Estado nutricional antropométrico, perfil lipídico e consumo alimentar como fatores de risco para doença cardiovascular em adolescentes

The dyslipidemia and excess weight in adolescents, when combined, suggest a progression of risk factors for cardiovascular disease (CVD). Besides these, the dietary habits and lifestyle have also been considered unsuitable impacting the development of chronic diseases. The study objectives were: (1) estimate the prevalence of lipid profile and correlate with body mass index (BMI), waist circumference (WC) and waist / height ratio (WHR) in adolescents, considering the maturation sexual, (2) know the sources of variance in the diet and the number of days needed to estimate the usual diet of adolescents and (3) describe the dietary patterns and lifestyle of adolescents, family history of CVD and age correlates them with the patterns of risk for CVD, adjusted for sexual maturation. A cross-sectional study was performed with 432 adolescents, aged 10-19 years from public schools of the Natal city, Brazil. The dyslipidemias were evaluated considering the lipid profile, the index of I Castelli (TC / HDL) and II (LDL / HDL) and non-HDL cholesterol. Anthropometric indicators were BMI, WC and WHR. The intake of energy, nutrients including fiber, fatty acids and cholesterol was estimated from two 24-hour recalls (24HR). The variables of lipid profile, anthropometric and clinical data were used in the models of Pearson correlation and linear regression, considering the sexual maturation. The variance ratio of the diet was calculated from the component-person variance, determined by analysis of variance (ANOVA). The definition of the number of days to estimate the usual intake of each nutrient was obtained by taking the hypothetical correlation (r) ≥ 0.9, between nutrient intake and the true observed. We used the principal component analysis as a method of extracting factors that 129 accounted for the dependent variables and known cardiovascular risk obtained from the lipid profile, the index for Castelli I and II, non-HDL cholesterol, BMI, and WC the WHR. Dietary patterns and lifestyle were obtained from the independent variables, based on nutrients consumed and physical activity weekly. In the study of principal component analysis (PCA) was investigated associations between the patterns of cardiovascular risk factors in dietary patterns and lifestyle, age and positive family history of CVD, through bivariate and multiple logistic regression adjusted for sexual maturation. The low HDL-C dyslipidemia was most prevalent (50.5%) for adolescents. Significant correlations were observed between hypercholesterolemia and positive family history of CVD (r = 0.19, p <0.01) and hypertriglyceridemia with BMI (r = 0.30, p <0.01), with the CC (r = 0.32, p <0.01) and WHR (r = 0.33, p <0.01). The linear model constructed with sexual maturation, age and BMI explained about 1 to 10.4% of the variation in the lipid profile. The sources of variance between individuals were greater for all nutrients in both sexes. The reasons for variances were  1 for all nutrients were higher in females. The results suggest that to assess the diet of adolescents with greater precision, 2 days would be enough to R24h consumption of energy, carbohydrates, fiber, saturated and monounsaturated fatty acids. In contrast, 3 days would be recommended for protein, lipid, polyunsaturated fatty acids and cholesterol. Two cardiovascular risk factors as have been extracted in the ACP, referring to the dependent variables: the standard lipid profile (HDL-C and non-HDL cholesterol) and "standard anthropometric index (BMI, WC, WHR) with a power explaining 75% of the variance of the original data. The factors are representative of two independent variables led to dietary patterns, "pattern 130 western diet" and "pattern protein diet", and one on the lifestyle, "pattern energy balance". Together, these patterns provide an explanation power of 67%. Made adjustment for sexual maturation in males remained significant variables: the associations between puberty and be pattern anthropometric indicator (OR = 3.32, CI 1.34 to 8.17%), and between family history of CVD and the pattern lipid profile (OR = 2.62, CI 1.20 to 5.72%). In females adolescents, associations were identified between age after the first stage of puberty with anthropometric pattern (OR = 3.59, CI 1.58 to 8.17%) and lipid profile (OR = 0.33, CI 0.15 to 0.75%). Conclusions: The low HDL-C was the most prevalent dyslipidemia independent of sex and nutritional status of adolescents. Hypercholesterolemia was influenced by family history of CVD and sexual maturation, in turn, hypertriglyceridemia was closely associated with anthropometric indicators. The variance between the diets was greater for all nutrients. This fact reflected in a variance ratio less than 1 and consequently in a lower number of days requerid to estimate the usual diet of adolescents considering gender. The two dietary patterns were extracted and the pattern considered unhealthy lifestyle as healthy. The associations were found between the patterns of CVD risk with age and family history of CVD in the studied adolescents

Fatores que afetam a satisfação e a fidelidade do consumidor: um estudo com usuários de calçado esportivo (tênis), na Região Sul da cidade de Natal

This paper aims to investigate the factors that influence the satisfaction and fidelity of tennis´s users with the region southern city of Natal, capital of Rio Grande do Norte as the area of analyzing , using the national satisfaction index models as a tool to study. In this study was used the questionnaire as a tool for collecting data based on the new Norwegian customer satisfaction barometer model proposed by Johnson et. al. (2001). The data collection took place during the months of May and June 2008, when 450 tennis´s users were interviewed. The main results obtained by multiple regression analysis and logistic regression showed that the users' satisfaction with the tennis´s brand is influenced by the quality, comfort, material used in the manufacture and price, while fidelity is potentized by the image of the brand and the satisfaction degree with the user's tennis and with the brand of tennis. In relation to user satisfaction with the tennis, that satisfaction is influenced by the quality, comfort, weight and the material used, while fidelity is potentized by the satisfaction with the tennis´s brand, with the possibility of paying the same amount again and the emotional commitment. As the processing of claims there was no direct influence on satisfaction and consumers fidelity due to the low number complaints

Modelos de dispersão para extremos de precipitação. Estudo de caso: o nordeste do Brasil

In this thesis used four different methods in order to diagnose the precipitation extremes on Northeastern Brazil (NEB): Generalized Linear Model s via logistic regression and Poisson, extreme value theory analysis via generalized extre me value (GEV) and generalized Pareto (GPD) distributions and Vectorial Generalized Linea r Models via GEV (MVLG GEV). The logistic regression and Poisson models were used to identify the interactions between the precipitation extremes and other variables based on the odds ratios and relative risks. It was found that the outgoing longwave radiation was the indicator variable for the occurrence of extreme precipitation on eastern, northern and semi arid NEB, and the relative humidity was verified on southern NEB. The GEV and GPD distribut ions (based on the 95th percentile) showed that the location and scale parameters were presented the maximum on the eastern and northern coast NEB, the GEV verified a maximum core on western of Pernambuco influenced by weather systems and topography. The GEV and GPD shape parameter, for most regions the data fitted by Weibull negative an d Beta distributions (ξ < 0) , respectively. The levels and return periods of GEV (GPD) on north ern Maranhão (centerrn of Bahia) may occur at least an extreme precipitation event excee ding over of 160.9 mm /day (192.3 mm / day) on next 30 years. The MVLG GEV model found tha t the zonal and meridional wind components, evaporation and Atlantic and Pacific se a surface temperature boost the precipitation extremes. The GEV parameters show the following results: a) location ( ), the highest value was 88.26 ± 6.42 mm on northern Maran hão; b) scale ( σ ), most regions showed positive values, except on southern of Maranhão; an d c) shape ( ξ ), most of the selected regions were adjusted by the Weibull negative distr ibution ( ξ < 0 ). The southern Maranhão and southern Bahia have greater accuracy. The level period, it was estimated that the centern of Bahia may occur at least an extreme precipitatio n event equal to or exceeding over 571.2 mm/day on next 30 years.

As relações da tríplice hélice nas fundações de apoio brasileiras: uma avaliação da dinâmica de captação de recursos para projetos de inovação

Foundations support constitute one of the types of legal entities of private law forged with the purpose of supporting research projects, education and extension and institutional, scientific and technological development of Brazil. Observed as links of the relationship between company, university, and government, foundations supporting emerge in the Brazilian scene from the principle to establish an economic platform of development based on three pillars: science, technology and innovation – ST&I. In applied terms, these ones operate as tools of debureaucratisation making the management between public entities more agile, especially in the academic management in accordance with the approach of Triple Helix. From the exposed, the present study has as purpose understanding how the relation of Triple Helix intervenes in the fund-raising process of Brazilian foundations support. To understand the relations submitted, it was used the interaction models University-Company-Government recommended by Sábato and Botana (1968), the approach of the Triple Helix proposed by Etzkowitz and Leydesdorff (2000), as well as the perspective of the national innovation systems discussed by Freeman (1987, 1995), Nelson (1990, 1993) and Lundvall (1992). The research object of this study consists of 26 state foundations that support research associated with the National Council of the State Foundations of Supporting Research - CONFAP, as well as the 102 foundations in support of IES associated with the National Council of Foundations of Support for Institutions of Higher Education and Scientific and Technological Research – CONFIES, totaling 128 entities. As a research strategy, this study is considered as an applied research with a quantitative approach. Primary research data were collected using the e-mail Survey procedure. Seventy-five observations were collected, which corresponds to 58.59% of the research universe. It is considering the use of the bootstrap method in order to validate the use of the sample in the analysis of results. For data analysis, it was used descriptive statistics and multivariate data analysis techniques: the cluster analysis; the canonical correlation and the binary logistic regression. From the obtained canonical roots, the results indicated that the dependency relationship between the variables of relations (with the actors of the Triple Helix) and the financial resources invested in innovation projects is low, assuming the null hypothesis of this study, that the relations of the Triple Helix do not have interfered positively or negatively in raising funds for investments in innovation projects. On the other hand, the results obtained with the cluster analysis indicate that entities which have greater quantitative and financial amounts of projects are mostly large foundations (over 100 employees), which support up to five IES, publish management reports and use in their capital structure, greater financing of the public department. Finally, it is pertinent to note that the power of the classification of the logistic model obtained in this study showed high predictive capacity (80.0%) providing to the academic community replication in environments of similar analysis.

Avaliação do acesso aos serviços de reabilitação física para vítimas de acidentes de trânsito: caminhos para melhoria da qualidade do sistema de saúde

The Physical Rehabilitation services (PR) are of fundamental importance in combating the global epidemic of Traffic Accidents (TA). Considering the numerous physical and social consequences of the survivors, quality problems in access to PR are a hazard to recovery of victims. It is necessary to improve the management of quality of services, assessing priority dimensions and intervening in their causes, to ensure rehabilitation available in time and suitable conditions. This study aimed to identify barriers to access to rehabilitation considering the perception of TA victims and professionals. The aim is also to estimate the access to rehabilitation and their associated factors. This is a qualitative and quantitative study of exploratory nature developed in Natal / RN with semi-structured interviews with 19 health professionals and telephone survey to 155 victims of traffic accidents. To explore barriers to access the speeches were transcribed and analyzed using the Alceste software (version 4.9). During the interviews used the following guiding question: “What barriers hinder or prevent access to physical rehabilitation for victims of traffic accidents?”. The names of classes and axes resulting from Alceste was performed by ad hoc query to three external researchers with subsequent consensus of the most representative name of analysis. We conducted multivariate analysis of the influence of the variables of the accident, sociodemographic, clinical and assistance on access to rehabilitation. Associations with p <0.20 in the bivariate analysis were submitted to logistic regression, step by step, with p <0.05 and confidence interval (CI) of 95%. The main barriers identified were: “Bureaucratic regulation”, “Long time to start rehabilitation”, “No post-surgery referral” and “inefficiency of public services”. These barriers were divided into a theoretical model built from the cause-effect diagram, in which we observed that insufficient access to rehabilitation is the product of causes related to organizational structure, work processes, professional and patients. Was constructed two logistic regression models: “General access to rehabilitation” and “Access to rehabilitation to public service”. 51.6% of patients had access to rehabilitation, and 32.9% in public and 17.9% in the private sector. The regression model “General access to rehabilitation” included the variables Income (OR:3.7), Informal Employment (OR:0.11), Unemployment (OR:0.15), Perceived Need for PR (OR:10) and Referral (OR: 27.5). The model “Access to rehabilitation in the public service” was represented by the “Referral to Public Service” (OR: 23.0) and “Private Health Plan” (OR: 0.07). Despite the known influence of social determinants on access to health services, a situation difficult to control by the public administration, this study found that the organizational and bureaucratic procedures established in health care greatly determine access to rehabilitation. Access difficulties show the seriousness of the problem and the factors suggest the need for improvements in comprehensive care for TA survivors and avoid unnecessary prolongation of the suffering of the victims of this epidemic.

Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

Hepatite C crônica em serviço de referência no nordeste do Brasil: um estudo retrospectivo de dezoito anos de acompanhamento

Chronic Hepatitis C is the leading cause of chronic liver disease in advanced final stage of hepatocellular carcinoma (HCC) and of death related to liver disease. Evolves progressively in time 20-30 years. Evolutionary rates vary depending on factors virus, host and behavior. This study evaluated the impact of hepatitis C on the lives of patients treated at a referral service in Hepatology of the University Hospital Onofre Lopes - Liver Study Group - from May 1995 to December 2013. A retrospective evaluation was performed on 10,304 records, in order to build a cohort of patients with hepatitis C, in which all individuals had their diagnosis confirmed by gold standard molecular biological test. Data were obtained directly from patient charts and recorded in an Excel spreadsheet, previously built, following an elaborate encoding with the study variables, which constitute individual data and prognostic factors defined in the literature in the progression of chronic hepatitis C. The Research Ethics Committee approved the project. The results were statistically analyzed with the Chi-square test and Fisher's exact used to verify the association between variable for the multivariate analysis, we used the Binomial Logistic regression method. For both tests, it was assumed significance p < 0.05 and 95%. The results showed that the prevalence of chronic hepatitis C in NEF was 4.96 %. The prevalence of cirrhosis due to hepatitis C was 13.7%. The prevalence of diabetes in patients with Hepatitis C was 8.78 % and diabetes in cirrhotic patients with hepatitis C 38.0 %. The prevalence of HCC was 5.45%. The clinical follow-up discontinuation rates were 67.5 %. The mortality in confirmed cases without cirrhosis was 4.10% and 32.1% in cirrhotic patients. The factors associated with the development of cirrhosis were genotype 1 (p = 0.0015) and bilirubin > 1.3 mg % (p = 0.0017). Factors associated with mortality were age over 35 years, abandon treatment, diabetes, insulin use, AST> 60 IU, ALT> 60 IU, high total bilirubin, extended TAP, INR high, low albumin, treatment withdrawal, cirrhosis and hepatocarcinoma. The occurrence of diabetes mellitus increased mortality of patients with hepatitis C in 6 times. Variables associated with the diagnosis of cirrhosis by us were blood donor (odds ratio 0.24, p = 0.044) and professional athlete (odds ratio 0.18, p = 0.35). It is reasonable to consider a revaluation in screening models for CHC currently proposed. The condition of cirrhosis and diabetes modifies the clinical course of patients with chronical hepatitis C, making it a disease more mortality. However, being a blood donor or professional athlete is a protective factor that reduces the risk of cirrhosis, independent of alcohol consumption. Public policies to better efficient access, hosting and resolution are needed for this population.