Atividade física em gestantes assistidas na atenção primária à saúde

OBJETIVO Analisar o padrão de atividade física de gestantes de baixo risco e os fatores associados. MÉTODOS Estudo transversal com 256 gestantes adultas no segundo trimestre gestacional, sorteadas dentre as assistidas pelas unidades de atenção primária à saúde do município de Botucatu, SP, em 2010. As atividades físicas foram investigadas por meio do “pregnancy physical activity questionnaire”, verificando-se tempo e intensidade de atividades ocupacionais, de deslocamento, domésticas e de lazer, expressos em equivalentes metabólicos dia. As gestantes foram classificadas segundo nível de atividade e em relação a atingir 150 min/semana de atividades físicas de lazer, variáveis dependentes do estudo. A associação entre essas variáveis e as socioeconômicas, características maternas, fatores comportamentais e modelo de atenção da unidade de saúde foi avaliada mediante modelos de regressão de Poisson com variância robusta, adotando-se modelo hierárquico. RESULTADOS A maior parte das gestantes era insuficientemente ativa (77,7%), 12,5% moderadamente ativa e 9,8% vigorosamente ativa. Os maiores gastos diários de energia foram com atividades domésticas, seguidas pelas atividades de locomoção; 10,2% atingiram a recomendação de 150 min semanais de atividades físicas de lazer. Trabalho fora de casa reduziu a chance de atingir essa recomendação (RP = 0,39, IC95% 0,16;0,93). Ter tido pelo menos um parto anterior (RP = 0,87, IC95% 0,77;0,99) e excesso ponderal pré-gestacional (RP = 0,85, IC95% 0,731;0,99) reduziram a chance de ser insuficientemente ativa, enquanto consumir menos alimentos saudáveis teve aumento discreto (RP = 1,18, IC95% 1,02;1,36). CONCLUSÕES Gestantes assistidas na atenção primária à saúde são insuficientemente ativas. Ter tido pelo menos um parto e apresentar sobrepeso pré-gestacional foram identificados como fatores protetores contra tal situação, enquanto consumo menos frequente de alimentos saudáveis foi fator de risco, sugerindo aglomeração de fatores de risco à saúde.

Sobrepeso pré-gestacional associa-se a ganho ponderal excessivo na gestação

PURPOSE: To evaluate the adequacy of gestational weight gain and to determine its association with maternal socioeconomic, demographic and nutritional factors and health care, to estimate the prevalence of low birth weight, macrosomia, preterm birth and cesarean delivery and to identify the association of these outcomes with the adequacy of weight gain. METHODS: A cross-sectional study was performed in 2009/2010 to obtain socioeconomic, demographic, nutritional, dietary and physical activity data of pregnant women assisted by primary health care in a municipality of the state of São Paulo. Subsequently, data were collected from the medical records to evaluate gestational weight gain. Type of delivery, birth weight and gestational age at delivery were obtained from the Livebirths Information System. Gestational weight gain was evaluated according to the recommendations of the Institute of Medicine (2009). Associations were investigated by comparing the frequencies and by logistic regression, with excessive weight gain (yes, no) and insufficient gain (yes, no) being the dependent variables. RESULTS: A total of 212 pregnant women were studied: 50.5% had excessive gain and 19.8% insufficient weight gain. Only prepregnancy nutritional status was associated with adequacy of weight gain: compared with normal weight, prepregnancy overweight women had a four-fold higher chance to gain excessive weight (OR 4.66, 95%CI 2.19-9.4). Nearly a third of babies were born by caesarian section, 5.7% were premature, 7.1% were underweight and 4.7% were macrosomic. There was no association between adequacy of gestational weight gain and these outcomes. CONCLUSION: The proportion of inadequate gestational weight gain was high. Overweight pregnant women have a four-fold higher chance to gain excessive weight, and priority should be given to actions promoting adequate prenatal weight gain.

Evaluation of the Capillary Blood Glucose Self-monitoringProgram

OBJECTIVE: to evaluate the structure, process and results of the Capillary Blood Glucose Self-monitoring Program in a Brazilian city. METHOD: epidemiological, cross-sectional study. The methodological framework of Donabedian was used to construct indicators of structure, process and outcome. A random sample (n = 288) of users enrolled and 96 health professionals who worked in the program was studied. Two questionnaires were used that were constructed for this study, one for professionals and one for users, both containing data for the evaluation of structure, process and outcome. Anthropometric measures and laboratory results were collected by consulting the patients' health records. The analysis involved descriptive statistics. RESULTS: most of the professionals were not qualified to work in the program and were not knowledgeable about the set of criteria for patient registration. None of the patients received complete and correct orientations about the program and the percentage with skills to perform conducts autonomously was 10%. As regards the result indicators, 86.4% of the patients and 81.3% of the professionals evaluated the program positively. CONCLUSION: the evaluation indicators designed revealed that one of the main objectives of the program, self-care skills, has not been achieved.

The sympathetic nervous system regulates the three glycerol-3P generation pathways in white adipose tissue of fasted, diabetic and high-protein diet-fed rats

The aim of the present study was to investigate the participation of the sympathetic nervous system (SNS) in the control of glycerol-3-P (G3P) generating pathways in white adipose tissue (WAT) of rats in three situations in which the plasma insulin levels are low. WAT from 48 h fasted animals, 3 day-streptozotocin diabetic animals and high-protein, carbohydrate-free (HP) diet-fed rats was surgical denervated and the G3P generation pathways were evaluated. Food deprivation, diabetes and the HP diet provoke a marked decrease in the rate of glucose uptake and glycerokinase (GyK) activity, but a significant increase in the glyceroneogenesis, estimated by the phosphoenolpyruvate carboxykinase (PEPCK) activity and the incorporation of 1-[C-14]-pyruvate into glycerol-TAG. The denervation provokes a reduction (similar to 70%) in the NE content of WAT in fasted, diabetic and HP diet-fed rats. The denervation induced an increase in WAT glucose uptake of fed, fasted, diabetic and HP diet-fed rats (40%, 60%, 3.2 fold and 35%, respectively). TAG-glycerol synthesis from pyruvate was reduced by denervation in adipocytes of fed (58%) and fasted (36%), saline-treated (58%) and diabetic (23%), and HP diet-fed rats (11%). In these same groups the denervation reduced the PEPCK mRNA expression (75%-95%) and the PEPCK activity (35%-60%). The denervation caused a similar to 35% decrease in GyK activity of control rats and a further similar to 35% reduction in the already low enzyme activity of fasted, diabetic and HP diet-fed rats. These data suggest that the SNS plays an important role in modulating G3P generating pathways in WAT, in situations where insulin levels are low. (C) 2012 Elsevier Inc. All rights reserved.

A Low-Protein, High-Carbohydrate Diet Increases Fatty Acid Uptake and Reduces Norepinephrine-Induced Lipolysis in Rat Retroperitoneal White Adipose Tissue

A low-protein, high-carbohydrate (LPHC) diet for 15 days increased the lipid content in the carcass and adipose tissues of rats. The aim of this work was to investigate the mechanisms of this lipid increase in the retroperitoneal white adipose tissue (RWAT) of these animals. The LPHC diet induced an approximately two- and tenfold increase in serum corticosterone and TNF-alpha, respectively. The rate of de novo fatty acid (FA) synthesis in vivo was reduced (50%) in LPHC rats, and the lipoprotein lipase activity increased (100%). In addition, glycerokinase activity increased (60%), and the phosphoenolpyruvate carboxykinase content decreased (27%). Basal [U-C-14]-glucose incorporation into glycerol-triacylglycerol did not differ between the groups; however, in the presence of insulin, [U-C-14]-glucose incorporation increased by 124% in adipocytes from only control rats. The reductions in IRS1 and AKT content as well as AKT phosphorylation in the RWAT from LPHC rats and the absence of an insulin response suggest that these adipocytes have reduced insulin sensitivity. The increase in NE turnover by 45% and the lack of a lipolytic response to NE in adipocytes from LPHC rats imply catecholamine resistance. The data reveal that the increase in fat storage in the RWAT of LPHC rats results from an increase in FA uptake from circulating lipoproteins and glycerol phosphorylation, which is accompanied by an impaired lipolysis that is activated by NE.

HPV16 Oncoproteins Induce MMPs/RECK-TIMP-2 Imbalance in Primary Keratinocytes: Possible Implications in Cervical Carcinogenesis

Cervical cancer is the third most common cancer in women worldwide. Persistent infection with high-risk HPV types, principally HPV16 and 18 is the main risk factor for the development of this malignancy. However, the onset of invasive tumor occurs many years after initial exposure in a minority of infected women. This suggests that other factors beyond viral infection are necessary for tumor establishment and progression. Tumor progression is characterized by an increase in secretion and activation of matrix metalloproteinases (MMPs) produced by either the tumor cells themselves or tumor-associated fibroblasts or macrophages. Increased MMPs expression, including MMP-2, MMP-9 and MT1-MMP, has been observed during cervical carcinoma progression. These proteins have been associated with degradation of ECM components, tumor invasion, metastasis and recurrence. However, few studies have evaluated the interplay between HPV infection and the expression and activity of MMPs and their regulators in cervical cancer. We analyzed the effect of HPV16 oncoproteins on the expression and activity of MMP-2, MMP-9, MT1-MMP, and their inhibitors TIMP-2 and RECK in cultures of human keratinocytes. We observed that E7 expression is associated with increased pro-MMP-9 activity in the epithelial component of organotypic cultures, while E6 and E7 oncoproteins co-expression down-regulates RECK and TIMP-2 levels in organotypic and monolayers cultures. Finally, a study conducted in human cervical tissues showed a decrease in RECK expression levels in precancer and cancer lesions. Our results indicate that HPV oncoproteins promote MMPs/ RECK-TIMP-2 imbalance which may be involved in HPV-associated lesions outcome.

Informações para a elaboração de um manual educativo destinado às mulheres com câncer de mama

O objetivo deste estudo foi identificar as informações necessárias para a elaboração de um manual educativo, para auxiliar a mulher no pré-operatório para tratamento do câncer de mama. Para isso, foram entrevistadas mulheres com o diagnóstico de câncer de mama e submetidas ao procedimento cirúrgico pela primeira vez no máximo há seis meses. Foram incluídas 51 mulheres na faixa etária de 25 a 84 anos; 32 tinham companheiro; 26, ensino fundamental incompleto; 24 consideraram sua ocupação como "do lar"; 43,1% foram submetidas à mastectomia; e 82,4% realizaram linfadenectomia axilar. Responderam um instrumento com dados sócio-demográficos e perguntas relativas às informações/orientações recebidas da equipe de saúde sobre tipos de cirurgia, internação, anestesia, uso do dreno e intercorrências. Para a elaboração de material educativo, conhecer esta realidade e as expectativas dos sujeitos é indispensável para que sejam priorizadas as necessidades dos clientes, e não somente as exigências terapêuticas.