Autogerindo o tratamento da osteoporose no regaste do bem-estar, mediado pela (in)visibilidade de indicadores da doença

The present study aimed to understand patients' experience with osteoporosis treatment. The methodological and theoretical frameworks were, respectively, the Grounded Theory and Symbolic Interactionism. The research subjects were 12 patients monitored in a specialized outpatient unit. The obtained statements were transcribed and analyzed, leading to a synthesis of the described themes. From the analysis process, two phenomena emerged: "self-evaluating health conditions according to the disease signs" and "making a decision about the treatment targeting at well-being". The realignment and the inter-relationship of the components belonging to these phenomena (themes, categories, and subcategories) allowed to identify the core category: "self-managing osteoporosis treatment for well-being recovery mediated by the (in)visibility of the disease signs". Furthermore, it allowed for the design of a theoretical model concerning the process used by the player in his cyclic movement of the experience, between adherence to and relaxation from the osteoporosis treatment.Este estudio tuvo como objetivo comprender la experiencia de los pacientes con el tratamiento de la osteoporosis. Los marcos teórico y metodológico fueron, respectivamente, la Grounded Theory y el Interaccionismo Simbólico. Los sujetos fueron 12 pacientes en una clínica especializada. Las declaraciones fueron transcritas y analizadas, habiendo sido obtenida una síntesis de los temas descritos. En el proceso de análisis surgieron dos fenómenos: "auto-evaluando el estado de salud de acuerdo a los indicadores de la enfermedad" y, "tomando una decisión sobre el tratamiento teniendo como meta el bienestar". La reestructuración y la interrelación de los componentes que pertenecen a estos fenómenos (temas, categorías y subcategorías) permitieron identificar la categoría central, llamada "auto-administrando el tratamiento de la osteoporosis en el rescate del bienestar, por medio de la (in)visibilidad de los indicadores de la enfermedad." Además, permitió elaborar un modelo teórico referente al proceso emprendido por el actor en su movimiento cíclico da experiencia, entre la adhesión y el relajamiento en lo que se refiere al tratamiento de la osteoporosis.O presente estudo teve como objetivo compreender a experiência dos pacientes com o tratamento da osteoporose. Os referenciais metodológico e teórico foram, respectivamente, a Grounded Theory e o Interacionismo Simbólico. A amostra desta pesquisa foi composta por 12 pacientes, acompanhados em um ambulatório especializado. Dos depoimentos obtidos, após transcritos e analisados, obteve-se uma síntese dos temas descritos. Do processo de análise, emergiram dois fenômenos: "autoavaliando o estado de saúde, segundo os indicadores da doença" e "tomando a decisão quanto ao tratamento, tendo como meta o bem-estar". O realinhamento e a inter-relação de componentes, pertencentes a esses fenômenos (temas, categorias e subcategorias), possibilitaram identificar a categoria central, denominada "autogerindo o tratamento da osteoporose no regaste do bem-estar, mediado pela (in)visibilidade de indicadores da doença". Ademais, permitiu elaborar um modelo teórico referente ao processo empreendido pelo ator no seu movimento cíclico da experiência, entre a adesão e o relaxamento quanto ao tratamento da osteoporose

Efficacy of vitamin D supplementation in gestational diabetes mellitus: Systematic review and meta-analysis of randomized trials.

BackgroundTrials have examined on the benefits of vitamin D supplementation in pregnant women.ObjectiveThis review aimed to evaluate whether oral vitamin D supplements, when given to pregnant women with gestational diabetes mellitus (GDM), would improve maternal and neonatal outcomes, compared with no treatment or placebo.MethodWe performed a systematic review following Cochrane methodology, and randomized trials were included where pregnant women with GDM received vitamin D supplementation versus placebo/no treatment or vitamin D and calcium versus placebo/no treatment. Primary outcomes were preeclampsia, preterm birth, cesarean delivery, gestational hypertension, and adverse events related to vitamin D supplementation. The search strategies were applied to the following databases: MEDLINE, Embase, LILACS, and CENTRAL. Similar outcomes in at least two trials were plotted using Review Manager 5.3 software. The quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).ResultsThe total of 1224 references were identified, eleven trials were potentially eligible, and six were included in this review (totaling 456 women). The meta-analysis of frequency of cesarean deliveries did not show significant differences between groups, none of the trials evaluated the remaining primary outcomes. For secondary outcomes, our results suggest that vitamin D supplementation in pregnant women with GDM may reduce newborn complications such as hyperbilirubinemia, polyhydramnios (RR: 0.40, 95% CI: 0.23 to 0.68; RR: 0.17, 95% CI: 0.03 to 0.89; respectively), and the need for maternal or infant hospitalization (RR: 0.13; 95% CI: 0.02 to 0.98; RR: 0.40, 95% CI: 0.23 to 0.69). However, the evidence was of low or very low quality.ConclusionWe did not find moderate or high quality evidence indicating that vitamin D supplementation, when compared with placebo, improves glucose metabolism, adverse maternal and neonatal outcomes related to GDM in pregnant women