Claudia Bernardi Cesarino

Caracterização e etiologia da insuficiência renal crônica em unidade de nefrologia do interior do Estado de São Paulo

OBJETIVOS: Caracterizar a los pacientes con insuficiencia renal cronica (IRC) que participan en un programa dialitico; verificar las causas de la IRC; identificar las enfermedades asociadas a la IRC; levantar el tipo de tratamiento y el acceso actual de esos pacientes. METODOS: Se trata de un estudio descriptivo epidemiologico, realizado en una Unidad de Nefrologia en el que fueron incluidos todos los pacientes registrados en el Programa Nefro Data. RESULTADOS: De los 217 pacientes registrados en la Unidad en estudio, observamos que el 68,2% tenian edad superior a 40 anos y el 59,4% eran del sexo masculino. En cuanto a la enfermedad de base, el 31,3% de los pacientes presentan Nefroesclerosis Hipertensiva y el 25,3% Diabetes Mellitus (DM), seguido de la Glomerulonefritis con el 24,5%. Respecto a las enfermedades asociadas, el 42,4% de los pacientes poseen Hipertension Arterial Sistemica (HAS), el 24,9% no poseen comorbidades, el 19,8% HAS y DM. En relacion al tipo de acceso vascular el 70,5% poseen fistula arteriovenosa, siendo la utilizacion del cateter de Tenckhoff exclusivo de la dialisis peritoneal en el 13,3%. CONCLUSION: los resultados permiten una mejor planificacion frente a las necesidades reales de los pacientes.Objectives: Characterize the pacients with chronic renal failure (CRF) in dialythical program; verify the causes of the CRF; identify the associated diseases to CRF; measure the type of treatment and the actual access of the pacients to them. Methods: This is a epidemiological descriptive research performed in a nephrology unit, and all pacients registered in the Nefro Data program were included. Results: Of the group of 217 patients registered in the studied unit, 68,2% have age of 40 or greater and 59,4% are male. Regarding the base disease, 31,3% of the pacients have Hipertensive Nephrosclerosis, 25,3% have Diabetes Mellitus (DM) and 24,5% have Glomerulonephritis. Regarding the associated diseases, 42,4% of the pacients have Systemic Arterial Hipertension (SAH) 24,9% don’t have comorbities, 19,8% have both SAH and DM. Regarding the type of vascular acess, 70,5% have arteriovenous fistula, being the utilization of the Tenckhoff catheter exclusive of peritoneal dialysis in 13,3% of the studied cases. Conclusion: The results allow a better planning with regard to the patients real needs.

Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population.

Introduction Metabolic syndrome (MS) is a set of cardiovascular risk factors and type 2 diabetes, responsible for a 2.5-fold increased cardiovascular mortality and a 5-fold higher risk of developing diabetes. Objectives 1-to evaluate the prevalence of MS in individuals over 18 years associated with age, gender, socioeconomic status, educational levels, body mass index (BMI), HOMA index and physical activity; moreover, to compare it to other studies; 2-to compare the prevalence of elevated blood pressure (BP), high triglycerides and plasma glucose levels, low HDL cholesterol and high waist circumference among individuals with MS also according to gender; 3-to determine the number of risk factors in subjects with MS and prevalence of complications in individuals with and without MS aged over 40 years. Methods A cross-sectional study of 1369 Individuals, 667 males (48.7%) and 702 females (51.3%) was considered to evaluate the prevalence of MS and associated factors in the population. Results The study showed that 22.7% (95% CI: 19.4% to 26.0%) of the population has MS, which increases with age, higher BMI and sedentary lifestyle. There was no significant difference between genders until age ≥70 years and social classes. Higher prevalence of MS was observed in lower educational levels and higher prevalence of HOMA positive among individuals with MS. The most prevalent risk factors were elevated blood pressure (85%), low HDL cholesterol (83.1%) and increased waist circumference (82.5%). The prevalence of elevated BP, low HDL cholesterol and plasma glucose levels did not show significant difference between genders. Individuals with MS had higher risk of cardiovascular complications over 40 years. Conclusion The prevalence of MS found is similar to that in developed countries, being influenced by age, body mass index, educational levels, physical activity, and leading to a higher prevalence of cardiovascular complications after the 4th decade of life.

Nurses' performance on hospital discharge: patients' point of view

Objective: To know the hospital discharge process in place and the nurses’ performance in preparing patients for discharge. Methods: A descriptive study using semi-structured interviews was used to collect data from 43 patients of medical-surgical units of a major teaching hospital in the state of Sao Paulo, Brazil. Results: The majority of patients (83.72%) received tailored discharge instructions. However, a great number of patients (72.08%) reported discharge instructions were not given by nurses. Almost a half of patients (48.84%) reported that discharge instructions were given by their physicians. Conclusion: The findings of this study provide insights to improve the educational process of new nurses and their preparation to provide effective discharge instructions. There is also a need to design and implement a hospital discharge process that promotes the participation of interdisciplinary health care providers who are involved in patient clinical care. This discharge process might be an effective way to change health care providers’ attitude toward discharge instructions.

Atuação do enfermeiro na alta hospitalar: reflexões a partir dos relatos de pacientes

Objective: To know the hospital discharge process in place and the nurses’ performance in preparing patients for discharge. Methods: A descriptive study using semi-structured interviews was used to collect data from 43 patients of medical-surgical units of a major teaching hospital in the state of Sao Paulo, Brazil. Results: The majority of patients (83.72%) received tailored discharge instructions. However, a great number of patients (72.08%) reported discharge instructions were not given by nurses. Almost a half of patients (48.84%) reported that discharge instructions were given by their physicians. Conclusion: The findings of this study provide insights to improve the educational process of new nurses and their preparation to provide effective discharge instructions. There is also a need to design and implement a hospital discharge process that promotes the participation of interdisciplinary health care providers who are involved in patient clinical care. This discharge process might be an effective way to change health care providers’ attitude toward discharge instructions.

Método funcional na administração em enfermagem: relato de experiência

The study presents a report of experience at school-hospital, interior of the state of Sao Paulo, where we realized an empiric experience observation of the nursing team work process at an internment unit, and in orderto use some questions, we established a relationship between thissystematicof work and someadministrativetheories including the ScientificAdministration Theory, by Taylor; the ClassicTheory, by Fayol; and the Bureaucratical Theory elaborated by Weber.

Endothelial Changes in Individuals with Prehypertension

INTRODUCTION Prehypertension is considered a precursor of systemic arterial hypertension and a predictor of morbidity-mortality due to cardiovascular diseases, which are the main causes of death in Brazil and the world. Thus, early diagnosis and the adoption of therapeutic measures in cases of prehypertension can reduce cardiovascular risk. The aim of the present study was to perform a selective review of the literature to identify and discuss early endothelial changes in individuals with pre-hypertension. RESULTS AND DISCUSSION The findings indicate an increase in ET-1-mediated vasoconstrictor tone in prehypertension, with endothelial-dependent vasodilatation impairment. Moreover, significantly high levels of angiotensin, arginine and vasopressin were found in this group of patients. A reduction in endothelial fibrinolytic capacity was another important change found in patients with prehypertention and was associated with an increased risk for atherothrombotic events. CONCLUSION The present findings demonstrate endothelial changes in individuals with prehypertension that contribute to the development of arterial hypertension as well as a high risk for cardiovascular events, underscoring the importance of the early adoption of optimized therapeutic measures for this population.

Necessidades de aprendizagem de profissionais de enfermagem na assistência aos pacientes com fístula arteriovenosa

Objectives: To identify the learning needs of professional nurses to provide quality care for patients with arteriovenous fistula (AV Fistula) for hemodialysis. Methods: This cross-sectional descriptive study was conducted with 36 professional nurses from the hemodialysis unit of a hospital in the State of Sao Paulo. A semi-structured questionnaire was used to collect the data. Initially, questionnaires were distributed to 43 nurses, but only 36 (83.7%) responded and returned the questionnaires. Results: A great number of nurses (44.9 %) reported to have difficulties in providing quality care for patients with AV Fistula. Difficulties were related to the access of AV Fistula for hemodialysis (47.2%), hemostasis of the site when withdrawing the needle after hemodialysis (19.4%) and lack of competency for the management of hematoma (13.9%), and patient’s instructions and education (19.4%). Conclusions: Nurses had many learning needs to prepare them to care for patients with arteriovenous AV Fistula. This finding led to the development of a protocol to facilitated quality care nursing care.OBJECTIVES: To identify the learning needs of professional nurses to provide quality care for patients with arteriovenous fistula (AV Fistula) for hemodialysis. METHODS: This cross-sectional descriptive study was conducted with 36 professional nurses from the hemodialysis unit of a hospital in the State of Sao Paulo. A semi-structured questionnaire was used to collect the data. Initially, questionnaires were distributed to 43 nurses, but only 36 (83.7%) responded and returned the questionnaires. RESULTS: A great number of nurses (44.9 %) reported to have difficulties in providing quality care for patients with AV Fistula. Difficulties were related to the access of AV Fistula for hemodialysis (47.2%), hemostasis of the site when withdrawing the needle after hemodialysis (19.4%) and lack of competency for the management of hematoma (13.9%), and patients instructions and education (19.4%). CONCLUSIONS: Nurses had many learning needs to prepare them to care for patients with arteriovenous AV Fistula. This finding led to the development of a protocol to facilitated quality care nursing care.

Characterization and etiology of the chronic renal failure in a countryside nephrology unit of São Paulo State

OBJETIVOS: Caracterizar a los pacientes con insuficiencia renal cronica (IRC) que participan en un programa dialitico; verificar las causas de la IRC; identificar las enfermedades asociadas a la IRC; levantar el tipo de tratamiento y el acceso actual de esos pacientes. METODOS: Se trata de un estudio descriptivo epidemiologico, realizado en una Unidad de Nefrologia en el que fueron incluidos todos los pacientes registrados en el Programa Nefro Data. RESULTADOS: De los 217 pacientes registrados en la Unidad en estudio, observamos que el 68,2% tenian edad superior a 40 anos y el 59,4% eran del sexo masculino. En cuanto a la enfermedad de base, el 31,3% de los pacientes presentan Nefroesclerosis Hipertensiva y el 25,3% Diabetes Mellitus (DM), seguido de la Glomerulonefritis con el 24,5%. Respecto a las enfermedades asociadas, el 42,4% de los pacientes poseen Hipertension Arterial Sistemica (HAS), el 24,9% no poseen comorbidades, el 19,8% HAS y DM. En relacion al tipo de acceso vascular el 70,5% poseen fistula arteriovenosa, siendo la utilizacion del cateter de Tenckhoff exclusivo de la dialisis peritoneal en el 13,3%. CONCLUSION: los resultados permiten una mejor planificacion frente a las necesidades reales de los pacientes.Objectives: Characterize the pacients with chronic renal failure (CRF) in dialythical program; verify the causes of the CRF; identify the associated diseases to CRF; measure the type of treatment and the actual access of the pacients to them. Methods: This is a epidemiological descriptive research performed in a nephrology unit, and all pacients registered in the Nefro Data program were included. Results: Of the group of 217 patients registered in the studied unit, 68,2% have age of 40 or greater and 59,4% are male. Regarding the base disease, 31,3% of the pacients have Hipertensive Nephrosclerosis, 25,3% have Diabetes Mellitus (DM) and 24,5% have Glomerulonephritis. Regarding the associated diseases, 42,4% of the pacients have Systemic Arterial Hipertension (SAH) 24,9% don’t have comorbities, 19,8% have both SAH and DM. Regarding the type of vascular acess, 70,5% have arteriovenous fistula, being the utilization of the Tenckhoff catheter exclusive of peritoneal dialysis in 13,3% of the studied cases. Conclusion: The results allow a better planning with regard to the patients real needs.

Learning needs of professional nurses to care for patients with arteriovenous fistula

Objectives: To identify the learning needs of professional nurses to provide quality care for patients with arteriovenous fistula (AV Fistula) for hemodialysis. Methods: This cross-sectional descriptive study was conducted with 36 professional nurses from the hemodialysis unit of a hospital in the State of Sao Paulo. A semi-structured questionnaire was used to collect the data. Initially, questionnaires were distributed to 43 nurses, but only 36 (83.7%) responded and returned the questionnaires. Results: A great number of nurses (44.9 %) reported to have difficulties in providing quality care for patients with AV Fistula. Difficulties were related to the access of AV Fistula for hemodialysis (47.2%), hemostasis of the site when withdrawing the needle after hemodialysis (19.4%) and lack of competency for the management of hematoma (13.9%), and patient’s instructions and education (19.4%). Conclusions: Nurses had many learning needs to prepare them to care for patients with arteriovenous AV Fistula. This finding led to the development of a protocol to facilitated quality care nursing care.OBJECTIVES: To identify the learning needs of professional nurses to provide quality care for patients with arteriovenous fistula (AV Fistula) for hemodialysis. METHODS: This cross-sectional descriptive study was conducted with 36 professional nurses from the hemodialysis unit of a hospital in the State of Sao Paulo. A semi-structured questionnaire was used to collect the data. Initially, questionnaires were distributed to 43 nurses, but only 36 (83.7%) responded and returned the questionnaires. RESULTS: A great number of nurses (44.9 %) reported to have difficulties in providing quality care for patients with AV Fistula. Difficulties were related to the access of AV Fistula for hemodialysis (47.2%), hemostasis of the site when withdrawing the needle after hemodialysis (19.4%) and lack of competency for the management of hematoma (13.9%), and patients instructions and education (19.4%). CONCLUSIONS: Nurses had many learning needs to prepare them to care for patients with arteriovenous AV Fistula. This finding led to the development of a protocol to facilitated quality care nursing care.

Prevalence of Physical Inactivity and its Effects on Blood Pressure and Metabolic Parameters in a Brazilian Urban Population

Mailing Address: José Fernando Vilela-Martin Av. Anisio Haddad, 7700, Casa: 129. Postal Code: 15093-000, Jardim das Palmeiras, São José do Rio Preto, SP Brazil. E-mail: vilelamartin@cardiol.br, vilelamartin@uol.com.br Prevalence of Physical Inactivity and its Effects on Blood Pressure and Metabolic Parameters in a Brazilian Urban Population Geiza da Graça Leite Rissardi,1 José Paulo Cipullo,1 Gisela Cipullo Moreira,1 Luiz Alberto Souza Ciorlia,1 Cláudia Bernardi Cesarino,1 Luiz Tadeu Giollo Junior,1 Angelina Zanesco,2 José Fernando Vilela-Martin1 Faculdade de Medicina de São José do Rio Preto (FAMERP),1 São José do Rio Preto, SP Brazil Universidade do Estado de São Paulo (UNESP),2 Rio Claro, SP Brazil