Controle glicêmico e auto percepção do grau de adesão à insulina em pacientes com diabetes tipo 1 no Brasil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2016-10-10T16:14:21Z No. of bitstreams: 1 Carine de Sousa Andrade Ribeiro Controle glicemico....pdf: 2273256 bytes, checksum: e1b6ca7883448988e46bc68525e65b0b (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2016-10-10T16:22:34Z (GMT) No. of bitstreams: 1 Carine de Sousa Andrade Ribeiro Controle glicemico....pdf: 2273256 bytes, checksum: e1b6ca7883448988e46bc68525e65b0b (MD5)Made available in DSpace on 2016-10-10T16:22:34Z (GMT). No. of bitstreams: 1 Carine de Sousa Andrade Ribeiro Controle glicemico....pdf: 2273256 bytes, checksum: e1b6ca7883448988e46bc68525e65b0b (MD5) Previous issue date: 2016-06-10CAPES e PfizerFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilIntrodução: Apesar dos avanços no manejo do diabetes mellitus tipo 1 (DM1), 60% a 90% dos pacientes apresentam controle glicêmico inadequado e 10% a 30% relatam baixa adesão à insulina. Os objetivos dessa tese foram identificar fatores associados à elevada concentração de hemoglobina glicada (HbA1c) e à uma melhor percepção da adesão à insulina em pacientes com DM1 em dez cidades de grande porte no Brasil. Métodos: Foi realizado um estudo de corte transversal, multicêntrico, com pacientes ≥18 anos, com diagnóstico médico de DM1, atendidos em centros de saúde. Dados sócio demográficos, comportamentais, clínicos, de conhecimento sobre o diabetes e satisfação com o tratamento foram obtidos por meio de entrevistas. A HbA1c foi dosada para todos os participantes. Considerou-se controle glicêmico inadequado quando HbA1c >7,0%. A auto percepção da adesão à insulina foi analisada em 3 categorias: regular/ruim, boa e excelente. Modelos multivariados hierarquizados de regressão linear foram utilizados para identificar fatores associados à elevada concentração de HbA1c e modelos multivariados de regressão multinomial foram usados para identificar fatores associados a adesão à insulina. Resultados: Dentre os 979 pacientes estudados, 63% eram do sexo feminino e a média da idade foi de 40 anos (DP:14,56). A média da HbA1c foi 9,4% (DP: 2,2) e 89,6% dos pacientes tinham controle glicêmico inadequado. No último ano não ter participado de aula/palestra sobre diabetes, não realizar consultas médicas em consultório particular e não ter dosado a HbA1c, além da baixa escolaridade e percepção regular/ruim da adesão à dieta e à insulina, foram fatores independentemente associados a elevadas concentrações de HbA1c. A auto percepção da adesão à insulina foi a variável mais fortemente associada ao aumento da HbA1c (β=1,385, IC95%:0,764; 2,007). Adesão à insulina regular/ruim, boa e excelente foi reportada por 5,8%, 15,1% e 79,1% dos pacientes, respectivamente. Idade entre 30 a 49 anos, sexo feminino, baixa escolaridade, adesão boa ou excelente à dieta, satisfação com o tratamento atual, dosagem de HbA1c no último ano, acompanhamento médico com endocrinologista, monitoramento regular da glicemia e mais de 10 anos de doença foram independentemente associados à percepção boa ou excelente da adesão à insulina. Conclusão: Embora somente 5,8% dos pacientes relatassem percepção regular/ruim da adesão à insulina, aproximadamente 90% dos pacientes tinham HbA1c >7,0%. Os achados sugerem que fatores comportamentais, de acesso à informação e à assistência qualificada parecem ser determinantes do controle glicêmico e da adesão à insulina. Assim, programas de controle do diabetes devem abranger ações multifatoriais que incluam educação em saúde e importância da adesão à insulina e do bom controle glicêmico em pacientes com DM1 no Brasil.Introduction: Despite advances in managing diabetes mellitus type 1 (DM1), 60% to 90% of patients have poor glycemic control and 10% to 30% reported low adherence to insulin. The objectives of this thesis was to identify factors associated with high levels of glycated hemoglobin (HbA1c) and a better understanding of adherence to insulin in patients with type 1 diabetes in Brazil. Methods: We conducted a cross-sectional, multicenter study, with patients ≥18 years old, diagnosed with type 1 diabetes treated at health centers in 10 cities in Brazil. We obtained sociodemographic, behavioral and clinical data, knowledge about diabetes and satisfaction with treatment through interviews. We measured HbA1c for all participants. It was considered inadequate glycemic control when HbA1c >7.0%. We analyzed self-perception of adherence to insulin in three categories: fair/poor, good and excellent. Multivariate linear regression models were used to identify hierarchical factors associated with HbA1c levels and multivariate models multinomial regression were used to identify factors associated with adherence to insulin. Results: Among the 979 patients studied, 63% were female and the average age was 40 years (SD: 14.56). The mean HbA1c was 9.4% (SD: 2.2) and 89.6% of patients had inadequate glycemic control. Last year did not participate in class/lecture on diabetes, not to visit a doctor in private practice and not have dosed HbA1c, as well as low education and perception poor adherence to diet and insulin, were factors independently associated with higher levels HbA1c. Self-perception of adherence to insulin was the variable most strongly associated with increased levels of HbA1c (β = 1.385, 95% CI: 0.764, 2.007). We reported adherence to fair/poor, good and excellent insulin by 5.8%, 15.1% and 79.1% of patients, respectively. Age between 30-49 years old, female, low education, good adhesion and excellent diet, satisfaction with current treatment, HbA1c measurement in the last year, medical follow-up with an endocrinologist, regular monitoring of blood glucose and more than 10 years of disease were independently associated with good or excellent perception of adherence to insulin. Conclusion: Although only 5.8% of patients to report fair/poor perception of adherence to insulin approximately 90% of patients had HbA1c >7.0%. Our findings suggest that behavioral factors, access to information and qualified assistance appear to be determinants of glycemic control and adherence to insulin. Thus, diabetes control programs should cover multifactorial actions include health education and the importance of adherence to insulin and good glycemic control in patients with type 1 diabetes in Brazil

Prevalence and characteristics associated with malnutrition at hospitalization among patients with acquired immunodeficiency syndrome in Brazil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-05-24T17:21:39Z No. of bitstreams: 1 Andrade Prevalence and Characteristics Associated.....pdf: 113426 bytes, checksum: 345336cd7febe8f9d77870a6df498acb (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-05-24T18:13:23Z (GMT) No. of bitstreams: 1 Andrade Prevalence and Characteristics Associated.....pdf: 113426 bytes, checksum: 345336cd7febe8f9d77870a6df498acb (MD5)Made available in DSpace on 2018-05-24T18:13:23Z (GMT). No. of bitstreams: 1 Andrade Prevalence and Characteristics Associated.....pdf: 113426 bytes, checksum: 345336cd7febe8f9d77870a6df498acb (MD5) Previous issue date: 2012Federal University of Bahia. School of Nutrition. Salvador, BA, BrasilFederal University of Bahia. School of Nutrition. Salvador, BA, BrasilFederal University of Bahia. School of Nutrition. Salvador, BA, BrasilFederal University of Bahia. School of Nutrition. Salvador, BA, BrasilDuke University. School of Medicine. Durham, NC, United States of America / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Federal University of Bahia. Institute of Collective Health. Salvador, BA, BrazilBrazil's National STD/AIDS Program is considered a model of success worldwide. However, AIDS-associated malnutrition continues in subgroups of Brazilian patients despite access to free highly active antiretroviral therapy (HAART). We aimed to identify the prevalence of malnutrition and associated factors among patients hospitalized with AIDS. Methods: We conducted a cross-sectional nutritional assessment among 127 adults hospitalized with AIDS in Brazil’s third largest city. Using anthropometric measurements, we determined the prevalence of malnutrition (body mass index ,18.5 kg/m2) at hospitalization. Prevalence ratios of malnutrition by demographic, socioeconomic, and clinical conditions were estimated using log-binomial regression. Results: One-third of participants were first informed of their HIV disease during the current hospitalization and recent treatment interruption was common (71%) among those on HAART. Forty-three percent were malnourished and 35% had severe weight loss at admission. Patient characteristics independently associated with malnutrition were older age (2% increased prevalence for each year; 95% confidence interval [CI] 0–4%) and very low daily per capita household income. Living on ,USD 2.00, USD 2.00–4.99 or USD 5.00–9.99 increased the prevalence of malnutrition by 2.01 (95% CI 1.06–3.81), 1.75 (95% CI 0.92–3.35) and 1.42 (95% CI 0.76–2.65) times, respectively, compared to $USD 10.00 per day. Chronic diarrhea was marginally associated with malnutrition (RR 1.42; 95% CI 0.99–2.04). Overall, 16% of the patients died during hospitalization. We observed a trend toward higher in-hospital case fatality among malnourished patients (22% vs. 12% for patients with and without malnutrition, respectively; chi square P = 0.14). Conclusions: Unacceptably high rates of malnutrition persist in Brazilians hospitalized with AIDS and our results reinforce the importance of nutritional evaluations in these patients. Improved early testing and treatment adherence strategies may continue to help reduce AIDS-related morbidity and mortality in Brazil, yet novel interventions to disrupt the cycle of poverty, HIV, and malnutrition are also urgently needed

Factors associated with high levels of glycated haemoglobin in patients with type 1 diabetes: a multicentre study in Brazil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-02-20T12:40:04Z No. of bitstreams: 1 Andrade CS Factors associated with high levels....pdf: 487243 bytes, checksum: b0c8f3bbdc89c4504b1fe22c53eaa4da (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-02-20T12:54:05Z (GMT) No. of bitstreams: 1 Andrade CS Factors associated with high levels....pdf: 487243 bytes, checksum: b0c8f3bbdc89c4504b1fe22c53eaa4da (MD5)Made available in DSpace on 2018-02-20T12:54:05Z (GMT). No. of bitstreams: 1 Andrade CS Factors associated with high levels....pdf: 487243 bytes, checksum: b0c8f3bbdc89c4504b1fe22c53eaa4da (MD5) Previous issue date: 2017The Brazilian Study of Diabetes Control was funded by Pfizer, Brazil. CSA received scholarship from the Coordination for the Improvement of Higher Education Personnel (CAPES), Brazilian Ministry of Education. GSR and EDM received scholarships from the National Council for Scientific and Technological Development (CNPq).Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Escola de Nutrição. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / State University of Feira de Santana. Department of Exact Sciences. Feira de Santana, BA, BrazilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, BrasilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Charitable Works Foundation of Sister Dulce. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, BrasilLong-term complications of type 1 diabetes mellitus (DM1) can be prevented with adequate glycaemic control. However, high levels of glycated haemoglobin (HbA1c) occur in 60%-90% of the patients with DM1. Thus, we aimed to investigate the role of sociodemographic, behavioural and clinical factors on the HbA1c levels of patients with DM1 in Brazil. Design, setting and participants A cross-sectional study was conducted in ambulatory patients with DM1 aged ≥18 years from 10 Brazilian cities. Sociodemographic, behavioural and clinical data were obtained through interviews. Main outcome measures HbA1c level was measured by liquid chromatography. Hierarchical multiple variable linear regression models were used to identify factors correlated with high levels of HbA1c. Results Of 979 patients with DM1, 63.8% were women, and the mean age was 40 (SD 14.6) years. The mean HbA1c level was 9.4% (SD 2.2%), and 89.6% of the patients had HbA1c ≥7.0%. Factors independently correlated with increased HbA1c levels included: lower education, non-participation in diabetes classes/lecture during the year before, having a self-perception of poor adherence to diet and insulin, not having private medical care and not measuring the HbA1c levels in the prior year. Of note, poor adherence to diet and insulin were the independent factors most strongly associated with high levels of HbA1c (mean increment in HbA1c levels of 0.88% and 1.25%, respectively). Conclusion Poor glycaemic control, which is common among Brazilian patients with DM1, is associated with lower education, self-perception of insufficient adherence to diet and insulin and inadequate monitoring of HbA1c levels. Specific actions, particularly those targeting improving adherence to diet and insulin, may contribute to successful management of patients with DM1

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field