High frequency of non-compliance of quality indicators in oral nutritional therapy in hospitalized patients

Background: Quality indicators are important tools in clinical practice for assessing and monitoring the quality of nutritional therapy. The objective of the study was to evaluate the quality of oral nutritional therapy of a Public University Hospital at tertiary level, through Quality Indicators in Oral Nutrition Therapy (IQTNO). Methods: A cross-sectional study was conducted with data related to all patients using Oral Nutrition Therapy, admitted to four clinical and surgical patients' wards, aged 18 years and over, between November/2017 and May/2018. Four indicators were applied, as recommended by the Clinical Nutrition task force of the International Life Sciences Institute (ILSI-Brazil) and a specific recommendation of the literature, using percentage targets. Statistical analyzes were performed in the Statistical Package for Social Sciences program. Results: Data were collected from 214 patients, 59.3% male, with a mean age of 58.5 ± 1.26 years. No indicator reached the proposed target, being in non compliance: application of Subjective Global Assessment (48.13%); non-compliance with oral nutritional therapy indication (73.36%); fasting over 24 hours in oral nutritional therapy (50%) and reassessment of patients in the last 7 days (5.61%). Conclusion: None of the indicators evaluated reached the goals for compliance in the analyzed service. The non-conformities found could be corrected with the implementation of protocols, as well as training and continuing education for health professionals.UFU - Universidade Federal de UberlândiaIntrodução: Os indicadores de qualidade são ferramentas importantes na prática clínica para avaliação e monitoramento da qualidade da terapia nutricional. O objetivo do estudo foi avaliar a qualidade da terapia nutricional oral de um Hospital Público Universitário de nível terciário, por meio de Indicadores de Qualidade em Terapia Nutricional Oral (IQTNO). Métodos: Foi realizado estudo transversal com dados relacionados a todos os pacientes em uso de Terapia Nutricional Oral, admitidos em quatro enfermarias de pacientes clínicos e cirúrgicos, com 18 anos ou mais, ambos os sexos, no período de Novembro/2017 à Maio/2018. Foram aplicados quatro indicadores, conforme recomendação da força tarefa de Nutrição Clínica da International Life Sciences Institute (ILSI - Brasil) e recomendação específica da literatura, por meio de metas percentuais. As análises estatísticas foram realizadas no programa Statistical Package for Social Sciences. Resultados: Foram coletados dados referentes a 214 pacientes, 59,3% do sexo masculino, com idade média de 58,5±1,26 anos. Nenhum indicador atingiu a meta proposta, estando em não conformidade: aplicação de Avaliação Global Subjetiva (48,13%); não conformidade da indicação da terapia nutricional oral (73,36%); jejum superior à 24h em terapia nutricional oral (50%) e reavaliação de pacientes nos últimos 7 dias (5,61%). Conclusão: Nenhum dos indicadores avaliados atingiram as metas para conformidade no serviço analisado. As não conformidades encontradas poderiam ser corrigidas com a implantação de protocolos, além de capacitação e educação continuada aos profissionais de saúde

Construction and Psychometric Evidences of a Visual Perception Scale

Este estudo teve como objetivo construir e conhecer os parâmetros psicométricos de um instrumento para\ud análise da percepção visual de adultos. Para a construção da escala participaram 295 adultos saudáveis,\ud sem déficits cognitivos ou perceptivo-visuais. Nesta etapa foi formulada uma escala tetrafatorial constituída\ud por 20 itens que avaliam quatro dimensões referentes à percepção visual: constância da forma, figurafundo, posição e relação espacial. Para obter evidências de validade foi utilizada uma amostra de 183\ud voluntários com boa saúde física e mental e acuidade visual normal ou corrigida. Os dados obtidos relatam\ud a existência de concordância interjuízes, adequação semântica e significância no teste-reteste do instrumento.\ud Os coeficientes de fidedignidade variaram de 0,84 a 0,93. Os quatro fatores esperados foram encontrados,\ud cada um contendo 5 itens, e juntos explicaram 57,52% da variância do constructo. O instrumento apresentou\ud parâmetros psicométricos adequados, o que pode justificar sua utilidade em pesquisas básicas e na prática\ud clínica.The main objective of this study was to develop and examine the psychometric parameters of an instrument used to evaluate adults' visual perception. The basic assumption was that visual perception includes constancy of form, figure-ground, position and spatial relation. A 4-factor solution was expected. Respondents were 183 healthy adults without cognitive or visual perception impairment. In the instrument it was possible to establish the existence of inter-judges agreement, semantic adequacy and test-retest significance. The reliability coefficients ranged from 0.84 to 0.93. The four expected factors were found, each one containing 5 items. This solution accounted for 57.52% of the construct variance indicating that the instrument has good psychometric parameters, which suggests its applicability in scientific research and clinical practice

Consumo de alimentos ultraprocessados no Brasil: distribuição e evolução temporal 2008–2018

OBJECTIVE To evaluate sociodemographic factors associated with the consumption of ultra-processed foods and the temporal evolution of their consumption in Brazil between 2008 and 2018. METHODS The study used food consumption data of individuals aged ≥ 10 years from 2008–2009 and 2017–2018 Pesquisas de Orçamentos Familiares (POF – Household Budget Surveys), grouping the foods according to the Nova classification. We used crude and adjusted linear regression models to assess the association between sociodemographic characteristics and consumption of ultra-processed foods in 2017–2018 and the temporal variation in their consumption between 2008 and 2018. RESULTS Ultra-processed foods accounted for 19.7% of calories in 2017–2018. The adjusted analysis showed that their consumption was higher in women (versus men) and the South and Southeast regions (versus North) and lower in blacks (versus whites) and rural areas (versus urban), in addition to decreasing with the increased age and increasing with higher education and income. Consumption of ultra-processed foods increased by 1.02 percentage points (pp) from 2008–2009 to 2017–2018. This increase was significantly higher among men (+1.59 pp), black people (+2.04 pp), indigenous (+5.96 pp), in the rural area (+2.43 pp), those with up to 4 years of schooling (+1.18 pp), in the lowest income quintile (+3.54 pp), and the North (+2.95 pp) and Northeast (+3.11 pp) regions. On the other hand, individuals in the highest level of schooling (-3.30 pp) and the highest income quintile (-1.65 pp) reduced their consumption. CONCLUSIONS The socioeconomic and demographic segments with the lowest relative consumption of ultra-processed foods in 2017–2018 are precisely those that showed the most significant increase in the temporal analysis, pointing to a trend towards national standardization at a higher level of consumption.OBJETIVO: Avaliar fatores sociodemográficos associados ao consumo de alimentos ultraprocessados e a evolução temporal do consumo no Brasil entre 2008 e 2018. MÉTODOS: Foram utilizados dados do consumo alimentar de indivíduos com idade ≥ 10 anos das Pesquisas de Orçamentos Familiares (POF) 2008–2009 e 2017–2018. Os alimentos foram agrupados segundo a classificação Nova. Modelos de regressão linear brutos e ajustados foram utilizados para avaliar a associação entre características sociodemográficas e o consumo de ultraprocessados em 2017–2018 e a variação temporal de seu consumo entre 2008 e 2018. RESULTADOS: Alimentos ultraprocessados representaram 19,7% das calorias em 2017–2018. A análise ajustada mostrou que seu consumo foi maior no sexo feminino (versus masculino) e nas regiões Sul e Sudeste (versus Norte), e menor em negros (versus brancos) e na área rural (versus urbana), além de diminuir com o aumento da idade e aumentar com escolaridade e renda. O consumo de ultraprocessados aumentou 1,02 pontos percentuais (pp) de 2008–2009 a 2017–2018, sendo este aumento mais expressivo em homens (+1,59 pp), negros (+2,04 pp), indígenas (+5,96 pp), na área rural (+2,43 pp), naqueles com até 4 anos de estudo (+1,18 pp), no quinto mais baixo de renda (+3,54 pp) e nas regiões Norte (+2,95 pp) e Nordeste (+3,11 pp). Por outro lado, seu consumo se reduziu na maior faixa de escolaridade (-3,30 pp) e no quinto mais alto de renda (-1,65 pp). CONCLUSÕES: Os segmentos socioeconômicos e demográficos que tiveram menor consumo relativo de ultraprocessados em 2017–2018 são justamente os que apresentaram um aumento mais expressivo na análise temporal, apontando para uma tendência de padronização nacional em um patamar de consumo mais alto

Food and nutritional security council: analysis of the social control over the food and nutritional security state policy in the State of Espírito Santo

Hunger, specific nutritional needs and all other forms of expression of food insecurity are not recent phenomena, nor is the concern about stanching them. The Food and Nutritional Security concept was reformulated and expanded over the years, and its current form aims not only to preserve, but also to expand the principle of social control regarding the formulation and monitoring of Food and Nutritional Security actions. The purpose of this study was to evaluate the social control of the Food and Nutritional Security Council of the State of Espírito Santo in relation to the FNS state policy, through the analysis of its internal regulations; the deliberations contained in the minutes of ordinary and extraordinary meetings of the council; and additional evaluation of the attendance of the entities' representatives. The predominance of deliberations about the organization of the structure and internal dynamics was observed, as well as reports on deliberations about the monitoring, proposals and FNS actions. There was also a significant amount of absences of civil and state entities' representatives at council meetings. It follows that although the Council represents an important strategy of social control in the pursuit of FNS state policies, this participation has not yet been fully carried out.A fome, as carências nutricionais específicas e todas as outras formas de manifestação de insegurança alimentar não são fenômenos recentes, assim como a preocupação em estancá-las. Para tanto, ao longo dos anos, o conceito de segurança alimentar e nutricional foi reformulado e ampliado, e a atual concepção prima não somente por preservar, mas ampliar o princípio de controle social na formulação e no monitoramento das ações de segurança alimentar e nutricional. O objetivo deste estudo foi avaliar o controle social do Conselho de Segurança Alimentar e Nutricional do Espírito Santo em relação à política estadual de SAN, por meio da análise de seu regimento interno; das deliberações contidas nas atas das reuniões ordinárias e extraordinárias do conselho e da avaliação complementar da frequência dos conselheiros representantes das entidades. Observou-se uma predominância de deliberações sobre a organização da estrutura e dinâmica interna e informe, em relação às deliberações sobre o monitoramento, as propostas e as ações de SAN. Constatou-se também quantidade significativa de ausências dos conselheiros representativos das entidades civis e do estado nas reuniões do conselho. Conclui-se que embora o Conselho se constitua em uma importante estratégia de controle social na realização das políticas de SAN no Estado, essa participação ainda não tem sido realizada de forma plena

Chlorophyll, nitrogen and antioxidant activities in Cumaru (Dipteryx odorata (Aubl.) Willd) (Fabaceae) in two water regimes

The Cumaru (Dipteryx odorata (Aubl.) Willd.) is a species used by traditional populations and industries using timber and non-timber forest products. This study aimed to analyze the levels of chlorophyll A, B, total ammonia levels, nitrate, proline, electrolyte leakage and activity of oxidative enzymes in evaluation to tolerance of cumaru plants subjected to drought for 21 days of stress. The experiment was conducted in a greenhouse at the Federal Rural University of Amazonia (UFRA), Belém, Pará, in the period from March to July 2015. The results showed a significant decrease in the relative water content of 50.8 and 55% for chlorophyll b, 45% to total chlorophyll and an increase in proline to the plants under drought. There was no significant difference to chlorophyll a, ammonium and nitrate. Increases in electrolyte leak with 22.74% for roots and 39.55% for leaves were observed. The enzyme catalase (CAT) showed a significant increase from the 14th day of the experiment, while changes in superoxide dismutase (SOD) and ascorbate peroxidase (APX) activities were observed from the 7th day of the experiment. Cumaru plants are not drought tolerant over 21 days; also, young plants of cumaru respond negatively to conditions of low water availability in the soil.Key words: Drought, oxidative stress, chlorophyll, tolerance, Dipteryx odorata

Intense transmission of visceral leishmaniasis in a region of northeastern Brazil: a situation analysis after the discontinuance of a zoonosis control program.

In São Luís, Maranhão, northeastern Brazil, the notification of visceral leishmaniasis (VL) cases intensified in 1982, showing endemic and epidemic patterns. In this city, the Center for Zoonoses Control (CZC) was an organization in charge of the control and prevention of the disease. However, technical and political reasons have led to a significant decline in the periodicity of its activities. Therefore, in this study we evaluated the epidemiological scenario of human visceral leishmaniasis (HVL) and the prevalence of the disease in dogs after the cessation of the CZC activities, covering the period of 2007 to 2016. The seroprevalence of canine leishmaniasis was determined based on clinical and serological profiles. HVL cases were notified using data provided by the Municipal Health Department of São Luís. A seropositivity rate of 45.8% (p = 0.0001) was found among dogs, 54% (p = 0.374) of which were asymptomatic. As for human cases, there were 415 notifications, with an increase in the incidence of the zoonosis observed during the aforementioned period. Thus, it can be inferred that after the control and surveillance activities were curtailed, there was an increase in the number of seropositive animals in circulation, acting as reservoirs of infection for dogs and humans

Understanding global changes of the liver proteome during murine schistosomiasis using a label-free shotgun approach.

Schistosomiasis is an endemic disease affecting over 207million people worldwide caused by helminth parasites of the genus Schistosoma. In Brazil the disease is responsible for the loss of up to 800 lives annually, resulting from the desabilitating effects of this chronic condition. In this study, we infected Balb/c mice with Schistosoma mansoni and analysed global changes in the proteomic profile of soluble liver proteins. Our shotgun analyses revealed predominance of up-regulation of proteins at 5weeks of infection, coincidingwith the onset of egg laying, and a remarkable down-regulation of liver constituents at 7 weeks, when severe tissue damage is installed. Representatives of glycolytic enzymes and stress response (in particular at the endoplasmic reticulum)were among the most differentially expressed molecules found in the infected liver. Collectively, our data contribute over 70 molecules not previously reported to be found at altered levels in murine schistosomiasis to further exploration of their potential as biomarkers of the disease.Moreover, understanding their intricate interaction using bioinformatics approach can potentially bring clarity to unknownmechanisms linked to the establishment of this condition in the vertebrate host. Significance: To our knowledge, this study refers to the first shotgun proteomic analysis to provide an inventory of the global changes in the liver soluble proteome caused by Schistosomamansoni in the Balb/cmodel. It also innovates by yielding data on quantification of the identified molecules as a manner to clarify and give insights into the underlying mechanisms for establishment of Schistosomiasis, a neglected tropical disease with historical prevalence in Brazil

Complicações Pós-Trauma: Gerenciando Edema Cerebral e Hipertensão Intracraniana

Introduction: The interconnection between cerebral edema and intracranial hypertension requires complex and rigorous monitoring, since cerebral edema directly influences the increase in intracranial pressure, resulting in a series of serious symptoms that can vary depending on the extent of the edema and other underlying factors. Objective: Understand complications arising from trauma and how to manage cerebral edema and intracranial pressure. Methodology: The Cochrane, Medline and Pubmed databases were used, searching for articles published between the years 2015 to 2023, in Portuguese or English. Conclusion: The treatment of these post-trauma conditions varies according to the clinical manifestations of each patient, therefore, obtaining an early diagnosis contributes to better monitoring and recovery.Introdução: A interconexão entre edema cerebral e hipertensão intracraniana aborda um acompanhamento complexo e rigoroso, uma vez que o edema cerebral influencia diretamente no aumento da pressão intracraniana, resultando em uma série de sintomas graves que podem variar dependendo da extensão do edema e de outros fatores subjacentes. Objetivo: Compreender as complicações decorrentes de traumas e como gerenciar o edema cerebral e a pressão intracraniana.  Metodologia: Foram utilizadas as bases de dados Cochrane, Medline e Pubmed, buscando artigos publicados entre os anos 2015 a 2023, nos idiomas Português ou Inglês. Conclusão: O tratamento dessas condições pós-trauma varia de acordo com o as manifestações clínicas de cada paciente, por isso, obter o diagnóstico precoce contribui para um melhor monitoramento e recuperação

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo