RESUMO
ABSTRACT Objective: Diabetes mellitus (DM) is a chronic disease of increasing importance in public health, associated with chronic complications including retinopathy, neuropathy, and kidney, cardiovascular and cerebrovascular disease. This study assessed the impact of strategic DM education actions on glycemic control and prevalence of chronic complications in patients with DM. Subjects and methods: Retrospective, quantitative, cohort study at a diabetes patients association comprised of a multidisciplinary team. In all, 533 individuals with DM were included. Sociodemographic and clinical data were collected using questionnaire and medical records. Of these, 333 patients evaluated for 12 to 24 months, with type 2 DM (T2DM, n = 317) and other types of DM (n = 16), were selected to collect data on retinopathy and diabetes kidney disease (DKD). Results: There was a predominance of elderly individuals, low education level, women, high rate of overweight and obesity, physical inactivity, dietary errors, dyslipidemia, and T2DM. More patients with T2DM versus type 1 DM had optimal glycemic control (46.3% vs. 12.2%, respectively; p < 0.001). The impact of the educational processes was demonstrated by the analysis of the initial and final glycated hemoglobin (HBA1c) levels. There was an increased prevalence of individuals with well-controlled DM during follow-up (prevalence ratio [PR] 2.76, 95%, p = 0.001), along with a significant reduction in retinopathy (PR: 0.679, p = 0.001) and albuminuria (PR: 0.637, 95%, p = 0.002) when these variables were evaluated in well-controlled versus uncontrolled HbA1c groups. Conclusions: A multidisciplinary approach with integration and quality was associated with improvements in DM control and reduced occurrence of chronic DM complications.
RESUMO
Objective: Diabetes mellitus (DM) is a chronic disease of increasing importance in public health, associated with chronic complications including retinopathy, neuropathy, and kidney, cardiovascular and cerebrovascular disease. This study assessed the impact of strategic DM education actions on glycemic control and prevalence of chronic complications in patients with DM. Subjects and methods: Retrospective, quantitative, cohort study at a diabetes patients association comprised of a multidisciplinary team. In all, 533 individuals with DM were included. Sociodemographic and clinical data were collected using questionnaire and medical records. Of these, 333 patients evaluated for 12 to 24 months, with type 2 DM (T2DM, n = 317) and other types of DM (n = 16), were selected to collect data on retinopathy and diabetes kidney disease (DKD). Results: There was a predominance of elderly individuals, low education level, women, high rate of overweight and obesity, physical inactivity, dietary errors, dyslipidemia, and T2DM. More patients with T2DM versus type 1 DM had optimal glycemic control (46.3% vs. 12.2%, respectively; p < 0.001). The impact of the educational processes was demonstrated by the analysis of the initial and final glycated hemoglobin (HBA1c) levels. There was an increased prevalence of individuals with well-controlled DM during follow-up (prevalence ratio [PR] 2.76, 95%, p = 0.001), along with a significant reduction in retinopathy (PR: 0.679, p = 0.001) and albuminuria (PR: 0.637, 95%, p = 0.002) when these variables were evaluated in well-controlled versus uncontrolled HbA1c groups. Conclusion: A multidisciplinary approach with integration and quality was associated with improvements in DM control and reduced occurrence of chronic DM complications.
Assuntos
Diabetes Mellitus Tipo 2 , Controle Glicêmico , Humanos , Feminino , Idoso , Hemoglobinas Glicadas , Estudos de Coortes , Estudos Retrospectivos , Prevalência , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologiaRESUMO
La craneotomía con paciente despierto (CPD) demanda un manejo multidisciplinario particular debido al componente de conciencia transoperatoria que aporta beneficios en la resección tumoral y preservación neurológica, pero también implica el manejo de los riesgos asociados a la necesidad de cooperación del paciente durante el procedimiento. En este trabajo se describen los beneficios y las complicaciones en pacientes operados bajo la modalidad de CPD. Además, se abordan los retos documentados tanto para el equipo profesional a cargo, como para los pacientes, los cuales tienen un rol activo durante la cirugía. En ese sentido, se exponen los criterios para la selección, preparación psicológica y neuropsicológica tanto previo como durante la cirugía. A su vez, se proponen las consideraciones para lograr un procedimiento exitoso y evitar las posibles secuelas psicológicas a largo plazo, como insumos para la protocolización de este tipo de procedimientos con base en nuestra experiencia.
Awake craniotomy (AC) requires a multidisciplinary management due to trans operative awareness, which benefits the tumor resection and neurologic preservation, but it also implies risks for the patient cooperation during the procedure. This article describes the benefits and complications in patients operated under AC. Besides, it approaches the documented challenges for both the professional team and patients, who have an active role during surgery. In this regard, the criteria for selection and psychological and neuropsychological preparation before and during surgery are set out. It suggests considerations to achieve a successful procedure and to avoid possible long- term psychological sequelae, as a resource for the protocol of this type of procedures based on our experience.
Assuntos
Humanos , Vigília , Procedimentos Neurocirúrgicos/métodos , Craniotomia/métodos , Período Pós-Operatório , Cooperação do Paciente , ConsciênciaRESUMO
Habilidades em comunicação são importantes para a promoção da saúde. O objetivo deste trabalho foi analisar os 100 artigos mais citados na área de linguagem infantil (crianças e adolescentes) e verificar a existência de interface com a área odontológica. Realizou-se uma busca dos artigos mais citados na área de linguagem, incluídos na base de dados Web of Science Core Collection até o mês de dezembro de 2021. Quatro pesquisadores realizaram a extração dos dados que incluiram: número de citações, título, autores, país, ano, periódicos, desenho do estudo e área temática. Foram excluídos os artigos cujas amostras eram compostas por adultos e idosos. Redes bibliográficas foram criadas usando o VOSviewer. O número total de citações de cada artigo incluído no top 100 variou de 251 a 1431. Quatro artigos foram citados mais de 1000 vezes. A maioria dos 100 artigos mais citados foi publicada por países da América do Norte (61 artigos; 27.101citações), seguida pela Europa (37 artigos; 13.695 citações). Os autores mais citados foram e Bishop DVM (10 artigos; 3653 citações) e Tomblin JD (10 artigos; 4261citações). A instituição com o maior número de publicações foi a University of Oxford/Inglaterra (11%) e University of Kansas/EUA (8%). Journal of Speech Language and Hearing Research foram as revistas com maior número de publicações (24%). Os desenhos de estudo mais frequentes foram estudo observacionais (77%). As condições clínicas mais abordadas foram Transtorno de Espectro Autista (TEA) (18%) e dislexia (14%). As áreas que mais publicaram os distúrbios estudados foram a fonoaudiologia (32%) e a psicologia (27%). Nenhum artigo apresentou interface com a área odontológica. A análise dos 100 artigos mais citados em linguagem permitiu uma melhor compreensão da área de linguagem infantil, destacando que as áreas que mais publicaram foram a fonoaudiologia e a psicologia com maior número de trabalhos na América do Norte. TEA e dislexia foram as condições clínicas mais estudadas. Não foi observada interface com a odontologia na análise deste estudo bibliométrico.
To analyze the 100 most cited articles in the area of language of children and adolescents and to verify the interface with dentistry, through a bibliometric analysis. A search was carried out of the 100 most cited articles in the language area, included in the Web of Science Core Collection database until December 2021. Four researchers performed the extraction of data that included the number of citations, title, authors, country, year, journals, study design, prevalent clinical conditions and professional area. Studies with adults and the elderly were excluded. Analyzes were performed using VOS viewer. The total number of citations ranged from 251 to 1431. Four articles were cited more than 1000 times. The most cited authors were Bishop DVM (10 articles; 3653 citations) and Tomblin JD (10 articles; 4261 citations). The institution with the highest number of publications was the University of Oxford/England (11%) followed by the University of Kansas/USA (8%). The Journal of Speech Language and Hearing Research was the journal with the highest number of publications (24%). The most frequent study design was observational (77%). The most discussed clinical conditions were autism spectrum disorder (18%) and dyslexia (14%). The most prevalent professional area was Speech Therapy (32%) and no study presented an interface with dentistry. The 100 most cited articles on language disorders are mostly observational, mainly address autism spectrum disorder and are in the field of Speech Therapy. There were no studies that presented an interface with dentistry.
Assuntos
Bibliometria , Linguagem Infantil , Odontologia , Pesquisa Interdisciplinar , Transtornos da LinguagemRESUMO
Resumen Los biobancos son infraestructuras multidisciplinares y esta investigación integradora pretende exponer su concepto a las diferentes ciencias que lo construyen e interpretan, para entender sus elementos esenciales de forma holística. La revisión integradora se realizó siguiendo la guía PRISMA y la evaluación de la calidad según CASPe dando como resultado un total de 30 trabajos. El análisis de los datos se realizó a través de las categorías aristotélicas y los resultados se interpretaron según el paradigma de la complejidad de Edgar Morin. El concepto de Biobanco fue aclarado al considerarlo como la representación de un fenómeno bio-socio-cultural en el que los campos científicos desarrollan relaciones de tipo: complementarias, antagónicas y ambiguas de conocimientos y prácticas. Esta red de significación, desde la filosofía, impacta en la construcción de la subjetividad y en las formas de socialización.
Abstract Biobanks are multidisciplinary infrastructures and, accordingly, this integrative research seeks to bring out the concept of biobank in the various sciences that construct and interpret it, so as to arrive at a holistic understanding of its essential components. This integrative review - guided by PRISMA and with quality assessment following CASPe - resulted in a selection of 30 articles. Data were analysed by Aristotelian categories and the results were interpreted on the complexity paradigm of Edgar Morin. The biobank concept was clarified by considering it to be the representation of a biological, social and cultural phenomenon in which knowledge and practices from diverse scientific fields enter into complementary, antagonistic and ambiguous types of relationship. This network of signification, analysed here using categories from Aristotelian philosophy, has impacts on the construction of subjectivity and forms of socialisation.
Assuntos
Humanos , Filosofia , Bancos de Espécimes BiológicosRESUMO
Introdução: Diversas diretrizes enfatizam as vantagens do manejo multidisciplinar no cuidado ao paciente com psoríase (PSO) e artrite psoriásica (PSA). O diagnóstico precoce de PSA se relaciona com melhores desfechos em 5 anos. No entanto, o diagnóstico precoce de PSA ainda é um desafio. Métodos: Estudo transversal retrospectivo de pacientes com diagnóstico prévio ou suspeito de PSO e/ou PSA atendidos em ambulatório conjunto de dermatologia e reumatologia do sul do Brasil de janeiro de 2013 a janeiro de 2017. Resultados: Entre os 55 pacientes previamente diagnosticados com PSO, 30,9% (n = 17) foram diagnosticados com PSA. Alterações do tratamento foram feitas em 58,5% (n = 48) dos pacientes, principalmente devido ao mau controle da pele e das articulações. Os imunobiológicos foram a classe de medicamentos mais comumente iniciada, correspondendo a 35,4% (n = 17) das modificações terapêuticas. O metotrexato foi o segundo medicamento mais comumente iniciado (18,8%, n = 9) ou com modificação da dose ou via de administração (20,8%, n = 10), totalizando 39,6% (n = 19) de modificações terapêuticas. Houve um aumento na proporção de pacientes em uso de tratamento sistêmico (79,3%, n = 65). Conclusão: Este estudo reforça a importância da abordagem multidisciplinar no diagnóstico precoce da PSA e demonstra que a abordagem conjunta entre dermatologia e reumatologia é possível de ser realizada no Brasil, com resultados semelhantes aos reportados na literatura internacional. (AU)
Introduction: Several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA is associated with better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: We conducted a retrospective cross-sectional study of patients with previous or suspected diagnosis of PSO and/or PSA treated at a combined dermatology and rheumatology outpatient clinic in southern Brazil from January 2013 to January 2017. Results: Of 55 patients previously diagnosed with PSO, 30.9% (n = 17) were diagnosed with PSA. Changes in treatment were made in 58.5% (n = 48) of patients, mainly due to poor control of cutaneous and articular symptoms. Immunobiological agents were the most commonly prescribed class of drugs, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most commonly prescribed drug (18.8%; n = 9) and the second drug to undergo most changes in dose or route of administration (20.8%; n = 10), accounting for 39.6% (n = 19) of changes in medical therapy. There was an increase in the number of patients undergoing systemic therapies (79.3%; n = 65). Conclusions: This study reinforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a collaborative approach between dermatology and rheumatology is feasible in Brazil, with outcomes similar to those reported in the international literature. (AU)
Assuntos
Equipe de Assistência ao Paciente , Psoríase/terapia , Reumatologia , Artrite Psoriásica/diagnóstico , Dermatologia , Instituições de Assistência AmbulatorialRESUMO
Resumo Muitas plantas são utilizadas com finalidades medicinais, constituindo alternativas terapêuticas complementares ao tratamento de doenças, trazendo inúmeros benefícios à saúde, quando utilizadas racionalmente e de maneira adequada. No entanto, as plantas constituem um arsenal grande de constituintes químicos, que podem ser benéficos, mas também podem representar um risco potencial à saúde. Desse modo, é importante que o usuário, os profissionais de saúde, e os prescritores, tenham conhecimentos sobre a planta, a correta identificação, conservação, modo de preparo e uso, além dos possíveis efeitos colaterais. As plantas medicinais, seus riscos e benefícios, são discutidos à luz das publicações científicas contemporâneas, atentando para a contribuição dos profissionais de saúde em relação ao seu papel de educadores e promotores de saúde atuantes em comunidades, especialmente aquelas usuárias do Sistema Único de Saúde.
Abstract Many plants are used for medicinal purposes, constituting therapeutic alternatives complementary to the medical treatment, bringing numerous health benefits, when used rationally and in an appropriate way. However, plants constitute a large arsenal of chemicals constituents, which may be beneficial, but may also pose a potential health risk. So, it is important that the user, the health professionals, and the prescribers, have knowledge about the plant, ensuring correct identification, conservation, preparation and use, as well as possible side effects. The study of the medicinal plants, their risks and benefits, and efficacy confirmation by carefully designed studies will be discussed in the light of contemporary scientific publications, paying attention to the contribution of health professionals in relation to their role as active educators and health promoters in communities, especially those users of the Unified Health System.