Preval��ncia e fatores associados �� diminui����o da fun����o pulmonar em obesos em pr��-operat��rio de cirurgia bari��trica

Introduction: Obesity shows changes in pulmonary function and respiratory mechanics, however, little is known regarding the prevalence of worsening respiratory function when considering the increase in central or peripheral adiposity or general obesity. Objectives: To analyze the association between anthropometric adiposity and decreased lung function in obese. Materials and Methods: Patients eligible for this study obese individuals (IMC���30kg/m2) in pre-bariatric surgery and referred for Treatment Clinic of Obesity and Related Diseases, located at the University Hospital Onofre Lopes (HUOL), from October 2005 and July 2014. The evaluation included clinical information and measurement of anthropometric measures (body mass index (BMI), body fat index (BFI) and waist circumference (WC) and neck (NC)) and spirometric. The prevalence and analysis by Poisson regression was performed considering the following outcome variables: forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and Maximum Voluntary Ventilation (MVV) and as predictor variables were considered: BMI, IAC, WC and NC and as control variables: age, gender, smoking history and comorbidities (diabetes mellitus, dyslipidemia and hypertension). Statistical analysis was performed using Statistical Package for Social Sciences software (SPSS - version 20.0). Results: We analyzed 384 individuals, 75% women, mean BMI: 46.6 (�� 8.7) kg/m2, IAC: 49.26 (�� 9.48)%, WC: 130.84 (�� 16.23) cm and NC: 42.3 (�� 4.6) cm. The higher prevalence of FVC and FEV1 <80% was observed in individuals with NC above 42 cm, followed those with a BMI above 45 kg/m2. Multivariate analysis using Poisson regression showed as risk factors associated with FVC <80%, the variables: NC above 42 cm (odds ratio (OR) 2.41) and BMI over 45Kg/m2 (OR 1.71 ). As for FEV1 <80% predicted, all predictor variables were associated, with the largest odds presented by the NC (3.40). MVVV was not associated with any studied varaible. Conclusion: Individuals with NC above 42 cm had higher prevalence of reduced lung function and the NC was the measure with the highest association with reduced lung function in obese.

Influ��ncia de fatores ambientais na Leishmaniose visceral no Rio Grande do Norte

The Visceral Leishmaniose (LV) disease is endemic in some places in Brazil. It is caused by the protozoa Leishmania chagasi, being transmitted for vector, the phlebotomies, Lutzomyia longipalpis. In virtue of the expansion of the illness in Rio Grande do Norte, it is necessary to evaluate the determinative ambient factors in the proliferation of the vector for better control of the illness. The variable rainfall and the social variables had been analyzed using space regression with two models and the ambient variable of ZANE and the variables analyzed in 205 houses in the cities of Natal, Extremoz, N��sia Floresta, S��o Gon��alo do Amarante, S��o Jose do Mipibu, Parnamirim and Maca��ba the Person and ML Chi-square were used . The analyses had shown that high rainfall, plain relief, the forest, the humid tropical climate the activities of production culture of sugar cane and fruit culture and the presence of bovines increase the risk of the LV. The work showed that it has space aggregation and that ambient factors influence in the LV in the State

An��lise da contribui����o de fatores gen��ticos e ambientais na manuten����o da hanseniase nos estados do Rio Grande do Norte e Par��

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior

Influ��ncia de fatores biopsicossociais sobre a mortalidade de idosos no munic��pio de Santa Cruz/RN: um estudo prospectivo

The aging process if characterizes for a complex events network, from multidimensional nature, that encloses biological, social, psychic and functional aspects. The alteration of one or more aspects can speed up the aging process, anticipating limitations and until the death in the aged. For an adjusted confrontation of this question is necessary an interdisciplinary vision, in which the some areas of the knowledge can interact and with this to intervenes of the best possible form. Then, information derived from studies of aspects related to incidence, morbidity-mortality and transition patterns, involved in the health-illness process can more accurately identify risk groups thereby establishing links between social factors, illness, incapacity and death. Thus, this study aimed to identify, by a multidimensional vision, the risk factors of mortality in a coorth of elderly in a city in the interior of the state of Rio Grande do Norte (RN), Brazil. A prospective study carried out in Santa Cruz RN, where 310 elderly were randomly selected to form a baseline. The follow-up was 53 months. The predictive variables were divided into sociodemographic, physical health, neuropsychiatric and functional capacity. The statistical analysis carried out by bivariate analysis, survival analysis, followed by binary logistic regression and Cox regression, in the multivariate analysis, considering significant levels p < 0.05 and confidence interval (CI) of 95%. A total of 60 (19.3%) elderly died during the follow-up, where cardiovascular disease was the main cause. The survival was approximately 24.8 months. The study of general survival showed, at 12, 24, 36, and 48 months of observation, a survival rate of 97%, 54%, 31%, and 5% respectively, with a statistical difference in survival only observed for the variables of cognitive function and Basic Activities of Daily Living. In the logistic regression analysis, the risk factors identified were cognitive deficits (OR = 8.74), poor perception of health (OR = 3.89) and dependence for Basic Activities of Daily Living (OR = 3.96). In the Cox analysis, as well as dependence for Basic Activities of Daily Living (HR = 3.17), cognitive deficit (HR = 4.30) and stroke (CVA) (HR = 3.49) continued as independent risk factors for death. The risk factors found in the study can be interpreted as the primary predictors for death among elderly members of the community. Therefore, improvements in health conditions, with actions towards sustaining an autonomous life with special attention for elderly with cognitive impairment, could mean additional healthy quality of life, resulting in the reduction of premature mortality in this population

Fatores preditivos da dor em pacientes submetidos �� cirurgia card��aca

A identifica����o de fatores que interferem na dor p��s-operat��ria �� ��til para minimizar o sofrimento desnecess��rio e favorecer a uma interven����o analg��sica adequada, evitando generaliza����es nas condutas terap��uticas. O prop��sito dessa investiga����o foi identificar os fatores preditivos da dor em pacientes submetidos �� cirurgia card��aca e a rela����o existente entre dor, analgesia e personalidade. Trata-se de um estudo prospectivo e anal��tico, aprovado pelo comit�� de ��tica da UFRN (175/06), o qual proporcionou uma abordagem multidisciplinar ao envolver ��reas distintas como: fisioterapia, psicologia, m��dica e enfermagem (interdisciplinaridade) na elucida����o do objeto de estudo relacionado a fatores preditivos da dor. Para caracteriza����o geral dos pacientes foi utilizada uma ficha de avalia����o fisioterap��utica; a dor p��s-operat��ria foi avaliada pela escala num��rica de dor e question��rio para dor McGill e o Invent��rio Millon de Estilos de Personalidade (MIPS) foi utilizado para identificar e avaliar as manifesta����es das caracter��sticas comportamentais e de personalidade. Foram acompanhados, do 1�� ao 5�� dia de p��s-operat��rio (DPO), 160 pacientes submetidos �� cirurgia card��aca, 57,5% do sexo masculino, com idade m��dia de 56,8��14,4 anos, sendo inclu��dos no estudo aqueles que se queixaram de dor no p��s-operat��rio em pelo menos um dos dias de avalia����o e assinaram termo de concentimento livre e esclarecido (TCLE). Os dados foram submetidos ao teste Qui-quadrado, regress��o log��stica multivariada, teste de correla����o de Spearman, teste t e ANOVA. Ao serem submetidos �� an��lise de regress��o foram encontrados seis fatores preditivos da dor: tempo cir��rgico > 3 horas, dreno mediastinal e lateral, tosse, v��mitos, tempo de dreno > 24 horas e sexo feminino. Estes fatores apresentaram uma correla����o positiva e significava com a intensidade dolorosa referida pelos pacientes na escala num��rica de dor e os pacientes que apresentaram mais fatores preditivos da dor referiram mais dor. 23 J�� em rela����o ao McGill n��o se obteve diferen��a significativa entre os pacientes com mais e menos fatores preditivos. Observou-se que foram administrados diferentes tipos de analg��sicos, isolados ou associados, sendo estes: paracetamol, paracetamol associado �� code��na, dipirona, tramadol, toradol e tilatil. A percep����o dolorosa apresentou magnitudes variando de leve a moderada do 1�� ao 5�� DPO e ao ser relacionada com as caracter��sticas de personalidade, nos pacientes com menos dor, observou-se os fatores: preserva����o, individualismo, introvers��o e os com mais dor foram: prote����o, extrovers��o, retraimento, discrep��ncia, afetividade, acomoda����o, comunicabilidade e firmeza. Evidenciou-se que o comportamento doloroso p��s-cirurgia card��aca �� multifatorial e que a determina����o da exist��ncia de fatores preditivos da dor permite ao profissional da ��rea de sa��de fazer o uso adequado dos analg��sicos, haja vista que o al��vio da dor �� responsabilidade de todos os profissionais da sa��de. Os aspectos psicol��gicos enquanto caracter��sticas de personalidade podem influenciar padr��es de comportamento como os observados.

Fatores litog��nicos em pacientes com lit��ase urin��ria de Fortaleza, Cear��

Lithiasis is considered a public health issue due to its high prevalence and rates of recurrence. Objective: To identify risk factors for lithiasis in kidney stone patients from Fortaleza, Brazil. In the first stage of the study, the medical records of 197 patients with urinary lithiasis covering the period 1996 2006 were analyzed with regard to clinical and metabolic data. In the second stage, 340 kidney stones were submitted to morphological examination under 10x magnification. According to the external morphology and the cut surface, the stones were classified as pure or mixed, and major and minor components were identified. In addition, the stone fragments of 25 patients treated with lithotripsy were submitted to morphological analysis. In the third stage, a subsample of 50 stones was used in a double-blind comparison of morphological and chemical findings. Results were expressed as concordant, partly concordant (discordant for minor components) or discordant (discordant for major components). The average age of first symptoms was 35.8��13.3 years, with no significant difference between the genders. The male/female ratio was 1:1.7. Recurrence was reported in 53.3% of cases. The main metabolic changes observed were hypernatriuria (80.7%), hypercalciuria (48.7%), low urine volume (43.7%), hyperoxaluria (30.5%) and hyperuricosuria (17.3%). Pure stones represented 34.7% of the total sample of 340 stones. The most common route of elimination was spontaneous for pure stones (49.1%) and surgical for mixed stones (50.5%). Pure stones consisted most frequently of calcium oxalate (OxCa) (59.3%) and uric acid (UA) (23.7%), the former prevalent in women, the latter prevalent in men. The most frequently observed component in mixed stones was OxCa (67.1%), followed by carbapatite (11.2%) and struvite (7.9%). The main components were OxCa and UA for men, and carbapatite and struvite for women. Nearly half (48%) the 25 analyzed fragments were pure, consisting of calcium oxalate dihydrate (COD) (56%), calcium oxalate monohydrate (COM) (48%), phosphate (32%) and UA (20%). Four patients (16%) had infectious stones. In the chemical analysis of the subsample of 50 stones, the most 64 frequently observed major components were calcium (70%), oxalate (66%), ammonium (56%), urate (28%) and carbonate (24%). In the morphological analysis, the main components were calcium and magnesium phosphate (32%), COM (24%), UA (20%), COD (18%) and cystine (6%). Morphological and chemical findings were totally concordant for 38% of the stones, partly concordant in 52% and discordant in 10%. Conclusion: The risk factors for lithiasis in kidney stone patients from Fortaleza (Brazil) were hyperoxaluria, hypercalciuria with or without hypernatriuria, hyperuricosuria and low urine volume

Aptid��o f��sica relacionada �� sa��de de escolares Norte- Rio-Grandenses

O sedentarismo �� cada vez mais acentuado entre os adolescentes em todo o mundo. Objetivou-se neste estudo analisar o estado nutricional e a aptid��o f��sica de escolares norte-rio-grandenses. Participaram 2065 sujeitos, selecionados aleatoriamente (Masc = 1066, Fem = 999) (Natal n=1158; Mossor�� n= 312; Lajes n= 231), divididos em tr��s grupos et��rios pelos est��gios maturacionais: 10 a 12 anos, 13 a 14 anos e _ 15 anos. Foi avaliada a composi����o corporal (IMC, dobras cut��neas tr��ceps e subescapular); o h��bito alimentar (question��rio de preval��ncia do consumo por grupo alimentar); o ��ndice de atividade f��sica (question��rio Baeck) e o n��vel de aptid��o f��sica (testes do salto em dist��ncia, flexibilidade, resist��ncia abdominal e cardiovascular). Utilizando-se a estat��stica descritiva, testes de m��dias pela an��lise dos intervalos de confian��a, o teste de Kruskall-Wallis, teste t, o Qui2 e o coeficiente de conting��ncia. Encontraram-se diferen��as significativas com p < 0001 na distribui����o do ��ndice de massa corporal (n = 1701); Regi��o Leste Potiguar (RLP) com excesso de peso e obesidade de 16,8 % e 15,2 %, a Regi��o Oeste 16,3% e 9,6 % e a Regi��o Central 10,4 % e 3,9 %, com as escolas privadas contribuindo significativamente na preval��ncia dessas vari��veis nas RLP e ROP com p < 0,003 e p < 0,001 respectivamente. O h��bito alimentar demonstrou que 98,3% dos sujeitos consomem alimentos do grupo das massas 98,3%; cereais 97,7%; latic��nios 94,7%; frutas 92,3%; gorduras 88,3% e as hortali��as 61,6%, n��o havendo diferen��as significativas no consumo alimentar entre o tipo de escolas e g��nero (n = 300). No ��ndice de atividade f��sica habitual h�� diferen��as entre esses respectivos extratos: 2,65��0,78 e 2,81��0,80 (p < 0,014) e 2,89��0,82 e 2,57��0,78 (p < 0,001), com as pr��ticas de atividades esportivas, programas de exerc��cios f��sicos e lazer ativo mais significativo em escolas privadas 2,85 �� 1,06 e 3,37��1,26 (p < 0,001) em prol do sexo masculino com 3,47��1,24 e 2,75��1,03 (p <0,001). Resist��ncia abdominal ( =19) e for��a de membros inferiores ( =128,5 cm) foram classificadas como muito fraco , a flexibilidade ( =26,9 cm) razo��vel e resist��ncia geral ( =1439 m) como bom . Conclui-se que o h��bito alimentar e o baixo ��ndice de atividade f��sica habitual influenciam negativamente os ��ndices da aptid��o f��sica relacionada �� sa��de dos escolares, com menor incid��ncia em institui����es privadas em fun����o das pr��ticas esportivas. Este estudo apresenta rela����o de interface multidisciplinar, tendo o seu conte��do uma aplica����o nos campos da Medicina, Nutri����o e Educa����o F��sica

Estado nutricional antropom��trico, composi����o corporal e press��o arterial em adolescentes

Os objetivos deste trabalho foram: (1) estimar as preval��ncias de excesso de peso e de gordura corporal, obesidade central e press��o arterial elevada (PAE) em adolescentes benefici��rios do Programa Nacional de Alimenta����o Escolar (PNAE) da rede municipal de ensino de Natal-RN; (2) verificar a associa����o entre vari��veis antropom��tricas e de composi����o corporal com a press��o arterial, a matura����o sexual e a hist��ria familiar positiva de fatores de risco para doen��a cardiovascular (FRDCV); (3) comparar dois padr��es de refer��ncia para classifica����o do excesso de peso em adolescentes; e (4) propor equa����es preditivas de massa gorda (MG) e massa livre de gordura (MLG) baseadas nos per��metros corporais. Trata-se de um estudo transversal, com 526 adolescentes benefici��rios do PNAE, em Natal, Brasil. O tamanho da popula����o de estudo foi definido por amostragem aleat��ria, em dois est��gios, e ponderada segundo n��mero de alunos de cada escola. No primeiro estudo, o excesso de peso foi determinado por ��ndice de Massa Corporal (IMC), a gordura corporal estimada por dobras cut��neas e a obesidade central por per��metro abdominal. A press��o arterial elevada foi classificada conforme a American Academy of Pediatrics. As preval��ncias foram apresentadas em valores relativos e efeito do desenho. Realizou-se uma an��lise fatorial para sintetizar o conjunto de vari��veis antropom��tricas visando identificar fatores comuns. Extra��ram-se dois fatores: (1) padr��o excesso de adiposidade e (2) padr��o adiposidade central elevada. Para avaliar a associa����o entre os padr��es de adiposidade corporal com press��o arterial elevada, faixa et��ria, matura����o sexual e hist��ria familiar de FRDCV utilizou-se a Raz��o de Chances e respectivo intervalo de confian��a de 95% e regress��o log��stica. No segundo estudo, calculou-se a sensibilidade e a especificidade do excesso de peso classificado segundo o IOTF e a World Health Organization WHO em rela����o ao excesso de adiposidade corporal; e a estat��stica Kappa para medir a concord��ncia entre os dois padr��es de refer��ncia. No terceiro estudo, foram elaborados modelos preditivos de MG e MLG com base em nove per��metros corporais, utilizando a bioimped��ncia Byodinamics 450 como padr��o de refer��ncia. Para tanto foram selecionados 218 adolescentes eutr��ficos, segundo o IMC a partir do estudo transversal. As equa����es foram estimadas por regress��o linear m��ltipla, considerando a idade e os per��metros corporais. Os resultados apontaram que 14,1% dos meninos e 15,7% das meninas tinham excesso de peso; 15,3% dos meninos e 11,6% das meninas tinham excesso de gordura corporal e dentre os meninos 14,3% tinham press��o arterial elevada e as meninas, 21,4%. Todos os efeitos do desenho foram inferiores a 2,5%. Nos meninos, o padr��o excesso de adiposidade foi associado �� hist��ria familiar positiva de FRDCV (ORajust=2,60; 1,09-6,22), matura����o sexual (ORajust=2,92; 1,04-8,22) e PAE (ORajust=3,66; 1,34-9,94). Os meninos com 12 anos e mais apresentaram 6,1 vezes mais chance de apresentar padr��o adiposidade central elevada do que os adolescentes com 10 a 11 anos (IC95% 2,32-16,04), assim como os p��beres apresentaram 3,2 vezes este mesmo padr��o em rela����o aos pr��-p��beres (IC95%1,14-8,85). A partir da compara����o entre os dois padr��es de referencia de classifica����o do excesso de peso por meio do IMC, observou-se que a sensibilidade foi de 79,3% para o crit��rio IOTF e de 88,9% para WHO e a especificidade foi de 94,7% e 89,9%, respectivamente. O n��vel de concord��ncia foi maior para o crit��rio IOTF (Kappa=0,70 x Kappa=0,64). Em rela����o �� constru����o das equa����es preditivas de gordura corporal, do total de 106 meninos e 112 meninas, foram desenvolvidas duas equa����es para estimar MG e duas para MLG, considerando o sexo. No sexo masculino, a equa����o para estimar a MG incluiu as vari��veis idade, punho, quadril e per��metro abdominal (R2=0,552; AIC=416,04) e MLG, idade, punho e antebra��o (R2=0,869; AIC=578,24). Enquanto que no feminino, MG foi estimada pelas vari��veis punho, per��metro do abd��men, do quadril, da coxa proximal e da panturrilha (R2=0,838; AIC=415,36); e a MLG por idade, punho, per��metro do abd��men, do quadril e da panturrilha (R2=0,878; AIC=512,48). Conclui-se que os adolescentes tinham elevada preval��ncia de excesso de adiposidade corporal e de press��o arterial elevada. Tanto o padr��o excesso de adiposidade quanto adiposidade central elevada constituem-se em padr��es de risco. O padr��o excesso de adiposidade foi associado �� press��o arterial, hist��ria familiar positiva de FRDCV e matura����o sexual em meninos. O crit��rio IOTF mostrou-se menos sens��vel, mais espec��fico, com maior n��vel de concord��ncia e maior probabilidade de identificar corretamente o excesso de gordura corporal nos adolescentes avaliados. Quatro equa����es foram desenvolvidas para a estimativa da MG e MLG em adolescentes. As equa����es desenvolvidas para estimar a MG no sexo feminino e MLG para ambos os sexos apresentaram valores elevados de coeficiente de determina����o ajustados e, portanto, s��o as preferenciais. Este estudo foi realizado com a participa����o de equipe multidisciplinar composta por professores da ��rea de Nutri����o, Endocrinologia Pedi��trica, Estat��stica, Educa����o F��sica, discentes do Curso de Gradua����o em Nutri����o e residentes em Pediatria

Avalia����o da preval��ncia de S��ndrome Metab��lica, Microalbumin��ria e Risco Cardiovascular em mulheres com S��ndrome dos Ov��rios Polic��sticos

Avaliar fatores de risco cardiovascular em mulheres brasileiras com s��ndrome dos ov��rios polic��sticos (SOP), atrav��s da utiliza����o de m��ltiplos par��metros, incluindo a determina����o da preval��ncia de s��ndrome metab��lica e seus componentes e pesquisa de microalbumin��ria como marcador de um poss��vel dano renal precoce nessas pacientes. M��todos: Foram avaliadas 102 mulheres de 20-34 anos de idade, com diagn��stico de SOP pelo Consenso de Rotterdam, tendo sido analisados par��metros cl��nicos, antropom��tricos, bioqu��micos e hormonais. Para diagn��stico de s��ndrome metab��lica, foram adotados crit��rios do National Cholesterol Education Program s Adult Treatment Panel III (NCEP-ATP III). Para avalia����o da microalbumin��ria foi utilizada a rela����o albumina/creatinina (A/C), calculada a partir dos n��veis de albumina e creatinina em amostra isolada de urina. Foram realizados testes estat��sticos para avaliar associa����es e correla����es entre vari��veis, bem como compara����o de m��dias ou medianas, adotando-se n��vel de signific��ncia de 5%. Resultados: A preval��ncia de s��ndrome metab��lica foi de 28,4% (29 em 102 pacientes), estando associada ao aumento do ��ndice de massa corporal (IMC). Quanto �� an��lise da preval��ncia dos componentes individuais da s��ndrome metab��lica, evidenciou-se: HDL-colesterol < 50 mg/dl em 69,6%, circunfer��ncia da cintura &#8805; 88 cm em 57,9%, triglicer��deos &#8805;150 mg/dl em 31,7%, press��o arterial &#8805;130/85 mmHg em 18,6% e glicemia de jejum &#8805;110 mg/dl em 2,9%. Quando definida pelos limites convencionais para a rela����o A/C (3,5 35 mg/mmol), a microalbumin��ria esteve presente em apenas tr��s pacientes (3,3%). Entretanto, considerando diferentes limites de corte estabelecidos em recentes estudos que demonstraram aumento do risco cardiovascular associado a n��veis muito baixos da rela����o A/C, a preval��ncia em mulheres com SOP foi alta, variando de 17,7 a 43,3% (para valores &#8805; 0,58 e &#8805; 0,37 mg/mmol, respectivamente). Mulheres com intoler��ncia �� glucose apresentaram n��vel significativamente mais elevado da rela����o A/C, quando comparadas ��s mulheres com normoglicemia. Os valores de microalbumin��ria n��o apresentaram correla����o significativa com IMC, n��veis press��ricos, ��ndices de sensibilidade insul��nica ou perfil lip��dico. Conclus��es: Os dados evidenciam uma alta preval��ncia de s��ndrome metab��lica e seus componentes individuais em mulheres brasileiras com SOP. Al��m do mais, observou-se elevado percentual de mulheres com n��veis de excre����o urin��ria de albumina em faixas significativamente associadas com aumento do risco para eventos cardiovasculares. Em conjunto, esses dados alertam para a necessidade da abordagem interdisciplinar e multidisciplinar das pacientes com SOP, visando �� institui����o de medidas voltadas para a preven����o prim��ria cardiovascular

Preval��ncia e fatores associados �� dor em professores de educa����o f��sica em academias de gin��stica da cidade do Salvador-BA

Physical Education professionals are usually exposed to excessive physical workloads that evolve into painful symptomatology and muscle and bone disorders that originate from the work-related exercises. Purposo: The goal of this study was to investigate the prevalence and factors associated with pain painful symptomatology in teachers in gymnastics academies. An analytical transversal cut study was performed involving 163 gymnastics teachers working in the main gyms in the city of Salvador-BA. For evaluation of pain, validated versions in Portuguese of the McGill Protocol and the Wisconsin Pain Inventory were used. For obtain results of descriptive statistical analysis of the collected data was performed, followed by TStudent, and Pearson and Spearman correlation tests to verify possible correlations between the presence of pain and other variables which were considered independent. Finally, for the identification of potential risk factors associated with pain, a binary logistic regression analysis was performed. For all statistical analysis, we cnsidered p< 0.05. Results: The painful symptoms was reported by 88.3% of the subjects surveyed. High pain levels were observed in 63.8% of the interviewed professionals, where the intensity varied from moderate to severe. Pain in the lumbar region was present in 55.2% of subjects. Positive correlations were found between the level of pain intensity and the variables related with the workload activity and daily life of the teachers in almost all body joints analyzed. Some factors had been verified associates to the painful sintomatologia as the age of the professionals, the daily hours load of labor work, and the lack of interval of rest between the lessons. Conclusions: We found a high prevalence in gym teachers working in the city of Salvador-BA, which interfered in various daily activities of their home and professional lives. The most affected region was the lumbar region, followed by the knees, neck, shoulders, ankles, hands, hips, feet, elbows and forearms. The factors associated with development of painful symptomatology were the age of the professionals, daily hours of work and the lack of rest intervals between lessons. The high prevalence of pain in Physical Education teachers can be regarded as a serious occupational health problem, which would demand the urgent deployment of preventive intervention programs to minimize the impact of pain among these professionals

Estudo dos fatores associados �� infec����o chag��sica em ��rea end��mica do Rio Grande do Norte

The Chagas disease is a infectious and parasite disease that has as the causative agent a Trypanosoma cruzi, a protozoan parasite that can be transmitted to humans by the faeces of triatomines ( barbeiros ) in the blood-sucking. To understand the relationship between factors associated with chagasic infection and the risk of transmission of Trypanosoma cruzi, this work aimed to make a correlation between the results of serology, obtained by different immunological techniques, used for diagnosis of Chagas disease and risk factors to which the population of the city of Apodi-RN is exposed, to be considered a endemic area. The case-control study was conducted with 199 individuals, which initially was applied a questionary about socio-economic questions and some risk factors which they were exposed and also favor the spread of disease. Then was given the diagnosis by immunological techniques of serology by indirect hemagglutination, ELISA and indirect immunofluorescence. From the diagnosis, the subjects were divided into case group (presence of infection) and control group (no infection). Regarding the descriptive characteristics of the sample, were found a higher frequency of female individuals (59.3%), between 36 and 50 years of age (36.7%), with low education level (91%) and income monthly up to 1 minimum wage (67.8%). The serology, performed by three techniques of different principles, had a reactivity of 38.9% by Indirect Hemagglutination, 39.7% by ELISA and 38.7% by Indirect Immunofluorescence. As the result of the serology, 71 of samples showed reactivity in 2 or more techniques. On some risk variables, was found a significant relationship between individuals who had been bitten by the triatomines and had positive serology for Chagas disease (93.3%). Other variables of risk revealed individuals who had positive serology and had domestic animal (80.3%), lived in poorly maintained homes (97.2%) and near the forest (84.5%). A better understanding of the dynamics of transmission of T. cruzi and the risk factors that contribute to its occurrence in a region are needed to develop effective strategies for control of Chagas disease in these ��reas

Influ��ncia das medidas antropom��tricas sobre a press��o arterial sist��mica de hipertensos cadastrados nas unidades de sa��de da fam��lia no munic��pio de Jo��o Pessoa - PB

Este trabalho objetiva avaliar a influ��ncia das medidas antropom��tricas sobre a press��o arterial sist��mica de uma coorte de hipertensos atendidos nas Unidades de Sa��de da Fam��lia (USF) no munic��pio de Jo��o Pessoa-PB durante o per��odo de 2008 a 2011. Para verificar as diferen��as de n��veis press��ricos entre as medidas realizadas nas consultas referentes ao cadastro, e a ultima press��o obtida no per��odo de acompanhamento foram utilizadas informa����es sobre a identifica����o, dados cl��nicos do paciente, fatores de risco e doen��as concomitantes. Testes estat��sticos de comparabilidade entre grupos foram empregados. Para investigar os padr��es de associa����o dos fatores de risco das vari��veis antropom��tricas e sociodemogr��ficas com a hipertens��o dos pacientes, foi empregado o Modelo de Regress��o Log��stica. Foram encontradas associa����es significativas (p<0,005) da hipertens��o com a obesidade e o sedentarismo. Com os resultados desta pesquisa pretende-se: fornecer indicadores sobre a efetividade da Estrat��gia Sa��de da Fam��lia; avaliar a qualidade das informa����es antropom��tricas; contribuir para a defini����o de estrat��gias que garantam o melhoramento dos acompanhamentos dos hipertensos e fornecer elementos cient��ficos de apoio para outras USF e institui����es governamentais.

Fatores determinantes da near miss materna em uma unidade de terapia intensiva obst��trica: avalia����o das compet��ncias profissionais da ��rea m��dica

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.

A influ��ncia da perda de peso no perfil inflamat��rio de mulheres com s��ndrome dos ov��rios polic��sticos

The polycystic ovary syndrome (PCOS) is considered the most common endocrine disorder in reproductive age women, with a prevalence ranging from 15 to 20%. In addition to hormonal and reproductive changes, it is common in PCOS the presence of risk factors for developing cardiovascular disease (CVD) and diabetes mellitus, insulin resistance (IR), visceral obesity, chronic low-grade inflammation and dyslipidemia. Due to the high frequency of obesity associated with PCOS, weight loss is considered as the first-line treatment for the syndrome by improving metabolic and normalizes serum androgens, restoring reproductive function of these patients. Objectives: To evaluate the inflammatory markers and IR in women with PCOS and healthy ovulatory with different nutritional status and how these parameters are displayed after weight loss through caloric restriction in with Down syndrome. Methods: Tumor necrosis factor-alpha (TNF-��), interleukin-6 (IL-6) and C-reactive protein (CRP) were assessed in serum samples from 40 women of childbearing age. The volunteers were divided into four groups: Group I (not eutrophic with PCOS, n = 12); Group II (not eutrophic without PCOS, n = 10), Group III (eutrophic with PCOS, n = 08) and Group IV (eutrophic without PCOS, n = 10). The categorization of groups was performed by body mass index (BMI), according to the World Health Organization (WHO) does not eutrophic, overweight and obesity (BMI> 25 kg / m��) and normal weight (BMI <24.9 kg / m��). IR was determined by HOMA-IR index. In the second phase of the study a controlled dietary intervention was performed and inflammatory parameters were evaluated in 21 overweight and obese women with PCOS, before and after weight loss. All patients received a low-calorie diet with reduction of 500 kcal / day of regular consumption with standard concentrations of macronutrients. Results: Phase 1: PCOS patients showed increased levels of CRP (p <0.01) and HOMAIR (p <0.01). When divided by BMI, both not eutrophic group with PCOS (I) as eutrophic with PCOS (III) showed increased levels of CRP (I = 2.35 �� 0,55mg / L and 2.63 �� III = 0,65mg / L; p <0.01) and HOMA-IR (I = 2.16 �� 2.54 and III = 1.07 �� 0.55; p <0.01). There were no differences in TNF-�� and IL-6 between groups. Step 2: After the weight loss of 5% of the initial weight was reduced in all of the components of serum assessed inflammatory profile, PCR (154.75 �� 19:33) vs (78.06 �� 8.9) TNF �� (10.89 �� 5.09) vs (6:39 �� 1:41) and IL6 (154.75 �� 19:33) vs (78.06 �� 08.09) (p <0:00) in association with improvement some hormonal parameters evaluated. Conclusion: PCOS contributed to the development of chronic inflammation and changes in glucose metabolism by increasing CRP, insulin and HOMA-IR, independent of nutritional status. The weight loss, caloric restriction has improved the inflammatory condition and hormonal status of the evaluated patients.

Quedas em idosos assistidos na estrat��gia sa��de da fam��lia: frequ��ncia e fatores associados

The growth of the elderly population is a global phenomenon and, in Brazil, this transformation is happening in a very rapid rhythm. With the current population aging, this emerging age group will need more health care and attention. One of the characteristics of the population aging is the progressive accumulation of disabilities, which makes it more vulnerable to falls. This study was developed with the purpose of knowing the episode falls in the scope of an elderly population treated at a Family Health Unit. It is a research with cross-sectional nature, and its sample was composed by 121 elderly. The research was approved by the Ethics Committee of HUOL, with Opinion n�� 816.022. We applied a questionnaire to the participants, and the results were statistically analyzed by using Chi-square test and Fisher���s exact test to verify the association between variables. In order to perform a multivariate analysis, we used the method of the Binomial Logistic Regression. For both tests, we accepted significance p<0,05 and CI of 95%. The results prove that the majority belongs to the female gender (76,9%); the age group of elderly reaches 88,4% and 11,6% is over-aged; regarding the marital status, 35,3% are married and 29,4% widowed; 92,1% with family income between one and two minimum wages; and 91,8% live with their partners and/or children. Regarding the frequency of falls, we found that 61,2% of the surveyed elderly suffered one or more falls in 2014. As associated factors, it became clear that 73,8% were due to extrinsic factors, 6,4% to intrinsic factors and 21,4% to both factors. As a consequence of the fall, we found that 89,2% have fear of falling again, 37,3% showed anxiety and 13,3% had their ambulation affected. Concerning the exposure to the risk factors, the most prevalent places were: street/avenue (31,0%), pavement (19,0%), living room (14,3%) and courtyard/backyard (10,7%). The study has proven a statistically significant association among female gender (p=0,001), rubble/objects in the backyard (p=0,015) and furniture that may cause accidents (p=0,005). It was evident among the elderly people surveyed, 72.7% receive little information about falls, being a risk factor for falls. We conclude that there is a high frequency of falls in the surveyed elderly, thereby constituting a worrisome data because this event in the elderly population is a serious matter, which raises the need to ensure them a safe environment in their homes and, above all, outside them. The information provided by the Family Health Strategy team are important to avoid these occurrences, which reinforces the need for developing health education activities together with the population as a way to prevent and reduce the occurrence of falls, thereby improving the quality of life of elderly.