Agravos fonoaudiológicos sob a ótica do agente comunitário de saúde

RESUMO Objetivo: verificar o conhecimento dos agentes comunitários de saúde quanto aos agravos fonoaudiológicos, investigando orientações realizadas. Métodos: estudo transversal com Agentes Comunitários de Saúde (ACS) atuantes nos Centros de Saúde (CS) do distrito sanitário Leste do município de Florianópolis, SC. Os ACS responderam a um questionário com caracterização sociodemográfica e conhecimento quanto a agravos fonoaudiológicos, por meio de questionamentos quanto às orientações realizadas em visitas referentes à promoção da saúde nos diferentes ciclos de vida. Foi realizada uma análise estatística descritiva no programa STATA 11.0. Resultados: foram entrevistados 55 ACS, com idade média de 44,56 anos, a maioria do sexo feminino (98,18%) e ensino médio (80%). Dentre os principais marcadores de saúde dos CS encontrou-se a Hipertensão arterial e a diabetes caracterizadas como doenças crônicas não transmissíveis. As orientações relacionadas à promoção da saúde materno infantil relatadas pelos ACS envolviam mais conhecimentos quanto aos agravos fonoaudiológicos em comparação com orientações a respeito da promoção da saúde da criança e do idoso. Conclusão: o estudo revelou que existe conhecimento por parte dos ACS com relação aos agravos fonoaudiológicos, já que são incorporados nas orientações realizadas pelos mesmos, porém este pode ser entendido como limitado. Considerando-se que o ACS é o principal elo entre a comunidade e a equipe de saúde torna-se essencial incorporar estes conhecimentos ao saber deste profissional como forma de efetivar as ações promoção e prevenção de saúde, configurando a integralidade do cuidado em saúde

Núcleos de Ensino da Unesp: artigos 2014: volume 1: processos de ensino e de aprendizagem dos conteúdos escolares

Conselho Nacional de Desenvolvimento Científco e Tecnológico (CNPq

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation

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