As trajetórias assistenciais de usuários com obesidade na rede de atenção à saúde de Porto Alegre

Resumo não disponíve

PROCEDIMENTO OPERACIONAL PADRÃO PARA IMPLEMENTAÇÃO DA ABREVIAÇÃO DE JEJUM E REALIMENTAÇÃO PRECOCE EM PACIENTES DA PROCTOLOGIA

Trabalho de Conclusão (Residência). Universidade Federal de Santa Catarina. Comissão de Residência Multiprofissional e Uniprofissional em Saúde. Residência Integrada Multiprofissional em Saúde.Introdução: Longos períodos de jejum são altamente prejudiciais ao paciente cirúrgico, tendo em vista que causam um estresse metabólico para além do trauma cirúrgico. Nesse contexto, visando minimizar os efeitos deletérios e acelerar a recuperação do paciente, mudanças foram propostas por meio de protocolos multimodais, como o Projeto Aceleração da Recuperação Total Pós-operatória (ACERTO) que estabelece cuidados perioperatórios que visam a aceleração da recuperação e menor permanência hospitalar do paciente cirúrgico. Objetivo: Desenvolver um Procedimento Operacional Padrão (POP) de abreviação de jejum pré-operatório e realimentação precoce pós-operatória para pacientes da Proctologia submetidos a procedimentos eletivos sob anestesia ou sedação nas dependências do Hospital Universitário Polydoro Ernani de São Thiago da Universidade Federal de Santa Catarina (HU/UFSC). Metodologia: Inicialmente, foi realizada uma revisão bibliográfica envolvendo a temática relacionada ao Projeto ACERTO, que possibilitou a abordagem dos tópicos presentes no POP. A construção do mesmo seguiu a normatização e estrutura estabelecidos pela Empresa Brasileira de Serviços Hospitalares (EBSERH). Resultados e discussões: O tempo médio de jejum para a realização de cirurgias eletivas, conforme dados da literatura, varia entre 10 a 16 horas. Recomendações do projeto ACERTO, baseadas em evidências, propõem que o jejum seja abreviado através da ingestão, de seis à duas horas antes da operação, de líquidos claros sem resíduos enriquecidos com carboidratos (maltodextrina à 12%) ou líquido claro com maltodextrina e fonte nitrogenada, seis à três horas antes; além disso, recomenda a realização de refeição de seis a oito horas antes do procedimento cirúrgico. A implementação do ACERTO, conforme dados de diversos estudos nacionais e internacionais com pacientes da cirurgia colorretal, demonstram: resultados cirúrgicos mais satisfatórios, com redução do risco de complicações, redução do tempo jejum e de hospitalização, melhora da recuperação da força muscular e redução dos níveis de cortisol, com aumento do bem estar físico e psicológico do paciente. Considerações finais: Este trabalho busca dar continuidade ao desenvolvimento dos protocolos de Abreviação de Jejum já estabelecidos no HU/UFS/EBSERH; e espera-se que a implementação deste POP, além de reduzir o tempo de jejum, de internação e o risco de complicações pós-cirúrgicas, possa instruir e incentivar os demais profissionais da saúde sobre a relevância deste tema e seu papel na aceleração da recuperação e melhoria da qualidade de vida e bem-estar de pacientes cirúrgicos, durante e após a internação hospitalar

Addressing concerns about smoking cessation and mental health: theoretical review and practical guide for healthcare professionals

Smoking rates in people with depression and anxiety are twice as high as in the general population, even though people with depression and anxiety are motivated to stop smoking. Most healthcare professionals are aware that stopping smoking is one of the greatest changes that people can make to improve their health. However, smoking cessation can be a difficult topic to raise. Evidence suggests that smoking may cause some mental health problems, and that the tobacco withdrawal cycle partly contributes to worse mental health. By stopping smoking, a person's mental health may improve, and the size of this improvement might be equal to taking antidepressants. In this article we outline ways in which healthcare professionals can compassionately and respectfully raise the topic of smoking to encourage smoking cessation. We draw on evidence-based methods such as cognitive-behavioural therapy (CBT) and outline approaches that healthcare professionals can use to integrate these methods into routine care to help their patients stop smoking.</p

Addressing concerns about smoking cessation and mental health: theoretical review and practical guide for healthcare professionals

Smoking rates in people with depression and anxiety are twice as high as in the general population, even though people with depression and anxiety are motivated to stop smoking. Most healthcare professionals are aware that stopping smoking is one of the greatest changes that people can make to improve their health. However, smoking cessation can be a difficult topic to raise. Evidence suggests that smoking may cause some mental health problems, and that the tobacco withdrawal cycle partly contributes to worse mental health. By stopping smoking, a person's mental health may improve, and the size of this improvement might be equal to taking antidepressants. In this article we outline ways in which healthcare professionals can compassionately and respectfully raise the topic of smoking to encourage smoking cessation. We draw on evidence-based methods such as cognitive–behavioural therapy (CBT) and outline approaches that healthcare professionals can use to integrate these methods into routine care to help their patients stop smoking

How common are Depression and Anxiety in adolescents with Chronic Fatigue Syndrome (CFS) and how should we screen for these mental health co-morbidities? A clinical cohort study

Adolescents with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) appear to be more likely to experience anxiety and/or depression using Patient Reported Outcome Measures (PROMs). However, we do not know how accurate these are at detecting problems in this patient group given the primary symptom of fatigue. We aimed to accurately determine the prevalence of anxiety/depression using gold-standard diagnostic interviews and evaluate the accuracy of PROMs measuring mood disorders in this patient group. We conducted a cross-sectional epidemiological study in a specialist tertiary paediatric CFS/ME service, England. The participants were164 12–18-year olds with clinician confirmed CFS/ME and their parents. The measures were a semi-structured diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, K-SADS, and questionnaires (Revised Children’s Anxiety and Depression Scale, RCADS; Spence Children’s Anxiety Scale, SCAS; Hospital Anxiety and Depression Scale, HADS). Parents completed the RCADS-P. 35% met the criteria for at least one common mental health problem. 20% had major depressive disorder, and 27% an anxiety disorder, with social anxiety and generalised anxiety being the most common. There was high co-morbidity, with 61% of those who were depressed also having at least one anxiety disorder. The questionnaires were moderately accurate (AUC &gt; 0.7) at detecting clinically significant anxiety/depression, although only the RCADS-anxiety reached the predefined 0.8 sensitivity, 0.7 specificity target. Mental health problems are particularly common amongst adolescents with CFS/ME. Most screening tools were not sufficiently accurate in detecting clinically significant anxiety and depression, so these should be used with care in combination with thorough psychological/psychiatric assessment

Identifying barriers to care in the Burmese and Bhutanese refugee populations of Burlington, Vermont

Introduction: Many refugees who escape persecution in their own country have trouble navigating and accessing the American health care system. Language barriers often impair effective communication, while financial challenges can be prohibitive after the eight-month government insurance subsidy for new refugees expires. In addition many refugees do not understand the concept of chronic disease, which is a concern considering the overall rise in hypertension (HTN) and type-two diabetes mellitus (T2DM) in the US population. Understanding how refugees access health care, and how well they understand chronic disease, is essential for organizations providing medical care for these populations. Little is known about how the Burmese and Bhutanese refugees experience the Vermont health care system, nor how well they understand chronic diseases such as HTN and T2DM. To address these limitations, we conducted focus groups with these two Vermont refugee populations at the Community Health Center of Burlington, Vermont (CHCB).https://scholarworks.uvm.edu/comphp_gallery/1035/thumbnail.jp

Endotoxin Tolerance Acquisition and Altered Hepatic Fatty Acid Profile in Aged Mice

(1) Background: Aging is linked to an altered immune response and metabolism. Inflammatory conditions, such as sepsis, COVID-19, and steatohepatitis are more prevalent in the elderly and steatosis is linked both to severe COVID-19 and sepsis. We hypothesized that aging is linked to a loss of endotoxin tolerance, which normally protects the host from excessive inflammation, and that this is accompanied by elevated levels of hepatic lipids. (2) Methods: An in vivo lipopolysaccharide (LPS) tolerance model in young and old mice was used and the cytokine serum levels were measured by ELISA. Cytokine and toll-like receptor gene expression was determined by qPCR in the lungs and the liver; hepatic fatty acid composition was assessed by GC–MS. (3) Results: The old mice showed a distinct potential for endotoxin tolerance as suggested by the serum cytokine levels and gene expression in the lung tissue. Endotoxin tolerance was less pronounced in the livers of the aged mice. However, the fatty acid composition strongly differed in the liver tissues of the young and old mice with a distinct change in the ratio of C18 to C16 fatty acids. (4) Conclusions: Endotoxin tolerance is maintained in advanced age, but changes in the metabolic tissue homeostasis may lead to an altered immune response in old individuals

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

Background: Only one-third of patients with depression respond fully to treatment with antidepressant medication. However, there is little robust evidence to guide the management of those whose symptoms are 'treatment resistant'.&lt;p&gt;&lt;/p&gt; Objective: The CoBalT trial examined the clinical effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment-resistant depression (TRD) compared with usual care alone.&lt;p&gt;&lt;/p&gt; Design: Pragmatic, multicentre individually randomised controlled trial with follow-up at 3, 6, 9 and 12 months. A subset took part in a qualitative study investigating views and experiences of CBT, reasons for completing/not completing therapy, and usual care for TRD.&lt;p&gt;&lt;/p&gt; Setting: General practices in Bristol, Exeter and Glasgow, and surrounding areas.&lt;p&gt;&lt;/p&gt; Participants: Patients aged 18-75 years who had TRD [on antidepressants for 6 weeks, had adhered to medication, Beck Depression Inventory, 2nd version (BDI-II) score of 14 and fulfilled the International Classification of Diseases and Related Health Problems, Tenth edition criteria for depression]. Individuals were excluded who (1) had bipolar disorder/psychosis or major alcohol/substance abuse problems; (2) were unable to complete the questionnaires; or (3) were pregnant, as were those currently receiving CBT/other psychotherapy/secondary care for depression, or who had received CBT in the past 3 years.&lt;p&gt;&lt;/p&gt; Interventions: Participants were randomised, using a computer-generated code, to usual care or CBT (12-18 sessions) in addition to usual care.&lt;p&gt;&lt;/p&gt; Main outcome measures: The primary outcome was 'response', defined as 50% reduction in depressive symptoms (BDI-II score) at 6 months compared with baseline. Secondary outcomes included BDI-II score as a continuous variable, remission of symptoms (BDI-II score of &lt; 10), quality of life, anxiety and antidepressant use at 6 and 12 months. Data on health and social care use, personal costs, and time off work were collected at 6 and 12 months. Costs from these three perspectives were reported using a cost-consequence analysis. A cost-utility analysis compared health and social care costs with quality adjusted life-years.&lt;p&gt;&lt;/p&gt; Results: A total of 469 patients were randomised (intervention: n = 234; usual care: n = 235), with 422 participants (90%) and 396 (84%) followed up at 6 and 12 months. Ninety-five participants (46.1%) in the intervention group met criteria for 'response' at 6 months compared with 46 (21.6%) in the usual-care group {odds ratio [OR] 3.26 [95% confidence interval (CI) 2.10 to 5.06], p &lt; 0.001}. In repeated measures analyses using data from 6 and 12 months, the OR for 'response' was 2.89 (95% CI 2.03 to 4.10, p &lt; 0.001) and for a secondary 'remission' outcome (BDI-II score of &lt; 10) 2.74 (95% CI 1.82 to 4.13, p &lt; 0.001). The mean cost of CBT per participant was £910, the incremental health and social care cost £850, the incremental QALY gain 0.057 and incremental cost-effectiveness ratio £14,911. Forty participants were interviewed. Patients described CBT as challenging but helping them to manage their depression; listed social, emotional and practical reasons for not completing treatment; and described usual care as mainly taking medication.&lt;p&gt;&lt;/p&gt; Conclusions: Among patients who have not responded to antidepressants, augmenting usual care with CBT is effective in reducing depressive symptoms, and these effects, including outcomes reflecting remission, are maintained over 12 months. The intervention was cost-effective based on the National Institute for Health and Care Excellence threshold. Patients may experience CBT as difficult but effective. Further research should evaluate long-term effectiveness, as this would have major implications for the recommended treatment of depression.&lt;p&gt;&lt;/p&gt

Human platelet protein ubiquitylation and changes following GPVI activation

Platelet activators stimulate post-translational modification of signalling proteins to change their activity or their molecular interactions leading to signal propagation. One covalent modification is attachment of the small protein ubiquitin to lysine residues in target proteins. Modification by ubiquitin can either target proteins for degradation by the proteasome or act as a scaffold for other proteins. Pharmacological inhibition of deubiquitylases or the proteasome inhibits platelet activation by collagen, demonstrating a role for ubiquitylation, but relatively few substrates for ubiquitin have been identified and the molecular basis of inhibition is not established. Here we report the ubiquitome of human platelets and changes in ubiquitylated proteins following stimulation by collagen related peptide (CRP-XL). Using platelets from six individuals over three independent experiments, we identified 1634 ubiquitylated peptides derived from 691 proteins, revealing extensive ubiquitylation in resting platelets. 925 of these peptides show an increase of more than 2-fold following stimulation with CRP-XL. Multiple sites of ubiquitylation were 16 identified on a number of proteins including Syk, filamin and integrin heterodimer subunits. This work reveals extensive protein ubiquitylation during activation of human platelets and opens the possibility of novel therapeutic interventions targeting the ubiquitin machinery