TOSSE PRODUTIVA E DISPNÉIA

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The effects of two early parenting interventions on child aggression and risk for violence in Brazil (The PIÁ Trial): protocol for a randomised controlled trial

Background Children in many low- and middle-income countries (LMICs) are at high risk for exposure to violence and later violent behaviour. The World Health Organization has declared an urgent need for the evaluation and implementation of low-cost parenting interventions in LMICs to prevent violence. Two areas of significant early risk are harsh parenting and poor child cognitive and socio-emotional development. Parenting interventions suitable for LMIC contexts have been developed targeting these risk factors and have been shown to have promising effects. However, their impact on child aggression, a key precursor of violence, has yet to be determined. The Pelotas Trial of Parenting Interventions for Aggression (PIÁ) has been designed to address this issue. Methods We are conducting a randomised controlled trial to evaluate two early parenting interventions for mothers of children aged between 30 and 42 months in a Brazilian city. The first of these, dialogic book-sharing (DBS), aims to promote child cognitive and socio-emotional development; and the second, the ACT Raising Safe Kids Program (ACT), is designed to reduce harsh parenting. These interventions are being compared with a control group receiving neither intervention. Three hundred and sixty-nine families in a birth cohort are being randomly allocated to one of the three groups (DBS, ACT, Control). Facilitators deliver the interventions to groups of five to 10 mothers at weekly sessions for 8 weeks in DBS and 9 weeks in ACT. Independent assessments of parenting and child development are being made before the interventions, shortly afterwards, and at follow-up 6 months later. The primary outcome is child aggression, and the two main secondary outcomes are: (1) child cognitive and socio-emotional development and (2) harsh parenting. Longer-term outcomes will be investigated as the birth cohort is followed into late childhood, adolescence, and adulthood. Discussion The Pelotas Trial of Parenting Interventions for Aggression (PIÁ) aims to evaluate the impact of two early parenting interventions on child aggression and several other key risk factors for the development of violence, including aspects of parenting and child cognition and socio-emotional functioning. The study is being carried out in a LMIC context where violence constitutes a major social and health burden. Since the two interventions are brief and, with modest levels of training, readily deliverable in LMIC settings, a demonstration that they benefit parenting and reduce risk factors for violence would be of major significance

TOSSE PRODUTIVA E DISPNÉIA

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Diálise peritoneal (DP) como tratamento da insuficiência cardíaca congestiva (ICC) em pacientes com doença renal crônica estágio IV Peritoneal dialysis for treating congestive heart failure in patients with stage IV chronic kidney disease

A Insuficiência Cardíaca Congestiva (ICC) é uma patologia com incidência crescente e que representa uma condição de grande impacto na saúde pública, com alta morbidade e mortalidade. O excesso de volume é uma complicação prevalente, presente em 80% dos pacientes atendidos com o diagnóstico de ICC. Estratégias farmacológicas e não farmacológicas no manejo terapêutico da ICC visam ao melhor manejo do volume e à redução no uso de diuréticos. A ultrafiltração extracorpórea tem evidenciado melhor controle de peso, redução nos dias de hospitalização e re-hospitalização dos pacientes com ICC. Neste artigo, relatamos dois casos atendidos no Hospital de Clínicas de Porto Alegre, relativos a pacientes com diagnóstico de ICC tratados com diálise peritoneal.<br>Congestive heart failure (CHF) has a growing incidence, a great impact on public health, and high morbidity and mortality. Excessive blood volume is a prevalent complication present in 80% of the patients diagnosed with CHF. Pharmacological and non-pharmacological strategies in the treatment of CHF aim to better manage blood volume and reduce the use of diuretics. Extracorporeal ultrafiltration has evidenced better weight control, and a reduction in the length of hospitalization and re-hospitalization of patients with CHF. We report the cases of 2 patients diagnosed with CHF and treated with peritoneal dialysis at Hospital de Clínicas de Porto Alegre

Impact of pharmaceutical care on the quality of life of patients with Chagas disease and heart failure: randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Pharmaceutical care is the direct interaction between pharmacist and patient, in order to improve therapeutic compliance, promote adequate pharmacotherapeutic follow-up, and improve quality of life. Pharmaceutical care may be effective in reducing complications and in improving the quality of life of patients with chronic diseases, like Chagas heart disease, while bringing a positive impact on health system costs. The morbidity and mortality indexes for patients with Chagas heart disease are high, especially if this heart disease is complicated by heart failure. In this setting, we hypothesize that pharmaceutical care might be an important tool for the clinical management of these patients by improving their quality of life, as a better compliance to their treatment and the avoidance and prompt correction of drug-related problems will minimize their symptoms, improve their functional class, and decrease the number of hospital admissions. Therefore, the aim of this trial is to evaluate the contribution of pharmaceutical care to clinical treatment of patients with Chagas heart disease complicated by heart failure.</p> <p>Methods/design</p> <p>A prospective, single-center randomized clinical trial will be conducted in patients with Chagas heart disease complicated by heart failure. A total of 88 patients will be randomly assigned into two parallel groups: an intervention group will receive standard care and pharmaceutical care, and a control group will receive only standard care. Both groups will be subjected to a follow-up period of 12 months. The primary outcome of this trial is the evaluation of quality of life, measured by the 36-item short-form and the Minnesota Living with Heart Failure Questionnaire. Secondary outcomes include drug-related problems, exercise tolerance as measured by the standard six-minute-walk test, and compliance.</p> <p>Discussion</p> <p>Patients with Chagas heart disease complicated by heart failure under pharmaceutical care are expected to improve their quality of life, present with a lower incidence of drug-related problems, improve their functional capacity, and improve in their compliance to treatment.</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier: NCT01566617</p