Body temperature, Aldrete-Kroulik index, and patient discharge from the Post-Anesthetic Recovery Unit

Patient discharge from post-anesthetic recovery (PAR) depends, among other factors, on normothermia and the patient's score on the Aldrete-Kroulik index. The objective of this study was to verify the relationship between the Aldrete-Kroulik index and body temperature in patients. This study was performed at the University of Sao Paulo University Hospital. Convenience sampling was used, and the sample consisted of 60 patients of ages between 18 and 60 years who underwent general anesthesia. The patients' body temperature was obtained by tympanic measurement, and the Aldrete-Kroulik index was measured on admission and at discharge from post-anesthetic recovery. The data were processed using SPSS, considering a significance level of 5%, and the Spearman and Wilcoxon tests were applied. In conclusion, no significant correlation was found between the two parameters for discharge.

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

Background Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Methods/design Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. Discussion This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. Trial registration ClinicalTrials.gov (NCT01698580)

Exercise training program based on minimum weekly frequencies: effects on blood pressure and physical fitness in elderly hypertensive patients

Background: Exercise training (ET) can reduce blood pressure (BP) and prevent functional disability. However, the effects of low volumes of training have been poorly studied, especially in elderly hypertensive patients. Objectives: To investigate the effects of a multi-component ET program (aerobic training, strength, flexibility, and balance) on BP, physical fitness, and functional ability of elderly hypertensive patients. Methods: Thirty-six elderly hypertensive patients with optimal clinical treatment underwent a multi-component ET program: two 60-minute sessions a week for 12 weeks at a Basic Health Unit. Results: Compared to pre-training values, systolic and diastolic BP were reduced by 3.6% and 1.2%, respectively (p < 0.001), body mass index was reduced by 1.1% (p < 0.001), and peripheral blood glucose was reduced by 2.5% (p= 0.002). There were improvements in all physical fitness domains: muscle strength (chair-stand test and elbow flexor test; p < 0.001), static balance test (unipedal stance test; p < 0.029), aerobic capacity (stationary gait test; p < 0.001), except for flexibility (sit and reach test). Moreover, there was a reduction in the time required to perform two functional ability tests: "put on sock" and "sit down, stand up, and move around the house" (p < 0.001). Conclusions: Lower volumes of ET improved BP, metabolic parameters, and physical fitness and reflected in the functional ability of elderly hypertensive patients. Trial Registration RBR-2xgjh3.

The Brazilian National Health Agency and the Mental Health Policy in the Context of the Private Health System: developments and challenges

This work analyses the mental health policy-making activity of the Brazilian National Health Agency (ANS), responsible for controlling health insurance companies. Three points are discussed: a) the framework of an economic and private health assistance regulatory activity, b) the ANS and its regulation activity and c) the rules produced by ANS in the mental health care field. It was concluded that, despite advances like the legal obligation to ensure medical treatment to all the diseases listed in ICD-10, the inclusion of suicidal patient damage and self-inflicted damage care, care provided by a multiprofessional team, the increase in the number of sessions with a psychologist, with an occupational therapist and of psychotherapy sessions, and mental health day hospitals included as part of the services offered, the authors identified specific regulatory gaps in this area. Some issues that ANS has to solve so that it can really play its institutional role of defending the public interest in the private health system are: the regulation of co-participation and franchise mechanisms, the increasing co-participation as a limitation of psychiatric hospitalization, and the limited number of crisis intervention psychotherapy sessions.

TOWARDS THE JOINT USE OF ICD AND ICF: A CALL FOR CONTRIBUTION

Background: To optimize patient functioning, rehabilitation professionals often rely on measurements of functioning as well as on classifications. Although the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) are used, their joint use has yet to become an established practice. To encourage their joint use in daily practice, the World Health Organization (WHO) has invited all rehabilitation practitioners worldwide to support the ICD-11 revision process by identifying the ICF categories that correspond to specific rehabilitation-relevant health conditions. The first step in completing this task, generating the list of these health conditions, was taken at a February 2012 workshop in Sao Paulo, Brazil. Objectives: The objectives of this paper are to present the results of the Sao Paulo workshop, and to invite practitioners to participate in the ICD-ICF joint use initiative. Discussion: Alternating plenary and small working group sessions were held and 103 rehabilitation-relevant health conditions were identified. With this list available, WHO together with the International Society of Physical and Rehabilitation Medicine (ISPRM), is reaching out to clinicians of all rehabilitation disciplines to take on the challenge of identifying the ICF categories for at least one of the health conditions listed.

Pilates in Heart Failure Patients: A Randomized Controlled Pilot Trial

Background: Conventional cardiac rehabilitation program consist of 15 min of warm-up, 30 min of aerobic exercise and followed by 15 min calisthenics exercise. The Pilates method has been increasingly applied for its therapeutic benefits, however little scientific evidence supports or rebukes its use as a treatment in patients with heart failure (HF). Purpose: Investigate the effects of Pilates on exercise capacity variables in HF. Methods: Sixteen pts with HF, left ventricular ejection fraction 27 +/- 14%, NYHA class III were randomly assigned to conventional cardiac rehabilitation program (n = 8) or mat Pilates training (n = 8) for 16 weeks of 30 min of aerobic exercise followed by 20 min of the specific program. Results: At 16 weeks, pts in the mat Pilates group and conventional group showed significantly increase on exercise time 11.9 +/- 2.5 to 17.8 +/- 4 and 11.7 +/- 3.9 to 14.2 +/- 4 min, respectively. However, only the Pilates group increased significantly the ventilation (from 56 +/- 20 to 69 +/- 17 L/min, P= 0.02), peak VO2 (from 20.9 +/- 6 to 24.8 +/- 6 mL/kg/min, P= 0.01), and O-2 pulse (from 11.9 +/- 2 to 13.8 +/- 3 mL/bpm, P= 0.003). The Pilates group showed significantly increase in peak VO2 when compared with conventional group (24.8 +/- 6 vs. 18.3 +/- 4, P= 0.02). Conclusions: The result suggests that the Pilates method may be a beneficial adjunctive treatment that enhances functional capacity in patients with HF who are already receiving standard medical therapy.

Intervention Based Exclusively on Stage- Matched Printed EducationalMaterials Regarding Healthy Eating Does Not Result in Changes to Adolescents' Dietary Behavior

Purpose. To assess the impact of a six-month stage-based intervention on fruit and vegetable intake, regarding perceived benefits and barriers, and self-efficacy among adolescents. Design. Randomized treatment-control, pre-post design. Subjects/ Setting. Schools were randomized between control and experimental groups. 860 adolescents from ten public schools in Bras ' ilia, Federal District, Brazil were evaluated at baseline; 771 (81%) completed the study. Intervention. Experimental group received monthly magazines and newsletters aimed at promotion of healthy eating. Measures. Self-reported fruit and vegetable intake, stages of change, self-efficacy and decisional balance scores were evaluated at baseline and post-intervention in both groups. Analysis. The effectiveness of the intervention was evaluated using the analysis of covariance model (ANCOVA) and repeated measurement analysis by means of weighted least squares. Comparison between the proportions of adolescents who advanced through the stages during the intervention was performed using the Mantel-Haenszel chi-square test. Results. After adjusting for sex and age, study variables showed no modifications through the proposed intervention. There was no statistical difference in participant mobility in the intervention and control groups between the stages of change, throughout the study. Conclusion. A nutritional intervention based exclusively on distribution of stage-matched printed educational materials was insufficient to change adolescents' dietary behavior.

Optical aids for low vision: use of the Internet to guide teachers of the visually impaired

PURPOSES: To describe and interpret teachers' opinions about and responsiveness to guidance on optical aids for low vision. METHODS: It was conducted a cross-sectional analytical study. The convenience, non-random sample consisted of 58 teachers from the public school network of the city of Campinas. It was constructed and applied a structured questionnaire, available online at the assessed website. For qualitative data collection it was conducted an exploratory study using the focus group technique. RESULTS: Responses expressed, for the most part, a marked interest in the website, its easiness of access, and the comprehensive nature of the information provided. Most people reported frequent use of the Internet to seek information, and found it easier to access the Internet at home. Among the qualitative aspects of the evaluation, we should mention the perceived importance of the website as a source of information, despite some criticism about the accessibility and reliability of the information found on the Internet. CONCLUSION: Teachers' need for training to deal with visually impaired students and their positive response to advice and information lead to the conclusion that web-based guidelines on the use of optical aids were considered beneficial to ease the understanding of visual impairment and the rehabilitation of the affected subjects.

Intervenções psicoeducacionais para cuidadores de idosos com demência: uma revisão sistemática

OBJETIVO: Identificar modelos de intervenções psicoeducacionais e os seus efeitos em cuidadores de idosos com demência. MÉTODOS: Levantamento de estudos publicados entre janeiro de 2000 e abril de 2012 nas bases de dados PubMed, Web of Knowledge, Lilacs e SciELO, utilizando as seguintes palavras-chave "psychoeducational and caregiver", "cuidador e demência e psicoeducação" e "cuidador e intervenção". Apenas os artigos que denominavam a intervenção estudada como psicoeducação fazem parte do presente estudo. RESULTADOS: Foram encontrados 27 artigos com relatos acerca do impacto de intervenções psicoeducacionais em cuidadores de idosos com demência. Os resultados mais prevalentes desses estudos são: melhora do bem-estar dos cuidadores (37% dos estudos); aumento do uso de estratégias de enfrentamento (30%); diminuição de pensamentos disfuncionais (30%); aumento do conhecimento sobre os serviços disponíveis (19%); melhora da autoeficácia (15%); e aumento de habilidades para o cuidado (11%). A abordagem psicoeducacional descrita nos estudos é do âmbito informativo, cognitivo-comportamental, com técnicas de gerenciamento de estresse e de emoções; técnicas de resolução de problemas e apoio emocional. CONCLUSÃO: A intervenção psicoeducacional contribui significativamente para a melhora do bem-estar do cuidador, contudo ainda é necessária uma padronização dessa abordagem, em termos de estrutura, duração e conteúdos ministrados, para que haja evidências mais precisas do efeito desse tipo de intervenção.

Temperatura corporal, índice Aldrete e Kroulik e alta do paciente da Unidade de Recuperação Pós-Anestésica

A alta do paciente da recuperação pós-anestésica (RPA) depende, dentre outros fatores, do retorno à normotermia e do escore alcançado pelo Índice de Aldrete e Kroulik. Sendo assim, o objetivo deste estudo foi verificar a relação entre o Índice de Aldrete e Kroulik e a temperatura corporal dos pacientes. O local de pesquisa foi o Hospital Universitário da Universidade de São Paulo. O cálculo amostral foi determinado por conveniência e foi constituído por 60 pacientes, entre 18 e 60 anos, submetidos à anestesia geral. Foram verificados a temperatura corporal na região timpânica e o Índice de Aldrete e Kroulik do paciente na recepção e alta da recuperação pós-anestésica. Os dados obtidos foram processados pelo pacote estatístico SPSS, com um nível de 5% de significância, e aplicaram-se o teste de Spearman e o teste de Wilcoxon. Conclui-se que não houve correlação significativa entre os dois parâmetros indicativos de alta.

Incapacidade relacionada à dor lombar crônica: prevalência e fatores associados

A incapacidade relacionada à dor lombar crônica (DLC) é um fenômeno complexo e multifatorial. O objetivo desse estudo foi identificar a prevalência e os fatores associados à incapacidade em pacientes com dor lombar crônica. Estudo transversal com amostra composta por 177 pacientes com DLC, de três serviços de saúde; que responderam ao formulário com dados demográficos, ao Inventário de Depressão de Beck, às Escalas Oswestry Disability Index, de autoeficácia para dor crônica, Tampa de Cinesiofobia e de Fadiga de Piper. A prevalência de incapacidade foi de 65% (IC95%: 57,5 - 72,0) e era de moderada a grave em 80,7% dos pacientes. O modelo de regressão múltipla identificou três fatores independentemente associados à incapacidade: ausência de trabalho remunerado, autoeficácia baixa e depressão. Os fatores associados à incapacidade identificados são modificáveis. Intervenções como recolocação no trabalho, tratamento para a depressão e reconceitualização da crença de autoeficácia podem ter um impacto importante na prevenção e redução de incapacidade.

Educação em saúde e a família do bebê prematuro: uma revisão integrativa

OBJETIVO: Identificar as necessidades de educação em saúde da família do recém-nascido pré-termo. MÉTODOS: Revisão integrativa de literatura, com buscas nas bases de dados PubMED e Literatura Latino-Americana e do Caribe em Ciências da Saúde, entre 1999 e 2011, e com uso dos descritores (prematuro, enfermagem neonatal, cuidados de enfermagem e alta hospitalar) em inglês, espanhol e português. RESULTADOS: Os dez estudos selecionados foram categorizados em três temáticas: a participação nos cuidados do filho, o preparo para a alta hospitalar e uso de material educativo. A maioria das atividades de educação em saúde é direcionada às mães e está relacionada aos cuidados básicos diários e, ainda, é incipiente a participação nestas atividades, a fim de promover o vínculo e aumentar a confiança no cuidado. CONCLUSÃO: Observou-se a necessidade de elaborar estratégias, embasadas nas metodologias ativas de aprendizagem, auxiliadas por materiais educacionais que facilitem a inserção dos pais na unidade neonatal e nos cuidados com seu filho.