Luciano Ramos de Lima

Acolhimento na atenção primária à saúde na ótica de enfermeiros

Objective To understand how the welcoming process occurs in the basic health units from the viewpoint of nurses. Methods An exploratory study with a qualitative approach that used semi-structured interviews, and adopted the content analysis technique proposed by Bardin for data analysis. Results Among the ten interviewed, nine were female. Analysis of the statements led to the emergence of access and the work process as empirical categories. Conclusion Welcoming is performed in the Basic Health Units of a Regional Federal District, but not in a structured manner, nor is it grounded in the recommendations of the Ministry of Health.

Relações hipotéticas entre os determinantes sociais da saúde que influenciam na obesidade em idosos

Os elevados indices de prevalencia de obesidade em idosos suscitam a necessidade de compreender os fatores envolvidos nesta desordem nutricional, por meio de metodos quantitativos que permitam uma analise relacional desses determinantes. O objetivo deste estudo foi propor um modelo hipotetico que estabeleca as relacoes entre os determinantes sociais da saude associados a obesidade em idosos. Para a construcao do modelo hipotetico, foram delineadas as variaveis latentes e observadas de acordo com a analise de 45 artigos nacionais e internacionais e em concordância com o referencial da Modelagem de Equacoes Estruturais. Foi construido um diagrama representativo para evidenciar as correlacoes entre os 11 determinantes sociais da saude relacionados a obesidade no idoso: atividade fisica, tabagismo, etilismo, consumo alimentar, contato social, ocupacao, renda, escolaridade, idade, sexo e estado civil. Espera-se que as relacoes hipoteticas estabelecidas no estudo contribuam para a compreensao das relacoes dos fatores que estao envolvidos nesse contexto visando ao desenvolvimento de estrategias para a saude da pessoa idosa.

Quality of life and time since diagnosis of Diabetes Mellitus among the elderly

Objectives: To evaluate the quality of life of the elderly with Diabetes Mellitus and to relate the time since diagnosis of diabetes with the quality of life of elderly persons receiving care at a basic health unit. Method: A cross-sectional quantitative study carried out in a Basic Health Unit with 196 elderly persons. For data collection, three instruments were used: one structured (sociodemographic and clinical variables) and the Whoqol-bref and Whoqol-old, with scores ranging from 0 to 100. Descriptive statistical analysis, Student’s T-test and Pearson’s correlation were performed. Results: Of the 196 diabetic patients, the majority were male (54.6%) with a mean age of 67.5 (±6.5) years. The mean time since diagnosis of Diabetes Mellitus was 9.1 years. The domains of the Whoqol-bref with the highest scores, indicating better quality of life, were Social Relations and Psychological, while a worse quality of life was observed in Environment. The facets of the Whoqol-old with the best scores were: Intimacy and Past, Present and Future Activities, and the worst was Death and Dying. The domains associated with one another were Physical and Psychological, Physical and Social Relations, and Psychological and Environmental. The associated aspects were Past, Present and Future Activities and Social Participation. Elderly persons with more than ten years of Diabetes Mellitus had worse quality of life scores in Physical (p=0.001), Social relations (p=0.002), and in the Autonomy (p=0.0012), Social Participation (p=0.041) and Death and Dying (p=0.001) facets. Conclusion: The time of diagnosis of Diabetes Mellitus was negatively associated with the quality of life of the elderly, with worse scores in most domains and facets of the Whoqol.

Lower quality of life, lower limb pain with neuropathic characteristics, female sex, and ineffective metabolic control are predictors of depressive symptoms in patients with type 2 diabetes mellitus treated in primary care

The primary objective of this study was to identify if lower limb pain with neuropathic characteristics is predictive of depressive symptoms in patients with type 2 diabetes mellitus (T2DM) treated in primary care in Brazil. It was investigated if diabetic and non-diabetic related variables could influence depressive symptoms. A quantitative and cross-sectional study was carried out in two Basic Health Units with users of the Brazilian Public Healthcare System, who were evaluated for depressive symptoms (BDI), quality of life (QoL, SF6D), pain intensity, neuropathy (loss of plantar sensitivity—LOPPS), body composition (DEXA), biochemical tests, sociodemographic variables, and comorbidities. The patients were stratified into four groups: N+P+, N+P−, N−P+, and N−P− (N = neuropathy and P = pain). One hundred twenty-one diabetics were selected by random sampling between August 2016 and June 2017. Neuropathy affected 53.8% of these individuals, and 59.5% reported intense pain. Overall depressive symptoms scores showed a positive correlation with pain intensity and a negative correlation with QoL. Depressive symptoms were reported by 66.9% of the sample, mostly female, with better levels of cholesterol, HDL and LDL; comorbidities; worse QoL; greater intensity of pain; impaired sleep; and painful neuropathy (N+P+). The predictive factors for depressive symptoms were lower QoL, pain with neuropathic characteristics, female sex, obesity, and ineffective glycemic control. These data may contribute to the understanding of the complexity of patients with T2DM who are treated in primary care and to public policies planning of care directed at the needs of this population.