Fernanda Penido Matozinhos

Fatores associados à úlcera por pressão em pacientes internados nos Centros de Terapia Intensiva de Adultos

Trata-se de um estudo seccional analitico com o objetivo de estimar a ocorrencia de ulceras por pressao e seus fatores associados em CTIs de adultos, em Belo Horizonte. A amostra foi constituida por 142 pacientes, com 18 anos ou mais, internados ate as 24h do dia anterior a coleta de dados, em 316 leitos, distribuidos em 22 CTIs. A presenca de pelo menos uma ulcera por pressao, e por paciente, foi de 35,2% (IC 95% = 27,4-47,7). Das 99 ulceras identificadas, constatou-se que foram mais frequentes nas regioes sacral (36,0%) e calcânea (22,0%). Observou-se que presenca de sepses (OR = 6,04; IC 95% = 1,09-33,53), tempo de internacao > 10 dias (OR = 7,61; IC 95% = 2,92-19,82) e risco alto e elevado na classificacao da escala de Braden (OR = 4,96; IC 95% = 1,50-16,50) foram fatores independentes e significativamente associados a presenca de ulcera por pressao. Conclui-se que sepses, tempo de internacao e risco alto e elevado na classificacao da escala de Braden sao fatores potencialmente associados a formacao de ulceras em pacientes acamados.

Factors associated to pressure ulcers in patients at Adult Intensive Care Units

Trata-se de um estudo seccional analitico com o objetivo de estimar a ocorrencia de ulceras por pressao e seus fatores associados em CTIs de adultos, em Belo Horizonte. A amostra foi constituida por 142 pacientes, com 18 anos ou mais, internados ate as 24h do dia anterior a coleta de dados, em 316 leitos, distribuidos em 22 CTIs. A presenca de pelo menos uma ulcera por pressao, e por paciente, foi de 35,2% (IC 95% = 27,4-47,7). Das 99 ulceras identificadas, constatou-se que foram mais frequentes nas regioes sacral (36,0%) e calcânea (22,0%). Observou-se que presenca de sepses (OR = 6,04; IC 95% = 1,09-33,53), tempo de internacao > 10 dias (OR = 7,61; IC 95% = 2,92-19,82) e risco alto e elevado na classificacao da escala de Braden (OR = 4,96; IC 95% = 1,50-16,50) foram fatores independentes e significativamente associados a presenca de ulcera por pressao. Conclui-se que sepses, tempo de internacao e risco alto e elevado na classificacao da escala de Braden sao fatores potencialmente associados a formacao de ulceras em pacientes acamados.

Avaliação de risco para úlcera por pressão em pacientes críticos

Pacientes acamados apresentam risco de desenvolver ulceras por pressao e representam um grupo prioritario para o estudo e identificacao deste agravo. Para tal, utilizam-se instrumentos de avaliacao especificos para o problema. O objetivo deste estudo foi analisar os fatores de risco para o desenvolvimento de ulcera por pressao em pacientes adultos internados em CTIs. Trata-se de um estudo seccional analitico no qual foram avaliados 140 pacientes, internados em 22 CTIs, utilizando-se a escala de Braden. Os resultados mostraram que pacientes internados por 15 dias ou mais apresentavam alguma categoria de risco. As maiores frequencias de ulcera por pressao foram encontradas em pacientes que estavam nas categorias: percepcao sensorial (completamente limitado), umidade (constantemente umida), mobilidade (completamente imobilizado), atividade (acamado), nutricao (adequado) e friccao e cisalhamento (problema). Conclui-se que a utilizacao dessa escala traduz-se em estrategia importante no cuidar de pacientes em terapia intensiva.Bedridden patients are in risk to developing pressure ulcers and represent a priority group to be studied to identify this condition. To reach this goal, specific instruments are used to assess this problem. The objective of this study was to analyze the risk factors to developing pressure ulcers in adult patients hospitalized in ICUs. This is a sectional analytical study, in which evaluations were performed on 140 patients, hospitalized in 22 ICUs, using the Braden scale. Results showed that patients hospitalized from 15 days or more showed some level of risk. The highest frequencies of pressure ulcers were found in patients in the following categories: sensorial perception (completely limited), moistness (constantly moist), mobility (completely immobilized), activity (bedridden), nutrition (adequate) and friction and shear (problem). In conclusion, the use of this scale is an important strategy when providing care to patients in intensive treatment.

Prevalência de saúde cardiovascular ideal na população brasileira - Pesquisa Nacional de Saúde (2013)

Primordial prevention is defined as the initial prevention of risk factors, through the adoption of healthier behaviors. Within this concept, the American Heart Association (AHA) has defined seven metrics, based on evidence, to achieve ideal cardiovascular health. The aim of this study was to evaluate the prevalence of cardiovascular health in the Brazilian population, according to sex, age, and region of residence, using data from the latest National Health Survey (2013). We assessed the risk factors, as recommended by the AHA, combined (number of factors) and individually: four behavioral (smoking, physical activity, body mass index and diet) and three biological factors (blood pressure, blood glucose and cholesterol levels). The Brazilian population has reached very low prevalence (1%), for the sum of 7 factors in ideal level. Individually, 3.2% of the population consumed ideal diet, followed by physical activity (23.6%) and body mass index (43.7%). The subjects aged between 18 and 35 years showed higher prevalence of metrics combined at the optimal levels (0.5%), which was also reached by the population of the Northern region. These results indicate that greater efforts are urgent by public policies at the level of primordial prevention in order to achieve appropriate targets of cardiovascular health in the Brazilian population.

Risk assessment for pressure ulcer in critical patients

Pacientes acamados apresentam risco de desenvolver ulceras por pressao e representam um grupo prioritario para o estudo e identificacao deste agravo. Para tal, utilizam-se instrumentos de avaliacao especificos para o problema. O objetivo deste estudo foi analisar os fatores de risco para o desenvolvimento de ulcera por pressao em pacientes adultos internados em CTIs. Trata-se de um estudo seccional analitico no qual foram avaliados 140 pacientes, internados em 22 CTIs, utilizando-se a escala de Braden. Os resultados mostraram que pacientes internados por 15 dias ou mais apresentavam alguma categoria de risco. As maiores frequencias de ulcera por pressao foram encontradas em pacientes que estavam nas categorias: percepcao sensorial (completamente limitado), umidade (constantemente umida), mobilidade (completamente imobilizado), atividade (acamado), nutricao (adequado) e friccao e cisalhamento (problema). Conclui-se que a utilizacao dessa escala traduz-se em estrategia importante no cuidar de pacientes em terapia intensiva.Bedridden patients are in risk to developing pressure ulcers and represent a priority group to be studied to identify this condition. To reach this goal, specific instruments are used to assess this problem. The objective of this study was to analyze the risk factors to developing pressure ulcers in adult patients hospitalized in ICUs. This is a sectional analytical study, in which evaluations were performed on 140 patients, hospitalized in 22 ICUs, using the Braden scale. Results showed that patients hospitalized from 15 days or more showed some level of risk. The highest frequencies of pressure ulcers were found in patients in the following categories: sensorial perception (completely limited), moistness (constantly moist), mobility (completely immobilized), activity (bedridden), nutrition (adequate) and friction and shear (problem). In conclusion, the use of this scale is an important strategy when providing care to patients in intensive treatment.

Physical and Social Environment Are Associated to Leisure Time Physical Activity in Adults of a Brazilian City: A Cross-Sectional Study

The physical activity practice is highlighted as a strategy to health promotion and to avoid chronic diseases. In addition to individual factors, environmental characteristics in which people live, may offer opportunities or barriers in adopting healthy habits and this is related to the physical activity (PA) practice among individuals. The aim of this study is to investigate the associations between neighborhood environment and leisure-time physical activity in adults. This is a cross-sectional study, developed using the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL 2008/2010) of Belo Horizonte, Brazil. Individuals with the habit of practicing PA for at least 150 minutes of moderate-intensity PA or at least 75 minutes of vigorous-intensity PA throughout the week in leisure time were classified as active in leisure time. To characterize the built and social environment we used georeferenced data of public and private places for physical activity, population density, residential density, homicide rate and total income of the coverage area of the basic health units. The covered area of the basic health units was used as context unit. For data analysis, we used multilevel logistic regression. The study included 5779 adults, 58.77% female. There was variability of physical activity in leisure time between area covered by the basic health units (Median Odds ratio = 1.30). After adjusting for individual characteristics, the increase of density of private places for physical activity (Odds ratios—OR = 1.31; 95% confidence interval—95% CI: 1.15 to 1.48) and the smaller homicide rate (OR = 0.82; IC95%: 0.70 to 0.96) in the neighborhood increased physical activity in leisure time. The evidence of this study shows that neighborhood environment may influence the physical activity practice in leisure time and should be considered in future interventions and health promotion strategies.

Self-perceived health and clinical-functional vulnerability of the elderly in Belo Horizonte/Minas Gerais

OBJECTIVE To determine the self-perceived health status and clinical-functional vulnerability of the elderly attended at a Reference Center of Minas Gerais, Brazil and to evaluate the association between these variables through the Clinical-Functional Vulnerability Index (IVCF-20) instrument. METHOD This is an epidemiological, retrospective study of 311 medical records. Statistical analyses were performed using the Stata program; the evaluations were by Pearsons Chi-square test and Poisson regression models. RESULTS The majority of the elderly presented negative self-perceived health status(70.10%); there was statistical significance between negative self-perceived health and the variables of mood and recent hospitalization. CONCLUSION Perceived health status influences the morbidity and mortality of the elderly. Mood disorders and recent hospitalizations directly interfere with active aging.

Saúde cardiovascular em população residente nas capitais brasileiras

Resume Objective: to estimate the prevalence of ideal cardiovascular health indicators in the Brazilian population, according to gender, age, education and region of residence. Method: cross-sectional study that used data from 41,134 participants of the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel). The ideal cardiovascular health assessment considers four behavioral factors: not smoking; body mass index less than 25 kg/m2; practicing physical activity, eating fruits and vegetables five or more times per day; and two clinical factors (no diagnosis of diabetes or hypertension). The sum of factors at ideal levels results in a score ranging from zero (worse cardiovascular health) to six (ideal cardiovascular health). Results: considering the six factors, only 3.4% of the studied population presented ideal levels of cardiovascular health, with the majority of participants (57.6%) presenting three or four ideal factors. Women had higher prevalence of ideal cardiovascular health (3.8% versus 2.9% for men) (p < 0.0001). Conclusion: the findings of this study are consistent with the elevated risk of mortality from cardiovascular disease, observed in the Brazilian population. This may contribute to a better understanding of the scenario of cardiovascular health in the urban population of the country.Objetivo: estimar a prevalencia das metricas de saude cardiovascular ideal em nivel populacional, segundo sexo, idade, escolaridade e regiao de moradia. Metodo: estudo transversal que utilizou dados de 41.134 participantes do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico. A avaliacao da saude cardiovascular ideal considerou quatro fatores comportamentais: nao fumar; apresentar indice de massa corporal menor do que 25 kg/m2; realizar atividade fisica; consumir frutas e hortalicas cinco ou mais vezes por dia, e dois fatores clinicos: nao referir diagnostico de diabetes e de hipertensao arterial. A soma dos fatores resultou em um escore que variou de zero (pior saude cardiovascular) a seis (saude cardiovascular ideal) fatores em niveis ideais. Resultados: considerando os seis fatores, somente 3,4% da populacao estudada apresentou niveis ideais de saude cardiovascular e a maioria dos participantes (57,6%) apresentou tres ou quatro fatores ideais. As mulheres apresentaram maior prevalencia de saude cardiovascular ideal (3,8% vs. 2,9% dos homens) (p < 0,0001). Conclusao: os achados deste estudo sao condizentes com o elevado risco de mortalidade por doencas cardiovasculares, observado para a populacao brasileira, e podem contribuir para a melhor compreensao do cenario da saude cardiovascular na populacao urbana do pais.

Perceptions of neighborhood environments and their association with overweight in children, adolescents, and caretakers in a medium-sized city in Brazil

BackgroundPrevious studies conducted in developed countries have suggested associations between perceptions of neighborhood characteristics and weight gain. However, there are few studies regarding the adult perception of the residential environment and overweight in children and adolescents in countries with low and medium income. The aim of the study was to assess the associations between caretakers’ perceptions of environmental characteristics and overweight in themselves and in their children, in a medium-sized city in Brazil.MethodsCross-sectional study was performed with 708 children and adolescents and their caretakers. Anthropometric measurements and a structured questionnaire filled out by caretakers concerning child and family characteristics were completed. For environmental assessment, 408 caretakers answered the Portuguese version of the “Neighborhood Environment Walkability Scale” by telephone call. A 95% confidence interval (95%CI) was used in the analysis. Unadjusted prevalence ratios (PR) were calculated, as were PR adjusted for age, gender, family income, and total time of exercise the children or adolescents practiced (from Poisson regression models predicting children’s and adolescents’ overweight), and for age and family income (from Poisson regression models predicting caretakers’ overweight). Statistical significance was defined as a p value <0.05.ResultsAdult perceptions about the absence of sidewalks on most streets (PR = 0.49, 95%CI = 0.42–0.98) and the absence of interesting things to look at (esthetics) in the neighborhood (PR = 0.65, 95%CI = 0.44–0.90) were inversely associated with the prevalence of overweight in the children and adolescents after adjustment. The absence of hills in the neighborhood (PR = 1.24, 95%CI = 1.05–1.45) and the perception of heavy exhaust fumes (PR = 1.26, 95%CI = 1.02–1.56) were directly associated with the prevalence of overweight in the caretakers. Finally, the high speed of traffic on the street (PR = 0.76, 95%CI = 0.63–0.92) was inversely associated with the prevalence of adult overweight.ConclusionsThe results showed, in Brazil, the importance of understanding aspects related to obesogenic environment in the context of medium-sized Brazilian cities.

Distribuição espacial da obesidade em área urbana no Brasil

The spatial distribution of a disease is important for the diagnosis and epidemiological understanding of the health situation and trends, enabling a better grasp of the factors that determine the health status of populations. The scope of the study was to analyze the spatial distribution of obesity in adults in Belo Horizonte. This cross-sectional study was developed by Telephone Survey from the database for 2008 to 2010 of the Surveillance of Risk and Protective Factors for Chronic Diseases. Obesity was defined as body mass index 30 kg/m2. A georeferenced base with the environmental data of addresses and zip codes of the location was developed and spatial scan statistics were employed. A comparative analysis of environmental variables related to clusters of higher and lower prevalence of obesity was conducted. A cluster of obese individuals without statistical significance was found in the central area of the city. Also, a significant cluster of non-obese individuals was found in the eastern area of the city. These findings suggest that reasons for low prevalence of obesity in urban Brazilian areas could be related to better social organization and high availability of places for food stores and the practice of physical activity.