Ricardo Castanho Moreira

Nursing Case Management and Glycemic Control Among Brazilians With Type 2 Diabetes: Pragmatic Clinical Trial.

BackgroundType 2 diabetes mellitus is a chronic condition that requires ongoing, life-long care in order to be controlled. ObjectivesThe aims of the study were to assess the effect of nursing case management on glycated hemoglobin (HbA1c) levels compared to usual care in people with type 2 diabetes mellitus and to determine if effects of nursing case management varied by gender, age, duration of disease, education, and income. MethodsThis is a pragmatic clinical trial, conducted in the municipality of Bandeirantes, Paraná, Brazil, in 2011 and 2012. Eighty individuals were recruited and randomized equally to receive nursing case management or usual care. Covariates were sociodemographic and clinical factors. The outcome was HbA1c measured at baseline, 6 months, and 12 months. ResultsThe sample consisted predominately of women; most had been diagnosed with type 2 diabetes mellitus within the previous 5 years. Mean age was 50.14 (SD = 7.00), with 5.27 (SD = 4.39) years of schooling and an average HbA1c of 9.90% (SD = 2.49). Hemoglobin A1c was reduced from an average of 10.33% to 9.0% (p < .01) in the nursing case management group and from 9.57% to 8.93% (p = .05) in the usual care group; the group by time effect was not significant. Case management effects varied by younger age (p = .05), duration of type 2 diabetes less than 5 years (p = .03), up to 4 years of schooling (p = .04), and being in the lowest-income stratum (p = .02). DiscussionBoth groups showed a statistically significant reduction of HbA1c at 6 and 12 months following baseline. The difference in proportional reduction of HbA1c between groups was not statistically significant.

Coronary disease risk assessment in men: Comparison between ASCVD Risk versus Framingham☆☆☆

INTRODUCTION This study evaluated the risk of men developing coronary heart disease and its determinant variables, comparing these results through two validated coronary risk scales. METHODS A cross sectional epidemiological analytical study in which data were collected by spontaneous demand, through a semi-structured questionnaire, clinical examination, and blood collection. The Chi-square test, logistic regression and Kappa for statistical analysis were performed. RESULTS The study included 637 men. Age was a determining factor (p<0.05) in blood pressure (BP) changes, central obesity, BMI, glycemia, total cholesterol, LDL and triglycerides. From this group of 637, 252 presented BP above the recommended values. It was found that 34.54% of men had high total cholesterol, 19.94% had high LDL, 46.78% presented HDL below normal values and 36.42% had elevated triglycerides. Metabolic syndrome was found in 24.96% of the men. With the Framingham scale, 637 men were evaluated, 12.56% were at intermediate-risk and 5.49% elevated risk, while on the ASCVD Risk scale 553 men were evaluated, and 7.05% had moderate risk and none had high coronary risk. In this study, 50.43% of men still had no previous diagnosis for any disease that increases the risk factors. CONCLUSIONS The determinant clinical variables were age, blood pressure, smoking, central obesity, race and education. The Framingham scale allowed the assessment of cardiac risk of all men in the study, with no age restriction or cholesterol value, so in population studies it shows advantages over the ASCVD Risk due to its comprehensive feature of including all individuals.

A trajetória do câncer contada pela enfermeira: momentos de revelação, adaptação e vivência da cura

Objetivo: Describir la trayectoria desde el diagnostico del cancer colorrectal hasta el final de la quimioterapia. Metodos: Estudio cualitativo desarrollado en una clinica oncologica en Curitiba/Parana. Los datos fueron recolectados a traves de la tecnica narrativa de entrevista de historias de vida, de enero a mayo/2011, con diez adultos de 35-60 anos. Resultados: Emergieron tres categorias: la revelacion, la adaptacion y la experiencia de la curacion. Se observo la eliminacion de habitos inadecuados y preocupacion con la familia antes del diagnostico. Sin embargo, al insertar la enfermedad en su rutina diaria, se hicieron necesarias adaptaciones para enfrentar las dificultades al tratamiento, pero despues de lo termino de este, muchos sujetos se sintieron bien para retornar su funcion profesional, siendo esta correlacionada a la sensacion de autonomia que le era comun antes de la enfermedad. Conclusion: Se verifico que los relatos de vida posibilitaron conocer los cuidados, la vivencia y los sentimientos de los participantes en la tentativa de encarar positivamente la trayectoria del cancer.Objective: To describe the trajectory from diagnosis to end of chemotherapy for colorectal cancer. Methods: Qualitative research developed in an oncology clinic in Curitiba/Parana. Data collection occurred through narrative interview technique through life stories, from January to May/2011, with ten participants, adults of 35-60 years. Results: There were three categories: development,adaptation and experience of healing. In these, there was the abandonment of poor habits and concern for the family before receiving the diagnosis. However, inserting the disease in their daily routine adjustments were necessary to address the problems facing the treatment. At the end,many subjects felt good to return to their professional activities, and this correlated with the sense of autonomy that it was common before the disease. Conclusion: It was noted that reports of life possible to know the care, the experience and the feelings of the participants in an attempt to face positively the course of cancer.

Performance of Hitchens-Pike-Todd-Hewitt medium for group B streptococcus screening in pregnant women.

Group B streptococcus (GBS), which commonly colonizes the female genital tract and rectum, can cause infections in newborns with varying severity, possibly leading to death. The aim of the present study was to evaluate Hitchens-Pike-Todd-Hewitt (HPTH) medium performance for GBS screening in pregnant women. A descriptive analytical cross-sectional study was performed with 556 pregnant women, of which 496 were at 35-37 weeks of gestation and 60 were at ≥ 38 weeks of gestation. The study was conducted from September 2011 to March 2014 in northern Paraná, Brazil. Vaginal and anorectal clinical specimens from each pregnant woman were plated on sheep blood agar (SBA) and seeded on HPTH medium and Todd-Hewitt enrichment broth. Of the 496 pregnant women at 35-37 weeks of gestation, 141 (28.4%) were positive for GBS, based on the combination of the three culture media and clinical specimens. The GBS colonization rates that were detected by each medium were 22.2% for HPTH medium, 21.2% for SBA, and 13.1% for Todd-Hewitt enrichment broth. Of the 60 pregnant women at ≥ 38 weeks of gestation, seven (11.7%) were positive for GBS. These results demonstrate that HPTH medium and SBA were more sensitive than Todd-Hewitt enrichment broth for GBS screening in pregnant women and good GBS recovery in culture, indicating that the two media should be used together for vaginal and anorectal specimens.

Prevalencia de las úlceras de pierna en la región sur de Brasil

INTRODUCCION Entre todos los tipos de heridas, las mas frecuentes estan localizadas en los miembros inferiores (1), y son denominadas ulceras de pierna. Estas se definen como lesiones espontaneas o accidentales cuya etiologia puede relacionarse con una enfermedad sistemica o del miembro y que no cicatriza en un intervalo de tiempo esperado (2). Se estima que cerca del 80 al 85 % de ellas tienen como etiologia la insuficiencia venosa cronica; del 5 al 10 % de los casos, la insuficiencia arterial, siendo las restante de origen neuropatico o de otras etiologias. En Alemania, un estudio realizado con 31.619 pacientes con ulceras de pierna demostro que el 79,7 % de ellas eran de etiologia venosa o arterial, lo que ratifica la distribucion de las frecuencias presentadas (3). La ulcera de etiologia venosa causa un impacto social y economico debido a la naturaleza recurrente y al largo tiempo transcurrido entre la aparicion de la RESUMEN Introduccion: la escasez de datos epidemiologicos de la ulcera de pierna en Brasil justifico este estudio. Asi, esta investigacion tuvo el objetivo de estimar la prevalencia de las ulceras de pierna. Material y metodo: estudio epidemiologico de prevalencia, por conglomerados, realizado en la ciudad de Bandeirantes – PR, Brasil, durante los meses de agosto a noviembre de 2012. Resultados: participaron en el estudio 1.499 individuos. La prevalencia fue de 6/1.000 personas, con mayor aparicion en mujeres y personas mayores. Discusion y conclusion: la prevalencia encontrada fue superior a otros estudios realizados en paises como Espana y Portugal, y el perfil de los individuos coincidio con la literatura.

Grupo de caminhada: fator de proteção para eventos cardiovasculares em mulheres hipertensas

Objective: to compare the mean difference of Framingham’s Cardiovascular Risk Score (FCRS) in women with hypertension who participated in a walking group with those who did not participate. Method: cross-sectional study held in a Community Health Unit (CHU) at the Family Health Strategy (FHS), in Bandeirantes-PR town, in the period from June to August 2008, with 40 hypertensive women, divided into two groups: Group 1- Walk and Group 2-No Walk. The instruments used were form sociodemographic, clinical and laboratory, and FCRS. Results: there was statistical difference of mean scores obtained by the groups. The Group 1-Walk presented an average score of 8.85 and Group 2-No Walk 12.15, being classified as low and medium risk for cardiovascular events, respectively. Conclusion: walking is an important protective factor for cardiovascular disease

Risk of developing diabetes mellitus in primary care health users: a cross-sectional study

OBJECTIVE to identify the risk of developing diabetes mellitus among primary care users in a municipality of the Southern Brazil. METHOD data were collected from October 2013 to April 2014 by applying the Finnish Diabetes Risk Score questionnaire on 189 users. RESULTS the majority of the interviewees presented a slight moderate to moderate risk of developing diabetes mellitus (63.5%). There was a greater prevalence of high risk among the men. The variables with a significant prevalence ratio for high risk were age, obesity, abdominal circumference, sedentarism and family history of diabetes mellitus. CONCLUSION the identified risk factors for diabetes reveal the importance of the health team and how it can intervene to prevent disease.

Riesgo para el desarrollo de la diabetes mellitus en los usuarios de atención primaria de salud

OBJECTIVE to identify the risk of developing diabetes mellitus among primary care users in a municipality of the Southern Brazil. METHOD data were collected from October 2013 to April 2014 by applying the Finnish Diabetes Risk Score questionnaire on 189 users. RESULTS the majority of the interviewees presented a slight moderate to moderate risk of developing diabetes mellitus (63.5%). There was a greater prevalence of high risk among the men. The variables with a significant prevalence ratio for high risk were age, obesity, abdominal circumference, sedentarism and family history of diabetes mellitus. CONCLUSION the identified risk factors for diabetes reveal the importance of the health team and how it can intervene to prevent disease.

Risco para desenvolvimento do diabetes mellitus em usuários da atenção primária a saúde: um estudo transversal

OBJECTIVE to identify the risk of developing diabetes mellitus among primary care users in a municipality of the Southern Brazil. METHOD data were collected from October 2013 to April 2014 by applying the Finnish Diabetes Risk Score questionnaire on 189 users. RESULTS the majority of the interviewees presented a slight moderate to moderate risk of developing diabetes mellitus (63.5%). There was a greater prevalence of high risk among the men. The variables with a significant prevalence ratio for high risk were age, obesity, abdominal circumference, sedentarism and family history of diabetes mellitus. CONCLUSION the identified risk factors for diabetes reveal the importance of the health team and how it can intervene to prevent disease.

The trajectory of cancer as told by nurses: moments of revelation, adaptation and the healing experience

Objetivo: Describir la trayectoria desde el diagnostico del cancer colorrectal hasta el final de la quimioterapia. Metodos: Estudio cualitativo desarrollado en una clinica oncologica en Curitiba/Parana. Los datos fueron recolectados a traves de la tecnica narrativa de entrevista de historias de vida, de enero a mayo/2011, con diez adultos de 35-60 anos. Resultados: Emergieron tres categorias: la revelacion, la adaptacion y la experiencia de la curacion. Se observo la eliminacion de habitos inadecuados y preocupacion con la familia antes del diagnostico. Sin embargo, al insertar la enfermedad en su rutina diaria, se hicieron necesarias adaptaciones para enfrentar las dificultades al tratamiento, pero despues de lo termino de este, muchos sujetos se sintieron bien para retornar su funcion profesional, siendo esta correlacionada a la sensacion de autonomia que le era comun antes de la enfermedad. Conclusion: Se verifico que los relatos de vida posibilitaron conocer los cuidados, la vivencia y los sentimientos de los participantes en la tentativa de encarar positivamente la trayectoria del cancer.Objective: To describe the trajectory from diagnosis to end of chemotherapy for colorectal cancer. Methods: Qualitative research developed in an oncology clinic in Curitiba/Parana. Data collection occurred through narrative interview technique through life stories, from January to May/2011, with ten participants, adults of 35-60 years. Results: There were three categories: development,adaptation and experience of healing. In these, there was the abandonment of poor habits and concern for the family before receiving the diagnosis. However, inserting the disease in their daily routine adjustments were necessary to address the problems facing the treatment. At the end,many subjects felt good to return to their professional activities, and this correlated with the sense of autonomy that it was common before the disease. Conclusion: It was noted that reports of life possible to know the care, the experience and the feelings of the participants in an attempt to face positively the course of cancer.