Prevenção da síndrome metabólica em crianças obesas: uma proposta de intervenção

OBJETIVO: Analisar o efeito de 12 semanas de intervenção envolvendo prática de atividade física, orientações alimentar e psicológica sobre fatores de risco para o desenvolvimento da síndrome metabólica em crianças e adolescentes obesos. MÉTODOS: Estudo longitudinal com 23 crianças e adolescentes obesos, com idade entre seis e 16 anos (12,0±3,2 anos). Foram mensurados: gordura corporal total e de tronco, glicemia, colesterol total e triglicérides, pressão arterial sistólica e diastólica. Os jovens foram submetidos a três sessões semanais de 60 minutos de exercício físico (atividades esportivas recreativas, ginástica, circuitos e caminhadas), durante 12 semanas. O teste do qui-quadrado foi usado para comparar dados categóricos daqueles que apresentaram valores acima das recomendações para cada fator de risco. O teste t para dados pareados foi aplicado para comparar os dois momentos do estudo. RESULTADOS: em indivíduos com alterações metabólicas no início do estudo, observou-se, após a intervenção, a diminuição de 11,6% na glicemia (105 para 93mg/dL; p=0,046) e de 24,9% no triglicérides (217 para 163mg/dL; p=0,013); porém, não houve diferenças na pressão arterial e no colesterol total. CONCLUSÕES: O programa de exercício físico aplicado nas crianças e adolescentes foi eficiente para melhorar os valores de glicemia e triglicérides.

Medidas e análise estatística em sinais bioelétricos sobre pontos de acupuntura

In the 20th century, the acupuncture has spread on occident as a complementary practice of heath care. This fact has motivated the international scientific community to invest in research that seek to understand why acupuncture works. In this work we compare statistically volt age fluctuation of bioelectric signals caught on the skin at an acupuncture point (IG 4) another nearby on acupuncture point. The acquisition of these signals was performed utilizing an electronic interface with a computer, which was based on an instrumentation amplifier designed with adequate specifications to this end. On the collected signals from a sample of 30 volunteers we have calculated major statistics and submitted them to pairing t-test with significance leveI a = O, 05. We have estimated to bioelectric signals the following parameters: standard deviation, asymmetry and curtose. Moreover, we have calculated the self-correlation function matched by on exponential curve we have observed that the signal decays more rapidly from a non-acupoint then from an acupoint. This fact is an indicative of the existence of information in the acupoint

Efeitos do treinamento de dupla tarefa no controle do equilíbrio dinâmico e estático de idosas pré-frágeis: um estudo piloto

The increasing world population of older individuals has become a subject of growing research for prevention and reversibility of the frailty because it is a major risk factor for the occurrence of falls, especially when it involves everyday situations of dual task. Some rehabilitation programs have already used the methods of dual-task with general exercises for improving gait and postural control, but has been reported that these interventions have little specificity with limited success to improve certain aspects of static and dynamic position during the performance of functional tasks. This study aimed to verify the measures of postural control in a group of elderly women with fragility phenotype after physical therapy intervention program based on dual-task treadmill training. We selected six pre-frail elderly subjects, with a minimum age of 65, female, living in the community and randomly assigned to two groups. The survey was conducted twice a week for 45 minutes, for four weeks. The simple task intervention consisted only in training on a treadmill and the dual task consisted of in treadmill training associated with visual stimuli. The assessments were made with the use of the Berg Balance Scale (BBS) and the Balance Master® computerized posturography, static and dynamically. The effects of retention were observed after one month, using the same instruments earlier used. The results showed a tendency toward improvement or maintenance of the balance after training on a treadmill, especially with respect to static equilibrium. Both groups showed the most notable changes in the variables related to gait, as the length and speed. The BBS scores and the baropodometric variables showed that the experimental group could keep all values similar or better even one month after completion of training unlike the control group. We concluded that the dual-task performance had no additional value in relation to the improvement of balance in general, but we observed that the effectiveness of visual stimulation occurred in the maintenance of short term balancevariables

Validação do questionário Internacional de Atividade Física (IPAQ) através da acelerometria em idosas

Physical activity is one of the main components of a healthy lifestyle, responsible for many health benefits. Despite being considered important for both disease prevention and health promotion there is high prevalence of sedentary behavior in the elderly population. Questionnaires are practical and feasible instruments for assessing levels of physical activity. However, they may have limitations in older age ranges. Accelerometers, movement sensors that make physical activity data more objective, emerge as reliable measuring devices. Aim: Determine the validity of the International Physical Activity Questionnaire (IPAQ) adapted for elderly with accelerometry in elderly women. Methods: 57 elderly women, with mean age of 66.05 ± 5.98 years who took part in hypertension control and physical activity incentive programs were assessed in relation to objective and subjective measures of physical activity. The accelerometer was used for 07 consecutive days, 24 hours per day before the IPAQ was applied. Data were analyzed using measures of central tendency and dispersion to characterize the sample according to variables collected. To check the validity of the data we used the Spearman correlation test, considering a significance level of p <0.05. Results: With respect to the categories of physical activity obtained by IPAQ, 46.4% developed moderate physical activity, followed by a high (30.3%) and low level (23.2%). There was a negative correlation only between self-reported time spent sitting and time spent on light activities as measured by accelerometry (r = - 0.408; p = 0.003) and mean activity level (counts/min) with physical activity levels evaluated by IPAQ (r = 0.297; p = 0.036). Conclusion: The IPAQ used in elderly women shows moderate to low validity levels according to accelerometry measures. Assessment of sedentary activities exhibited acceptable levels compared to accelerometry; however, moderate (r = 0.096; p > 0.05) to vigorous (r = 0.098; p > 0.05) activities were not correlated, demonstrating the inability of IPAQ to evaluate this type of activity in elderly women

Formação ética para a cidadania: uma investigação de habilidades sociais medidas pelo inventário de habilidades sociais

O objetivo desta pesquisa foi investigar se o repertório de habilidades sociais importantes para a formação ética de um grupo de estudantes de ensino médio, curso pré-vestibular e curso de graduação em psicologia evidenciava mudanças relacionadas à diferença de idade e características específicas dos contextos interativos oferecidos pelas instituições de ensino participantes desse processo. Foi aplicado o Inventário de Habilidades Sociais a uma amostra de 45 estudantes e questionários semiestruturados a nove professores. Entre os alunos, os resultados indicaram diferença estatisticamente significativa entre as classes das categorias de ensino investigadas em relação a diferentes conjuntos de habilidades sociais. Dos resultados obtidos com os professores, pode-se depreender que estes possuem noção clara das capacidades que o aluno deve obter para agir com ética e ser cidadão, mas esses professores não propiciam condições, no contexto escolar, para a promoção de tais habilidades. Isso indicou a necessidade de melhorias na capacitação dos docentes, visando à ampliação do repertório de habilidades sociais de seus alunos.

Atividades preventivas realizadas pelos cirurgiões-dentistas do PSF de Natal-RN

Family Health Program (FHP) presents itself as a restructured model on basic cares besides having prevention practices and promotion in health as essential parts. According to that, the purpose of this study is to perceive which prevention practices in oral health are accomplished by the dentists from the FHP of Natal-RN as well as the way they have been developed, the knowledge basis to execute the procedure and the use of evaluation instruments by the dentists and by the Oral Health Co-Ordinator. A list of dentists participating on the FHP of Natal in March, 2006 (n= 91) was obtained so it was possible to formulate a structured interview. After excluding those with less than six months attending to the program, and considering the loss, eighty dentists got to be interviewed. It had questions about individual and group preventive procedures, sources of basement to develop the activities and to verify the impact and evaluation instruments. Besides that, an interview was made with the Oral Health Co-Ordinator about the evaluating process and the existence of a protocol as well as about document analysis in the Ambulatory Informations System Unique Health System (AIS-UHS), Information of Basic Care System and Pact of Recorder. The main individual activities consist on Oral Hygiene Orientation (87,5%) and Fluoridization (95%). Group activities remain at scholar groups acts(91,25%) being fluoridization done by 91,25% and educative activities by 86,25% mainly through speeches (61,25%).Orientations about oral cancer were detached on the aged group (39,96%)and hypertensive and diabetic group (19,51%), as well as integration with the health team was respectively 21,93% and 39,02%. Speeches and talk rounds are the main activities for aged, hypertensive and diabetics, and are also expressive to pregnant women. For pregnant women and babies group predominate hygiene and diet orientation. About the evaluation instruments 73,75% of the dentists do not consider their existence, despite 73,75% consider that actions have impact specially due to a increase of hygiene and decrease of caries index on the children. The main sources of basement are clinical experience (42,5%) and preparative courses (33,75%), only 7,5% mentioned population need and local reality. The Oral Health Co-Ordinator related the Attention Pact Recorder and records from the AIS - UHS as evaluation source but also detached the lack of epidemiologic surveying. She mentioned the increase of supervised brushing as a positive result and detached the hardness of the professional to act inside the family and as a team. The AIS-UHS records showed that fluoridization is more used individually and the supervised brushing is predominant as a group action, besides that educative activities at the Health Establishment predominate due to actions at the community. Facing the results, it was verified the act in different groups, special attention given to scholars, as well as focus the activities on caries giving less emphasis to other oral problems. Despite that, there was no epidemiologic instruments or data of the local reality to guide the actions and to be part of the planning and evaluation process

Avaliação da prevenção de falhas em processos utilizando métodos de tomada de decisão

Este trabalho apresenta uma investigação sobre o emprego de FMEA (Failure Mode and Effect Analysis) de Processo com a exposição de irregularidades na sua utilização. O método AHP (Analytic Hierarchy Process) e os Conjuntos Fuzzy são aplicados no estudo das práticas atuais de utilização de FMEA. O AHP é aplicado para a priorização das irregularidades quanto à gravidade de sua ocorrência. Os Conjuntos Fuzzy são aplicados para avaliação do desempenho da utilização de FMEA em algumas empresas do ramo automotivo. Como resultado, tem-se a aceitação de oito e a não aceitação de três dos onze formulários de FMEA averiguados.

Correlações entre medidas determinadas in vivo por ultrassom e na carcaça de ovelhas de descarte

Objetivou-se estudar as medidas de espessura de gordura subcutânea, área de olho-de-lombo, comprimento e profundidade máxima do músculo longissimus dorsi entre a 13ª costela e 1ª vértebra lombar determinadas por ultrassom e na carcaça de ovelhas de descarte abatidas em diferentes estágios fisiológicos, além dos coeficientes de correlação e determinação das medidas avaliadas. Utilizaram-se 21 ovelhas da raça Santa Inês, distribuídas nos seguintes grupos: OL = ovelhas que permaneceram por 60 dias em lactação com seus cordeiros e foram abatidas um dia após o desmame dos mesmos; OSC = ovelhas que permaneceram por 60 dias em lactação com seus cordeiros e mais 30 dias sem os cordeiros e foram posteriormente abatidas; e ONP = ovelhas que não pariram durante o ano. O comprimento máximo do músculo longissimus dorsi obtido pelo ultrassom e na carcaça dos animais não foi influenciado pelos estágios fisiológicos. O ultrassom pode ser utilizado com razoável precisão para estimar características da carcaça de ovelhas de descarte, em particular a espessura de gordura subcutânea.

Cartografia de uma intervenção comunitária para prevenção de DST/HIV/AIDS

Community-based interventions have been presented as a proposal of operationalization of the concept of vulnerability to STD/Aids prevention. This study aimed to analyze the Community intervention developed through the project Strengthening of Community action networks for STD/Aids prevention: know and intervenein, at Mãe Luiza neighborhood, in the city of Natal, State of Rio Grande do Norte, Brazil. The study was conducted in the same location where intervention occurs and took as time reference the first 30 months of construction and deployment process, from April 2010 until December 2012. This is research with qualitative approach, participatory character, developed from the immersion of the researcher in the field, being this community intervention itself. In this perspective, the study approximates to the Cartographic method in which the researcher-researched is engendered in the acts and effects research. The data-generating sources were the memories of the researcher from the field notes, written narratives of subjects involved in the intervention and documents pertaining to the project. In the methodological path of cartography, the image of the rhizome by Deleuze and Guattari (1995) has accompanied the immersion in the field given the nature of research-intervention which approach to the concept of object-Rhizome. The presentation of results was composed for the attempted rhizomatic and a hypertext representation, based on the descriptive narrative taken from the documentary analysis and the multi-faceted narratives with the voices, the looks and the affections narrated by the subject involved, respectively. On the path taken, three lanes were drawn as synthesis of learning produced by experience-that can contribute to understanding the process under study, in his singular character, and reflections on other experiences of community intervention: track 1- Community intervention as active-reflective space and a cause; track 2 Inclusion as power and challenge of community involvement; track 3 Sustainability as A challenge of Community intervention. The study indicates that community intervention is presented as a potential producer of health as also produces practical and creative skills, subjects and inventive in the daily life of the community with a view to reinventing knowledge and practices for the prevention of STD/HIV/Aids

Prevalência de incontinência urinária e fatores associados em idosos institucionalizados

Urinary incontinence (UI) is a geriatric syndrome that is especially prevalent in institutionalized individuals, and that causes economic and social impacts derived from treatment costs and overload of caregiver. UI also entails physical consequences to the health of the elderly, such as urinary tract infections or pressure ulcers, among other health problems. However, the existing national research on this condition is still scarce and comprises serious methodological biases. Therefore, the objective of this study is to determine the prevalence of urinary incontinence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December, 2013 and carried out in 10 nursing homes in the city of Natal (Northeast Brazil). UI was verified through the program Minimum Data Set version 3.0, which was also used to assess fecal incontinence, urinary devices and UI control programs. Data collection included sociodemographic information, UI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). Bivariate analysis was performed using the Chi-Square Test (or Fisher‟s Exact Test) and the Linear Chi-Square Test, calculating the prevalence ratio with 95% confidence interval. Variables with p value under 0.20 were included in the multivariate analysis, which was performed using the Stepwise Forward logistic regression. The inclusion of variables in the final model depended on the likelihood ratio test, absence of multicollinearity and on the Hosmer-Lemeshow test. A statistical significance level of 0.05 was considered. Six (1.8%) hospitalized elderly, one individual in palliative care (0.3%) and one (0.3%) individual under the age of 60 were excluded from the study. The final sample consisted of 321 elderly, mostly females, with a mean age of 81.5 years. The prevalence of UI was 59.43% and the final model revealed statistically a significant association between UI and white race, physical inactivity, stroke, mobility constraints and cognitive decline. The most frequent UI type was functional UI due to physical or cognitive disability, and incontinence control measures were applied only to a minority of residents (approximately 8%). It is concluded that UI is a health issue that affects more than half of the institutionalized elderly, and is associated with white race, physical inactivity, stroke and other geriatric syndromes such as immobility and cognitive disability. Most of these associated factors are modifiable and therefore the findings of this study highlight the importance of UI prevention and treatment in nursing homes, which include general measures, such as physical and psychosocial activities, and specific measures, such as prompted voiding

Medidas da dinâmica respiratória em crianças de quatro a dez anos

TEMA: medidas da dinâmica respiratória são freqüentemente utilizadas na clínica fonoaudiológica, mas poucos são os dados científicos destas na população infantil. OBJETIVO: estudar a dinâmica respiratória entre crianças que respiram pelo modo nasal. MÉTODO: o estudo foi realizado com uma amostra aleatória estratificada de 106 crianças respiradoras nasais de escolas da cidade de Marília / SP, entre quatro e dez anos de ambos os sexos. Foram realizadas as medidas de capacidade vital (CV), nas posições em pé e sentada, com e sem oclusão nasal; de tempo máximo de fonação (TMF) de vogais e consoantes sustentadas, além de fala em seqüência com a contagem de números. RESULTADOS: a medida média da CV na posição em pé com e sem oclusão nasal foi 1515,56 ml e 1538,67 ml respectivamente e na posição sentada, 1524 ml e 1539,15 ml respectivamente; o TMF das vogais em segundos foi: /a/ = 8,32 , /i/ = 8,61 e /u/ 8,42; o de consoantes foi: /s/ = 6,64 e /z/ = 7,65 e o de seqüência de números foi de 7,76 segundos. Resultados: observou-se que o tempo médio destas medidas aumentou progressivamente conforme as faixas etárias. Tanto para o TMF das vogais como, para o das consoantes, houve diferença estatística significante (p < 0,05) nas idades mais distantes, ou seja, entre quatro e dez anos, quatro e nove, e quatro e oito anos. em faixas etárias consecutivas não houve diferença estatística significante nos valores de CV. Houve forte associação entre a CV e o crescimento físico da criança. CONCLUSÃO: esse estudo mostrou medidas de dinâmica respiratória em crianças que podem ser úteis no diagnóstico e terapia fonoaudiológica. Outras pesquisas deveriam ser desenvolvidas para adicionais informações sobre o assunto.

Medidas da dinâmica respiratória em idosos participantes de grupos de terceira idade

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

Eficácia do ondansetron e da alizaprida na prevenção de náusea e vômito em laparoscopia ginecológica

JUSTIFICATIVA E OBJETIVOS: A laparoscopia ginecológica é procedimento que determina alta incidência de náusea e vômito no pós-operatório. Este estudo teve por finalidade comparar a eficácia do ondansetron e da alizaprida na prevenção de náusea e vômito em pacientes submetidas à laparoscopia ginecológica. MÉTODO: Participaram do estudo 52 pacientes, estado físico ASA I ou II, com idades entre 21 e 50 anos, sem queixas gástricas prévias, submetidas à laparoscopia para diagnóstico ou cirurgia. As pacientes foram divididas em 2 grupos: o grupo 1 recebeu ondansetron (4 mg) e o grupo 2, alizaprida (50 mg), por via venosa, antes da indução da anestesia. Todas as pacientes receberam midazolam (7,5 mg) por via oral como medicação pré-anestésica, sufentanil (0,5 µg.kg-1) e propofol (2 mg.kg-1) para indução, propofol (115 µg.kg-1) e N2O/O2 em fração inspirada de O2 a 40% para manutenção e atracúrio (0,5 mg.kg-1) como bloqueador neuromuscular. A analgesia pós-operatória foi realizada com cetoprofeno (100 mg) e buscopam composto®. RESULTADOS: Ambos os grupos foram idênticos quanto aos dados antropométricos e à duração da cirurgia e da anestesia. No grupo 1 (n=27) uma paciente apresentou náusea, No grupo 2, uma paciente apresentou náusea e três vomitaram, resultados estatisticamente não significativos. CONCLUSÕES: O ondansetron e a alizaprida foram similares na prevenção de náusea e vômito em pacientes submetidas à laparoscopia ginecológica.

Análise das medidas de boa e má diversidade na construção de comitês de classificadores através de metaheurísticas de otimização multiobjetivo

Committees of classifiers may be used to improve the accuracy of classification systems, in other words, different classifiers used to solve the same problem can be combined for creating a system of greater accuracy, called committees of classifiers. To that this to succeed is necessary that the classifiers make mistakes on different objects of the problem so that the errors of a classifier are ignored by the others correct classifiers when applying the method of combination of the committee. The characteristic of classifiers of err on different objects is called diversity. However, most measures of diversity could not describe this importance. Recently, were proposed two measures of the diversity (good and bad diversity) with the aim of helping to generate more accurate committees. This paper performs an experimental analysis of these measures applied directly on the building of the committees of classifiers. The method of construction adopted is modeled as a search problem by the set of characteristics of the databases of the problem and the best set of committee members in order to find the committee of classifiers to produce the most accurate classification. This problem is solved by metaheuristic optimization techniques, in their mono and multi-objective versions. Analyzes are performed to verify if use or add the measures of good diversity and bad diversity in the optimization objectives creates more accurate committees. Thus, the contribution of this study is to determine whether the measures of good diversity and bad diversity can be used in mono-objective and multi-objective optimization techniques as optimization objectives for building committees of classifiers more accurate than those built by the same process, but using only the accuracy classification as objective of optimization

Prevenção de conflitos médico-legais no exercício da medicina

Os conflitos médico-legais que ocorrem no exercício da Cirurgia e da Medicina são motivos de preocupação não só no meio médico, mas também na sociedade como um todo, pois se de um lado geram um maior desgaste emocional ao médico, por outro, os pacientes estão sendo rejeitados. As causas desses conflitos são muitas, envolvendo fatores não assistenciais, como o sistema de saúde distorcido e desorganizado, a falta de participação da sociedade e do médico na melhoria desse sistema, o aparelho formador que lança no mercado grande número de jovens médicos despreparados para o exercício dessa nobre profissão, além da falta do ensino continuado. A solução para esses conflitos não poderá ser por meio de simples criação de leis, e nem pela negativa da existência do erro médico, que ocorre numa freqüência até maior do que os próprios conflitos. Todavia, pode-se afirmar que é muito importante melhorar a relação médico-paciente. É necessário, ainda, que o médico conheça a fundo seus deveres de conduta e que, principalmente, se abstenha de praticar abusos do poder. A sociedade deve também entender que a saúde não é uma questão exclusiva dos médicos e que deve lutar pela melhoria das condições dos níveis de vida.