34 research outputs found
Impact of the training of community health workers on food education: methodological aspects and potentialities / Impacto da capacitação de agentes comunitários de saúde em educação alimentar: aspectos metodológicos e potencialidades
Objetivo: analisar os aspectos metodológicos e as potencialidades do estudo “Impacto da capacitação de Agentes Comunitários de Saúde (ACS) em educação alimentar (EA) - Vitória/ES”. Métodos: os ACS de 25 Unidades de Saúde (US) foram convidados e avaliados em Centro de Investigação Cardiovascular. Foram realizadas quatro etapas: Avaliação da saúde e nutrição dos ACS; Estudo qualitativo; Capacitação em EA; Reavaliação. Resultados: foram coletados dados bioquímicos e antropométricos, de consumo alimentar, exames clínicos, eletrólitos urinários e testes físicos. Estudo qualitativo realizado para levantamento da percepção dos ACS sobre o estudo. As US foram randomizadas em dois grupos (intervenção e controle). O grupo intervenção participou de uma capacitação em EA, tendo como base o Guia Alimentar para a População Brasileira. Ao final da capacitação, os ACS foram reavaliados para identificar mudanças nas condições de saúde. Conclusão: este estudo pode contribuir para o planejamento, monitoramento e avaliação de ações específicas na atenção primária.
Multimorbidade e cuidado com a saúde de agentes comunitários de saúde em Vitória, Espírito Santo, 2019: um estudo transversal
Objective: To evaluate health conditions, health care and life habits of community health workers (CHW) in Vitória, Espírito Santo, Brazil. Methods: Cross-sectional study of baseline data from an intervention study. Biochemical, anthropometric, hemodynamic examinations were carried out and an interview was conducted between October/2018 and March/2019 in Vitória. Appropriate statistical tests, according to the sample design, were performed using SPSS software version 21.0, adopting p<0.05. Results: Evaluated 262 CHW with a mean age of 46.1±9.3 years. High prevalence of pre-diabetes(22.9%), diabetes mellitus (17.2%), hypertension (37,0%), obesity (39.8%), hypercholesterolemia (57.3%), hypertriglyceridemia (27.1%), multimorbidity (40.8%), physical inactivity (60.9%) and use of anxiolytics/ antidepressants (22.5%). About 40% of CHW had three or more morbidities. Conclusion: High percentages of chronic diseases, multimorbidity, sedentary lifestyle and use of anxiolytics/antidepressants were observed in CHW in Vitória.Objetivo: Evaluar condiciones de salud, cuidados de la salud y hábitos de vida de los Agentes Comunitarios de Salud (ACS) en Vitória, Espírito Santo, Brasil. Métodos: Estudio transversal de la línea de base de un estudio de intervención. Se realizaron clínicos y entrevistas entre octubre/2018 y marzo/2019 en Vitória. Se realizaron las pruebas estadísticas adecuadas utilizando el software SPSS versión 21.0, adoptando p<0.05. Resultados: Se evaluaron 262 ACS, con una edad promedio de 46,1±9,3 años. Hubo altas prevalencias de prediabetes (22,9%), diabetes mellitus (17,2%), hipertensión arterial (37,0%), obesidad (39,8%), hipercolesterolemia (57,3%), hipertrigliceridemia (27,1%), multimorbilidad (40,8%), inactividad física (60,9%) y uso de ansiolíticos/antidepresivos (22,5%). Aproximadamente el 40% tenía tres o más enfermedades. Conclusión: Se observaron altos porcentajes de enfermedades crónicas, multimorbilidad, sedentarismo y uso de ansiolíticos/antidepresivos en los ACS de Vitória.Objetivo: Avaliar condições de saúde, cuidados com a saúde e hábitos de vida de agentes comunitários de saúde (ACS) de Vitória, Espírito Santo, Brasil. Métodos: Estudo transversal da linha de base de um estudo de intervenção. Foram realizados exames bioquímicos, antropométricos, hemodinâmicos e entrevistas, entre outubro/2018 e março/2019, em Vitória. Testes estatísticos apropriados, conforme o delineamento da amostra, foram realizados utilizando-se o software SPSS versão 21.0, e adotando-se p<0,05. Resultados: Foram avaliados 262 ACS com idade média de 46,1±9,3 anos. Observaram-se elevados percentuais de pré-diabetes (22,9%), diabetes mellitus (17,2%), hipertensão arterial (37,0%), obesidade (39,8%), hipercolesterolemia (57,3%), hipertrigliceridemia (27,1%), multimorbidade (40,8%), sedentarismo (60,9%) e uso de ansiolíticos/antidepressivos (22,5%). Cerca de 40% dos ACS apresentaram três ou mais morbidades. Conclusão: Foram observados elevados percentuais de doenças crônicas, multimorbidade, sedentarismo e uso de ansiolíticos/antidepressivos em ACS de Vitóri
Thyroid and pituitary gland development from hatching through metamorphosis of a teleost flatfish, the Atlantic halibut
Fish larval development, not least the spectacular
process of flatfish metamorphosis, appears to be
under complex endocrine control, many aspects of
which are still not fully elucidated. In order to obtain
data on the functional development of two major
endocrine glands, the pituitary and the thyroid, during
flatfish metamorphosis, histology, immunohistochemistry
and in situ hybridization techniques were applied on
larvae of the Atlantic halibut (Hippoglossus hippoglossus),
a large, marine flatfish species, from hatching
through metamorphosis. The material was obtained
from a commercial hatchery. Larval age is defined as
day-degrees (D =accumulated daily temperature from
hatching). Sporadic thyroid follicles are first detected in
larvae at 142 D (27 days post-hatch), prior to the
completion of yolk sack absorption. Both the number
and activity of the follicles increase markedly after yolk
sack absorption and continue to do so during subsequent
development. The larval triiodothyronine (T3)
and thyroxine (T4) content increases, subsequent to yolk
absorption, and coincides with the proliferation of thyroid
follicles. A second increase of both T3 and T4 occurs
around the start of metamorphosis and the T3 content
further increases at the metamorphic climax. Overall,
the T3 content is lower than T4. The pituitary gland can
first be distinguished as a separate organ at the yolk sack
stage. During subsequent development, the gland becomes
more elongated and differentiates into neurohypophysis (NH), pars distalis (PD) and pars intermedia
(PI). The first sporadic endocrine pituitary cells are observed
at the yolk sack stage, somatotrophs (growth
hormone producing cells) and somatolactotrophs (somatolactin
producing cells) are first observed at 121 D
(23 days post-hatch), and lactotrophs (prolactin producing
cells) at 134 D (25 days post-hatch). Scarce
thyrotrophs are evident after detection of the first thyroid
follicles (142 D ), but coincident with a phase in
which follicle number and activity increase (260 D ).
The somatotrophs are clustered in the medium ventral
region of the PD, lactotrophs in the anterior part of the
PD and somatolactotrophs are scattered in the mid and
posterior region of the pituitary. At around 600 D ,
coinciding with the start of metamorphosis, somatolactotrophs
are restricted to the interdigitating tissue of the
NH. During larval development, the pituitary endocrine
cells become more numerous. The present data on thyroid
development support the notion that thyroid hormones
may play a significant role in Atlantic halibut
metamorphosis. The time of appearance and the subsequent
proliferation of pituitary somatotrophs, lactotrophs,
somatolactotrophs and thyrotrophs indicate at
which stages of larval development and metamorphosis
these endocrine cells may start to play active regulatory
roles.This work has been carried out within the
projects ‘‘Endocrine Control as a Determinant of Larval Quality in
Fish Aquaculture’’ (CT-96-1422) and ‘‘Arrested development: The
Molecular and Endocrine Basis of Flatfish Metamorphosis’’
(Q5RS-2002-01192), with financial support from the Commission
of the European Communities. However, it does not necessarily
reflect the Commission’s views and in no way anticipates its future
policy in this area. This project was further supported by the
Swedish Council for Agricultural and Forestry Research and Pluriannual
funding to CCMAR by the Portuguese Science and
Technology Council
Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial
Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council