Acurácia dos indicadores clínicos do diagnóstico de enfermagem volume de líquidos excessivo em pacientes submetidos à hemodiálise

Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation nº 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients

Apoio social e síndrome da fragilidade em idosos residentes na comunidade

Introduction: The frailty in the elderly is the result of a complex interplay between many social and clinical factors involved in its genesis. Although there is an understanding of its association with increased risk of adverse clinical outcomes, still it is unclear whether this syndrome can be aggravated due to lack of social support. So, the objective of this study was to analyze the association between social support and frailty syndrome in elderly community residents. Materials and methods: Observational analytical cross-sectional study, with a sample of 300 elderly living in the city of Natal-RN. Were collected informations about socialdemographic, economics and physical health data. The Social support was assessed by the status of cohabitation; marital status; contact frequency and diversity rate; received and given attendance frequency rate; and Map Minimum Relations of the Elderly. The frailty was assessed using the following criteria: unintentional weight loss, weakness, low physical activity, exhaustion and Slowness. To observe any possible associations, we performed the Pearson chi-square test, the Student t test and multivariate analysis using binary logistic regression, adopting a significance level of 5%. Results: It was observed that there were no associations of frailty with the social support variables, except for housekeeping mode (p = 0.046) of the MMRI. For the sociodemographic, economic, physical health and social support data, only age (p <0.001), sedentary lifestyle (p = 0.002) and poor perceived health (p = 0.001) were the ones that remained in the logistic regression model, with strong association for the presence of frailty. Conclusion: Among the variables related to social support, only to help with housekeeping was significantly associated with frailty. However, more studies need to be developed to characterize the social vulnerability, as well as health services need to recognize the importance of social support as an integral part of care for the elderly

Qualidade de vida e saúde física e mental de médicos: uma autoavaliação por egressos da Faculdade de Medicina de Botucatu - UNESP

OBJETIVO: O presente artigo teve como objetivo analisar resultados de autoavaliações em termos de qualidade de vida (QV), saúde física (SF) e saúde mental (SM) realizadas por ex-alunos do curso de medicina de uma universidade pública brasileira, associando-se tais indicadores a dados demográficos e diversas dimensões da atuação profissional. MÉTODOS: estudo de corte transversal que teve como população-alvo todos os egressos da Faculdade de Medicina de Botucatu (UNESP) no período de 1968 a 2005, utilizando-se um questionário autoaplicável, respondido por correio ou internet. RESULTADOS: Dos 2.864 questionários enviados, 1.224 (45%) foram respondidos. Tanto a QV como SF e SM foram avaliadas como boa ou muito boa por 67,8%, 78,8% e 84,5% dos participantes, respectivamente. Nos modelos finais de regressão logística, associaram-se a avaliação favorável de QV: ter boa SF e SM, frequentar congressos regulamente, ter tempo suficiente de lazer e estar satisfeito com a profissão. SF boa ou muito boa associou-se independentemente com QV e SM positivas, faixa de renda mais alta, prática regular de atividades físicas e nunca ter fumado. SM favorável permaneceu associada com satisfação profissional, tempo para lazer, e boa avaliação da QV e da SF. CONCLUSÕES: Entre os médicos egressos da UNESP, SF e SM foram aspectos indissociáveis e também relacionados à QV. Bons hábitos, como praticar atividades físicas, ter tempo para lazer e não fumar foram associados à melhor avaliação da saúde em geral e devem ser incentivados. A satisfação profissional teve um peso importante no bem-estar emocional relatado pelos participantes.

Peritoneal Dialysis-Related Peritonitis Due to Staphylococcus aureus: A Single-Center Experience over 15 Years

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Quality of life and its association with cardiovascular risk factors in a community health care program population

OBJECTIVE: To evaluate quality of life in a population that attended a specific community event on health care education, and to investigate the association of their quality of life with the presence of cardiovascular risk factors INTRODUCTION: Interest in health-related quality of life is growing worldwide as a consequence of increasing rates of chronic disease. However, little is known about the association between quality of life and cardiovascular risk factors. METHODS: This study included 332 individuals. Demographics, blood pressure, body mass index, and casual glycemia were evaluated. The brief version of the World Health Organization Quality of Life questionnaire on quality of life was given to them. The medians of the scores obtained for the physical, psychological, emotional, and environmental domains were used as cutoffs to define higher and lower scores. A multinomial logistic regression model was used to define the parameters associated with lower scores. RESULTS: Diabetes mellitus, dyslipidemia, and obesity were associated with lower scores in the physical domain. Dyslipidemia was also associeted with lower scores in the psychological domain. Male gender and regular physical activity had protective effects on quality of life. Aging was inversely associated with decreased quality of life in the environmental domain. CONCLUSION: The presence of cardiovascular risk factors is related to a decreased quality of life. Conversely, male gender and regular physical activity had protective effects on quality of life. These findings suggest that exercising should be further promoted by health-related public programs, with a special focus on women.

Armadillo meat intake was not associated with leprosy in a case control study, Curitiba (Brazil)

Leprosy's progression and its maintained endemic status, despite the availability of effective treatments, are not fully understood and recent studies have highlighted the possibility of involved Mycobacterium leprae ambient reservoirs. Wild armadillos can carry leprosy and, because their meat is eaten by humans, development of the disease among armadillo meat consumers has been investigated. This study evaluated the frequency of armadillo meat intake among leprosy patients as well as age and gender matched controls with other skin diseases from a dermatological unit. Armadillo meat consumption among both groups was adjusted by demographic and socioeconomic covariates based on a conditional multiple logistic regression model. One hundred twenty-one cases and 242 controls were evaluated; they differed in socioeconomic variables such as family income, hometown population and access to treated water. The multivariate analysis did not show an association between the intake of armadillo meat and leprosy (odds ratio = 1.07; CI 95% 0.56-2.04), even when only cases with no known contacts were analyzed. We conclude that leprosy is not associated with the intake of armadillo meat in these patients.

Associação entre acrocórdons e resistência à insulina

FUNDAMENTOS: Acrocórdons são lesões dermatológicas comuns na população e estão associados ao diabetes mellitus, à obesidade, à resistência insulínica e à aterosclerose. A identificação precoce de pacientes com resistência insulínica pode ter papel preventivo primário. OBJETIVO: Avaliar a associação entre presença de acrocórdons cervicais ou axilares e resistência insulínica. MÉTODOS: Estudo transversal com pacientes dermatológicos adultos atendidos em hospital universitário. Casos foram definidos como portadores de mais de cinco acrocórdons cervicais e/ou axilares. A resistência insulínica foi estimada pelo índice HOMA-IR. Resultados foram ajustados pelas demais covariáveis de risco para resistência insulínica conhecidos, a partir de regressão logística múltipla. RESULTADOS: Avaliaram-se 98 casos e 103 controles, que não diferiram entre si quanto à idade ou ao gênero. Acrocórdons se associaram diretamente aos valores de HOMA-IR (Odds Ratio = 1,4), hipertrigliceridemia e índice de massa corpórea, independentemente do ajuste por diabetes mellitus, idade, fototipo, gênero, história de diabetes mellitus familiar e relação cintura/quadril. Níveis qualitativamente elevados de HOMA-IR (> 3,8) também evidenciaram associação significativa (Índice de probabilidade = 7,5). CONCLUSÕES: Presença de múltiplos acrocórdons se associou à resistência insulínica, independentemente dos demais fatores de risco.

Group B streptococci colonization in pregnant women: risk factors and evaluation of the vaginal flora

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Metabolic syndrome and its associated risk factors in Brazilian postmenopausal women

Objective To evaluate the prevalence of metabolic syndrome (MetS) and its associated risk factors in Brazilian postmenopausal women.Methods In this cross-sectional study, a total of 368 postmenopausal women, aged 40-75 years, seeking health care at a public outpatient center in Southeastern Brazil, were included. According to the US National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines, MetS was diagnosed in subjects with three or more of the following: waist circumference >= 88 cm, blood pressure >= 130/85 mHg, triglycerides >= 150 mg/dl, high density lipoprotein cholesterol <50 mg/dl and glucose >= 110 mg/dl. Data on past medical history, tobacco use, anthropometric indicators, and values of C-reactive protein (CRP) were collected. Multivariate analysis, using a logistic regression model (odds ratio, OR) was used to evaluate the influence of various simultaneous MetS risk factors.Results The prevalence of having at least three, four and five MetS diagnostic criteria were met in 39.6%, 16.8% and 3.8% of the cases, respectively. The most prevalent risk factor was abdominal obesity, affecting 62.5% of women. The risk of MetS increased with a personal history of diabetes (OR 5.95, 95% confidence interval (CI) 2.82-12.54), hypertension (OR 4.52, 95% CI 2.89-7.08), cardiovascular disease (OR 2.16, 95% CI 1.18-3.94) and high CRP (>1 mg/dl) (OR 3.35, 95% CI 1.65-6.79). Plasma CRP levels increased with the number of MetS components present. Age, time since menopause and smoking had no influence, while hormone therapy reduced MetS risk (OR 0.64, 95% CI 0.42-0.97).Conclusion Metabolic syndrome was highly prevalent among Brazilian postmenopausal women seeking gynecologic health care. Abdominal obesity, diabetes, hypertension and high CRP were strong MetS predictors and hormone therapy appeared to play a protective role for this condition.

Association between distressing non-work-related events and occupational injuries

The following is a report on a case-control study whose objective was to investigate the association between distressing non-work-related events and occupational injures. Ninety three injured workers (cases) were matched with 372 non-injured controls in a large metallurgical factory in southeastern Brazil. Exposure to distressing non-work-related events was measured through a questionnaire focusing on situations pertaining to personal problems unrelated to work activities. The data were analyzed by adjusting a conditional logistic regression model, where occurrence of the work injury was the dependent dichotomous variable and answers from the questionnaire were independent continuous variables. The analysis showed an association between some distressing non-work-related events and occupational injuries. These findings imply expanding the horizon of preventive measures used in targeting. work injuries which have traditionally been focused on the control of strictly workplace risks.

Fatores associados à vacinação contra influenza em idosos em município do Sudeste do Brasil

OBJETIVO: Mesmo gratuita e disponível no Brasil desde 1999, a cobertura vacinal contra a influenza ainda é inadequada em diversos municípios do País. O objetivo da pesquisa foi estimar a cobertura vacinal e identificar fatores relacionados à vacinação contra a influenza em idosos. MÉTODOS: Realizou-se inquérito domiciliar em amostra aleatória sistemática (N=365) da população urbana maior de 60 anos em Botucatu, São Paulo. Foi aplicado modelo de regressão logística múltipla, cuja variável dependente foi ter sido vacinado em 2002. Foram testadas no modelo as covariáveis: sexo, idade, socioeconômicas (renda per capita, número de pessoas por cômodo, escolaridade, estado civil, ocupação, tempo de moradia), antecedentes mórbidos, de internação, hábito de fumar, sintomas respiratórios nos últimos 15 dias e atividades comunitárias (trabalho voluntário, atividades no bairro, igreja). RESULTADOS: Registrou-se cobertura vacinal de 63,2% (IC 95%: 58,3-68,2). Foi observado menor percentual de vacinados entre os idosos na faixa etária de 60 a 64 anos. As variáveis que se mostraram associadas à vacinação e permaneceram no modelo final foram: idade (OR=1,09 por ano; IC 95%: 1,06-1,13); hipertensão arterial (OR=1,92; IC 95%: 1,18-3,13); inserção em atividades na comunidade (OR=1,63; IC 95%: 1,01-2,65). A vacinação em portadores de doenças crônicas não atingiu níveis adequados conforme esperado para este grupo de risco, com exceção dos hipertensos. A participação em atividades comunitárias e sociais foi relacionada com o estado vacinal. CONCLUSÕES: Condições socioeconômicas, hábitos e idade não restringiram o acesso à campanha vacinal. Por outro lado, campanhas específicas, endereçadas a indivíduos da faixa de 60 a 64 anos, podem ampliar a cobertura da vacinação.

Quais as características propostas pelo BIRADS-US que melhor diferenciam nódulos malignos dos benignos?

OBJETIVO: analisar qual das características propostas pelo BIRADS-US tem maior impacto na diferenciação das lesões benignas das malignas. MÉTODOS: estudamos as características ultra-sonográficas do BIRADS em 384 nódulos submetidos à biópsia percutânea no período de fevereiro de 2003 a dezembro de 2006. Utilizou-se, para o exame, o aparelho Logic 5, com transdutor linear multifreqüencial de 7,5-12 MHz. A análise ultra-sonográfica do nódulo foi baseada no BIRADS-US levando em conta: forma, orientação, margem, limites da lesão, ecogenicidade, características acústicas posteriores, o tecido circunjacente e a presença de calcificações. Estes dados foram submetidos à análise estatística com modelo de regressão logística. Para o estudo de associação entre estas variáveis utilizamos o teste do c² e também calculamos a sensibilidade e a especificidade das variáveis tecido ao redor, calcificações, efeito posterior, limite da lesão e orientação. RESULTADOS: as lesões benignas representaram 42,4% e as malignas, 57,6%. A análise por regressão logística encontrou odds ratio (OR) aumentado para câncer de 7,7 vezes quando o tecido ao redor esteve alterado, de 6,2 vezes quando houve presença das microcalcificações no interior das lesões, de 1,9 quando o efeito acústico foi sombra, de 25,0 vezes quando houve o halo ecogênico e de 7,1 vezes quando a orientação foi não paralela. CONCLUSÕES: dentre as características estudadas, o limite da lesão, representado pela presença ou não do halo ecogênico, é o mais importante diferenciador das massas benignas das malignas.

Predictive factors of outcome following staphylococcal peritonitis in continuous ambulatory peritoneal dialysis

Background and aims: Staphylococcus epidermidis and other coagulase-negative staphylococci (CoNS) are the most common agents of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Episodes caused by Staphylococcus aureus evolve with a high method failure rate while CoNS peritonitis is generally benign. The purpose of this study was to compare episodes of peritonitis caused by CoNS species and S. aureus to evaluate the microbiological and host factors that affect outcome. Material and methods: Microbiological and clinical data were retrospectively studied from 86 new episodes of peritonitis caused by staphylococci species between January 1996 and December 2000 in a university dialysis center. The influence of microbiological and host factors (age, sex, diabetes, use of vancomycin, exchange system and treatment time on CAPD) was analyzed by logistic regression model. The clinical outcome was classified into two results (resolution and non-resolution). Results: the odds of peritonitis resolution were not influenced by host factors. Oxacillin susceptibility was present in 30 of 35 S. aureus lineages and 22 of 51 CoNS (p = 0.001). There were 32 of 52 (61.5%) episodes caused by oxacillin-susceptible and 20 of 34 (58.8%) by oxacillin-resistant lineages resolved (p = 0.9713). of the 35 cases caused by S. aureus, 17 (48.6%) resolved and among 51 CoNS episodes 40 (78.4%) resolved. Resolution odds were 7.1 times higher for S. epidermidis than S. aureus (p = 0.0278), while other CoNS had 7.6 times higher odds resolution than S. epidermidis cases (p = 0.052). Episodes caused by S. haemolyticus had similar resolution odds to S. epidermidis (p = 0.859). Conclusions: S. aureus etiology is an independent factor associated with peritonitis non-resolution in CAPD, while S. epidermidis and S. haemolyticus have a lower resolution rate than other CoNS. Possibly the aggressive nature of these agents, particularly S. aureus, can be explained by their recognized pathogenic factors, more than antibiotic resistance.

Foraging Behavior of the Swarm-founding Wasp Polybia (Trichothorax) sericea (Hymenoptera, Vespidae): Daily Resource Collection Activity and Flight Capacity

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)