Effects of Oral Nutritional Supplementation on Patients with Venous Ulcers: A Clinical Trial.

Background: The dosage and safety of nutritional supplements for patients with venous ulcers are still not well established. Aim: To evaluate the effects of a high calorie, high protein, arginine-, zinc-, and vitamins A, C, and E-enriched nutritional supplement on the biochemical profile, dietary intake, anthropometry, muscle strength, and characteristics of lesions of patients with venous ulcers. Methods: A controlled before−after clinical trial with a four-week follow-up involved 27 patients with venous ulcers under outpatient treatment in Brazil. It was administered in two to three doses per day (200 mL each) of a high-calorie and high-protein supplement enriched with arginine, zinc, and vitamins A, C, and E. Patients were assessed for anthropometric parameters, dietary intake, biochemical tests, and healing conditions according to the Pressure Ulcer Scale for Healing (PUSH). Results: It was observed that an increase in energy and protein supply led to an adequate intake of immunonutrients (zinc and vitamins A, C, and E), increased body weight, increased body mass index, and stronger handgrip strength. The injury area and the score on the PUSH notably decreased after the intervention (p < 0.001). Conclusions: The administered supplement, at the tested dosage, improved the nutritional status and characteristics of lesions in patients with venous ulcers.

Prevalence of diabetes mellitus according to associated factors in rural traditional populations in Goiás, Brazil: a cross-sectional study.

OBJECTIVE: To identify the prevalence of and factors associated with diabetes mellitus in rural traditional communities. METHODS: Cross-sectional study carried out in 115 rural communities distributed in 45 municipalities in the state of Goiás, including: 13 river communities, 51 quilombolas and 63 agrarian reform settlements. Probabilistic sampling was performed, and participants were selected at random. The outcome variable was self-reported diabetes mellitus, while exposure variables were sociodemographic, lifestyle, health conditions and access to health services. Multiple regression was used to determine the association between study variables. RESULTS: Among the 2,537 participants, the overall prevalence of diabetes was 9.8%, with 13.5% in river dwellers, 10.0% in quilombolas and 9.3% in settlers. Factors associated with diabetes were negative self-perception of health, being a former smoker, high blood pressure, hypercholesterolemia, and living in a river community. CONCLUSION: The results reinforce the need to strengthen strategies for the prevention and control of diabetes and its complications in rural populations, especially among river dwellers.

Prevalence of diabetes mellitus according to associated factors in rural traditional populations in Goiás, Brazil: a cross-sectional study / Prevalência de diabetes mellitus autorreferido e fatores associados em população rural e tradicional de Goiás: estudo transversal

ABSTRACT: Objective: To identify the prevalence of and factors associated with diabetes mellitus in rural traditional communities. Methods: Cross-sectional study carried out in 115 rural communities distributed in 45 municipalities in the state of Goiás, including: 13 river communities, 51 quilombolas and 63 agrarian reform settlements. Probabilistic sampling was performed, and participants were selected at random. The outcome variable was self-reported diabetes mellitus, while exposure variables were sociodemographic, lifestyle, health conditions and access to health services. Multiple regression was used to determine the association between study variables. Results: Among the 2,537 participants, the overall prevalence of diabetes was 9.8%, with 13.5% in river dwellers, 10.0% in quilombolas and 9.3% in settlers. Factors associated with diabetes were negative self-perception of health, being a former smoker, high blood pressure, hypercholesterolemia, and living in a river community. Conclusion: The results reinforce the need to strengthen strategies for the prevention and control of diabetes and its complications in rural populations, especially among river dwellers.

RESUMO: Objetivo: Identificar a prevalência e os fatores associados ao diabetes mellitus em comunidades rurais. Métodos: Estudo transversal desenvolvido em 115 comunidades rurais distribuídas em 45 municípios do Estado de Goiás, sendo: 13 ribeirinhas, 51 quilombolas e 63 assentamentos de reforma agrária. Realizou-se amostragem probabilística, e os participantes foram selecionados de forma aleatória. A variável desfecho foi diabetes mellitus autorreferido, enquanto as de exposição foram sociodemográficas, estilo de vida, condições de saúde e acesso a serviços de saúde. Utilizou-se regressão múltipla para verificar a associação entre variáveis de estudo. Resultados: Entre os 2.537 participantes, a prevalência geral de diabetes foi de 9,8%, sendo 13,5% nos ribeirinhos, 10,0% nos quilombolas e 9,3% nos assentados. Os fatores associados ao diabetes foram a autopercepção negativa de saúde, ser ex-fumante, hipertensão arterial, hipercolesterolemia e residir em comunidade ribeirinha. Conclusão: Os resultados reforçam a necessidade de fortalecer estratégias para prevenção e controle da diabetes e suas complicações em populações rurais, especialmente entre os ribeirinhos.

Effectiveness of two bundles in venous leg ulcer healing: A randomized controlled trial.

The objective of this study was to compare the effectiveness of 2 bundles in venous leg ulcer healing. This study is a open, randomized, controlled clinical trial with parallel treatment, 1:1 allocation rate, and 24-week follow-up. Twenty-eight patients with venous leg ulcers of the lower limbs were allocated to 2 groups: group A (n = 14) and group B (n = 14). The mean age of the participants was 59.67 ± 11.95 years, and the mean ulcer surface area was 29.32 (±98.43) cm2. The primary outcome was ulcer healing. Secondary outcomes were wound area reduction rate, Pressure Ulcer Scale of Healing (PUSH) scores, and the presence and intensity of pain before, during and after dressing change. Two different bundles were applied in 2 phases to the randomized groups. All participants engaged in an educational activity, performed exercises, rested with legs elevated, received oral nutrition supplementation (Cubitan; Danone Nutricia), and had their ulcers cleaned with warm saline solution and biguanide polyhexanide solution (Prontosan; B. Braun). Topical therapy in the first phase was papain 2% or 4% for group A and 2% hydrogel for group B. Both groups received single-layer elastic compression therapy (SurePress; ConvaTec). In the second phase, group A received compression therapy with Unna boot (Viscopaste; Smith-Nephew) as the primary dressing, while group B received a cellulose membrane (Membracel; Vuelo Pharma) followed by the Unna boot (Viscopaste; Smith-Nephew).In group A, 71.42% of the ulcers healed; in group B, the figure was 64.28%. Wound area, PUSH scores, and the occurrence and intensity of pain decreased significantly and equivalently in groups A and B.Both bundles are effective in the treatment of venous leg ulcers and pain relief.

Impaired tissue integrity, related factors and defining characteristics in persons with vascular ulcers / Deterioro de la integridad cutácnea, factores relacionados y características determinantes en personas con úlceras vasculares / Integridade tissular prejudicada, fatores relacionados e características definidoras em pessoas com úlceras vasculares

This transversal study aimed to analyze factors related to, and defining characteristics of, Impaired Tissue Integrity in persons with vascular ulcers, and compare the mean of these factors between the groups presenting different degrees in the severity of tissue compromise. The study was undertaken in February-August 2009, in the municipal health network of Goiânia in the state of Goiás, using interviews, clinical examinations and photographic records of the wounds. For analysis, simple and percentage frequencies and the Student t-test (p<0.05) were used. Five related factors were identified in more than half of the 42 participants: impaired circulation, knowledge deficit, chemical irritants, fluid excess and nutritional factors. Three defining characteristics were identified in all of the participants. There was no difference in the mean of related factors between groups. Impaired Tissue Integrity in persons with vascular ulcers was a phenomenon which demands professional attention extending beyond circulatory impairment. The mean of factors did not indicate greater or lesser severity of the compromising of the tissue integrity.

Se objetivó analizar factores relacionados, características determinantes en el deterioro de la integridad tisular en personas con úlceras vasculares y comparar los promedios de los factores entre grupos que presentaban diferentes grados de comprometimiento tisular. Pesquisa transversal, realizada de febrero - agosto/ 2009, en la red municipal de salud de Goiânia, utilizándose entrevista, examen clínico y registro fotográfico de la lesión. Para el análisis se utilizó frecuencia simple y porcentual y prueba t de Student (p<0,05). Se identificaron cinco factores en la mayoría de los 42 participantes: circulación perjudicada, déficit de conocimiento, irritantes químicos, exceso de líquidos y factores nutricionales. Tres características fueron identificadas en los participantes. No hubo diferencia en promedio de factores entre grupos. La integridad tisular deteriorada en personas con úlceras vasculares se configuró como un fenómeno que demanda atención profesional más allá del comprometimiento circulatorio. El promedio de FR no indicó mayor o menor gravedad del comprometimiento de la integridad tisular.

Objetivou-se analisar fatores relacionados e características definidoras de Integridade Tissular Prejudicada em pessoas com úlceras vasculares e comparar a média desses fatores entre grupos que apresentavam diferentes graus na gravidade do comprometimento dos tecidos. Pesquisa transversal, realizada de fevereiro a agosto de 2009, na rede municipal de saúde de Goiânia-GO utilizando-se entrevista, exame clínico e registro fotográfico da lesão. Para análise, utilizou-se freqüência simples e percentual e teste t de Student (p<0,05). Identificaram-se cinco fatores relacionadosem mais da metade dos 42 participantes: circulação prejudicada, déficit de conhecimento, irritantes químicos, excesso de líquidos e fatores nutricionais. Três características definidoras foram identificadas em todos os participantes. Não houve diferença na média de fatores relacionados entre grupos. Integridade Tissular Prejudicada em pessoas com úlceras vasculares configurou-se fenômeno que demanda atenção profissional para além do comprometimento da circulação. A média de fatores não indicou maior ou menor gravidade do comprometimento da integridade tissular.