Síndrome metabólico, factores de riesgo en niños y adolescentes con sobrepeso / Metabolic syndrome, risk factors in children and adolescents with overweight

INTRODUCCIÓN: se asocia al Síndrome Metabólico, la probabilidad de contraer enfermedad cardiovascular, hipertensión, resistencia a la insulina, diabetes y muerte prematura. OBJETIVO: evaluar la presencia de Síndrome Metabólico en niños y adolescentes con sobrepeso y establecer la prevalencia de los factores de riesgo asociados al Síndrome Metabólico. MÉTODOS: estudio transversal, descriptivo y analítico en niños y adolescentes con sobrepeso que acudieron a consulta de Endocrinología de los Hospitales Manuel Ascencio Villarroel y Albina Patiño de la ciudad de Cochabamba entre mayo a julio de 2015. Un total de 41 niños y adolescentes de 7 a 16 años de edad (24 hombres y 17 mujeres), fueron sometidos a evaluación antropométrica y laboratorial. RESULTADOS: la prevalencia de Síndrome Metabólico en niños y adolescentes fue de 41%; el componente más frecuente de SM fue el HDL bajo que alcanzó el 78%, seguido de hipertrigliceridemia con un 48.8 %. Se observa la existencia de una asociación altamente significativa (Sig. 0.021) en la determinación del Índice de HOMA con el sobrepeso y obesidad. De igual forma entre la Insulina y el Índice de HOMA (Sig. 0,009). Al relacionar los criterios para la determinación de Síndrome metabólico, el 41,7% de los pacientes con sobrepeso presenta un solo factor de riesgo, al igual que el 44,83% de los que presentan obesidad, los que presentan 2 factores de riesgo, los valores son similares entre la población que presenta sobrepeso y obesidad (41,7% y 41,4 % respectivamente). CONCLUSIONES: desarrollar hábitos y estilo de vida saludables a una edad temprana, para evitar las consecuencias del Síndrome Metabólico, además de reducir los costos de atención a pacientes con enfermedades cardiovasculares o Diabetes Mellitus tipo 2. De ahí la importancia de realizar estudios que confirmen el diagnóstico precoz.

INTRODUCTION: Metabolic Syndrome (SM) is associated with the probability developing cardiovascular disease, hypertension, insulin resistance, diabetes and premature death. OBJECTIVE: To evaluate the presence of Metabolic Syndrome in overweight children and adolescents and besides to establish the prevalence of risk factors associated with the Metabolic Syndrome. METHOD: It is a cross-sectional, descriptive and analytical study about overweight children and adolescents who were attended at Endocrinology service of the Manuel Ascencio Villarroel and Albina Patiño Hospitals in Cochabamba city during May to July 2015. A total of 41 children and adolescents of 7 to 16 years old (24 men and 17 women) were submitted to anthropometric and laboratory evaluation. RESULTS: The MS prevalence in children and adolescents was 41%; the most frequent component was low HDL, which reached 78%, followed by hypertriglyceridemia with 48.8%. It was observed the existence highly significant association (Sig. 0.021) in the determination of the HOMA Index with overweight and obesity. In the same way were between Insulin and the HOMA Index (Sig. 0.009). Relating the criteria for the determination of metabolic syndrome, 41.7% of the overweight patients presented a single risk factor, it is similar the 44.83% obesity patients, they presented 2 risk factors, The values are similar between the population that is overweight and obese (41.7% and 41.4%, respectively). CONCLUSIONS: It is important to developing healthy habits and lifestyle at an early form, to avoid the consequences of the Metabolic Syndrome, in addition to reducing the costs of care for patients with cardiovascular diseases or Type 2 Diabetes Mellitus. It is imperative to perform studies to confirming early diagnostic.

O parto assistido por enfermeira obstetra: perspectivas e controvérsias / Birth delivery assisted by nurse midwife: perspectives and controversies

Apresentar conflitos existentes na assistência ao parto por enfermeiro obstetra e propor formas de minimizá-los. Métodos: Pesquisou-se a evolução histórica da assistência ao parto e as ações que se fizeram necessárias para a capacitação dos profissionais da área. Os Códigos de Ética de Enfermagem e Médica, a legislação vigente, os livros básicos de ginecologia e obstetrícia, os artigos de revistas médicas e de enfermagem, tendo Lilacs e Medline como fontes de dados, além de textos leigos e de Organizações Não Governamentais foram pesquisados. Identificaram-se conflitos na assistência ao parto por enfermeiro obstetra, para os quais se propõe formas de atuação. Resultados: A análise do material pesquisado mostra que a assistência ao parto, inicialmente domiciliar e depois institucional, trouxe o intervencionismo nesta atividade; que o aspecto social e humano do nascimento foi minimizado e o parto transformado em ato médico. Encontrou-se forte ligação entre enfoque de humanização do parto e sua assistência por enfermeiro. Conclusões: Conclui-se que, mesmo com respaldo legal e ético, a assistência ao parto por enfermeira obstetra é motivo de conflitos entre a equipe de saúde, particularmente no referente aos limites de atuação do enfermeiro e do médico. Tais conflitos devem ser identificados e discutidos nas instituições e estas devem investir no trabalho em equipe e dispor de protocolos claros, definindo limites de responsabilidades.

To present the conflicts in birth deliveries assisted by nurse midwife and propose ways to minimize them. Methods: We researched the historical evolution of childbirth and the actions that were necessary for the training of professionals. Codes of Ethics of Nursing and Medicine, the current law, basic books of obstetrics and gynecology, articles from medical and nursing journals, with Lilacs and Medline as data sources; laic texts and others from non-governmental organizations (NGO) were surveyed. Conflicts were identified in birth deliveries by nurse midwife, for which we propose ways of acting. Results: The analysis of research material shows that the time of delivery, initially at home and afterwards in institutions, brought interventionism in this activity; that social and human aspects of birth and delivery were minimized and birth delivery changed into medical act. We found a strong link between the focus in humanization at child delivery and its assistance by nurses. Conclusions: We conclude that even with legal and ethical support the delivery care by nurse midwife is a source of conflict between the health team, particularly with regard to the limits of performance of the nurse and doctor. Such conflicts must be identified and discussed in the institutions and they should invest in teamwork and have clear protocols defining boundaries of responsibility.

The need to include obstetric nurses in prenatal care visits in the public health system / A necessidade de inserção do enfermeiro obstetra na realização de consultas de pré-natal na rede pública

Objective: To investigate, with a qualitative approach, the role of Obstetric Nurses at the primary level of care given to women's health as a vital component of the multidisciplinary team, which today is fundamental for providing care, prevention as well as health education and promotion, especially in programs whose activities are geared towards primary care of pregnant, parturient, and puerpera women. Methods: Brazilian laws and the determinations of Nursing Councils in reference to the activities of the obstetric nurse were researched, including the nurse's responsibilities and limits. The bibliographic search was conducted in health-related journals, lay publications, and the Internet. Results: The conflicts between professional physicians and nurses were discussed. Conclusions: It was concluded that the activities of the nurse, conducting low-risk prenatal clinical visits in the basic healthcare network, has legal and ethical support and provides true benefit to the clients.

Objetivo: Pesquisar com abordagem qualitativa o papel da atuação do Enfermeiro Obstetra no nível primário de atenção à saúde da mulher, como componente importante da equipe multidisciplinar, hoje fundamental para o acolhimento, educação, prevenção e promoção em saúde, particularmente nos programas em que a ação se refere ao atendimento primário, cujo exemplo marcante é a atenção à gestante, parturiente e puérpera. Métodos: Pesquisaram-se as leis brasileiras e as determinações dos Conselhos de Enfermagem referentes à atuação do enfermeiro obstetra, suas competências e limites. A pesquisa bibliográfica foi feita em revistas da área de saúde, publicações leigas escritas e na internet. Resultados: Discutiram-se os conflitos entre profissionais médicos e enfermeiros. Conclusões: Conclui-se que a atuação do enfermeiro, realizando consultas de pré-natal de baixo risco na rede básica de saúde, tem amparo legal e ético, com real benefício à clientela.