Prevalence, Incidence and Factors Associated with Diabetic Foot in People with Type 2 Diabetes: Systematic Review with Meta-Analysis.

BACKGROUND: Diabetic Foot is a severe chronic complication of diabetes and an important factor in the morbidity of diabetic people, resulting in high health costs and increased risk of death. OBJECTIVE: To analyze the incidence, prevalence, and risk factors associated with diabetic foot in people with type 2 Diabetes Mellitus. METHOD: Systematic literature review. Searches in MedLine via PubMed, LILACS, Web of Science, Scopus CINAHL, and Cochrane Library databases were performed. Inclusion of 52 studies. The R program, Metan packages, was used to calculate the meta-analysis. Given the heterogeneity of studies, the random effect was used to calculate the meta-analysis of risk factors. RESULTS: The meta-analysis showed that the prevalence of diabetic foot was 14% in a hospital setting and 5% in a community setting. The overall prevalence and incidence were 9% and 4%, respectively. Significant risk factors included time of DM (odds ratio [OR] =1.46, confidence interval [CI], 0.36-2.57, P = 0.009), smoking (OR = 1.46, CI, 1.16 -1.85, P< .001), glycated hemoglobin (OR = 0.96, CI, 0.50; 1.42, P< .001), peripheral arterial disease (OR = 3.38, CI, 2.07; 5.53, P < .001) and peripheral neuropathy (OR = 5.88, CI, 2.39-14.45, P<.001). CONCLUSION: Multidisciplinary monitoring, educational strategies, periodic foot examination for alterations, and early identification of risk factors are essential to prevent ulceration and reduce the disease burden.

Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis.

BACKGROUND: The Paleolithic diet has been studied in the scope of prevention and control of chronic noncommunicable diseases (CNCD). The objective of this study was to analyze the influence of the Paleolithic diet on the prevention and control of CNCD in humans, specifically on anthropometric markers, through a systematic review with meta-analysis. METHODS: What is the effect of the Paleolithic diet on anthropometric parameters (weight, body mass index and waist circumference) compared to other control diets based on recommendations in adults? We included only randomized studies with humans that used the Paleolithic Diet in the prevention and control of CNCD published in Portuguese, English or Spanish. The search period was until March 2019, in the LILACS, PubMed, Scielo, Science Direct, Medline, Web of Science and Scopus databases. The abstracts were evaluated by two researchers. We found 1224 articles, of which 24 were selected and 11 were included in the meta-analysis. The effect of dietary use on body weight, body mass index and waist circumference was evaluated. RESULTS: The summary of the effect showed a loss of - 3.52 kg in the mean weight (CI 95%: - 5.26; - 1.79; p < 0,001; I2 = 24%) of people who adopted the Paleolithic diet compared to diets based on recommendations. The analysis showed a positive association of adopting the Paleolithic diet in relation to weight loss. The effect was significant on weight, body mass index and waist circumference. CONCLUSION: The Paleolithic diet may assist in controlling weight and waist circumference and in the management of chronic diseases. However, more randomized clinical studies with larger populations and duration are necessary to prove health benefits. TRIAL REGISTRATION: CRD42015027849 .

Cognitive Assessment Tools for Screening Older Adults With Low Levels of Education: A Critical Review.

Introduction: Cognitive assessment of older adults who are either illiterate or with low levels of education is particularly challenging because several battery tasks require a certain educational background. Early detection of mild cognitive impairment (MCI) in the elderly using validated screening tools is of great importance since this population group could benefit from new drugs that are being investigated for the treatment of dementias. Cutoff scores for psychometric properties of cognitive tests are not well established among adults with low levels of education. The present study aimed to critically review the literature on cognitive assessment tools for screening cognitive syndromes including MCI and Alzheimer's disease (AD) in older adults with low levels of education. Methods: We conducted a systematic search of MEDLINE, LILACS, Cochrane, and SCOPUS electronic databases of cross-sectional and prospective studies with adults over 55 years of age. Results: We found a significant number of assessment tools available (n = 44), but only a few of them showed diagnostic accuracy for the diagnosis of MCI and AD in older adults with low levels of education: the Mini-Mental State Exam; the Montreal Cognitive Assessment; the Persian Test of Elderly for Assessment of Cognition and Executive Function; the Six-Item Screener; and the Memory Alteration Test. Few studies evaluated individuals with low levels of education, with a wide range of cutoff scores and cognitive test batteries. Conclusion: We found that a small number of studies evaluated adults with 4 years of formal education or less. Our findings further support the importance of developing specific tools for the assessment of older adults with low levels of education.

Effectiveness of Educational Technology in Promoting Quality of Life and Treatment Adherence in Hypertensive People.

The objective of this study was to test the effectiveness of an educational intervention with use of educational technology (flipchart) to promote quality of life (QOL) and treatment adherence in people with hypertension. It was an intervention study of before-and-after type conducted with 116 hypertensive people registered in Primary Health Care Units. The educational interventions were conducted using the flipchart educational technology. Quality of life was assessed through the MINICHAL (lowest score = better QOL) and the QATSH (higher score = better adherence) was used to assess the adherence to hypertension treatment. Both were measured before and after applying the intervention. In the analysis, we used the Student's t-test for paired data. The average baseline quality of life was 11.66 ± 7.55, and 7.71 ± 5.72 two months after the intervention, showing a statistically significant reduction (p <0.001) and mean of differences of 3.95. The average baseline adherence to treatment was 98.03 ± 7.08 and 100.71 ± 6.88 two months after the intervention, which is statistically significant (p < 0.001), and mean of differences of 2.68. The conclusion was that the educational intervention using the flipchart improved the total score of quality of life in the scores of physical and mental domains, and increased adherence to hypertension treatment in people with the disease.

[Content validation of the dimensions constituting non-adherence to treatment of arterial hypertension]. / Validação de conteúdo das dimensões constitutivas da não adesão ao tratamento da hipertensão arterial.

The objective of the study was to validate the content of the dimensions that constituted nonadherence to treatment of arterial systemic hypertension. It was a methodological study of content validation. Initially an integrative review was conducted that demonstrated four dimensions of nonadherence: person, disease/treatment, health service, and environment. Definitions of these dimensions were evaluated by 17 professionals, who were specialists in the area, including: nurses, pharmacists and physicians. The Content Validity Index was calculated for each dimension (IVCi) and the set of the dimensions (IVCt), and the binomial test was conducted. The results permitted the validation of the dimensions with an IVCt of 0.88, demonstrating reasonable systematic comprehension of the phenomena of nonadherence.

[Hypertension communicated and hypertension understood: nursing know-how and practices in a Family Health Program in Fortaleza, State of Ceará]. / Hipertensão comunicada e hipertensão compreendida: saberes e práticas de enfermagem em um Programa de Saúde da Família de Fortaleza, Ceará

The scope of the study was to examine the communication practices of nurses in consultation of arterial hypertension in the Family Health Program in Fortaleza, Ceará, revealing the elements that cause asymmetry of power between nurses and the hypertensive individuals verbal expression. The theoretical references are Critical Discourse Analysis and Pragmatics. This is an exploratory descriptive and qualitative study, in which participant observation was conducted in a Basic Family Health Unit. The following discourses arose: the nurse as conductor of the interaction with verbal and nonverbal discursive commands; the hypertensive subject as subjugated by the nurse; the nurse as an articulated instrument that communicates a body of social practice; the body of the hypertensive person as a tool that supports an imaginary power load; the interaction between nurse and the hypertensive person in a one-sided situation, obliging the hypertensive individual to obey orders. The relationship between the nurse and the hypertensive person develops asymmetrically, built on symbolic materials of social practices under the legitimacy of the paradigm of current Nursing Consultation in our society.

[Access to the emergency service by clients with hypertensive crisis in a hospital in Fortaleza, CE, Brazil]. / Acesso ao serviço de emergência pelos usuários com crise hipertensiva em um hospital de Fortaleza, CE, Brasil.

A hypertensive crisis is a sudden and symptomatic elevation of blood pressure at risk of acute deterioration of target organs. Although the prevalence in the literature of the burden is 1%, the risk of complications and death associated with the problem of health in the emergency services have revealed the need for deeper issues related to access to the service of health. It is a quantitative and descriptive research, held in a public hospital Fortaleza city, between April and July of 2006, with 118 patients. The results show that people with hypertensive crisis has sought health services, especially the emergency, in order to get care. The study indicates access as a key element in meeting the needs of users who seek the services of health, and the waiting time, the resolution and the reception, important parameters on the quality of care.

[Education of the nurse for caring: reflections of professional practice]. / Formação do enfermeiro para o cuidado: reflexes da prática profissional.

It is a reflective study that aimed at discussing the education of the nurse concerning the care in a perspective of change of the professional practice. The curricular guidelines for the profession are based Guidelines and Basis for National Edcucation which have aims to educate capable nurses to transform the practical reality of the Brazilian nursing. However, we realize that only the implementation of such guidelines does not make possible the education of critical, reflexive and transforming professionals regarding the real world.