Efeitos do treino resistido na capacidade funcional e na reatividade pressórica em pacientes intradialíticos

Pacientes com doença renal crônica (DRC) submetidos ao treinamento resistido durante a hemodiálise apresentam benefícios substanciais dos sistemas muscular e cardiovascular, da capacidade funcional e da sua qualidade de vida. Entretanto, as melhorias na reatividade pressórica ainda não estão bem esclarecidas. O objetivo foi analisar o efeito do treino resistido na melhora da capacidade funcional e da reatividade pressórica em pacientes hemodialisados, em Natal/RN no ano de 2014. Trata-se de um ensaio clínico controlado e randomizado, com amostra de 64 pacientes, com média de idade de 42,28 (±11,48) anos, distribuídos em grupo experimental (GE) e controle (GC). Para mensurar os ganhos de força de membros inferiores foram utilizados os testes de sentar e levantar e de levantar e caminhar, já para a reatividade pressórica o teste cold pressor, em ambos os grupos antes e após a intervenção. Além disso, apenas o GE participou do treinamento resistido durante a hemodiálise em 16 semanas, composto por 3 sessões semanais, 3 séries de 10 repetições máximas (RM) estimadas (para extensores de joelho e flexores de quadril e joelho), entre 50 a 70% de 10 RM. Para a intensidade do treinamento foi utilizada a escala de Borg entre 11 a 14 durante as seções. Os dados foram analisados utilizando o Teste t para amostras independentes (inter-grupos) bem como para comparar a diferença das médias nos grupos pré e pós-intervenção (intra-grupos) a partir do Teste t para amostras repetidas. Para todas as variáveis foi considerada a significância estatística de 5% executados no software SPSS® 20.0. O estudo foi aprovado pelo comitê de ética do Hospital Universitário Onofre Lopes (HUOL - UFRN) número 37992214.2.0000.5292. Após a intervenção, verificou-se que os pacientes do GE tiveram um desempenho melhor nos testes de força (p<0,001) em comparação ao GC. Resultado também observado na pressão arterial sistólica e diastólica (PAS e PAD) ambas de repouso que apresentaram redução dos níveis pressóricos apenas no GE (p<0,001). Na reatividade pressórica tanto nos períodos pré bem como após 2 minutos também demonstraram reduções estatisticamente significativas do GE (p<0,001 e p=0,012) respectivamente quando comparado ao GC. Conclui-se que o treinamento resistido melhorou desempenho nos testes de força de membros inferiores beneficiando a capacidade funcional dos pacientes em hemodiálise, como também a pressão arterial de repouso e os níveis de reatividade pressórica obtiveram reduções significativas de seus valores após a intervenção. Além disso, este tipo de treinamento também pode ser utilizado como uma estratégia de proteção aos fatores de risco cardiovascular em pacientes renais crônicos.

Análise do perfil de encaminhamento da atenção primária para pré-natal de alto risco: desafios para o ensino de competências em saúde materno-infantil

OBJECTIVE: to identify a profile of the main causes of inappropriate referrals from primary care to specialized services, as strategy for the curriculum development of core competencies related to maternal health. METHODS: a cross-sectional study was performed using document analysis of all referrals of pregnant women from primary care to the high-risk pregnancy service, state of Rio Grande do Norte, Brazil. All pregnant women referred from June to December 2014 (n = 771) were included. According to their causes the referrals were categorized as adequate, inadequate or inconclusive. RESULTS: a total of 188 referrals were classified as inadequate (24.4%) and 93 inconclusive (12.1%) totalizing 36.5% of inappropriate referrals. The main causes identified in these inappropriate referrals were: low-risk pregnancy (12.8%), unconfirmed hypertension (12.1%), risk of abortion (8.9%), teenage pregnancy (7.1%) , toxoplasmosis (5.3%), Rh incompatibility (4.6%) and urinary tract infection (4.3%). These data contributed to the formulation of the following products: 1) a continuing education program for health professionals working in primary care, undergraduate students and residents; and 2) development of a virtual platform to support professionals who need to refer patients to high-risk pregnancy service. CONCLUSION: the results of this study are relevant in the current context of education of health professionals, with potential for positively impact not only in the development of skills related to maternal health in undergraduate and graduate education, as well as contributing for improvement of the health care of the population.

Fatores determinantes da near miss materna em uma unidade de terapia intensiva obstétrica: avaliação das competências profissionais da área médica

Objective: Evaluate the determinants of morbidity and mortality in an obstetric intensive care unit and professional medical skills of students/residents at a university hospital. Methods: observational cross - sectional with 492 pregnant/pue rperal women and 261 students/residents. Patients were admitted to the obstetric intensive care unit during a year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and G raphPad6. Chi - square tests were used to evaluate risk factors and student t test evaluates resident/students' skills concerning the cognitive test and the Mini - Cex. Results: the main risk factors to near miss were: non - white race (OR = 2.527; RR = 2.342) ; marital status(married women) (OR = 7.968; RR = 7.113) , schooling (primary) (OR = 3.177 ; RR = 2.829) , from country town (OR = 4.643 ; RR = 4.087), low income (OR = 7014 ; RR = 5.554) , gestational hypertensive disorders (OR = 16.35 ; RR = 13.27) , re alization of pre - natal (OR = 5.023 ; RR = 4.254) and C - section before labor(OR = 39.21 ; RR = 31.25). In cognitive/Mini - cex analysis were noted significant difference in the performance of students on the subject (3.75 ± 0.93, 4.03 ± 0.94 and 4.88 ± 0.35). We still observed the best performance of residents, when compared to graduation students (p < 0.01). Conclusions: the prevalence of near miss was associated with socioeconomic/clinics factors and care issues, revealing the importance of interventions to improve these indicators. In addition, we suggest a better curriculum insertion of this subject in the medical Course disciplines due the importance to avoid the near miss through of adequacy of medical education.

Efeitos de um programa de treino cognitivo e das técnicas de higiene do sono para as funções executivas e para a qualidade de sono em idosos saudáveis

The aging process causes changes in the elderly’s sleep/awake standard impairing their cognitive abilities, particularly executive functioning, which already suffers loss by aging. The literature suggests that executive function and preserved sleep quality are key to maintaining good quality of life and independence of older people, requiring interventions to minimize the impact of losses incurred by the aging process. This study evaluated the effect of a cognitive training program and sleep hygiene techniques for executive functions and sleep quality in healthy older people. The participants were 41 healthy older adults, of both sexes, who were randomly divided into four groups: control group [GC], cognitive training group [GTC], sleep hygiene group [GHS] and training group + hygiene [GTH]. The research was developed in three stages: 1st - initial assessment of cognition and sleep; 2nd - specific intervention to each group; 3rd - post-intervention revaluation. The results showed that GTC had significant improvements in cognitive tasks flexibility, planning, verbal fluency and some aspects of episodic memory, besides gains in sleep quality and decrease on daytime hypersomnolence. The GHS improved sleep quality and daytime sleepiness as well and had significant improvements in insights capacity, planning, attention and in all evaluated aspects of episodic memory. The GTH had significant gains in cognitive flexibility, problem solving, verbal fluency, attention and episodic memory. The CG showed significant worsening in excessive daytime sleepiness in capacity planning. Thus, we conclude that cognitive training interventions and sleep hygiene strategies are useful in improving cognitive performance and quality of healthy elderly sleep.

Serviços-escola de psicologia do Rio Grande do Norte: formação profissional e política pública de saúde em debate

The Psychology University Services is stablished normatively as an indispensable equipment to the recognition of the graduation courses of psychologists by the Brazilian Education Ministery. The Public Healthcare Policies (Universal Health System/SUS) constitutes itself as a input field of the professional category, but shows huge challenges in the formation of these professionals. The objective of this work is to analyse the functioning of the Psychology University Services (SEP) and the Superior Educational Institutions from Natal, understood as important formation devices to attend the actual demands of the psychologist's work on SUS. For this, it sought a) characterize the psychological practices developed in the SEP; b) relate the National Curricular Lines of Direction of the psychology courses to the skills and competences developed in the SEP to the performance on the public healthcare policies; c) mapping ways of including the SEP in the network designed by the healthcare policy. Interviews were performed with 13 academic supervisors, 8 field supervisors and technicians of superior level (TNC), along with 9 managers, being for of the Psychology University Services and 5 of the graduation programs. Questionnaires were also applied to 57 interns and 24 graduates. Besides that, two conversation circles were performed with the faculty and technician members from two of the Educational Institutions that were participating of the research, as well as a workshop with students and psychologists, promoted by the CRP 17. We observed that most part of the faculty members and managers know the DCN and comprehend that the formation is in process of change in what concerns to the extension of the formation to the performance of the psychologists in various contexts. However, most part of the TNC don't know about them. Moreover, the results point to the predominance of the assisting model based on the traditional clinic psychology, although the articulation with the public healthcare and social assistance networks can already be timidly visualized. Different modalities of practices in theses Psychology University Services were also detected, such as conversation groups, thematic workshops, organizational consultancies, team meetings with the interns and TNS in a daily basis, matriciament in mental health, therapeutic monitoring, among others. Yet, the SEP in Rio Grande do Norte are still isolated from the other courses that perform in the healthcare area and also from the services that compose the public healthcare and public policies.

Efeitos do treino de marcha em esteira com adição de carga ao membro inferior não parético de indivíduos com acidente vascular cerebral: ensaio clínico controlado e randomizado

Introduction: Gait after stroke is characterized by a significant asymmetry between the lower limbs, with predominant use of the non-paretic lower limb (NPLL) over using the paretic lower limb. Accordingly, it has been suggested that adding load/weight to the NPLL as a form of restricting the movement of this limb may favor the use of the paretic limb, reducing interlimb asymmetry. However, few studies have been conducted up to this moment, which only investigated the immediate effects of this practice. Objectives: 1) Investigating whether there is an influence of adding load to the NPLL during treadmill training on cardiovascular parameters and on gait performance of individuals with stroke, compared to treadmill training without load addition; 2) Analyzing the effects of treadmill training with and without load added to the NPLL on kinematic parameters of each lower limb during gait; 3) Analyzing the effects of treadmill training with and without load added to the NPLL on measurements of functional mobility and postural balance of these patients. Materials and Methods: This is a randomized single blinded clinical trial involving 38 subjects, with a mean age of 56.5 years, at the subacute post-stroke phase (with mean time since stroke of 4.5 months). Participants were randomly assigned into an experimental group (EG) or control group (CG). EG (n= 19) was submitted to gait training on a treadmill with the addition of load to the NPLL by ankle weights equivalent to 5% of body weight. CG (n= 19) was only submitted to gait training on a treadmill. Behavioral strategies which included home exercises were also applied to both groups. The interventions occurred daily for two consecutive weeks (Day 1 to Day 9), being of 30 minutes duration each. Outcome measures: postural balance (Berg Functional Balance Scale – BBS), functional mobility (Timed Up and Go – TUG; kinematic variables of 180° turning) and kinematic gait variables were assessed at baseline (Day 0), after four training sessions (Day 4), after nine training sessions (Day 9), and 40 days after completion of training (Follow-up). Cardiovascular parameters (mean arterial pressure and heart rate) were evaluated at four moments within each training session. Analysis of variance (ANOVA) was used to compare outcomes between EG and CG in the course of the study (Day 0, Day 4, Day 9 and Follow-up). Unpaired t-tests allowed for intergroup comparison at each training session. 5% significance was used for all tests. Results: 1) Cardiovascular parameters (systemic arterial pressure, heart rate and derivated variables) did not change after the interventions and there were no differences between groups within each training session. There was an improvement in gait performance, with increased speed and distance covered, with no statistically significant difference between groups. 2) After the interventions, patients had increased paretic and non-paretic step lengths, in addition to exhibiting greater hip and knee joint excursion on both lower limbs. The gains were observed in the EG and CG, with no statistical difference between the groups and (mostly) maintained at follow-up. 3) After the interventions, patients showed better postural balance (higher scores on BBS) and functional mobility (reduced time spent on the TUG test and better performance on the 180° turning). All gains were observed in the EG and CG, with no statistically significant difference between groups and were maintained at follow-up. Conclusions: The addition of load to the NPLL did not affect cardiovascular parameters in patients with subacute stroke, similar to treadmill training without load, thus seemingly a safe training to be applied to these patients. However, the use of the load did not bring any additional benefits to gait training. The gait training program (nine training sessions on a treadmill + strategies and exercises for paretic limb stimulation) was useful for improving gait performance and kinematics, functional mobility and postural balance, and its use is suggested to promote the optimization of these outcomes in the subacute phase after stroke.

Educação superior em turismo: o profissional de turismo frente às competências exigidas pelo mercado de trabalho do setor hoteleiro em Natal

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior