RESUMO
BACKGROUND: Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (DM) have increased risk of endothelial dysfunction, cardiovascular disease, and mortality. Several studies have separately analyzed endothelial function in these populations. However, data of patients with both CKD and DM are scarce. The aim of this study was to evaluate whether the presence of DM has any additional effect on the endothelial dysfunction of CKD patients. METHODS: We measured endothelial progenitor cells (EPCs), stromal-derived factor 1 alpha (SDF-1α), serum and urinary nitric oxide (NO), flow-mediated dilation (FMD), and pulse wave velocity (PWV) in 37 CKD patients with DM (CKD-DM group) and in 37 without DM (CKD group). RESULTS: CKD-DM group had a higher prevalence of obesity (P < 0.01), previous myocardial infarction (P = 0.02), myocardial revascularization (P = 0.04), and a trend for more peripheral artery disease (P = 0.07). Additionally, CKD-DM group had higher EPC (P = 0.001) and PWV (P < 0.001) values. On the other hand, no difference in SDF-1α and serum or urinary NO and FMD was observed between the groups. CONCLUSIONS: Endothelial dysfunction is frequent in CKD patients, and an additive effect of diabetes cannot be implicated, suggesting the predominant role of uremia in this condition.
Assuntos
Quimiocina CXCL12/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Endotélio Vascular/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Células Progenitoras Endoteliais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/sangue , Análise de Onda de Pulso , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicaçõesRESUMO
O diabetes mellitus (DM) está associado com alguns tipos de câncer. No entanto, estudos realizados sobre a associação entre DM e câncer de cabeça e pescoço (CCP) apresentaram resultados controversos. Na avaliação da associação entre DM e câncer, destaque deve ser dado à metformina, medicamento utilizado no DM tipo 2, que se mostra inversamente associado a alguns tumores. O objetivo deste estudo foi avaliar a associação entre DM e CCP, bem como o impacto do uso de metformina no risco de CCP. Este estudo caso-controle incluiu 1021 casos de CCP com confirmação histológica de carcinoma espino celular selecionados em cinco hospitais de grande porte no estado de São Paulo entre 2011 e 2014. Os 1063 controles foram recrutados nos mesmos hospitais, pareados por frequência com os casos por sexo e idade (em grupos de 5 anos). Para avaliar o risco de CCP associado ao DM, odds ratios (OR) e intervalos com 95 por cento de confiança (IC 95 por cento ) foram estimados por meio de regressão logística não condicional. Os participantes diabéticos tiveram associação inversa com o CCP (OR = 0,68; IC 95 por cento : 0,49-0,95), e a proteção foi maior entre diabéticos usuários metformina (OR = 0,54; IC 95 por cento : 0,29-0,99)
Diabetes mellitus (DM) is directly associated with some cancers. However, studies on the association between DM and head and neck cancer (HNC) have rendered controversial results. Assessing DM and cancer, emphasis should be given to metformin, a medication used for DM type 2, which is shown to be inversely associated with some cancers. The objective of this study was to evaluate the association between DM and HNC, as well as the impact of metformin use on the risk of HNC. This case-control study included 1021 HNC cases with squamous cell carcinoma, histologically confirmed, and admitted in five large hospitals in the state of São Paulo, from 2011 to 2014. A total of 1063 controls were selected in the same hospitals and were frequency-matched to cases by sex and age (in 5-year groups). In order to assess the risk of CCP associated with DM, odds ratios (OR) and 95 per cent confidence intervals (CI 95 per cent ) were estimated using unconditional logistic regression. Diabetic participants had an inverse risk of HNC (OR=0.68; 95 per cent CI: 0.49 0.95), and this inverse association was more intense among diabetic metformin users (OR=0.54; 95 per cent CI: 0.29-0.99)
Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus Tipo 1/tratamento farmacológico , Neoplasias de Cabeça e Pescoço , Metformina/uso terapêutico , Estudos de Casos e ControlesRESUMO
Objective: To assess the quality of a multiprofessional healthcare model for in-hospital patients by means of two performance indicators (communication and knowledge about the case). Methods: A cross-sectional study assessed the knowledge that professionals had about the clinical information of patients and the use of communication strategies by the team. Healthcare professionals were interviewed during their work period. Seven occupational categories were interviewed. A total of 199 medical charts were randomly selected for interviews, and 312 professionals of different categories were interviewed. The sample comprised mostly nurses and physical therapists in the charts that were interviewed. Results: There were no statistically significant differences between the expected performing model group and the under-performing model group for sex, location and job. In the under-performing model group, a larger number of professionals correlated with less knowledge. Communication was improved when nurses had the relevant information about interdisciplinary care (97.4%), appropriate use of the Plan of Care form (97.0%), and formalized discussions with physicians (88.2%). In the expected performing model group, it was observed that the higher the number of healthcare professionals involved, the higher the communication levels. Conclusions: This model of care based on case knowledge and multiprofessional team communication performance indices allowed to assess quality of care. This assessment is measurable and there is the possibility of establishing the quality of care delivered.
Objetivo: Avaliar a qualidade de um modelo de assistência a pacientes internados por meio de dois índices de desempenho (comunicação e conhecimento do caso) das equipes multiprofissionais. Métodos: Foi realizado um corte transversal para avaliação do conhecimento dos profissionais a respeito das informações clínicas do paciente e o uso de estratégias de comunicação intraequipe. Foi utilizado o formato de entrevistas feitas com profissionais durante o período de trabalho. Sete categorias profissionais foram entrevistadas e foram sorteados para entrevista 199 prontuários. Foram avaliados 312 profissionais das diversas categorias. A amostra foi caracterizada pela predominância do envolvimento dos profissionais de enfermagem e fisioterapia nos prontuários entrevistados. Resultados: Não houve diferenças estatisticamente significativas entre os grupos do modelo de desempenho esperado e do modelo de desempenho abaixo do esperado para as variáveis: sexo, situação e cargo dos profissionais. No grupo modelo de desempenho abaixo do esperado, evidenciou-se que quanto maior o número de profissionais envolvidos, menor o grau de conhecimento. A comunicação foi melhor quando o enfermeiro teve as informações relevantes sobre a assistência interdisciplinar (97,4%), utilizou de forma adequada o impresso denominado Plano Assistencial (97,0%) e formalizou a discussão com o médico (88,2%). No grupo do modelo de desempenho esperado, evidenciou-se que quanto maior o número de profissionais envolvidos, maior o grau de comunicação. Conclusões: Neste modelo assistencial, baseado no desempenho dos índices do conhecimento do caso e comunicação da equipe multiprofissional, pôde-se avaliar a qualidade da assistência. Portanto, essa avaliação é mensurável e é possível determinar o nível de qualidade da assistência prestada.
RESUMO
OBJECTIVE: To assess the quality of a multiprofessional healthcare model for in-hospital patients by means of two performance indicators (communication and knowledge about the case). METHODS: A cross-sectional study assessed the knowledge that professionals had about the clinical information of patients and the use of communication strategies by the team. Healthcare professionals were interviewed during their work period. Seven occupational categories were interviewed. A total of 199 medical charts were randomly selected for interviews, and 312 professionals of different categories were interviewed. The sample comprised mostly nurses and physical therapists in the charts that were interviewed. RESULTS: There were no statistically significant differences between the expected performing model group and the under-performing model group for sex, location and job. In the under-performing model group, a larger number of professionals correlated with less knowledge. Communication was improved when nurses had the relevant information about interdisciplinary care (97.4%), appropriate use of the Plan of Care form (97.0%), and formalized discussions with physicians (88.2%). In the expected performing model group, it was observed that the higher the number of healthcare professionals involved, the higher the communication levels. CONCLUSIONS: This model of care based on case knowledge and multiprofessional team communication performance indices allowed to assess quality of care. This assessment is measurable and there is the possibility of establishing the quality of care delivered.