Percepção de pessoas sobre a hipertensão arterial e conceitos de Imogene King.

Diante da relevância das doenças cardiovasculares, objetivou-se analisar as percepções de um grupo de pessoas portadoras de hipertensão arterial focalizando o processo de adoecimento, relacionando-as com os conceitos dos sistemas pessoal e interpessoal de Imogene King. Estudo descritivo-exploratório desenvolvido em unidade de referência de Fortaleza, Ceará, aceito pelo Comitê de Ética da Universidade Estadual do Ceará. Participaram 50 hipertensos (34 mulheres e 16 homens) com idade de 23 a 84 anos. Evidenciou-se medo das complicações, satisfação na adaptação ao tratamento, indignação ante a modificação no estilo de vida e conformação com a doença. O enfermeiro, visto como parte do atendimento inicial e em contraste com a insegurança transmitida pelo paciente, revela necessidade de reflexão no cuidado prestado

Modelagem Matemática: um relato de experiência no sistema de aula remota / Mathematical Modeling: an experience report in the remote learning system

Para auxiliar os estudantes a vivenciar uma Matemática real e presente no dia a dia é preciso, como professor/pesquisador, investigar, fazer experiências e testar novas ideias. O presente artigo busca relatar uma experiência de atividade desenvolvida em uma turma do 3° ano do Ensino Médio com a Modelagem Matemática. A atividade foi uma pesquisa referente à situação da cidade de Campo Largo quanto aos casos de moradores infectados com o novo Coronavírus[1]. Foi um momento inusitado que trouxe resultados positivos, tais como, aos estudantes, oportunizar momentos em que se tornaram protagonistas na situação de aprendizagem, aos professores, as considerações sobre o desenvolvimento de situações fora do ambiente escolar e que contribuíram para uma análise mais reflexiva a respeito da prática docente e da importância da escola para vivência social de todos

Análogos de insulina no tratamento do diabetes gestacional

Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients

Metabólitos Secundários e ação antioxidante de Croton heliotripifolius e Croton blanchetianus

Antioxidants are compounds that, at optimal concentrations in relation to oxidable substrates, react with free radicals preventing or reducing oxidative stress. Many diseases and degenerative processes are associated with overproduction of free radicals. This stimulated several research groups to investigate the antioxidant potential of substances produced by several families of the world flora. This study identified the major classes of secondary metabolites present in ethanol leaf extracts of C. blanchetianus (Marmeleiro) and C. helliotripiifolius (Velame), and assessed their antioxidant potential. Ethanol extracts were obtained by the exhaustive extraction method cold and resulted in 3.29% and 3.26% extraction efficiency. Then phytochemical analyses were performed on the extracts to investigate the presence of tannins, flavonoids, flavonones, flavonols, catechins and xanthones. The antioxidant activity of extracts was determined by in vitro photocolorimetric method based on the sequestration of free radicals, using DPPH (1,1-diphenyl-2-picryl-hydrazyl). Both extracts were able to sequestrate DPPH free radical. Croton blanchetianus extract activity showed to be more efficient than BHT (Butylated Hidroxytoluene) (positive control), with EC50 = 6.5 ± 0.5 mg mL-1. Croton helliotripifolius extracts showed lower antioxidant activity, with EC50 = 50.15 ± 0.21 but still higher than that observed for BHT. However, the results observed for the ethanol extracts are possibly the result of the presence and concentration of phenolic compounds such as tannins and flavonoids, which were identified in this study.Antioxidantes são compostos que reagem com os radicais livres controlando o estresse oxidativo. Muitas doenças estão associadas à produção de radicais livres, os quais tem estimulado investigações do potencial antioxidante de diversas famílias da flora mundial. Essa pesquisa teve como objetivo identificar as principais classes de metabólitos secundários presentes nos estratos etanólicos das folhas de Croton blanchetianus (Marmeleiro) e Croton helliotripifolius (Velame), e avaliar o seu potencial antioxidante. Os estratos etanólicos foram obtidos das folhas, apresentou um rendimento de 3,29% e 3,26%. Em seguida, os estratos foram submetidos a análise fitoquímica, nos quais foi possível identificar a presença de taninos condensados, flavonoides, flavononas, flavonóis, flavononóis, catequinas e xantonas. A atividade antioxidante dos estratos foi determinada pelo método fotocolorimétrico in vitro realizada por meio do sequestro de radicais livres, usando o DPPH (1,1-difenil-2-picril-hidraliza). Ambos os estratos foram capazes de sequestrar o radical livre DPPH, sendo que o estrato de Croton blanquetianus mostrou ser mais eficiente do que o BHT (Hidroxitolueno butilado; controle positivo), com CE50 = 6,5 ± 0,5 mg mL-1. Contudo, os resultados observados para os estratos etanólicos, possivelmente sejam atribuídas à presença e a concentração de compostos fenólicos pertencentes as classes dos taninos e flavonoides, os quais foram identificados nesse estudo

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit