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Agora USB ; 20(2): 283-297, jul.-dic. 2020.
Article in Spanish | LILACS | ID: biblio-1152770


Resumen Se reflexiona en torno al diseño normativo que regula la investigación en Colombia y las prácticas de los investigadores desde un enfoque ético, abordando asuntos pro blemáticos en las ciencias de la salud, las ciencias sociales y las disciplinas ambien tales, para concluir que se necesita fortalecer el control del Estado en estos temas, la actualización de la normatividad y una mayor formación de los investigadores y miembros de Comités de Ética en investigación, especialmente en: la protección de los participantes, el cuidado de los animales, los conflictos de interés, el manejo de comunidades y de grupos vulnerables, los protocolos comunitarios, el consentimien to informado, la consulta previa, el cuidado de la biodiversidad y el acceso a recursos genéticos.

Abstract This paper reflects on the normative design, which regulates research in Colombia and the practices of researchers from an ethical approach, by addressing critical issues in the health sciences, social sciences, and environmental disciplines, to conclude that it is necessary to strengthen state control in these issues, the updating of the regulations and greater training of researchers and members of Ethics Committees in research , especially in the protection of participants, animal care, conflicts of interest, the management of communities, and vulnerable groups, community pro tocols, informed consent, prior consultation, biodiversity care, and access to genetic resources.

Humanities/ethics , Education, Professional
Rev. colomb. cir ; 35(2): 244-249, 2020000.
Article in Spanish | LILACS | ID: biblio-1096441


Durante estas tres décadas del cuidado continuo de pacientes hospitalizados hemos reconocido la fisiopa-tología de la respuesta metabólica al estrés y la afectación de los enfermos desde la activación molecular de la sepsis, hasta el compromiso hemodinámico y neurológico del shock, ofreciendo soporte nutricional para obtener mejores resultados para la salud y la vida de nuestros pacientes, mediante recomendaciones que han sido comprobadas en poblaciones heterogéneas con diversas presentaciones en la práctica clínica. En esta revisión de la literatura proponemos sugerencias sobre la intervención nutricional en el paciente con SARS-CoV2 o COVID-19

During last three decades of continuous care of hospitalized patients, we have recognized the pathophysiology of the metabolic response to stress and the involvement of patients, from the molecular activation of sepsis to the hemodynamic and neurological involvement of shock, offering nutritional support to obtain better results for the health and life of our patients, through recommendations that have been verified in heterogeneous populations with different presentations in clinical practice. In this literature review we propose suggestions on nutritional intervention in patients with SARS-CoV2 or COVID-19

Humans , Coronavirus Infections , Nutrition for Vulnerable Groups , Pandemics , Diet, Food, and Nutrition
Rev. bras. educ. méd ; 44(supl.1): e136, 2020.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1137586


Resumo: Introdução: Compreendendo a abordagem holística de saúde e considerando as desigualdades brasileiras, infere-se a discrepância dos estados de saúde entre grupos sociais, sobretudo no que concerne à população em situação de rua (PSR). Essas pessoas lidam com o desamparo institucionalizado, e a pandemia da Covid-19 expôs ainda mais essa situação. Quanto à formação dos profissionais de saúde, torna-se fundamental a abordagem do tema. Relato de Experiência: Com base na inclusão de experiências de docentes que articulavam ações de integração ensino-serviço com a equipe do Consultório na Rua de Mossoró, bem como a abordagem de temas relacionados às populações mais vulneráveis em eixo longitudinal ao curso, despertou-se o interesse dos discentes do curso de Medicina da Ufersa para ações direcionadas à PSR. Destarte, surge, em 2019, a ação "Saúde nas Ruas", em parceria com o Consultório na Rua, que fornece suporte à PSR em diversos aspectos, com a participação dos alunos do curso de Medicina. A ação, proposta a partir de iniciativa dos próprios alunos, marcou o início do planejamento da inclusão do atendimento a essa população no programa do internato do curso, bem como a criação de um projeto de extensão longitudinal para ações voltadas à PSR. Nesse processo, os discentes puderam imergir na realidade dessa população, e os usuários tiveram autonomia para compartilhar suas experiências e dores. Discussão: Mediante uma formação acadêmica que visa romper com o modelo tecnicista, os estudantes possibilitaram voz à PSR e, compreendendo essas pessoas como sujeitos do processo, refletiram sobre o agir médico na transformação da realidade em que se inserem. Conclusão: O corpo acadêmico participante potencializou em si a empatia e o desejo por uma saúde pública democrática e acessível. Ficou evidente ainda a imprescindibilidade de trabalhar temas específicos sobre populações vulneráveis, com o objetivo de fortalecer a atuação médica como forma de garantir o direito à saúde.

Abstract: Introduction: A clear discrepancy in the health status between social groups in Brazil, particularly the homeless population (HP), can be inferred from the apparent inequalities when considering health from a holistic perspective. The homeless have to deal with institutionalized abandonment, and the COVID-19 pandemic has accentuated this issue. Addressing this theme has become an essential element of the training of health professionals. Experience Report: The interest of medicine students at UFERSA in actions directed at the HP was triggered by teachers' experiences of coordinating service-learning integration actions with the street health care unit in Mossoró, and tackling issues related to the most vulnerable groups throughout the course. In 2019 the "Health on the Streets" action is therefore launched in partnership with the street health care unit, providing support to the HP in several aspects, and involving the participation of the medicine students. The action, proposed based on the students' own initiative, marked the start of the planning for including care for this group in the internship program of the course, as well as the creation of a longitudinal community outreach project for actions with the HP. The students had the opportunity to immerse themselves in the reality of this population, while the users had the autonomy to share their experiences and sufferings. Discussion: Following an academic method that aims to break away from the technicist model, the students gave voice to the HP and, understanding these people as subjects of the process, reflected on the role of medicine in transforming their reality. Conclusion: The academics who participated in this project enhanced their empathy and desire for democratic and accessible public health. It also became evident that tackling specific issues regarding vulnerable groups is indispensable, with a view to strengthening the role of the physician in guaranteeing the right to health.

Rev. invest. clín ; 71(5): 297-305, Sep.-Oct. 2019. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1289699


Participants of Pharma-sponsored research are exposed to risks, benefits, and uncertainties that do not occur in other forms of clinical studies. Ethics committees represent the subjects’ first line of protection. This responsibility begins with the study review and ends after all study subjects finish the intervention. The objective of this paper is to review the most common controversial issues found in Pharma-sponsored studies. Potential solutions are proposed to prevent or resolve the polemical aspects. However, different challenges will be faced in the near future (e.g., when new therapies reach their late stage of development). All parties involved in research should work together to guarantee the protection of participants, the paramount principle on which clinical investigation is based. Pharma-sponsored research is a crucial driver to develop and implement innovative approaches to improve the informed consent process and the execution of the studies.

Rev. invest. clín ; 71(4): 217-225, Jul.-Aug. 2019. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1289690


Abstract Vulnerability in research occurs when the participant is incapable of protecting his or her interests and therefore, has an increased probability of being intentionally or unintentionally harmed. This manuscript aims to discuss the conditions that make a group vulnerable and the tools and requirements that can be used to reduce the ethical breaches when including them in research protocols. The vulnerability can be due either to an inability to understand and give informed consent or to unequal power relationships that hinder basic rights. Excluding subjects from research for the only reason of belonging to a vulnerable group is unethical and will bias the results of the investigation. To consider a subject or group as vulnerable depends on the context, and the investigator should evaluate each case individually.

Rev. Col. Bras. Cir ; 46(5): e20192267, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1057167


RESUMO Várias doenças da cavidade abdominal têm, na abordagem cirúrgica, sua principal forma de tratamento. Entretanto, o próprio procedimento cirúrgico é um agente estressor que pode promover efeitos adversos não relacionados com o objetivo do tratamento. A pré-habilitação emergiu como um programa multifatorial de condicionamento de saúde pré-operatório, que promove melhora na capacidade funcional e na evolução pós-operatória. O presente estudo faz uma revisão da literatura usando os bancos de dado MEDLINE, Ovid, Google Scholar e Cochrane para determinar o conceito, as indicações, os meios de seleção dos pacientes, e para sugerir as formas de implementação do programa de pré-habilitação em cirurgias abdominais de grande porte.

ABSTRACT Surgical approach is the main form of treatment for several diseases of the abdominal cavity. However, surgical procedure itself is a stressor that may lead to adverse effects unrelated to the treatment goal. Prehabilitation has emerged as a multifactorial preoperative health conditioning program, which promotes improvement in functional capacity and postoperative evolution. The present study reviews literature using MEDLINE, Ovid, Google Scholar, and Cochrane databases in order to determine the concept of prehabilitation program and the indications and means of patient selection for it, as well as to suggest ways to implement this program in cases of major abdominal surgeries.

Humans , Male , Female , Postoperative Complications/prevention & control , Preoperative Care/methods , Elective Surgical Procedures/psychology , Abdomen/surgery , Postoperative Period , Psychotherapy , Preoperative Care/psychology , Exercise , Risk Factors , Nutritional Support , Recovery of Function
Perspect. nutr. hum ; 20(2): 205-214, jul.-dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-1002759


Resumen Introducción: los diagnósticos de comienzos del siglo XX daban cuenta del deterioro de las condiciones materiales de vida de la población, en particular la más pobre. Uno de los aspectos más importantes era el problema del acceso a la alimentación. El objetivo de esta reflexión fue analizar los resultados de una encuesta nutricional aplicada a los jornaleros de la Municipalidad de Santiago en 1936. Reflexión: la encuesta de la Municipalidad de Santiago de Chile ofrece información relevante sobre consumo de calorías, talla y peso. Esta encuesta permite discutir los alcances que tuvo la encuesta como técnica de investigación durante los años 1930 y 1940, y las razones de por qué se impuso frente a otros métodos como el uso de las cuentas nacionales. Conclusión: la encuesta aplicada a los trabajadores de la Municipalidad de Santiago muestra sus condiciones privilegiadas en cuanto a ingreso, consumo e Índice de Masa Corporal.

Abstract Introduction: Diagnoses in the beginning of the 20th Century showed the deterioration of material conditions of life in the general population, especially the poorest. One of the most important aspects was the problem of access to adequate food and diet. The objective of this reflection is to analyze the results of a nutrition survey applied in 1936 to the workers of the Department of Cleanliness of the Municipality of Santiago de Chile. Reflection: The survey of the Municipality of Santiago de Chile provides important information on calorie consumption, height and weight. This survey allows for discussion of the scope of the survey as a research technique during the 1930s and 1940s, and the reasons why it was imposed against other methods such as the use of national surveillance systems. Conclusion: The survey applied to the workers of the Municipality of Santiago shows their privileged conditions in regards to income, dietary intake, and Body Mass Index.

Arq. bras. psicol. (Rio J. 2003) ; 70(3): 213-231, set./dez. 2018.
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-986476


O presente estudo tem o objetivo analisar a proteção de direitos humanos dentro de um contexto histórico e desenvolvimentista na Amazônia, utilizando-se do caso das quebradeiras de coco babaçu. Para isso perpassou-se pelos conflitos sociais existentes na Amazônia e decorrentes desta política, analisou-se a proteção multinível e suas dimensões e a necessidade do âmbito subnacional de proteção dos direitos humanos, para, por fim, apresentar o caso das quebradeiras como exemplo de resistência e fortalecimento do protecionismo para com grupos vulnerabilizados dentro do contexto amazônico, junto à atuação em escuta e clínica ampliada, exemplificando a relação transdisciplinar entre Direito e psicologia em favor de uma atuação à proteção subnacional de direitos humanos através da abertura de novos espaços políticos para comunidades locais e movimentos sociais

The present study has the objective of analyzing the protection of human rights within a historical and developmental context in the Amazon, using the case of babaçu coconut breakers. Taking into account that the social conflicts existing in the Amazon region were the result of this strategy, the multilevel protection and its dimensions and the need for the subnational scope of protection of human rights were analyzed, in order to present the case of the breakers as an example of resistance and strengthening of protectionism towards vulnerable groups within the Amazon context, along with the performance in listening and clinical practice, exemplifying the transdisciplinary relationship between Law and Psychology, in favor of an action related to the subnational protection of human rights through the opening of new political spaces for local communities and social movements

El presente estudio tiene el objetivo de analizar la protección de derechos humanos dentro de un contexto histórico y desarrollista en la Amazonia, utilizando el caso de las rompedoras de coco babaçu. Para ello se percató por los conflictos sociales existentes en la Amazonia y derivados de esta política, se analizó la protección multinivel y sus dimensiones y la necesidad del ámbito subnacional de protección de los derechos humanos, para, por fin, presentar el caso de las quebradoras como ejemplo de resistencia y fortalecimiento del proteccionismo hacia grupos vulnerables dentro del contexto amazónico, junto a la actuación en escucha y clínica ampliada, ejemplificando la relación transdisciplinaria entre Derecho y psicología en favor de una actuación a la protección subnacional de derechos humanos a través de la apertura de nuevos espacios políticos para comunidades locales y movimientos sociales

Humans , Amazonian Ecosystem/policies , Vulnerable Populations , Civil Rights , Human Rights
Cad. saúde colet., (Rio J.) ; 26(3): 298-307, July-Sept. 2018. tab
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-952531


Resumo Introdução o letramento de pessoas com diabetes quanto à nutrição é importante, pois uma alimentação saudável pode melhorar a qualidade de vida dessas pessoas. Objetivo Objetivou-se criar um instrumento denominado Letramento Nutricional entre pessoas com Diabetes (LND) e avaliar a sua validade, confiabilidade e interpretabilidade. Método estudo metodológico com verificação da validade de conteúdo; pré-teste; estimativa da confiabilidade (consistência interna: alfa de Cronbach; reprodutibilidade: kappa-K, coeficiente de correlação intraclasse [CCI]); estimativa da validade de critério concorrente e interpretabilidade feita pela contagem dos acertos das associações de palavras com escores de 0 a 24 (corte ≤ 18) e teste de hipóteses em amostra probabilística para população infinita por meio de regressão logística; p ≤ 0,05 (OR/IC95%). Resultados a validade de conteúdo foi satisfatória. A confiabilidade (alfa = 0,68; K ≥ 0,60 e CCI = 0,68) foi boa. Quanto à validade concorrente, constatou-se correlação entre o LND e a escolaridade (rs = 0,88; p = 0,000). Dos 212 participantes, 75,8% apresentaram LND > 18. No teste de hipóteses, verificou-se que quanto maior a escolaridade, maior o LND (1,20/1,09-1,31) e o LND foi menor entre homens (0,50/0,25-1,01). Conclusão o LND foi considerado válido, confiável e de fácil interpretação, podendo ser utilizado em pesquisas futuras ou mesmo em serviços de saúde que prestam assistência às pessoas com diabetes.

Abstract Background The literacy about nutrition of people with diabetes is important since healthy eating can improve the life quality of these people. Objective The objective of this study was to create an instrument called "Nutrition Literacy among people with Diabetes (NLD)" and evaluate its validity, reliability and interpretability. Method Methodological study with verification of content validity; pre-test; reliability estimation (internal consistency: Cronbach's alpha; reproducibility: kappa-K, Intraclass Correlation Coefficient - ICC); estimation of the validity of concurrent criterion and interpretability made by counting the correct words associations with scores from 0 to 24 (cut ≤ 18) and hypothesis test in sample for infinite population through logistic regression p≤0.05; (OR / CI 95%). Results The content validity was satisfactory. Reliability (alpha = 0.68, K≥0.60 and CCI = 0.68) was good. Regarding the concurrent validity, a correlation between NLD and schooling (rs = 0.88, p = 0.000) was found. From the 212 participants, 75.8% presented NLD> 18. In the hypothesis test, it was found that the higher the schooling, the higher the NLD (1.20 / 1.09-1.31); the NLD was lower among men (0.50 / 0.25-1.01). Conclusion The NLD was considered valid, reliable and easy to interpret, and it could be used in future research or even in health services that provide assistance to people with diabetes.

Chinese Medical Ethics ; (6): 20-23, 2018.
Article in Chinese | WPRIM | ID: wpr-706035


Objective:By observing the process of informed consent in clinical trials of one top three hospital, to disclose the non - standard phenomenon existingin the process of informed consent in clinical trials, and put for-ward that there should be special protection mechanism for vulnerable groups to participate in clinical trials. Meth-ods:Combined with the actual situation of one top three hospital, we comprehensively analyzed the problems exist-ing in the process of informed consent of clinical trials in our center, put forward strict solutions, and also formula-ted strict standards for the informed consent process of vulnerable groups. Results:Through the strict requirements of the informed consent process of vulnerable groups, the test process of vulnerable groups participating in the clini-cal trial was standardized; meanwhile the vulnerable groups were given special protection. Conclusion:Informed consent is an important guarantee that protects vulnerable groups to participate in clinical trials.

Cogit. Enferm. (Online) ; 22(4): 1-6, Out-Dez. 2017.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-876596


Objetivou-se analisar o aspecto nutricional de pacientes oncológicos em atendimento ambulatorial, em Joaçaba-SC. Estudo transversal, que utilizou a avaliação subjetiva global produzida pelo paciente e questionário de consumo alimentar, do Ministério da Saúde. Participaram 70 pacientes, idade média 60,3±13,9 anos, 38 (54,3%) homens, 57 (81,4%) sem acompanhamento nutricional, 48 (68,6%) com alimentação regular, 16 (22,9%) alimentação adequada e seis (8,6%) boa alimentação. O fumo teve associação com câncer de pulmão e orofaringe e o consumo de carne com câncer de intestino. A redução de peso foi elevada, 36 (52,2%) reduziram mais de 5% do peso corporal. Pessoas bem nutridas reduziram menos o peso comparado às desnutridas, tiveram melhor aceitação da dieta e menos queixas alimentares. Desnutridos totalizaram 58 indivíduos (83%), todos em estágio avançado da doença. A desnutrição teve elevada prevalência neste estudo, devendo ser implantadas estratégias de acompanhamento eficazes com equipe multiprofissional para melhorar o tratamento nutricional desta população (AU).

The objective was to analyze the nutritional aspect of cancer patients in outpatient care in Joaçaba-SC. Cross-sectional study using global subjective assessment by the patient and the food consumption questionnaire of the Brazilian Health Department. Seventy patients participated with a mean age of 60.3±13.9 years, 38 (54.3%) men, 57 (81.4%) without nutritional monitoring, 48 (68.6%) with a regular diet, 16 (22.9%) appropriate diet and (8.6%) good diet. Smoking was associated with lung and oropharyngeal cancer and meat consumption with bowel cancer. The weight reduction was high, as 36 (52.2%) lost more than 5% of their body weight. Well-nourished people lost less weight when compared to malnourished individuals, accepted the diet better and had less food complaints. In total, 58 individuals (83%) were malnourished, all of them in the advanced stage of the disease. The prevalence of malnourishment was high in this study. Effective monitoring strategies need to be implemented with a multiprofessional team to improve the nutritional treatment in this population (AU).

La finalidad fue analizar el aspecto nutricional de pacientes oncológicos en atención ambulatoria en Joaçaba-SC. Estudio transversal, que utilizó la evaluación subjetiva global producida por el paciente y cuestionario de consumo alimentario del Ministerio de la Salud brasileño. Participaron 70 pacientes, promedio de edad 60,3±13,9 años, 38 (54,3%) hombres, 57 (81,4%) sin seguimiento nutricional, 48 (68,6%) con alimentación regular, 16 (22,9%) alimentación adecuada y seis (8,6%) buena alimentación. El humo estaba asociado al cáncer de pulmón y faringe inferior y el consumo de carne con cáncer intestinal. La reducción de peso fue alta, 36 (52,2%) redujeron más del 5% del peso corporal. Personas bien nutridas redujeron menos el peso comparado a las desnutridas, aceptaron mejor la dieta y tuvieron menos quejas alimentarias. Desnutridos totalizaron 58 individuos (83%), todos en estado avanzado de la enfermedad. La prevalencia de la desnutrición fue alta en este estudio. Deben ser implantadas estrategias de seguimiento eficaces con equipo multiprofesional para mejorar el tratamiento nutricional de esta población (AU).

Humans , Nutrition for Vulnerable Groups , Malnutrition , Food Service, Hospital , Medical Oncology
Cad. Saúde Pública (Online) ; 33(10): e00139516, oct. 2017. tab
Article in Portuguese | LILACS | ID: biblio-952327


Resumo: A pré-hipertensão arterial é precursora da hipertensão arterial e fator de risco para doenças cardiovasculares. Populações vulneráveis estão mais propensas a esse tipo de agravo devido às dificuldades de acesso aos serviços de saúde. Pesquisa anterior realizada em comunidades quilombolas reportou elevada prevalência de hipertensão arterial. Este trabalho teve por objetivo estimar a prevalência de pré-hipertensão em quilombolas e avaliar fatores associados. Trata-se de um estudo transversal de base populacional realizado com indivíduos com 18 anos ou mais. A pré-hipertensão foi definida como pressão arterial sistólica ≥ 121mmHg e < 140mmHg e/ou diastólica ≥ 81mmgH e < 90mmHg. Empregou-se análise multivariada valendo-se de regressão de Poisson com variância robusta. Também foram calculadas frações atribuíveis populacionais (FAPs) para os fatores associados modificáveis. A prevalência de pré-hipertensão foi de 55% (IC95%: 50,2-59,7). O sexo masculino (RP = 1,54), a escolaridade de 1-4 anos completos de estudos (RP = 1,44) e as categorias de IMC sobrepeso (RP = 1,39) e obesidade (RP = 1,87) apresentaram associação positiva com a pré-hipertensão. Maiores frações atribuíveis foram observadas entre os indivíduos com escolaridade de 1-4 anos de estudos (13,7%) e entre os classificados com sobrepeso (9,35%) e obesidade (4,6%). A prevalência de pré-hipertensão nas comunidades quilombolas foi elevada, e sua identificação pode permitir o rastreamento e a sensibilização de um grupo com maior risco cardiovascular e de progressão para a hipertensão arterial. Observa-se a necessidade de amplo acesso a serviços de saúde e ações específicas voltadas à orientação, prevenção e promoção da saúde nessa população.

Abstract: Arterial prehypertension is a precursor of arterial hypertension and a risk factor for cardiovascular diseases. Vulnerable populations are more prone to this condition due to difficulties in access to health services. A previous study in quilombola communities (descendants of African slaves) reported a high prevalence of arterial hypertension. The current study aimed to estimate the prevalence of arterial prehypertension in quilombolas and to assess associated factors. This was a cross-sectional population-based study in individuals 18 years and older. Prehypertension was defined as arterial systolic pressure ≥ 121mmHg and < 140mmHg and/or diastolic ≥ 81mmHg and < 90mmHg. Multivariate Poisson regression with robust variance was used. Population-attributable fractions (PAF) were also calculated for the modifiable associated factors. Prevalence of prehypertension was 55% (95%CI: 50.2-59.7). Male gender (PR = 1.54), 1 to 4 complete years of schooling (PR = 1.44), and BMI classified as overweight (PR = 1.39) and obesity (PR = 1.87) showed positive association with prehypertension. Higher attributable fractions were observed in individuals with 1 to 4 years of schooling (13.7%) and those classified as overweight (9.35%) and obese (4.6%). Prevalence of prehypertension in quilombola communities was high, and its identification may allow screening and awareness-raising in a group with increased risk of cardiovascular disease and progression to full-blown hypertension. The study highlights the need for broad access to health services and specific measures for orientation, prevention, and health promotion in this population.

Resumen: La pre-hipertensión arterial es precursora de la hipertensión arterial y un factor de riesgo para enfermedades cardiovasculares. Las poblaciones vulnerables están más propensas a este tipo de problema de salud, debido a sus dificultades de acceso a los servicios de salud. La investigación anterior, realizada en comunidades quilombolas, reportó una elevada prevalencia de hipertensión arterial. Este trabajo tuvo como objetivo estimar la prevalencia de pre-hipertensión en quilombolas y evaluar sus factores asociados. Se trata de un estudio transversal de base poblacional, realizado con individuos con 18 años o más. La pre-hipertensión se definió como presión arterial sistólica ?≥ 121mmHg y < 140mmHg y/o diastólica ≥ 81mmHg y < 90mmHg. Se empleó un análisis multivariado, valiéndose de la regresión de Poisson con estimación robusta de la variancia. También se calcularon Fracciones Atribuibles Poblacionales (FAP) para los factores asociados modificables. La prevalencia de pre-hipertensión fue de un 55% (IC95%: 50,2-59,7). El sexo masculino (RP = 1,54), una escolaridad de 1 a 4 años completos de estudios (RP = 1,44) y las categorías de IMC sobrepeso (RP = 1,39) y obesidad (RP = 1,87) presentaron una asociación positiva con la pre-hipertensión. Mayores fracciones atribuibles se observaron entre los individuos con escolaridad de 1 a 4 años de estudios (13,7%) y entre los clasificados con sobrepeso (9,35%) y obesidad (4,6%). La prevalencia de pre-hipertensión en las comunidades quilombolas fue elevada, y su identificación puede permitir el rastreo y sensibilización de un grupo con mayor riesgo cardiovascular y con progresión hacia la hipertensión arterial. Se observa la necesidad de un amplio acceso a servicios de salud y acciones específicas dirigidas a la orientación, prevención y promoción de la salud en esa población.

Humans , Male , Female , Adolescent , Adult , Young Adult , Prehypertension/ethnology , Brazil/ethnology , Brazil/epidemiology , Body Mass Index , Sex Factors , Prevalence , Cross-Sectional Studies , Risk Factors , African Continental Ancestry Group , Overweight/ethnology , Overweight/epidemiology , Waist Circumference , Prehypertension/prevention & control , Prehypertension/epidemiology , Middle Aged
Rev. bras. epidemiol ; 20(1): 91-101, Jan.-Mar. 2017. tab
Article in Portuguese | LILACS | ID: biblio-843738


RESUMO: Objetivo: Há escassez de literatura sobre a saúde bucal dos quilombolas. O presente estudo procurou descrever a autopercepção de saúde bucal, bem como verificar fatores a ela associados em comunidades quilombolas no Estado do Rio Grande do Sul. Métodos: Os dados para este estudo transversal foram coletados por meio da aplicação de um questionário. Posto que o estudo fez parte de um levantamento sobre segurança alimentar, a amostra probabilística por conglomerado foi estimada para o desfecho de insegurança alimentar, consistindo de 583 indivíduos de comunidades quilombolas no Rio Grande do Sul. A associação entre o desfecho de autopercepção de saúde bucal negativa e variáveis sociodemográficas, de saúde geral e bucal foi aferida por intermédio de razões de prevalência obtidas por meio de regressão de Poisson com variância robusta, com intervalo de confiança de 95% (IC95%). Resultados: Autopercepção negativa de saúde bucal foi reportada por 313 (53,1%) indivíduos. Satisfação com mastigação e com aparência bucal esteve relacionada com maior prevalência de percepção negativa de saúde bucal, não havendo associação entre o número de dentes e o desfecho. Uso de álcool teve uma associação fraca com o desfecho. Conclusão: Satisfação com aparência e mastigação é fator associado com autopercepção de saúde bucal dos quilombolas no Rio Grande do Sul.

ABSTRACT: Objective: There’s a shortage of evidence on the oral health of quilombolas. This study aims to describe oral health self-perception, as well as to verify its associated factors in quilombola communities in the state of Rio Grande do Sul. Methods: The data for this cross-sectional health survey were collected by application of a questionnaire. Since this study was part of a survey on nutritional security, the probabilistic cluster sample was estimated for the outcome of nutritional insecurity, comprising 583 individuals across quilombola communities in Rio Grande do Sul. The association between the outcome of negative oral health self-perception and sociodemographic, general health, and oral health variables was measured by prevalence ratios obtained through Poisson regressions with robust variance and 95% confidence intervals. Results: Negative self-rated oral health was reported by 313 (53.1%) of the individuals. Satisfaction with chewing ability and satisfaction with oral appearance were associated with a higher prevalence of negative perception of oral health, while there was no association between the outcome and number of teeth. Use of alcohol had a borderline association with the outcome. Conclusion: Satisfaction with appearance and chewing ability are factors associated with oral-health self-perception of the quilombolas in Rio Grande do Sul.

Humans , Male , Female , Adult , Self Concept , Oral Health , African Continental Ancestry Group , Brazil , Cross-Sectional Studies , Middle Aged
Salud ment ; 40(1): 29-42, Jan.-Feb. 2017. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-846004


Abstract Background. People with a severe mental illness (SMI) are a highly vulnerable group for the transmission risk of the human immunodeficiency virus (HIV). They have a higher seroprevalence compared with the general population and their life expectancy is shorter than those of people without the disease. This narrative review describes individual factors or those inherent to a person’s characteristics and the sociocultural factors conditioning sexual behaviour and prevention norms. Objective. The purpose of this narrative review is to describe individual and sociocultural factors associated with the risk of HIV in people with a severe mental illness. Method. 82 empirical studies published between 1981 and 2015, addressing HIV transmission risk factors and sociocultural dimensions related to vulnerability were selected. Four indexes were used for this purpose: ISI Web of Knowledge, Redalyc, SciELO, and PUBMED; and four multidisciplinary electronic databases: Ebscohost Web, ProQuest, Sage Publications and ScienceDirect. Results. The analysis based on coding and systematic categorization shows that people with SMI are more vulnerable to risk than the general population, with differentials based on the severity of the disease symptomatology and economic and sociocultural characteristics associated with HIV-related risk practices. Discussion and conclusion. The need to design longitudinal studies with mixed methodology is proposed to attain a deeper understanding of the interaction of factors associated and processes conditioning risk. In this population group, structural preventive programs that take into account social and gender inequality must be implemented.

Resumen Antecedentes. Las personas con trastornos mentales graves (TMG) constituyen un grupo de alta vulnerabilidad al riesgo de transmisión del virus de inmunodeficiencia humana (VIH). Asimismo, presentan una mayor seroprevalencia en comparación con la población en general y su esperanza de vida es más corta que la de personas sin TMS. La presente revisión narrativa describe los factores individuales e inherentes a las características de estas personas y los factores socioculturales que condicionan los comportamientos sexuales y las normas de prevención. Objetivo. Describir los factores individuales y socioculturales asociados con el riesgo de infección del VIH en personas con trastornos mentales graves. Método. Se seleccionaron 82 estudios empíricos publicados entre 1981 y 2015 sobre los factores asociados al riesgo de transmisión del VIH y dimensiones socioculturales relacionadas con la vulnerabilidad. Se utilizaron cuatro índices: ISI Web of Knowledge, Redalyc, SciELO y PUBMED; y cuatro bases de datos electrónicas multidisciplinarias: Ebscohost Web, ProQuest, Sage Publications y ScienceDirect. Resultados. Un análisis basado en la codificación y categorización sistemática muestra que las personas con TMG son más vulnerables al riesgo que la población general, con diferenciales basados en la gravedad sintomatológica de la enfermedad y en las características económicas y socioculturales que se asocian con prácticas de riesgo. Discusión y conclusión. Se propone desarrollar estudios con un diseño longitudinal y metodología mixta para alcanzar una comprensión más profunda de la interacción de factores asociados y procesos que condicionan el riesgo. Los programas preventivos estructurales realizados con este grupo de personas deben considerar las desigualdades sociales y la inequidad de género.

Chinese Medical Ethics ; (6): 572-575, 2017.
Article in Chinese | WPRIM | ID: wpr-619277


Objective:To find a better way to protect the security and interests of vulnerable groups by exploring the problem of protecting the vulnerable groups in drug clinical trial from the perspectives of ethics committees,organization and researchers.Methods:According to the relevant literature and the actual situation of the hospital,this paper analyzed the security issues of vulnerable groups comprehensively.Results:Only the ethics committees,organization and researchers work together,can it protect the security and interests of vulnerable groups to the greatest extents.Conclusion:Further research on the security of vulnerable groups not only promotes the development of human health,but also plays a decisive role in improving the protection of subjects in drug clinical trial.

Cad. saúde colet., (Rio J.) ; 24(3): 376-383, jul.-set. 2016. tab
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-828378


Resumo Objetivo Determinar a prevalência da hipertensão arterial (HA) e investigar fatores associados em uma comunidade quilombola da Bahia, Brasil. Métodos A HA foi determinada por autorreferimento de diagnóstico feito por um médico ou enfermeiro. Por meio de questionário, foram coletados dados demográficos, socioeconômicos, hábitos de vida e alimentares e presença de comorbidades. Foram realizadas medidas antropométricas e dosagens bioquímicas para determinação de sobrepeso/obesidade, diabetes e dislipidemias. Empregaram-se análise univariada para determinar associação entre HA e variáveis de interesse, e análise múltipla por regressão de Poisson para estimativa das razões de prevalência. Resultados A população estudada foi de 213 indivíduos maiores de 18 anos. A prevalência de HA foi de 38,5%. Após análise ajustada, permaneceram associados à HA: sexo feminino, idade, menor escolaridade, maior renda per capita, uso de medicamentos nos últimos 15 dias, obesidade e diabetes mellitus. Conclusões Os resultados evidenciam a necessidade de ações intersetoriais voltadas para a melhoria das condições de vida e saúde dessa comunidade. A adequação da infraestrutura e do funcionamento do serviço de saúde local, bem como a realização de campanhas de promoção da saúde, pode contribuir para a prevenção, diagnóstico precoce e tratamento da hipertensão e outros agravos.

Abstract Objective To determine the prevalence of hypertension and investigate associated factors in a Quilombola community of Bahia (Brazil). Methods Hypertension was based on diagnosis made by a physician or a nurse and self-reported by participants; demographic, socioeconomic, lifestyle, food habits, and comorbidities data were collected through a previously validated questionnaire. Anthropometric and biochemical measurements for overweight/obesity, diabetes and dyslipidemia were performed. Univariate and multivariable analysis using Poisson regression were conducted to estimate the association between hypertension and the variables of interest to estimate the adjusted prevalence ratios. Results The study population comprised 213 individuals older than 18 years. The hypertension prevalence was 38.5%. In the adjusted analysis hypertension was associated with female sex, age, lower education, higher per capita income, use of drugs in the last 15 days, obesity, and diabetes mellitus. Conclusions The results highlight the need for intersectorial actions to improve the community living conditions and health. The adequacy of local health service infrastructure and operation as well as health promotion campaigns can contribute to the prevention, early diagnosis and treatment of hypertension and other diseases.

Rev. medica electron ; 38(3): 351-360, mayo.-jun. 2016.
Article in Spanish | LILACS-Express | LILACS | ID: lil-784146


Introducción: la tuberculosis constituye, aún, un importante problema de salud. La Organización Mundial de la Salud está tratando de lograr una disminución radical de la carga de esta enfermedad y reducir a la mitad su prevalencia y mortalidad con su estrategia Alto a la tuberculosis. El Programa Nacional de Control de la Tuberculosis iniciado en 1962, recomienda la búsqueda sistemática de los casos de tuberculosis en los grupos vulnerables. Objetivo: informar los resultados diagnósticos de la localización de casos, a través de la pesquisa activa o sistemática en grupos vulnerables, de la provincia de Matanzas, bajo las condiciones de operación del Programa Nacional de Control de la Tuberculosis de Cuba. Materiales y Métodos: el equipo de salud desde julio/2009 a diciembre/ 2013, realizó una investigación descriptiva y de corte transversal, pesquisa activa para diagnóstico de tuberculosis en grupos vulnerables. Resultados: el volumen de la pesquisa activa en personas de los grupos vulnerables, las tuberculinas y los rayos x de tórax realizados se incrementaron por años. El mayor número de pesquisados correspondió al adulto mayor, seguidos de diabéticos y personas que viven en asentamientos críticos. La prevalencia de infección tuberculosis latente total, fue de un 0.089 % en estos grupos. Los casos que se diagnosticaron (todas las formas) fueron principalmente en alcohólicos, ex reclusos e inmunodeprimidos. Del total de los casos de tuberculosis BAAR+, en los 5 años, el 43,9 % se diagnosticó mediante la pesquisa activa. Conclusiones: la tuberculosis fue mayormente diagnosticada en los grupos vulnerables, mediante la pesquisa activa. Se identificó que es bajo la prevalencia de esta infección latente en estos grupos.

Background: tuberculosis is still an important health problem. The World Health Organization is trying to achieve a radical decrease of this disease load and to reduce its prevalence and mortality to the half with its strategy "Stop tuberculosis". The National Program of Tuberculosis Control, started in 1962, recommends the systematic search of the tuberculosis cases in the vulnerable groups. Aim: to inform the diagnosis results of case localization through the active or systematic screening in vulnerable groups of the province of Matanzas, under the operational conditions of the National Program of Tuberculosis Control of Cuba. Materials and methods: from July 2009 to december 2013, the health team carried out a cross-sectional, descriptive research of the active screening for diagnosing tuberculosis in vulnerable groups. Outcomes: the volume of the active screening in persons from the vulnerable groups, the tuberculin skin tests, and thorax X rays increased per years. The highest number of screened persons corresponded to elder people, followed by diabetic ones and people living in critical places. The prevalence of the total latent tuberculosis infection was 0.089 % in these groups. The diagnosed cases (all of the forms) were mainly among alcohol abusers, ex-prisoners and immunodepressed people. 43.9 % of the total of AFB+ tuberculosis cases in the five years was diagnosed through the active screening. Conclusions: tuberculosis was mainly diagnosed in the vulnerable groups, through the active screening. It was identified that the prevalence of this latent infection is low in these groups.

Rev. panam. salud pública ; 39(1): 32-37, Jan. 2016. tab, graf
Article in English | LILACS | ID: lil-783026


ABSTRACT Objective To assess trends in 1) tuberculosis (TB) case notification by year and 2) cumulative treatment outcomes (stratified by type of TB) in relation to the proportion of indigenous population in municipalities in a countrywide study in Mexico for the period 2009–2013. Methods This ecological operational research study used municipality data for the five-year study period. As no single identifier variable existed for indigenous persons, municipalities were categorized into one of three groups based on the proportion of their indigenous population (< 25% (“low”), ≥ 25% to < 50% (“medium”), and ≥ 50% (“high”)). TB case notification rates (CNRs) were standardized to a 100 000 population. Result For the first four years of the study period (2009 through 2012), for all new TB cases reported nationally, the municipalities with a high proportion of indigenous people (≥ 50%) had the highest CNRs (ranging from 20.8 to 17.7 over that period). In 2013, however, the CNR in the high proportion municipalities dropped to 16.7, lower than the CNR for that year in the municipalities with a medium proportion of indigenous people (P < 0.001). In the municipalities with low and medium proportions of indigenous people, the CNR hovered between 15.1 and 17.3 over the study period. For the 96 195 new TB cases reported over the study period, the treatment success rate ranged between 81% and 84% for all three municipality groups. For previously treated TB cases, CNRs ranged between 1.0 and 1.7 for all three groups over the study period. The average proportion of previously treated TB cases (of all TB cases) was 9% for the three groups in 2009 but dropped to 8% by 2013. The cumulative treatment success rate for all previously treated cases (a total of 8 763 for the study period) was 64% in municipalities with a low proportion of indigenous people, 61% in those with a medium proportion, and 69% in those with a high proportion. Conclusions Despite the slightly higher CNR in municipalities with predominantly indigenous populations, there were no stark differences in TB burden across the three municipality groups. The authors were unable to confirm if the relatively low CNRs found in this study were a reflection of good TB program performance or if TB cases were being missed. A survey of TB prevalence in indigenous people, with individualized data, is needed to inform targeted TB control strategies for this group in Mexico.

RESUMEN Objetivo Evaluar las tendencias en la notificación de casos de tuberculosis por año y los desenlaces terapéuticos acumulados (estratificados por tipo de tuberculosis), con respecto a la proporción de la población indígena de los municipios, en una investigación de ámbito nacional en México del 2009 al 2013. Métodos Estudio ecológico de investigación operativa en el que se utilizaron datos de los municipios correspondientes al período quinquenal definido. Dado que no existía una variable única de identificación de las personas indígenas, los municipios se clasificaron en tres grupos en función de la proporción de su población indígena (“baja”, menos de 25%; “intermedia”, de 25% a menos de 50%; y “alta”, 50% o más). Las tasas de notificación de casos de tuberculosis se normalizaron por 100 000 habitantes. Resultados Durante los primeros cuatro años del período del estudio (del 2009 al 2012), los municipios con una alta proporción de indígenas presentaron las más altas tasas de notificación de todos los casos nuevos de tuberculosis (de 20,8 a 17,7 en este período). En el 2013, sin embargo, la tasa de notificación en los municipios con una alta proporción disminuyó a 16,7 casos por 100 000 habitantes y fue más baja que la tasa de los municipios con una proporción intermedia de indígenas (P < 0,001). En los municipios con una proporción baja e intermedia, la tasa de notificación de casos osciló entre 15,1 y 17,3 por 100 000 habitantes durante el período del estudio. En los 96 195 casos nuevos de tuberculosis notificados durante todo el período, la tasa de éxito del tratamiento fluctuó entre 81% y 84% en los tres grupos de municipios. En los casos de tuberculosis anteriormente tratados, las tasas de notificación oscilaron entre 1,0 y 1,7 en los tres grupos durante el período estudiado. El promedio de la proporción de casos de tuberculosis anteriormente tratados (con respecto a todos los casos de tuberculosis) fue 9% en los tres grupos en el 2009 pero disminuyó a 8% en el 2013. La tasa acumulada de éxito terapéutico en todos los casos anteriormente tratados (de un total de 8 763 durante el período del estudio) fue 64% en los municipios con una baja proporción de población indígena, 61% en los municipios con una proporción intermedia y 69% en los municipios donde la proporción era alta. Conclusiones Pese a una tasa de notificación de casos discretamente superior en los municipios con poblaciones predominantemente indígenas, no se encontraron diferencias considerables de la carga de morbilidad por tuberculosis en los tres grupos de municipios. Los autores no pudieron verificar si las tasas de notificación relativamente bajas observadas en el presente estudio correspondían a un buen desempeño del programa contra la tuberculosis o se debía a los casos de tuberculosis pasados por alto. Es preciso realizar una encuesta de prevalencia de tuberculosis en las poblaciones indígenas que aporte datos individualizados, con el propósito de fundamentar las estrategias de control de la tuberculosis que se dirigen a este grupo de la población en México.

Tuberculosis/transmission , Health of Indigenous Peoples , Health Services, Indigenous/supply & distribution , Mexico
Journal of Korean Diabetes ; : 271-276, 2016.
Article in Korean | WPRIM | ID: wpr-726840


The prevalence of diabetes has increased consistently throughout recent decades. Among patients, 70.7% are aware of their disease, and 63% receive treatment. However, less than 20% of those treated maintain their blood sugar level (glycosylated hemoglobin > 6.5%), indicating that most diabetic patients do not receive appropriate treatment. Diabetes management requires consistent treatment and self-management, but elderly patients who lack social or family support and patients from socially disadvantaged classes tend to have less access to medical care and often stop treatment due to economic hardship. While public health centers, Diabetes registration and management center and home nursing services are available to support vulnerable diabetic patients, many are still neglected by our health care system. To improve patient quality of life, a free service providing information and consistent care based on community should be established. Also, when diabetic education team, patients, and their family's, community organizations connection is firmly formation, in the community can be used to effectively manage diabetes.

Aged , Blood Glucose , Delivery of Health Care , Education , Home Nursing , Humans , Prevalence , Public Health , Quality of Life , Self Care , Vulnerable Populations
Rev. APS ; 18(3)set. 2015.
Article in Portuguese | LILACS | ID: lil-784465


A Estratégia de Saúde da Família (ESF), orientada pelosprincípios organizacionais e doutrinários do SUS, rege aprática de Atenção à Saúde por meio da equidade, acessibilidadea todas as famílias, por encontrar nessa práticao espaço de atenção nos âmbitos biopsicossocial, culturale econômico que contribua para o crescimento saudáveldesse grupo. Objetiva-se, com este estudo, analisar comose dá a equidade do acesso à Atenção à Saúde das famíliasvulneráveis, identificadas na estratificação do diagnósticosituacional realizado na disciplina de Saúde da Famíliada Residência Multiprofissional de Atenção à Saúde daUFPE/CAV no ano de 2012. Trata-se de um estudo descritivoobservacional, com análise quantitativa dos atendimentose da entrevista semiestruturada da populaçãoatendida na Unidade de Saúde da Família Severino NogueiraAlves (ESF Cajueiro). A população do estudo compreende628 famílias, estratificadas segundo a Escala deCoelho e Savassi, da seguinte forma: sem risco, risco leve/R1, moderado/R2 e máximo/R3 da população cadastradana ESF, sendo 543 famílias atendidas no ano de 2012pelos profissionais da Estratégia de Saúde da Família e,posteriormente, dessas 543, foram entrevistadas 50 famí-lias que tiveram menor número de atendimentos de umaforma geral. Foram utilizados, como fonte de dados, osinstrumentos: Relatório Diário de Atendimento/Ambulatóriodo ano de 2012 e o questionário semiestruturadorealizado junto a essas famílias por entrevista domiciliar.Os resultados subsidiaram os aspectos socioeconômicosdas famílias, a distribuição dos atendimentos de formageral e segundo o risco familiar e profissional de saúde, aspectos relacionados à concepção de saúde, acesso, organização,qualidade e estrutura do serviço segundo riscofamiliar e aspectos relacionados à qualidade e efetividadeda assistência à saúde recebida na USF. O estudo aponta anecessidade de inserir efetivamente a equidade do acessoàs famílias segundo a análise do risco de vulnerabilidadedo indivíduo, da família e da comunidade, para assim obteruma maior resolutividade e prevenção ao adoecimento.Isso para que se possa desenvolver um cuidado integral,que contribua para um real avanço na reorientaçãodo processo de trabalho na Atenção Básica, atuando comsenso crítico, mediante uma prática competente e resolutiva,com ações de promoção, prevenção e reabilitação dosindivíduos envolvidos no seu processo de cuidar.

The Family Health Strategy (FHS) driven by organizationaland doctrinal principles of the SUS, governs the practiceof health care through fair, accessible to all families, byfinding this space attention in biopsychosocial, cultural andeconomic spheres, to contribute to the healthy growth ofthis group. Objective of this study was to analyze how isthe equity of access to health care for vulnerable familiesidentified in the stratification situation analysis conductedin the discipline of family Residência Multiprofissionalde Atenção à Saúde da UFPE/CAV in 2012. This is anobservational descriptive study with a quantitative analysisof visits and semistructured interviews of the populationserved in the Family Health Unit Severino Alves Nogueira(ESF Cajueiro). The study population comprised 628families stratified by Scale Coellho and Savassi as follows:no risk, slight risk/R1, moderate/R2 and maximum risk/R3 the population enrolled in the ESF, and 543 familiesmet in the year 2012 by professionals of the Family HealthStrategy and subsequently these 543 families 50 familieswho had fewer visits generally were interviewed. DailyReport of Attendance / Clinic in the year 2012 and the semistructuredquestionnaire conducted with these householdsby household interviews: the instrument was used as adata source. The results have allowed the socioeconomicaspects of the households, the distribution of services ingeneral and according to family and professional healthrisk related to the concept of health aspects, access,organization, structure and quality of service accordingto family risk and related aspects quality and effectivenessof health care received at USF. We conclude that the study shows the need to effectively enter the equity of accessto households according to risk analysis of vulnerabilityof the individual, family and community; order to obtaina higher resolution and prevention to illness, so that wecan develop a comprehensive care, contributing to realprogress in reorienting the process of working in primarycare, working with critical sense, by a competent andsolving practice involving actions promotion, preventionand rehabilitation of individuals involved in your careprocess.

Equity , Health Services Accessibility , Risk Groups , Family , Family Health , National Health Strategies