Obesidade e capacidade funcional podem estar associadas com diversas comorbidades em idosos residentes em instituições de longa permanência

ResumoIntrodução: o envelhecimento é um processo complexo que geralmente ocorre concomitantemente com o declínio e a reformulação das diferentes funções do corpo, dentre as quais, destacam-se as mudanças antropométricas, funcionais e cognitivas, bem como o aparecimento de diversos problemas de saúde. Objetivo: analisar a correlação entre a obesidade e a capacidade funcional com o déficit cognitivo e outras comorbidades em idosos residentes em Instituições de Longa Permanência. Materiais e Métodos: estudo transversal descritivo realizado em 40 idosos de ambos os sexos residentes em Instituições de Longa Permanência. Foram mensurados dados antropométricos, cognitivos e funcionais. As comorbidades foram verificadas com base no prontuário médico. Os dados foram analisados por meio do teste T independente, Teste Qui-Quadrado e Correlação Linear de Pearson. Foi adotado o valor de p<0,05 para apontar as diferenças significativas. O programa SPSS, 22.0 foi usado para realizar as análises. Resultado: o déficit cognitivo foi de 73% para mulheres e 48% para homens. A força de preensão palmar dominante foi de 11,6 ± 7,5 no sexo masculino e 6,2 ± 5,2 no sexo feminino, e não dominante 10,3 ± 6,5 e 5,3 ± 3,8 para masculino e feminino respectivamente. O IMC foi 25,9 ± 3,7 e 28,1 ± 5,0 para homens e mulheres respectivamente. Conclusão: a obesidade e o déficit cognitivo estão elevados entre os idosos institucionalizados. Houve associação do IMC e da força com as comorbidades, porém não com o desempenho cognitivo. Adicionalmente, os resultados dos testes funcionais se mostraram bastante comprometidos, uma vez que estão bastante inferiores aos valores encontrados em outros estudos. AbstractIntroduction: aging is a complex process that usually occurs concomitantly with the decline and the reformulation of the different body functions, among which, the anthropometric, functional and cognitive changes are distinguished, as well as the appearance of several health disorders. Objective: analyze the correlation between obesity and functional capacity with cognitive impairment and other comorbidities in the elderly living in long-stay institutions. Materials and Methods: descriptive cross-sectional study conducted in 40 elderly of both genders, who live in LSI. Anthropometric, cognitive and functional data were measured. Comorbidities were verified based in medical records. Data were analyzed using independent T test, chi-square test and Pearson’s linear correlation. It was adopted p value <0.05 to point out the significant differences. Result: cognitive impairment was 73% for women and 48% for men. The strength of dominant handgrip was 11.6 ± 7.5 in males and 6.2 ± 5.2 in females, and non-dominant 10.3 ± 6.5 and 5.3 ± 3.8 for male and female respectively. BMI was 25.9 ± 3.7 and 28.1 ± 5.0 for men and women respectively. Conclusion: obesity and cognitive impairment are high among the institutionalized elderly. There was an association of BMI and strength with comorbidities, but not with cognitive performance. Additionally, the results of the functional tests showed much compromised, since they are well below than the values found in other studies. figshare DOI: 10.6084/m9.figshare.819860

O financiamento do Sistema Socioeducativo no contexto do Plano Decenal de Atendimento Socioeducativo do Distrito Federal – PDASE/DF (2015 a 2020)

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Educação, Programa de Pós-Graduação em Educação, 2021.A Constituição Federal/88 e o Estatuto da Criança e do Adolescente/90 são normativas que efetivaram a transição da doutrina da situação irregular para a doutrina da proteção integral, reafirmando no Brasil o Estado democrático de direito. No entanto, foi a partir do Sistema Nacional do Sistema Socioeducativo (SINASE/2012), que o atendimento de adolescentes em cumprimento de medida socioeducativa, foi regulamentado. O objetivo desta pesquisa foi analisar o financiamento do sistema socioeducativo no Distrito Federal, por meio do mapeamento das fontes de recursos, da utilização dos recursos públicos para a manutenção do sistema na perspectiva do I Plano Decenal de Atendimento Socioeducativo (PDASE/DF), bem como da elaboração do cálculo do custo-adolescente no sistema distrital e nas unidades de internação. Trata-se de pesquisa bibliográfica e documental, de caráter exploratório, que se utiliza da abordagem quantitativa e estatística à luz de análise descritiva e analítica de dados físicos e financeiros. Os dados financeiros foram requeridos junto aos sistemas de informação governamental. A dissertação foi dividida em três capítulos. No primeiro, foi realizada a descrição da trajetória das concepções jurídicas acerca dos direitos da criança e do adolescente, assim como trata dos principais conceitos que respaldam a pesquisa, como federalismo, descentralização das políticas sociais e o direito à educação, em sua especificidade para os jovens privados de liberdade. No segundo, investigou-se o financiamento do SINASE, a fim de compreender as competências dos entes da federação, a partir do cofinanciamento, das fontes e destinação de recursos no âmbito da União, na perspectiva do Sistema de Garantias de Direitos da Criança e do Adolescente (SGD). O terceiro capítulo, por fim, dedicou-se à análise da política distrital de atendimento socioeducativo com foco no financiamento com a intenção de cotejar a projeção orçamentária do I PDASE-DF com a execução orçamentária gerida pelo órgão competente, para compreender como ocorreu a destinação de recursos ao sistema socioeducativo. Conclui-se que o sistema apresenta fragilidade institucional, pois não há articulação entre os órgãos envolvidos na gestão além de escassez de regulamentação e de financiamento, sobretudo quanto à efetivação do papel suplementar da União, comprometendo o cumprimento do preceito constitucional da prioridade absoluta. Quanto à política de financiamento no DF, a metodologia utilizada nesta pesquisa identificou que não há articulação entre os órgãos de gestão, além de insuficiência de financiamento, visto que a projeção orçamentária do I PDASE/DF apresentou uma discrepância expressiva em relação ao que foi executado pelo sistema, por outro lado houve uma evolução no atendimento, pois passou-se de iniciativas isoladas de criação de instituições para “menores infratores”, para a concepção e planejamento de um sistema. Este trabalho analisou o financiamento sob três dimensões: as receitas, as despesas e o custo do adolescente. A título exploratório foi possível calcular o custo- adolescente real do sistema socioeducativo no DF, bem como fazer uma aproximação do cálculo do custo-adolescente nas unidades de internação. Os dados revelaram o aumento de gastos com pessoal associado à queda importante do número de adolescentes, resultando em uma alta no custo-adolescente no sistema do DF e nas unidades de internação. A despeito de serem valores elevados, é importante lembrar que as atividades desenvolvidas nas unidades de internação não se restringem à dimensão educacional, pois envolvem custos associados à especificidade do sistema socioeducativo.The Federal Constitution of 1988 and the Brazilian Child and Adolescent Rights Act (ECA) of 1990 are regulations that brought about the transition from the doctrine of irregular status to the doctrine of full protection and affirmed the democratic rule of law in Brazil. However, the care of adolescents in accordance with the socio-educational measure was not regulated until the National System of the socio-educational system (SINASE/2012). The aim of this research was to analyze the financing of the socio-educational system in the Federal District, through the mapping of the sources of resources, the use of public funds for the maintenance of the system in the perspective of the I Decennial Plan for Socio-Educational Service (PDASE/DF), as well as the elaboration of the costing of adolescents in the district system and in the inpatient units. This is an exploratory bibliographic and documentary research using a quantitative and statistical approach in terms of descriptive and analytical analysis of physical and financial data. Financial data was required by government information systems. The dissertation was divided into three chapters. In the first, a description of the trajectory of legal ideas about the rights of children and adolescents was carried out, as well as the treatment of the main concepts that support the research, such as federalism, decentralization of social policy and the right to education, in its particularity for young people deprived of liberty. In the second chapter, the financing of SINASE was studied in order to understand the competences of the federation entities, from the co- financing, the sources and the distribution of the resources within the Union, from the perspective of the system of guarantees for the rights of the child and adolescent (SGD). Finally, the third chapter was dedicated to the analysis of the district policy of socio-educational care, with a focus on funding, with the intention of comparing the I PDASE-DF budget projection with the budget execution managed by the competent body, in order to understand how the allocation took place. of resources to the socio-educational system. The conclusion is that the system has an institutional weakness, as there is no link between the bodies involved in its management, in addition to a lack of regulation and funding, especially in relation to the realization of the complementary role of the Union, which jeopardizes compliance with the constitutional requirement of absolute priority. Regarding the funding policy in the Federal District (DF), the methodology used in this work has established that there is no link between the administrative bodies, in addition to insufficient funding, since the budget projection of the I PDASE/DF showed a significant discrepancy in terms of what was carried out by the system, on the other hand, there was an evolution in the service, since it moved from isolated initiatives to create institutions for "minor offenders" to the design and planning of a system. In this work, funding was analyzed under three dimensions: the income of the juvenile, the expenses and the costs. On an exploratory basis, it was possible to calculate the real costs of the juveniles for the socio- educational system in the Federal District, as well as to make an approximation of the cost calculation of the juveniles in the inpatient units. The data showed the increase in staff costs combined with the significant decrease in the number of youth, resulting in an increase in youth costs in the Federal District (DF) system and in the inpatient units. Although these are high values, it is important to remember that the activities developed in the inpatient units are not limited to the educational dimension, as they include costs associated with the specificity of the socio- educational system

Effects of a 12-Week Exercise Training Program on Physical Function in Institutionalized Frail Elderly

With the increase in life expectancy, the Brazilian elderly population has risen considerably. However, longevity is usually accompanied by problems such as the loss of functional capacity, cognitive decline, frailty syndrome, and deterioration in anthropometric parameters, particularly among those living in long-term care facilities. This randomized controlled trial aimed to verify the effects of exercise training on biochemical, inflammatory, and anthropometric indices and functional performance in institutionalized frail elderly. The sample consisted of 37 elderly people of both genders, aged 76.1 ± 7.7 years, who were randomly allocated into 2 groups: 13 individuals in the exercise group (EG) and 24 in the control group (CG). Anthropometrics, clinical history, functional tests, and biochemical evaluation were measured before and after the completion of a physical exercise program, which lasted for 12 weeks. The 12-week exercise program for frail elderly residents in a long-term care facility was efficient in improving muscle strength, speed, agility, and biochemical variables, with reversal of the frailty condition in a considerable number. However, no effects in anthropometric and inflammatory parameters were noted

Omega-3 supplementation on inflammatory markers in patients with chronic Chagas cardiomyopathy: a randomized clinical study

Abstract Background Several studies have been focusing on the effect of omega-3 polyunsaturated fatty acids on modulation of inflammatory markers in several cardiopathies. Although immunoregulatory dysfunction has been associated to the chronic cardiac involvement in Chagas disease, there is no study examining the effects of omega-3 supplementation in these patients. We investigated the effects of omega-3 PUFAs on markers of inflammation and lipid profile in chronic Chagas cardiomyopathy patients. Methods The present study was a single-center double-blind clinical trial including patients with chronic Chagas cardiomyopathy. Patients were randomly assigned to receive omega-3 PUFAs capsules (1.8g EPA and 1.2g DHA) or placebo (corn oil) during an 8-week period. Cytokines, fasting glucose, lipid, and anthropometric profiles were evaluated. Results Forty-two patients (23 women and 19 men) were included in the study and there were only two losses to follow-up during the 8-week period. Most of sociodemographic and clinical characteristics were similar between the groups at baseline, except for the cytokines IL-1β, IL-6, IL-8, IL-10, IL-17α, and IFNγ. The omega-3 PUFAs group demonstrated greater improvements in serum triglycerides (−21.1 vs. −4.1; p = 0.05) and IL-10 levels (−10.6 vs. −35.7; p = 0.01) in comparison to controls after 8 weeks of intervention. No further differences were observed between groups. Conclusion Omega-3 PUFAs supplementation may favorably affect lipid and inflammatory profile in chronic Chagas cardiomyopathy patients, demonstrated by a decrease in triglycerides and improvements on IL-10 concentration. Further studies examining the clinical effects of omega-3 fatty acids supplementation in chronic Chagas cardiomyopathy are necessary. Trial registration NCT01863576

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

Abstract: INTRODUCTION: The benefit of a cardiac rehabilitation (CR) program for patients with Chagas heart failure (CHF) remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. METHODS: A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session). Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test), muscle respiratory strength (manovacuometry), and body composition (anthropometry and skinfolds) were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography), biomarkers (lipid profile, glucose, and glycated hemoglobin) and quality of life (Minnesota Living with Heart Failure Questionnaire) were assessed at baseline and at the end of the intervention. RESULTS: Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF) and respiratory strength improved after 8 months. Patients with right ventricular (RV) dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV) diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. CONCLUSIONS: CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength

Relationship between Dietary Fatty Acid Intake with Nonalcoholic Fatty Liver Disease and Liver Fibrosis in People with HIV

We aimed to evaluate the relationship between food intake of lipids with nonalcoholic fatty liver disease (NAFLD) and/or liver fibrosis in people living with HIV/AIDS (PLWHA). In this cross-sectional study, transient elastography was used to detect the presence of NAFLD and/or liver fibrosis. The dietary intake of fats and fatty acids (FA) were assessed by two 24 h dietary recalls (24-HDR) (n = 451). Multivariate logistic regression models were performed. Participants with higher intake of total fat were associated with higher odds for NAFLD compared to those with lower consumption [adjusted odds ratio (aOR) = 1.91 (95% confidence interval (95% CI) 1.06–3.44)]. Furthermore, participants with intermediate intake of n6-PUFA (n6-poly-unsaturated FA) and lauric FA had lower odds for NAFLD, respectively aOR = 0.54 (95% CI 0.3–0.98) and aOR = 0.42 (95% CI 0.22–0.78). Additionally, a higher intake of myristoleic FA (fourth quartile) was a significant protective factor for NAFLD [aOR = 0.56 (95% CI 0.32–0.99)]. Participants with higher intake of lauric FA [0.38 (95% CI 0.18–0.80)], myristic FA [0.38 (0.17–0.89)], palmitoleic FA [0.40 (0.19–0.82)] and oleic FA [0.35 (0.16–0.79)] had positively less odds of having liver fibrosis. On the other hand, higher intake of n-6 PUFA was significantly associated with fibrosis [aOR = 2.45 (95% CI 1.12–5.32)]. Dietary assessment of total fat and FA should be incorporated into HIV care as a tool for preventing NAFLD and fibrosis in PLWHA

Effect of an exercise-based cardiac rehabilitation program on quality of life of patients with chronic Chagas cardiomyopathy: results from the PEACH randomized clinical trial

Abstract To investigate the effect of an exercise-based cardiac rehabilitation program on the quality of life (QoL) of patients with chronic Chagas cardiomyopathy (CCC). PEACH study was a single-center, superiority randomized clinical trial of exercise training versus no exercise (control). The sample comprised Chagas disease patients with CCC, left ventricular ejection fraction < 45%, without or with HF symptoms (CCC stages B2 or C, respectively). QoL was assessed at baseline, after three months, and at the end of six months of follow-up using the SF-36 questionnaire. Patients randomized for the exercise group (n = 15) performed exercise training (aerobic, strength and stretching exercises) for 60 min, three times a week, during six months. Patients in the control group (n = 15) were not provided with a formal exercise prescription. Both groups received identical nutritional and pharmaceutical counseling during the study. Longitudinal analysis of the effects of exercise training on QoL, considering the interaction term (group × time) to estimate the rate of changes between groups in the outcomes (represented as beta coefficient), was performed using linear mixed models. Models were fitted adjusting for each respective baseline QoL value. There were significant improvements in physical functioning (β =  + 10.7; p = 0.02), role limitations due to physical problems (β =  + 25.0; p = 0.01), and social functioning (β =  + 19.2; p < 0.01) scales during the first three months in the exercise compared to the control group. No significant differences were observed between groups after six months. Exercise-based cardiac rehabilitation provided short-term improvements in the physical and mental aspects of QoL of patients with CCC. Trial registration: ClinicalTrials.gov Identifier: NCT02517632; August 7, 2015

Study power for adjusted models.

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Quality of life assessed by SF-36 (n = 30).

Quality of life assessed by SF-36 (n = 30).</p