Programa de prevenção de doenças crônicas não comunicáveis em escolas de educação infantil da rede municipal de ensino de Porto Alegre

Trabalho apresentado no 31º SEURS - Seminário de Extensão Universitária da Região Sul, realizado em Florianópolis, SC, no período de 04 a 07 de agosto de 2013 - Universidade Federal de Santa Catarina.Programa de prevenção de doenças crônicas não comunicáveis, desenvolvido em escolas de educação infantil da rede municipal de educação do município de Porto Alegre, coordenada pelo Núcleo Interdisciplinar de Prevenção de Doenças Interdisciplinar de Doenças Crônicas na Infância da Pró-Reitoria de Extensão da UFRGS, na qual participam a Secretaria Municipal de Educação da Prefeitura Municipal de Porto Alegre e o Departamento de Enfermagem da UFCSPA. A população-alvo são crianças de 0 a 5 anos, matriculadas nas escolas de educação infantil da rede pública de ensino do município de Porto Alegre, seus pais ou responsáveis e os profissionais destas escolas. Além da capacitação dos pais e profissionais pela difusão dos conhecimentos sobre estas doenças e sua associação com sobrepeso/obesidade, iniciados nos primeiros anos de vida, sobre os riscos da ingestão excessiva de sal e açúcar desde os primeiros meses de vida , haverá a análise dos dados da avaliação antropométrica (peso, altura e circunferência abdominal) e pressão arterial dessas crianças e dos dados de questionários sobre ocorrência familiar de doenças crônicas não comunicáveis, da atividade física dos pais, que servirão de subsídios para a elaboração de políticas públicas para a prevenção de doenças crônicas não comunicáveis nas escolas. Foram avaliadas até agora 673 crianças em 8 das 34 escolas. Uma ação integrada com a Secretaria da Saúde está sendo estruturada para o encaminhamento das crianças identificadas com sobrepeso/obesidade e com alterações na pressão arterial para assegurar seu atendimento numa linha de cuidados pré-estabelecida e prioritária, constituindo-se assim uma integração real e eficiente entre universidade-escola-serviço de saúde para a promoção da saúde e identificação precoce de crianças com anormalidades numa fase em que é possível instituir tratamento com sucesso

Síndrome metabólica em adolescentes obesos: comparação entre três diferentes critérios diagnósticos

Objective: To investigate the difference in the proportion of adolescents with metabolic syndrome diagnosed based on three different criteria, as well as the use of insulin resistance instead of fasting glucose.Methods: Cross-sectional study with 121 obese adolescents, between 10 and 14 years old, from public schools of the city of Porto Alegre, Brazil, in 2011. Anthropometric, blood pressure, and biochemical variables were assessed. Metabolic syndrome was defined using three different diagnostic criteria: the International Diabetes Federation (IDF), Cook and de Ferranti. All of them include five components: waist circumference, blood pressure, high-density lipoprotein (HDL) cholesterol, triglycerides and fasting glucose, and there should be at least three abnormal results for the diagnosis of the syndrome. the Homeostasis Model Assessment - Insuline Resistance (HOMA-IR) was used for the characterization of insulin resistance. the analysis of agreement among the criteria was performed using Kappa statistics.Results: Metabolic syndrome Was diagnosed in 39.7, 51.2, and 74.4% of adolescents, according to the IDF, Cook and de Ferranti criteria, respectively. There was agreement for the three diagnostic criteria in 60.3% of the sample. Waist circumference was the most prevalent component (81.0, 81.0, and 96.7%), whereas high fasting glucose was the least prevalent (7.4, 1.7, and 1.7%). the use of HOMA-IR significantly increased the proportion of positive diagnoses for the syndrome.Conclusion: the results showed significant differences between the three diagnostic criteria. While there is no consensus on the diagnostic criteria for metabolic syndrome, differences in the prevalence of the disease in pediatric population will be frequent.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundo de Incentivo a Pesquisa e Eventos (FIPE), Hospital de Clinicas de Porto Alegre (HCPA)Research and Events Incentive Fund - FIPE of Hospital de Clinicas de Porto Alegre - HCPAUniversidade Federal de São Paulo UNIFESP, São Paulo, BrazilUniv Fed Rio Grande do Sul, Escola Educ Fis ESEF, Porto Alegre, RS, BrazilUniv Fed Rio Grande do Sul, ESEF, Porto Alegre, RS, BrazilUniv London, Inst Child Hlth, London WC1N 1EH, EnglandUniv Fed Rio Grande do Sul, Fac Med, Dept Pediat, Porto Alegre, RS, BrazilHCPA, Serv Pediat, Porto Alegre, RS, BrazilUniv Fed Santa Maria, Santa Maria, RS, BrazilUniversidade Federal de São Paulo UNIFESP, São Paulo, BrazilCNPq: 159754/2010-0Web of Scienc

Impact of COVID-19 infection among heart transplant recipients : a southern brazilian experience

Purpose: The coronavirus-2019 (COVID-19) infection is associated with a high risk of complications and death among heart transplant recipients. However, most cohorts are from high-income countries, while data from Latin America are sparse. Methods: This is a retrospective cohort of heart transplant recipients followed at a hospital in Rio Grande do Sul, Brazil, between March 1st 2020 and October 1st 2021. Results: Of the 62 heart transplant recipients on follow-up, 21 (34%) were infected by COVID-19, 58 (36-63) years of age, 67% male, body mass index of 26 (23-29) kg/m2, 48% with hypertension, 43% with chronic kidney disease, 5% with diabetes, within 2 (1-4) years of post-transplant follow-up. At presentation, the main symptoms were fever (62%), myalgia (33%), cough (33%), headache (33%), and dyspnea (19%). Hospitalization was required for 13 (62%) patients, with a time from first symptoms to the admission of 5 (1-12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Three (14%) were infected after at least a first dose of COVID-19 vaccine. The main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%) and venous thromboembolism (10%). Immunosuppression therapy was modified in 48%, with a reduction in the majority (89%). Two (10%) patients died in the hospital due to refractory hypoxemia and multiple organ dysfunction. The incidence of COVID-19 among transplant patients was comparable to the general population in the State of Rio Grande do Sul with a peak in December 2020. Conclusion: Heart transplant recipients shown a high rate of COVID-19 infection in Southern Brazil, with typical symptom presentation in most cases. There was an elevated rate of hospitalization, supplementary oxygen support, and complications. In-hospital lethality among infected heart transplanted recipients was similar to previously reported data worldwide despite the high rates of infection in Latin America

Cardiopulmonary exercise capacity and quality of life of patients with heart failure undergoing a functional training program : study protocol for a randomized clinical trial

Background: Exercise intolerance is a common finding in heart failure that generates a vicious cycle in which the individual starts to limit his activities even more due to progressive fatigue. Regular physical exercise can increase the cardiopulmonary exercise capacity of these individuals. A new approach to physical exercise, known as functional training, could improve the oxygen consumption and quality of life of patients with heart failure; however, there is no information about the effect of this modality of exercise in this patient population. This randomized trial will compare the effects of 36 sessions of functional training versus strength training in heart failure patients. Methods: This randomized parallel-design examiner-blinded clinical trial includes individuals of both sexes aged ≥40 years receiving regular follow-up at a single academic hospital. Subjects will be randomly allocated to an intervention group (for 12-week functional training) or an active comparator group (for 12-week strength training). The primary outcomes will be the difference from baseline to the 3-month time point in peak oxygen consumption on cardiopulmonary exercise testing and quality of life assessed by the Minnesota Living with Heart Failure Questionnaire. Secondary outcome measures will include functionality assessed by the Duke Activity Status Index and gait speed test; peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively; endothelial function by brachial artery flow-mediated dilation; lean body mass by arm muscle circumference; and participant adherence to the exercise programs classified as a percentage of the prescribed exercise dose. Discussion: The functional training program aims to improve the functional capacity of the individual using exercises that relate to his specific physical activity transferring gains effectively to one’s daily life. In this context, we believe that that functional training can increase the cardiopulmonary exercise capacity and quality of life of patients with heart failure. The trial has been recruiting patients since October 2017

Functional training improves peak oxygen consumption and quality of life of individuals with heart failure : a randomized clinical trial

Background: Functional training may be an effective non-pharmacological therapy for heart failure (HF). This study aimed to compare the effects of functional training with strength training on peak VO2 and quality of life in individuals with HF. Methods: A randomized, parallel-design and examiner-blinded controlled clinical trial with concealed allocation, intention-to-treat and per-protocol analyses. Twenty-seven participants with chronic HF were randomly allocated to functional or strength training group, to perform a 12-week physical training, three times per week, totalizing 36 sessions. Primary outcomes were the difference on peak VO2 and quality of life assessed by cardiopulmonary exercise testing and Minnesota Living with Heart Failure Questionnaire, respectively. Secondary outcomes included functionality assessed by the Duke Activity Status Index and gait speed test, peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively, endothelial function by brachial artery flow-mediated dilation, and lean body mass by arm muscle circumference. Results: Participants were aged 60 ± 7 years, with left ventricular ejection fraction 29 ± 8.5%. The functional and strength training groups showed the following results, respectively: peak VO2 increased by 1.4 ± 3.2 (16.9 ± 2.9 to 18.6 ± 4.8 mL.kg-1.min-1; p time = 0.011) and 1.5 ± 2.5 mL.kg-1.min-1 (16.8 ± 4.0 to 18.6 ± 5.5 mL.kg-1.min-1; p time = 0.011), and quality of life score decreased by 14 ± 15 (25.8 ± 14.8 to 10.3 ± 7.8 points; p time = 0.001) and 12 ± 28 points (33.8 ± 23.8 to 19.0 ± 15.1 points; p time = 0.001), but no difference was observed between groups (peak VO2: p interaction = 0.921 and quality of life: p interaction = 0.921). The functional and strength training increased the activity status index by 6.5 ± 12 and 5.2 ± 13 points (p time = 0.001), respectively, and gait speed by 0.2 ± 0.3 m/s (p time = 0.002) in both groups. Conclusions: Functional and strength training are equally effective in improving peak VO2, quality of life, and functionality in individuals with HF. These findings suggest that functional training may be a promising and innovative exercise-based strategy to treat HF

Nurses' performance in classifying heart failure patients based on physical exam : comparison with cardiologist's physical exam and levels of N-terminal pro-B-type natriuretic peptide

Aim.The purpose of this study is to compare clinical assessment of congestion performed by a nurse to that performed bycardiologist and correlate them with NT-ProBNP levels.Background.The nurses’ role in heart failure has been strongly focused in therapeutic, educational and self-care interventions.The diagnostic performance of nurses in heart failure outpatients is not well explored. N-terminal pro-B-type natriuretic peptideis a cardiac marker that reflects elevated filling pressures.Design.Cross-sectional contemporaneous study.Methods.Heart failure outpatients underwent a systematic clinical assessment of clinical congestion score performed by car-diologist and nurse during the same visit. Assessments were performed independently and N-terminal pro-B-type natriureticpeptide levels obtained. The nurses’ ability to classify patients in hemodynamic profile was compared to the cardiologist’s.Results.Eighty-nine assessments were performed in 63 patients with heart failure. The correlation of clinical congestion scoresobtained by nurse with those obtained by cardiologist wasrs=0Æ86;p<0Æ001. The correlation of clinical congestion scoresfrom nurse and cardiologist with levels of N-terminal pro-B-type natriuretic peptide were as follows:rs=0Æ45;p<0Æ0001 andrs=0Æ51, respectively,p<0Æ0001. Patients with clinical congestion score‡3 had levels of NT-ProBNP significantly higher thanthose with clinical congestion score<3, in the assessment performed by the cardiologist (1866 SD 1151 vs. 757 SD 988 pg/ml;p<0Æ0001) and by the nurse (1720 SD 1228 vs. 821 SD 914 pg/ml;p<0Æ0001). The nurse and cardiologist had similarcapacity in classifying patients in congested quadrants (p=0Æ027) or in dry quadrants (p=0Æ03), according to the levels ofN-terminal pro-B-type natriuretic peptide. Area under the receiver-operating characteristic curve of the nurse and cardiologist todetect congestion was, respectively, 0Æ77 and 0Æ72. Conclusions.Our data suggests that nurses trained in heart failure may have a similar performance to that of the cardiologistfor the clinical detection of congestion and assessment of the hemodynamic profile in patients with chronic heart failure