Risk factors for unstable blood glucose level: integrative review of the risk factors related to the nursing diagnosis

Objetivo: identificar evidencias en la literatura acerca de posibles factores de riesgo del diagnóstico "riesgo de nivel de glucemia inestable" para personas con diabetes mellitus tipo 2 y compararlos con los factores de riesgo descritos por la NANDA International . Método: revisión integradora orientada por la pregunta: ¿Cuáles son los factores de riesgo de nivel de glucemia inestable en personas con diabetes mellitus tipo 2? Se incluyeron estudios primarios cuyos resultados eran variaciones en los niveles glucémicos, publicados en inglés, portugués o español en el PubMed o CINAHL entre 2010 y 2015. Resultados: se observó que una alteración en los niveles de: hemoglobina glucosilada, índice de masa corporal >;31 Kg/m2, historia previa de hipoglucemia, déficit cognitivo/demencia, neuropatía autonómica cardiovascular, comorbilidades y pérdida de peso, correspondían a factores de riesgo descritos por la NANDA International . Otros factores de riesgo identificados fueron: edad avanzada, raza negra, mayor tiempo de diagnóstico de diabetes, somnolencia diurna, macroalbuminuria, polimorfismos genéticos, insulinoterapia, uso de antidiabéticos orales, uso de metoclopramida, actividad física inadecuada y glucemia de ayuno baja. Conclusiones: se identificaron factores de riesgo del diagnóstico riesgo de nivel de glucemia inestable para personas con diabetes mellitus tipo 2, de los cuales 42% correspondían a los de la NANDA International . Esos hallazgos pueden contribuir para la práctica de enfermeros clínicos en la prevención de los efectos deletéreos de la variación glucémica.Objetivo: identificar evidências na literatura acerca de possíveis fatores de risco do diagnóstico risco de glicemia instável para pessoas com diabetes mellitus tipo 2 e compará-los com os fatores de risco descritos pela NANDA International . Método: revisão integrativa norteada pela pergunta: quais são os fatores de risco de glicemia instável em pessoas com diabetes mellitus tipo 2? Incluíram-se estudos primários cujos desfechos eram variações nos níveis glicêmicos, publicados em inglês, português ou espanhol no PubMed ou CINAHL entre 2010 e 2015. Resultados: observou-se que alteração nos níveis de hemoglobina glicada, índice de massa corpórea>;31 Kg/m2, história prévia de hipoglicemia, déficit cognitivo/demência, neuropatia autonômica cardiovascular, comorbidades e perda de peso correspondiam a fatores de risco descritos pela NANDA International . Outros fatores de risco identificados foram: idade avançada, raça negra, maior tempo de diagnóstico de diabetes, sonolência diurna, macroalbuminúria, polimorfismos genéticos, insulinoterapia, uso de antidiabéticos orais, uso de metoclopramida, atividade física inadequada e glicemia de jejum baixa. Conclusões: identificaram-se fatores de risco do diagnóstico risco de glicemia instável para pessoas com diabetes mellitus tipo 2, dos quais 42% correspondiam àqueles da NANDA International . Esses achados podem contribuir para a prática de enfermeiros clínicos na prevenção dos efeitos deletérios da variação glicêmica.Objective: to identify evidence in the literature on the possible risk factors for the risk of unstable blood glucose diagnosis in individuals with type 2 diabetes mellitus, and to compare them with the risk factors described by NANDA International. Method: an integrative literature review guided by the question: what are the risk factors for unstable blood glucose level in people with type 2 diabetes mellitus? Primary studies were included whose outcomes were variations in glycemic levels, published in English, Portuguese or Spanish, in PubMed or CINAHL between 2010 and 2015. Results: altered levels of glycated hemoglobin, body mass index>;31 kg/m2, previous history of hypoglycemia, cognitive deficit/dementia, autonomic cardiovascular neuropathy, comorbidities and weight loss corresponded to risk factors described in NANDA International. Other risk factors identified were: advanced age, black skin color, longer length of diabetes diagnosis, daytime sleepiness, macroalbuminuria, genetic polymorphisms, insulin therapy, use of oral antidiabetics, and use of metoclopramide, inadequate physical activity and low fasting glycemia. Conclusions: risk factors for the diagnosis, risk for unstable blood glucose level, for persons with type 2 diabetes mellitus were identified, and 42% of them corresponded to those of NANDA International. These findings may contribute to the practice of clinical nurses in preventing the deleterious effects of glycemic variation

Consulta de puerpério: perfil das mulheres mães e experiências vivêciadas: Puerperium consultation: knowledge and experiences of women mothers

Introdução: A consulta puerperal compreende a atenção à saúde da mulher e do recém-nascido desde as primeiras semanas após o parto até o final do puerpério de forma holística, por ser um processo de mudanças e adaptações e assim proteger o desenvolvimento do vínculo  da mãe com o bebê, e reduzir mortalidade materna e infantil, diminuir as chances de abandono à amamentação, avaliação das condições de saúde da mulher e do recém-nascido, também auxiliar com as mudanças fisiológicas. Metodologia: Trata-se de um estudo descritivo, com abordagem qualitativa. O cenário da pesquisa foi a cidade de Montes Claros, município brasileiro do estado de Minas Gerais, que pertence à mesorregião do Norte de Minas, localizando-se a norte da capital do estado. Resultados: Os dados de caracterização do perfil destacam que as mulheres do estudo são na maioria jovem e de cor parda, apresentam escolaridade ensino médio completo ou ensino superior completo, não são casadas e possuem renda mensal considerada boa e não planejaram a gravidez. Considerações finais: No presente estudo foi possível notar que o pré-natal tem boa adesão pelas mulheres, mas a realização da consulta puerperal, término do pré-natal, não ocorre da mesma forma

Violência obstétrica no parto normal: revisão integrativa / Obstetric violence in normal childbirth: integrative review

Objetivo: Identificar a violência obstétrica sofrida na assistência ao parto normal através da revisão bibliográfica. Métodos: Trata-se de um estudo realizado através de levantamento bibliográfico na modalidade de revisão integrativa de literatura. Buscou-se por publicações científicas indexadas nas seguintes bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), ScientificElectronic Library Online (SciELO), JournalCitationReports (JCR), PubMed e MEDLINE. Foram identificados 28 artigos, sendo 14 artigos selecionados para avaliação, destes, 07 foram considerados elegíveis para leitura integral entre os anos de 2017 a 2021. Resultados e Discussão: A violência obstétrica mais citada nos artigos selecionados foram a negligência que é desde o pré natal na atenção primária até o momento oportuno do parto na atenção terciária. A análise apontou que através do cuidado de enfermagem, é possível estabelecer um vínculo do profissional com a parturiente, a fim de proporcionar um parto que respeita a fisiologia do processo de parturição e a liberdade da mulher, evitando assim a violência obstétrica. Conclusão: O estudo possibilitou uma ampla visibilidade da violência obstétrica como uma questão de saúde pública. Portanto, é válido a importância de a assistência a mulher ser melhorada no pré-natal, parto e puerpério pelo acesso às informações, cuidado e comunicação eficaz

Nutritional and laboratory parameters affect the survival of dogs with chronic kidney disease.

Chronic kidney disease is a common disease in dogs, and factors such as serum concentrations of creatinine, albumin, and phosphorus at the moment of diagnosis may influence the survival of these patients. The present retrospective study aimed to evaluate the relationship between survival in dogs with chronic kidney disease and laboratory parameters (creatinine, phosphorus, albumin, and hematocrit) and nutritional parameters (body condition score, muscle mass score, type of food, appetite and feeding method). A total of 116 dogs with chronic kidney disease stages 2 to 4 were included, and survival was calculated considering the time between diagnosis and death. Survival curves were configurated by Kaplan-Meier analysis and a comparison between survival curves was performed by the log-rank test. Factors related to survival were disease stage (p<0.0001), serum phosphorus concentration (p = 0.0005), hematocrit (0.0001), body condition score (p = 0.0391), muscle mass score (p = 0.0002), type of food (p = 0.0009), feeding method (p<0.0001) and appetite (p = 0.0007). Based on data obtained in this study, it is possible to conclude that early diagnosis, as well as nutritional evaluation and renal diet intake, are determinant strategies to increase survival in dogs with chronic kidney disease

Evaluation of diagnostic methods for the detection of intestinal schistosomiasis in endemic areas with low parasite loads: Saline gradient, Helmintex, Kato-Katz and rapid urine test

<div><p>Background</p><p>In some tropical countries, such as Brazil, schistosomiasis control programs have led to a significant reduction in the prevalence and parasite burden of endemic populations. In this setting, the Kato-Katz technique, as the standard diagnostic method for the diagnosis of <i>Schistosoma mansoni</i> infections, which involves the analysis of two slides from one fecal sample, loses its sensitivity. As a result, a significant number of infected individuals are not detected. The objective of this study was to perform extensive parasitological testing of up to three fecal samples and include a rapid urine test (POC-CCA) in a moderate prevalence area in Northern Minas Gerais, Brazil, and evaluate the performance of each test separately and in combination.</p><p>Methods and findings</p><p>A total of 254 individuals were examined with variants of the standard Kato-Katz technique (up to18 Kato-Katz slides prepared from three fecal samples), a modified Helmintex (30 g of feces), the saline gradient (500 mg of feces), and the POC-CCA methods. We established a reference standard taking into consideration all the positive results in any of the parasitological exams. Evaluation of the parasite burden by two Kato-Katz slides confirmed that most of the individuals harbored a light infection. When additional slides and different parasitological methods were included, the estimated prevalence rose 2.3 times, from 20.4% to 45.9%. The best sensitivity was obtained with the Helmintex method (84%). All parasitological methods readily detected a high or moderate intensity of infection; however, all lost their high sensitivity in the case of low or very low intensity infections. The overall sensitivity of POC-CCA (64.9%) was similar to the six Kato-Katz slides from three fecal samples. However, POC-CCA showed low concordance (κ = 0.34) when compared with the reference standard.</p><p>Conclusions</p><p>The recommended Kato-Katz method largely underestimated the prevalence of <i>S</i>. <i>mansoni</i> infection. Because the best performance was achieved with a modified Helmintex method, this technique might serve as a more precise reference standard. An extended number of Kato-Katz slides in combination with other parasitological methods or with POC-CCA was able to detect more than 80% of egg-positive individuals; however, the rapid urine test (POC-CCA) produced a considerable percentage of false positive results.</p></div

Prevalence profile of intestinal schistosomiasis in an endemic population divided by different age groups according to the different parasitological methods.

<p>Black circles indicate the prevalence profile in the population considering the sum of all parasitological methods used (reference standard: 18 Kato-Katz slides, saline gradient, and Helmintex); grey squares indicate the prevalence profile considering the recommended two KK slides from one fecal sample. Prevalence values (%) for each age group are indicated.</p

Sensitivity of different diagnostic methods for the detection of intestinal schistosomiasis considering the parasite load, as defined by egg counts of two Kato-Katz slides.

<p>Sensitivity of different diagnostic methods for the detection of intestinal schistosomiasis considering the parasite load, as defined by egg counts of two Kato-Katz slides.</p

Flowchart describing the workflow for the diagnosis of intestinal schistosomiasis in an endemic population within the district of Brejo do Amparo, Januária, Minas Gerais, Brazil.

<p>Fecal samples were examined with the Kato-Katz technique with one fecal sample and two (SPL1 K1-K2), six (SPL1 K1-K6), 12 (SPL1 K1-K12), and 14 thick-smears (SPL1 K1-K14), or with three fecal samples with two slides each (SPL1-3 K1-K2), saline gradient, Helmintex and spontaneous sedimentation technique (HPJ). Further, individual urine samples were analyzed with the point-of-care rapid urine test (POC-CCA) that detects the circulating cathodic antigen of <i>Schistosoma mansoni</i>. The numbers in brackets indicate the number of individuals tested with each method.</p

Prevalence of <i>Schistosoma mansoni</i> infection and other intestinal parasites in a rural community of the Municipality of Januária, Minas Gerais, Brazil.

<p>Prevalence of <i>Schistosoma mansoni</i> infection and other intestinal parasites in a rural community of the Municipality of Januária, Minas Gerais, Brazil.</p

Performance of the rapid urine test (POC-CCA) for the diagnosis of <i>Schistosoma mansoni</i> infection.

<p><b>A:</b> Photograph showing the different reactions possible with the POC-CCA: negative, trace, weak (+), medium (++) and strong (+++). <b>B:</b> Distribution of the POC-CCA results in individuals from an endemic area classified as negative (n = 116) or positive (n = 112) for <i>S</i>. <i>mansoni</i> infection by extensive parasitological testing (Reference standard: 18 Kato-Katz slides, saline gradient, and Helmintex); total n = 228). Data indicate the percentages of POC-CCA reactivities in each group of parasitologically negative or positive individuals. Red circles indicate discordant results in comparison with the reference standard (false positive: 28 and 2%; or false negative: 35%).</p