n = 40) or OL phase (those who received placebo during RCT phase; n = 31). Seven outcomes were examined: change in ADHD symptoms (clinician/parent), ADHD responder, overall responder, change in mood, change in functioning, and change in aggression. Demographic, developmental variables, current clinical and physical characteristics, MTHFR genotype at two common variants, and pre-treatment serum/plasma levels (vitamin D, B12, folate, zinc, copper, iron, ferritin, potassium, calcium, magnesium, and homocysteine) were all considered as putative predictors. RESULTS: Substantial nutrient deficiencies pre-treatment were observed only for vitamin D (13%) and copper (15%), otherwise most children entered the trial with nutrient levels falling within expected ranges. Regression analyses showed varying predictors across outcomes with no one predictor being consistently identified across different variables. Lower pre-treatment folate and B12 levels, being female, greater severity of symptoms and co-occurring disorders pre-treatment, more pregnancy complications and fewer birth problems were identified as possible predictors of greater improvement for some but not all outcome measures although predictive values were weak. Lower IQ and higher BMI predicted greater improvement in aggression. CONCLUSIONS: This study replicates Rucklidge et al. (2014b) showing the limited value of using serum nutrient levels to predict treatment response although we cannot rule out that other non-assayed nutrient levels may be more valuable. Additionally, no specific demographic or clinical characteristics, including MTHFR genetic status, were identified that would preclude children with ADHD from trying this treatment approach.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Suplementos Nutricionais , Micronutrientes/uso terapêutico , Vitaminas/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/sangue , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/genética , Biomarcadores/sangue , Índice de Massa Corporal , Criança , Feminino , Humanos , Inteligência , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Transtornos Nutricionais/sangue , Transtornos Nutricionais/diagnóstico , Transtornos Nutricionais/genética , Transtornos Nutricionais/terapia , Polimorfismo de Nucleotídeo Único , Prognóstico , Índice de Gravidade de Doença
12.
Endocrinol Diabetes Nutr ; 66(7): 425-433, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30509881

RESUMO

OBJECTIVES: To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. MATERIAL AND METHODS: Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an "ad hoc" survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). RESULTS: 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4±4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3±1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2,000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. CONCLUSIONS: RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement.


Assuntos
Endocrinologia/organização & administração , Pesquisas sobre Serviços de Saúde , Unidades Hospitalares , Hospitais Gerais/organização & administração , Programas Nacionais de Saúde/organização & administração , Ciências da Nutrição/organização & administração , Assistência ao Paciente , Estudos Transversais , Grupos Diagnósticos Relacionados , Doenças do Sistema Endócrino/epidemiologia , Doenças do Sistema Endócrino/terapia , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Gerais/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Transtornos Nutricionais/epidemiologia , Transtornos Nutricionais/terapia , Assistência ao Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Pesquisa , Espanha
13.
Pediatrics ; 142(Suppl 2): S53-S61, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30275249

RESUMO

Advances in treatment and multidisciplinary management have resulted in improved survival of individuals with Duchenne muscular dystrophy (DMD). Updated DMD treatment recommendations as found in the 2018 DMD Care Considerations are aimed to assist multidisciplinary care teams in providing standardized care to their patients, including attention to nutritional and gastrointestinal health. Challenges remain for care teams in accurately estimating height and nutritional status for individuals with DMD. It can be difficult for patients to maintain a healthy weight. Risk factors for obesity include glucocorticoid therapy and loss of ambulation. In contrast, in the later stages of the disease, swallowing dysfunction can lead to poor nutrition and consideration for gastrostomy tube placement. Constipation is highly prevalent, underrecognized, and undertreated in DMD. With this article, we address the assessment and management of gastrointestinal and nutritional issues, as well as clinical controversies.


Assuntos
Gastroenteropatias/terapia , Distrofia Muscular de Duchenne/terapia , Transtornos Nutricionais/terapia , Gastroenteropatias/etiologia , Humanos , Distrofia Muscular de Duchenne/complicações , Transtornos Nutricionais/etiologia , Necessidades Nutricionais , Estado Nutricional
14.
J Nutr Sci Vitaminol (Tokyo) ; 64(4): 251-257, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30175787

RESUMO

Nutritional complications frequently occur among patients undergoing rehabilitation, and the importance of nutrition in these patients has been emphasized. However, there is not enough evidence available on rehabilitation nutrition. The Japan Rehabilitation Nutrition Database was set up to reflect the real-world clinical practice of rehabilitation nutrition. This paper describes the construction and quality evaluation of the registry database. We constructed a large-scale database that can be used for the clinical research of nutrition for rehabilitation. To verify the data, a simple comparison of the numbers of cases, data loss, data duplication, data type errors, out of range values, and input errors in the option columns was performed. From March 2016 to June 2017, 797 cases were registered in the rehabilitation database from 18 facilities. The variable entry error frequency ranges from 0% to 0.4% and the frequency of a main item missing from 0.4% to 10.9%. Energy intake on hospitalization was missing in 10.9% of cases, and Mini Nutritional Assessment Short Form and Food Intake LEVEL Scale on hospitalization was missing in 9.7% of cases. Stroke accounted for 45.7% of the diseases registered, pneumonia for 36.5%, and proximal femoral fracture for 17.8%. Through the use of this database, research on rehabilitation nutrition can be conducted, and there is a possibility that useful results for future clinical practice may be obtained. Verification of the secondary use of the database is becoming the basis for evidence-based nutritional rehabilitation.


Assuntos
Bases de Dados Factuais , Transtornos Nutricionais/prevenção & controle , Estado Nutricional , Reabilitação , Confiabilidade dos Dados , Sistemas de Gerenciamento de Base de Dados , Registros Eletrônicos de Saúde , Humanos , Internet , Japão , Transtornos Nutricionais/complicações , Transtornos Nutricionais/terapia , Sistema de Registros , Design de Software
15.
J BUON ; 23(1): 244-247, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29552791

RESUMO

PURPOSE: Home parenteral nutrition (HPN) has been proposed as the treatment of choice in patients suffering from intestinal failure (IF) and has been claimed to improve survival and quality of life either in patients with benign disorders or even in those with malignancies. The purpose of the present analysis was to report characteristics and outcomes of adult patients with IF receiving HPN in Greece. METHODS: Patients that received HPN between 2011 and 2017 were included in this retrospective analysis. Characteristics of the included patients, cause of HPN, duration of HPN, route of HPN administration, complications as well as survival rates were recorded. RESULTS: A total of 189 patients were included in the present analysis. Of these, 163 (86.3%) suffered from cancer while 26 (13.7%) received HPN due to non-malignant diseases. The reported mortality was 74.6% while overall severe complications rate was 77%. CONCLUSIONS: According to the findings of our study, HPN seems to have beneficial effect but it should be considered with caution by the physicians who should take into account the indications of each patient to receive parenteral nutrition, the underlying disease and prognosis and the access of each patient to home care services.


Assuntos
Neoplasias/complicações , Transtornos Nutricionais/terapia , Nutrição Parenteral Total no Domicílio/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
16.
Nutr Hosp ; 35(Spec No1): 1-9, 2018 03 07.
Artigo em Espanhol | MEDLINE | ID: mdl-29565627

RESUMO

Eating disorders (ED) are characterized by persistent changes in eating habits that negatively affect a person's health and psychosocial abilities. They are considered psychiatric disorders, highly variable in their presentation and severity, with a huge impact on nutrition, which conditions various therapeutic approaches within a key multidisciplinary context. A group of experts in nutrition, we decided to set up a task force adscribed to the "Sociedad Española de Nutrición Parenteral y Enteral" (SENPE), which has stated as one of its goals the development of a consensus document to generate a protocol based on the best scientific evidence and professional experience available in order to improve health care in this field.


Assuntos
Avaliação Nutricional , Transtornos Nutricionais/terapia , Consenso , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Humanos , Transtornos Nutricionais/diagnóstico , Transtornos Nutricionais/epidemiologia , Terapia Nutricional , Apoio Nutricional , Educação de Pacientes como Assunto
17.
J Acad Nutr Diet ; 118(3): 486-498, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29477186

RESUMO

Nutrition is an integral component of medical care for people living with human immunodeficiency virus (HIV)/autoimmune deficiency syndrome (AIDS) (PLWHA). The Academy of Nutrition and Dietetics supports integration of medical nutrition therapy into routine care for this population. Fewer PLWHA experience wasting and undernutrition, while the prevalence of obesity and other chronic diseases has increased significantly. Improved understanding of HIV infection's impact on metabolism and chronic inflammation has only increased the complexity of managing chronic HIV infection. Nutrition assessment should encompass food insecurity risk, changes in body composition, biochemical indices, and clinical indicators of comorbid disease. Side effects from current antiretroviral therapy regimens are less prevalent than with previous generations of therapy. However, micronutrient deficiencies and chronic anemia also remain significant nutritional risks for PLWHA, making vitamin and mineral supplementation necessary in cases of acute deficiency or food insecurity. Additional factors can impact HIV-related nutrition care among the pediatric population, older adults, minority groups, those co-infected with tuberculosis or hepatitis, and PLWHA in rural or underserved areas. Registered dietitian nutritionists and nutrition and dietetic technicians, registered should participate in multidisciplinary care to incorporate nutrition into the medical management of PLWHA.


Assuntos
Dietética/normas , Infecções por HIV/terapia , Transtornos Nutricionais/terapia , Terapia Nutricional/normas , Guias de Prática Clínica como Assunto , Academias e Institutos , HIV , Infecções por HIV/complicações , Humanos , Avaliação Nutricional , Transtornos Nutricionais/virologia , Terapia Nutricional/métodos
18.
Eur J Cancer Care (Engl) ; 27(2): e12818, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29345017

RESUMO

This retrospective study investigated the efficiency of nutritional support in unresectable locally advanced oesophageal squamous cell carcinoma (LAOSCC) patients who received concurrent chemoradiotherapy (CCRT) based on 5-fluorouracil and cisplatin. In the routine care group, 63 patients served as historical controls and received nutrition support in a reactive manner. In addition, 57 patients in the nutritional support group received timely diet counselling, oral nutritional supplements, enteral nutrition and/or parenteral nutrition during CCRT. This support was based on scores from nutritional risk screening 2002 (NRS-2002) after June 2014. The nutritional support group had significant advantages over the routine care group with respect to the incidence of neutropenia, the objective response rate, the change in serum albumin and the lengths of hospital stay. In addition, the nutritional support group had significantly higher levels of IgG and IL-2, higher proportions of NK, CD3+ and CD4+ cells as well as a higher ratio of CD4+ /CD8+ cells than the routine care group (p < .05). In contrast, the nutritional support group had a significantly lower level of IL-6. In conclusion, the current nutritional care programme could bring benefits of improving treatment compliance, reducing toxicity and lengths of hospital stay and enhancing the immune response.


Assuntos
Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/terapia , Transtornos Nutricionais/dietoterapia , Apoio Nutricional/métodos , Adulto , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Carcinoma de Células Escamosas/economia , Carcinoma de Células Escamosas/imunologia , Quimiorradioterapia , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Cisplatino/economia , Aconselhamento , Citocinas/metabolismo , Esquema de Medicação , Neoplasias Esofágicas/economia , Neoplasias Esofágicas/imunologia , Carcinoma de Células Escamosas do Esôfago , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Fluoruracila/economia , Gastos em Saúde , Humanos , Imunidade Celular , Imunoglobulina G/metabolismo , Imunoglobulina M/metabolismo , Infusões Intravenosas , Tempo de Internação/economia , Subpopulações de Linfócitos/imunologia , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Transtornos Nutricionais/etiologia , Transtornos Nutricionais/terapia , Apoio Nutricional/economia , Estudos Prospectivos , Critérios de Avaliação de Resposta em Tumores Sólidos , Estudos Retrospectivos , Resultado do Tratamento , Fator de Necrose Tumoral alfa/metabolismo
19.
Crit Rev Food Sci Nutr ; 58(14): 2299-2305, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28686043

RESUMO

Sickle cell disease (SCD) is one of the common inherited blood disorders in humans and has been associated with decreased dietary intake which results in poor nutritional status and impaired growth. Nutrition is one of the most important but often forgotten aspect of care of patients with chronic disorders and there have been emerging concern in literature on increased nutritional needs of SCD patients. This paper sought to review the available literature on the roles of individual nutrients in the pathophysiology and management of SCD among children. Children with SCD have been shown to exhibit suboptimal status with respect to both macronutrients and micronutrients. Thus, nutrition could play an important role in the management of SCD. However, there is paucity of evidence coming from trials with large sample sizes to support the suggestion that supplementation with various nutrients that have been considered in this review will be helpful.


Assuntos
Anemia Falciforme/complicações , Anemia Falciforme/terapia , Transtornos Nutricionais/complicações , Transtornos Nutricionais/terapia , Estado Nutricional , Criança , Humanos
20.
Adv Exp Med Biol ; 1010: 281-293, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29098678
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