Análise da importância da construção do vínculo em uma comunidade de extrema vulnerabilidade social: limitações e relato de experiência

O presente trabalho apresenta a importância do vínculo com a comunidade e como este fator é essencial na construção de ações em saúde e na melhoria dos serviços perante a população, buscando propiciar mais autonomia a ela e integração dos saberes científico e popular. Trata-se de um estudo descritivo, do tipo relato de experiência, do projeto de extensão intitulado “Saberes e Práticas de Saúde no Contexto de uma Comunidade em Vulnerabilidade Social”, desenvolvido no município de Arapiraca-AL, Brasil. Foram realizadas ações na comunidade e ao final de cada ação, foi aberto um espaço de fala para os participantes expressarem suas perspectivas, aprendizados e experiências de vida, demonstrando confiança no compartilhamento das vivências. O presente estudo possibilitou conhecer as concepções dos moradores da comunidade em relação às práticas e saberes em saúde, e reconhecer o papel do intercâmbio de conhecimento

Determinantes Sociais da Saúde e a ocorrência das Doenças Diarreicas Agudas em Arapiraca/Alagoas: Exercício prático

Objetivo: Identificar os principais Determinantes Sociais da Saúde (DSS) relacionados à ocorrência de Doenças Diarreicas Agudas (DDAs) em Arapiraca/Alagoas. Metodologia: Relato de experiência prática, pautada na análise dos prontuários no período 2015-2016 nas Unidades Básicas de Saúde José Barbosa Leão (Planalto), Francisco Pereira Lima (4º Centro de Saúde) e Daniel Houly, em busca de casos de diarreia e da identificação de determinantes sociais das doenças diarreicas nos territórios, a partir de diagnósticos comunitários realizados no primeiro semestre de 2017. Resultados e Discussão: Com um total de 4.748 prontuários analisados, foram encontrados 168 casos de diarreia. A partir dessas informações, pôde-se constatar que fatores socioeconômicos e ambientais, como o acesso insuficiente à água tratada e a ausência de saneamento básico adequado, podem ser apontados como determinantes locais para a ocorrência de doenças diarreicas agudas. Conclusão: Observou-se maior valor absoluto e incidência de DDAs no bairro Planalto, resultado associado às condições socioeconômicas e de infraestrutura deficientes encontradas na comunidade, ressaltando assim a importância de intervenção interna e externa, visando à melhoria dessas variáveis

Can carbohydrate mouth rinse improve performance during exercise? A systematic review

The purpose of this review was to identify studies that have investigated the effect of carbohydrate (CHO) mouth rinse on exercise performance, and to quantify the overall mean difference of this type of manipulation across the studies. The main mechanisms involving the potential benefit of CHO mouth rinse on performance was also explored. A systematic review was conducted in the following electronic databases: PubMed, SciELO, Science Direct, MEDLINE, and the Cochrane Library (Cochrane Central Register of Controlled Trials), without limit of searches. Eleven studies were classified as appropriate and their results were summarized and compared. In nine of them, CHO mouth rinse increased the performance (range from 1.50% to 11.59%) during moderate- to high-intensity exercise (~75% Wmax or 65% VO2max, ~1 h duration). A statistical analysis to quantify the individual and overall mean differences was performed in seven of the 11 eligible studies that reported power output (watts, W) as the main performance outcome. The overall mean difference was calculated using a random-effect model that accounts for true variation in effects occurring in each study, as well as random error within a single study. The overall effect of CHO mouth rinse on performance was significant (mean difference = 5.05 W, 95% CI 0.90 to 9.2 W, z = 2.39, p = 0.02) but there was a large heterogeneity between the studies (I2 = 52%). An activation of the oral receptors and consequently brain areas involved with reward (insula/operculum frontal, orbitofrontal cortex, and striatum) is suggested as a possible physiological mechanism responsible for the improved performance with CHO mouth rinse. However, this positive effect seems to be accentuated when muscle and liver glycogen stores are reduced, possibly due to a greater sensitivity of the oral receptors, and require further investigation. Differences in duration of fasting before the trial, duration of mouth rinse, type of activity, exercise protocols, and sample size may account for the large variability between the studies

Psychosocial aspects of arterial hypertension: influence of stressful life events and the relevance of social support

Submitted by Ana Beatriz Oliveira ([email protected]) on 2019-04-23T12:31:33Z No. of bitstreams: 1 2018amorim-jf.pdf: 2144659 bytes, checksum: 73c56b89a23a378ee0c36a65ffb09e6a (MD5)Approved for entry into archive by Ana Beatriz Oliveira ([email protected]) on 2019-04-23T12:58:21Z (GMT) No. of bitstreams: 1 2018amorim-jf.pdf: 2144659 bytes, checksum: 73c56b89a23a378ee0c36a65ffb09e6a (MD5)Made available in DSpace on 2019-04-23T12:58:21Z (GMT). No. of bitstreams: 1 2018amorim-jf.pdf: 2144659 bytes, checksum: 73c56b89a23a378ee0c36a65ffb09e6a (MD5) Previous issue date: 2018Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.Objetivo: Investigar o efeito da ocorrência de EVPE e do suporte social na hipertensão arterial. Método: Estudo caso-controle com pareamento de 1:1 realizado com 300 adultos (35-65 anos) em Recife-PE. Para o pareamento considerou-se as seguintes variáveis: sexo, faixa etária (± 5 anos), cadastro na mesma USF e residência na mesma microárea. A pesquisa de campo foi realizada no período de dezembro de 2016 a julho de 2017. Os EVPE foram avaliados por um inventário englobando as dimensões: estresse no trabalho, na família e pessoal. O suporte social foi avaliado pelo Medical Outcome Studies Social Support Survey – MOS-SSS em sua versão brasileira validada no Brasil. Também foram coletadas informações sobre condições socioeconômicas e demográficas, estilo de vida, exame físico e medidas antropométricas. Para a comparação das médias das dimensões do apoio social aplicou-se o teste de Mann Whitney (p< 0,05). As análises de regressão logística univariadas foram realizadas para verificar a associação entre EVPE e as demais variáveis com a HA. As variáveis independentes que apresentaram p<0,25 foram incluídas no modelo multivariado de regressão logística (backward wald). Resultados: Indivíduos que relataram terem convivido com alguém próximo em restrição de liberdade (OR 2,34 IC:1,03-5,33) tiveram mais chance de serem hipertensos e o evento mudança de moradia se apresentou como fator de proteção à HA (OR 0,49 IC: 0,24-0,98) nas análises univariadas. Após análise ajustada se mantiveram como fatores de risco independente para HA: excesso de peso (OR 2,13 IC:1,09-4,16), raça/cor negra (OR 2,95 IC:1,34-6,49), história familiar de hipertensão (OR 5 IC:2,12-11,77). Conclusão: Os EVPE investigados ocorrem, mas estes, isoladamente, não estiveram associados à HA em população que convive com situações de desemprego, violência, condições de moradia precárias dentre outros.Objective: To investigate the effect of stressful life events (SLE) and social support in the hypertension. Method: Case-control study with 1 control to each case, performed with 300 adults (35-65 years) in Recife-PE. For the pairing the following variables were considered: sex, age range (± 5 years), registration of the same Family Health Strategy (FHS) and living in the same microarea. the data collection was done in the period from December 2016 to July 2017. The SLE was evaluated by a questionnaire encompassing the dimensions: work, family and personal stress. Social support was evaluated by the Medical Outcome Studies Social Support Survey - MOS-SSS in its translated version, validated in Brazil. Were analyzed the socioeconomic and demographic conditions, lifestyle, physical examination and anthropometric measurements. For the comparison of the means of the variables of support social applied the test of Mann Whitney (p <0.05), the univariate analyzes were published to verify if there is any difference between the values of SLE and the other variables with hypertension. The independent variables that presented p <0.25 were included in the multivariate logistic regression model (backward wald). Results: Individuals who reported having lived with someone close to them in freedom restriction (OR 2.34 CI: 1.03-5.33) were more likely to be hypertensive and the change in their home was a protective factor for hypertension (OR 0.49 CI: 0.24-0.98) in the univariate analyzes. After adjusted analysis, they remained as independent risk factors for arterial hypertension: overweight (OR 2.13 CI: 1.09-4.16), race black (OR 2.95 CI: 1.34-6.49), heredity (OR 5 CI: 2.12-11.77). Conclusion: The SLE investigated occur, but these, in isolation, do not influence the genesis of hypertension in a population that lives in situations of unemployment, violence, poor housing conditions, among others

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)