Skeletal muscle mass increases after viral eradication with direct-acting antivirals in patients with chronic hepatitis C: A longitudinal study.

BACKGROUND: Results of studies evaluating the effect of viral eradication following direct-acting antiviral (DDA) therapy on skeletal muscle mass of patients with chronic hepatitis C (CHC) are scarce. AIM: To assess the components of sarcopenia (low muscle mass, low muscle strength and low physical performance) in a cohort of CHC individuals before and after DAA therapy. METHODS: We performed a longitudinal study of patients with CHC who underwent body composition assessment before (T0), and at 12 (T1) and 48 (T2) weeks after DDA therapy. Bioelectrical Impedance Analysis was used to assess skeletal mass muscle (SM) and phase angle (PhA). SM index (SMI) was calculated by dividing the SM by squared height. Muscle function was evaluated by hand grip strength (HGS) and timed up-and-go (TUG) test. Mixed-effects linear regression models were fitted to SMI, HGS and physical performance and were used to test the effect of HCV eradication by DAA. RESULTS: 62 outpatients (mean age, 58.6 ± 10.8 years; 58% with compensated cirrhosis) were included. Significant decreases in liver fibrosis markers and an increase of 0.20 and 0.22 kg/m2 in the SMI were observed at T1 and T2. Following DAA therapy, an increase of one unit of PhA was associated with a reduction of 0.38 min in TUG. CONCLUSION: HCV eradication with DAA therapy was associated with a dynamic reduction of non-invasive markers of liver fibrosis and increased muscle mass in 62 patients with CHC who had an undetectable HCV load at 12 weeks after completion of antiviral treatment.

Compreensão de cuidadores de pessoas idosas acamadas acerca da assistência recebida pela atenção primária à sua saúde / Understanding of caregivers of bedridden older adults about the primary assistance received to their own health care

Resumo Objetivo Identificar a compreensão de cuidadores de pessoas idosas acamadas acerca da assistência recebida pela atenção primária em relação à sua própria saúde. Método Estudo qualitativo baseado na fenomenologia de Alfred Schütz. A abordagem dos cuidadores de pessoas idosas acamadas ocorreu pelo agente comunitário em sua área de abrangência em uma unidade básica de saúde localizada no norte do Espírito Santo, Brasil. A escolha do local se deu por conveniência. A coleta de dados ocorreu entre os meses de setembro a dezembro de 2022 nos domicílios. Aplicou-se um questionário contendo questões sobre o perfil sociodemográfico dos participantes, somados a seis perguntas fenomenológicas para entender o típico vivido de cada cuidador de pessoas idosas e sua intencionalidade. Os dados foram analisados à luz da fenomenologia. Resultados Participaram 16 cuidadores de pessoas idosas acamadas, sendo 15 do sexo feminino, 15 tinham laço familiar; 15 não receberam treinamento que o qualificasse na função. 37,5% dos cuidadores apresentaram idade acima de 61 anos. Em relação ao típico vivido, emergiram das falas as seguintes categorias: 1- Impactos físicos, emocionais e sociais na saúde do cuidador; 2- Necessidade de qualificação; 3- Suporte da equipe de saúde e a subcategoria: 3.1- Ausência do profissional médico e/ou enfermeiro. Conclusão Compreendeu-se que os cuidadores são invisíveis e não recebem assistência da equipe de saúde para a sua saúde, e quando ocorre a visita domiciliar, os profissionais visam o atendimento a pessoa idosa fragmentando a assistência que deveria ser ampliada para as necessidades da comunidade familiar, incluindo o cuidador.

Abstract Objective To identify caregivers' understanding of healthcare assistance received from primary health care regarding their own health. Method A qualitative study based on Alfred Schütz's phenomenology was conducted. The approach to caregivers of bedridden older adults was carried out by community health agents within their coverage area in a primary health care unit located in the northern region of Espírito Santo, Brazil. The choice of location was convenience-based. Data collection took place between September and December 2022 in households. A questionnaire containing questions about the participants' sociodemographic profile, along with six phenomenological questions to understand the typical experiences of each caregiver of older adults and their intentionality, was administered. Data were analyzed using phenomenological methods. Results Sixteen caregivers of bedridden older adults participated, with fifteen being female, fifteen having a family relationship with the care recipient, and fifteen lacking training qualifying them for the caregiver role. 37.5% of caregivers were aged 61 years or older. Regarding the typical experiences, the following categories emerged from the participants' narratives: 1- Physical, emotional, and social impacts on the caregiver's health; 2- Need for qualification; 3- Support from the healthcare team, with a subcategory: 3.1- Absence of medical and/or nursing professionals. Conclusion It was understood that caregivers are invisible and do not receive healthcare assistance from the healthcare team for their own health. When home visits occur, professionals focus on attending to the older adult, fragmenting the assistance that should be extended to the needs of the family community, including the caregiver.

Sarcopenia in chronic viral hepatitis: From concept to clinical relevance.

Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma (HCC) is increasing, chronic hepatitis B (CHB) and chronic hepatitis C (CHC) remain the most relevant risk factors for advanced liver disease worldwide. In addition to liver damage, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia, lymphoproliferative disorders, renal disease, insulin resistance, type 2 diabetes, sicca syndrome, rheumatoid arthritis-like polyarthritis, and autoantibody production. Recently, the list has grown to include sarcopenia. Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0% of patients with advanced liver disease. Nonetheless, among published studies, there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia. In particular, the interaction between sarcopenia, CHB and CHC has not been completely clarified in a real-world setting. Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV. Thus, in the present review, we provide an overview of the concept, prevalence, clinical relevance, and potential mechanisms of sarcopenia in patients with chronic viral hepatitis, with an emphasis on clinical outcomes, which have been associated with skeletal muscle loss in these patients. A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV, independent of the stage of the liver disease, will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.

Educational material production and validity: educational instrument for home care for premature newborns.

OBJECTIVE: to produce and validate a booklet, based on Jean Watson's Theory, on home care for premature newborns, based on caregivers' experiences. METHOD: a methodological study, developed in the following stages: diagnosis of knowledge needs about home care; survey of scientific content; educational material production; and validity by judges/experts. RESULTS: the literature review resulted in 19 articles. The main themes (breastfeeding, bath care, bond building, infection prevention and support network) were listed for producing the booklet "Booklet for Premature Newborns: Demystifying Home Care". The booklet content and appearance received the overall Content Validity Index of 0.85, considered suitable within the scientific rigor of validity. FINAL CONSIDERATIONS: the booklet produced and validated is an educational material whose main role is to provide knowledge and awaken caregivers' autonomy in providing home care to newborns.

Educational material production and validity: educational instrument for home care for premature newborns / Producción y validación de material educativo: instrumento educativo para el cuidado domiciliario del recién nacido prematuro / Produção e validação de material educativo: instrumento educativo para o cuidado domiciliar ao recém-nascido prematuro

ABSTRACT Objective: to produce and validate a booklet, based on Jean Watson's Theory, on home care for premature newborns, based on caregivers' experiences. Method: a methodological study, developed in the following stages: diagnosis of knowledge needs about home care; survey of scientific content; educational material production; and validity by judges/experts. Results: the literature review resulted in 19 articles. The main themes (breastfeeding, bath care, bond building, infection prevention and support network) were listed for producing the booklet "Booklet for Premature Newborns: Demystifying Home Care". The booklet content and appearance received the overall Content Validity Index of 0.85, considered suitable within the scientific rigor of validity. Final considerations: the booklet produced and validated is an educational material whose main role is to provide knowledge and awaken caregivers' autonomy in providing home care to newborns.

RESUMEN Objetivo: producir y validar una cartilla, basada en la Teoría de Jean Watson, sobre el cuidado domiciliario del recién nacido prematuro, a partir de las experiencias de los cuidadores. Método: estudio metodológico, desarrollado en las siguientes etapas: diagnóstico de las necesidades de conocimiento sobre el cuidado domiciliario; encuesta de contenido científico; producción de material educativo; y validación por jueces/expertos. Resultados: la revisión de la literatura resultó en 19 artículos. Se enumeraron los temas principales (lactancia materna, cuidado del baño, creación de vínculos, prevención de infecciones y red de apoyo) para la producción del folleto "Cuaderno para Recién Nacidos Prematuros: Desmitificando el Cuidado Domiciliario". El contenido y apariencia del cuadernillo recibió el Índice de Validez de Contenido Global de 0,85, considerado adecuado dentro del rigor científico de la validez. Consideraciones finales: la cartilla producida y validada es un material educativo que tiene como función principal proporcionar conocimientos y despertar la autonomía de los cuidadores en la atención domiciliaria al recién nacido.

RESUMO Objetivo: produzir e validar cartilha, baseado na Teoria de Jean Watson, sobre os cuidados domiciliares ao recém-nascido prematuro, a partir de vivências de cuidadores. Método: estudo metodológico, desenvolvido nas etapas: diagnóstico das necessidades de conhecimento sobre os cuidados domiciliares; levantamento dos conteúdos científicos; produção de material educativo; e validação por juízas/experts. Resultados: a revisão da literatura resultou em 19 artigos. Elencaram-se os principais temas (amamentação, cuidados com o banho, construção de vínculo, prevenção de infecções e rede de apoio), para produção da cartilha intitulada "Cartilha de Cuidados com o Recém-Nascido Prematuro: Desmistificando o Cuidar no Domicílio". O conteúdo e aparência da cartilha recebeu o Índice de Validade de Conteúdo Global de 0,85, considerado adequado dentro do rigor científico de validade. Considerações finais: a cartilha produzida e validada é um material educativo cujo papel principal é proporcionar conhecimento e despertar a autonomia dos cuidadores na prestação dos cuidados domiciliares ao recém-nascido.

Metabolic-associated fatty liver disease is associated with low muscle mass and strength in patients with chronic hepatitis B.

BACKGROUND: Although the prognostic relevance of sarcopenia has been increasingly recognised in the context of liver disease, there is a paucity of data evaluating body composition in patients with chronic hepatitis B (CHB). Beyond virus-related factors, nutritional and metabolic aspects can be associated with skeletal muscle abnormalities in these patients and should not be disregarded. AIM: To evaluate the association between components of sarcopenia and demographic, clinical, lifestyle, nutritional, and biochemical variables in CHB patients. METHODS: Dual-energy X-ray absorptiometry (DXA) was used to assess muscle mass by quantifying appendicular lean mass (ALM) adjusted for body mass index (ALMBMI). Muscle function was evaluated by hand grip strength (HGS) and the timed up and go test. Metabolic-associated fatty liver disease (MAFLD) was defined according to the criteria proposed by an international expert panel. A body shape index and the International Physical Activity Questionnaire were used to assess central obesity and physical activity level, respectively. RESULTS: This cross-sectional study included 105 CHB outpatients followed at the tertiary care ambulatory centre (mean age, 48.5 ± 12.0 years; 58.1% males; 76.2% without cirrhosis; 23.8% with compensated cirrhosis). The DXA-derived fat mass percentage was inversely correlated with the ALMBMI (r = - 0.87) and HGS (r = - 0.63). In the multivariable analysis, MAFLD, sedentarism and central obesity were positively and independently associated with low ALMBMI. MAFLD and central obesity were independently associated with low HGS. CONCLUSION: MAFLD and central obesity were associated with low muscle mass and strength in patients with chronic hepatitis B, independent of the liver disease stage.

Participation of adolescents from the Quilombola community in the creation of an educational game about alcohol consumption.

OBJECTIVE: To describe and discuss the participation of adolescents from a quilombola community in the transformation of the comic "Possible Story" ("Uma História Possível"), from the Comic on alcohol, into an educational game. METHOD: Implementation of the creative and sensitive method of art-based research, with adolescents from a quilombola community in the state of Espírito Santo, for the development of a board game. RESULTS: The democratic and interactive space favored the problematization of images and narratives about alcohol consumption mediated in the comic book. The group selected scenes, reordered the story, devised questions and riddles, formulated true and false assertions in a 17-card composition of the board game. The potential of the game as a content mediating tool to promote learning, reinforcement, and fixation of scientific content was evaluated. CONCLUSION: The active and dynamic participation of adolescents took place from conception to evaluation of the board game, encouraging them to reflect on a community context of cultural permissiveness of alcohol use.

Participation of adolescents from the Quilombola community in the creation of an educational game about alcohol consumption / Participación de adolescentes de comunidad Quilombola en la creación de juego educativo sobre consumo de alcohol / Participação de adolescentes de comunidade Quilombola na criação de jogo educativo sobre o consumo de álcool

ABSTRACT Objective: To describe and discuss the participation of adolescents from a quilombola community in the transformation of the comic "Possible Story" ("Uma História Possível"), from the Comic on alcohol, into an educational game. Method: Implementation of the creative and sensitive method of art-based research, with adolescents from a quilombola community in the state of Espírito Santo, for the development of a board game. Results: The democratic and interactive space favored the problematization of images and narratives about alcohol consumption mediated in the comic book. The group selected scenes, reordered the story, devised questions and riddles, formulated true and false assertions in a 17-card composition of the board game. The potential of the game as a content mediating tool to promote learning, reinforcement, and fixation of scientific content was evaluated. Conclusion: The active and dynamic participation of adolescents took place from conception to evaluation of the board game, encouraging them to reflect on a community context of cultural permissiveness of alcohol use.

RESUMEN Objetivo: Describir y discutir la participación de adolescentes de una comunidad quilombola en la transformación de cómics de "Una Historia Posible" (Uma História Possível), del Almanaque sobre alcohol en juego educativo. Método: Implementación del método creativo y sensible de investigación basada en arte, con adolescentes de una comunidad quilombola de Espírito Santo, Brasil, en el desarrollo de un juego de mesa. Resultados: El espacio democrático e interactivo favoreció la problematización de imágenes y narrativas sobre el consumo de alcohol mediado en los cómics. El grupo seleccionó escenas, reordenó la historia, elaboró preguntas y charadas, formuló aserciones de mito o verdad en una composición de 17 fichas del juego de mesa. Se evaluó el potencial del juego como herramienta mediadora de contenido para promover el aprendizaje, el repaso y la memorización de contenidos científicos. Conclusión: La participación activa y dinámica de adolescentes ocurrió desde la concepción hasta la evaluación del juego de mesa, estimulándolos a la reflexión sobre un contexto comunitario de permisividad cultural de uso del alcohol.

RESUMO Objetivo: Descrever e discutir a participação de adolescentes de uma comunidade quilombola na transformação de quadrinhos de "Uma História Possível", do Almanaque sobre o álcool, em jogo educativo. Método: Implementação do método criativo e sensível de pesquisa baseada em arte, com adolescentes de uma comunidade quilombola do Espírito Santo, no desenvolvimento de um jogo de tabuleiro. Resultados: O espaço democrático e interativo favoreceu a problematização de imagens e narrativas sobre o consumo de álcool mediadas na história em quadrinhos. O grupo selecionou cenas, reordenou a história, elaborou perguntas e charadas, formulou asserções de verdadeiro e falso numa S composição de 17 cartas do jogo de tabuleiro. Avaliou-se o potencial do jogo como ferramenta mediadora de conteúdo para promover a aprendizagem, o reforço e fixação de conteúdos científicos. Conclusão: A participação ativa e dinâmica de adolescentes deu-se desde a concepção até a avaliação do jogo de tabuleiro, estimulando-os à reflexão sobre um contexto comunitário de permissividade cultural de uso do álcool.

Skeletal muscle mass index and phase angle are decreased in individuals with dependence on alcohol and other substances.

OBJECTIVE: The aim of this study was to evaluate whether low skeletal muscle mass index (SMI) and low phase angle (PhA) are associated with demographic, clinical, lifestyle, and nutritional status in patients dependent on alcohol and other substances. METHODS: We prospectively included 63 individuals dependent on alcohol and other substances and 71 age- and sex-matched healthy controls. Body composition was assessed by bioelectrical impedance analysis. Subjective global assessment was used to evaluate malnutrition. All included participants underwent a psychiatric evaluation, including the administration of the Mini-International Neuropsychiatric Interview. Univariate and multivariate analysis were performed to evaluate associations between low skeletal muscle mass index (SMI) and low phase angle (PhA) and nutritional, lifestyle, and alcohol use and cocaine/crack use variables, controlling for sex and age. RESULTS: Low SMI and low PhA were identified in 11.1% and 44.5% of the substance dependents, respectively. Low midarm muscle circumference (r = 0.58; P < 0.001), low midarm muscle area (r = 051; P < 0.001), and reduced PhA (r = 0.59; P < 0.001) were positively correlated with low SMI. Multivariate analysis showed that heavy alcohol consumption (≥80 g·d· ≥5 y-1; odds ratio [OR], 2.33; 95% confidence interval [CI], 1.12-4.84; P = 0.02) and sedentary lifestyle (OR, 4.39; 95% CI, 1.29-14.89; P = 0.02) were independently associated with reduced SMI. Low PhA was independently associated with heavy alcohol consumption (OR, 3.64; 95% CI, 1.62-8.15; P = 0.002) and cocaine or crack use (OR, 3.97; 95% CI, 1.05-15.11; P = 0.04) in multivariate analysis. CONCLUSIONS: Low SMI and low PhA are independently associated with heavy alcohol consumption. Low PhA is independently associated with cocaine or crack use.

Registros de enfermagem e os desafios de sua execução na prática assistencial / Nursing records and the challenges of their implementation in the assistance practice / Registros de enfermería y retos de su ejecución en la práctica asistencial

Objetivo: compreender a percepção do enfermeiro sobre a relevância dos registros de Enfermagem na prestação da assistência ao cliente. Método: trata-se de estudo descritivo, exploratório de natureza qualitativa, que foi desenvolvido em um hospital do município do norte do estado do Espírito Santo. Participaram deste estudo sete enfermeiros. A coleta de dados se deu por meio de entrevista semiestruturada. Utilizou-se a análise de conteúdo. Resultados: foram organizados em categorias analíticas empíricas, a saber: definição e relevância dos registros de Enfermagem, dificuldades encontradas para a realização dos registros de Enfermagem e melhoria da qualidade dos registros de Enfermagem no cotidiano de trabalho. Observou-se que a Enfermagem se preocupa com o fazer, em detrimento aos registros sistemáticos de sua assistência. Conclusão: considerando que os registros de Enfermagem contribuem para a melhoria da qualidade da assistência, evidencia-se a necessidade de um acompanhamento mais rigoroso dos registros efetuados nos serviços de saúde. Destaca-se a necessidade de uma educação continuada no que concerne aos aspectos técnicos, éticos e legais dos registros de Enfermagem.(AU)

Objective: to understand the nurse's perception on the relevance of the Nursing records when providing customer care. Method: this is a descriptive and exploratory study of a qualitative nature, developed in a hospital in a municipality in the North of the state of Espírito Santo. Seven nurses participated in this study. Data was collected through semi-structured interviews. Content analysis was used. Results: the results were organized into empirical analytical categories, namely: definition and relevance of the Nursing records, difficulties encountered in the realization of the Nursing records and improvement of the quality of the Nursing records in daily work. It was observed that Nursing is concerned with the doing, to the detriment of the systematic records of its care. Conclusion: considering that Nursing records contribute to improve the quality of care, there is a need for a more rigorous monitoring of the records made in the health services. The need for continuing education regarding the technical, ethical and legal aspects of Nursing records is highlighted.(AU)

Objetivo: comprender la percepción de los enfermeros sobre la relevancia de los registros de enfermería en la atención al cliente. Método: estudio descriptivo, exploratorio de naturaleza cualitativa, llevdo a cabo en un hospital del norte del estado de Espírito Santo. Siete enfermeros participaron en este estudio. Los datos fueron recogidos a través de entrevistas semiestructuradas. Se utilizó el análisis de contenido. Resultados: se organizaron en categorías analíticas empíricas, a saber: definición y relevancia de los registros de enfermería, dificultades encontradas en la realización de los registros de enfermería y mejora de la calidad de los registros de enfermería en el trabajo diario. Se observó que la enfermería se preocupa por ejecutar tareas, perjudicando los registros sistemáticos de las mismas. Conclusión: teniendo en cuenta que los registros de enfermería contribuyen a mejorar la calidad de la atención, existe la necesidad del seguimiento más riguroso de los registros realizados en los servicios de salud. Destacamos la necesidad de la educación continua en lo referente a los aspectos técnicos, éticos y legales de los registros de enfermería.(AU)

Bioelectrical Impedance Analysis-Derived Measurements in Chronic Hepatitis C: Clinical Relevance of Fat-Free Mass and Phase Angle Evaluation.

OBJECTIVE: Because cirrhotic patients are at high risk of malnutrition and sarcopenia, we evaluated the prevalence of low fat-free mass index (FFMI) and low phase angle (PhA) among patients with chronic hepatitis C (CHC). METHODS: In total, 135 subjects with CHC (50.4% males; mean age, 52.4 ± 11.8 years; 65.9% noncirrhotic and 34.1% compensated cirrhotic patients) were prospectively included and evaluated by bioelectrical impedance analysis. Subjective global assessment was used to evaluate malnutrition. RESULTS: Low FFMI and low PhA were identified in 21.5% and 23.7% of the patients, respectively. Compensated cirrhotic patients had lower PhA values than those without cirrhosis. Low FFMI was associated with male sex (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.00-7.01; P = .04) and malnutrition (OR, 4.27; 95% CI, 1.42-12.90; P = .01). Low PhA was associated with cirrhosis (OR, 3.92; 95% CI, 1.56-9.86; P = .004), malnutrition (OR, 5.52; 95% CI, 1.73-17.62; P = .004), and current alcohol use (OR, 2.77; 95% CI, 1.01-7.58; P = .05). Reactance (Xc) normalized for height (H), an indicator of muscle strength, was independently associated with male sex, age, hypertension, and serum albumin. CONCLUSION: Host factors, including clinical comorbidities, lifestyle, and nutrition status, are associated with low FFMI and low PhA in noncirrhotic and in compensated cirrhotic patients with CHC. These findings highlight the relevance of evaluating body composition in patients chronically infected by hepatitis C virus independently of the stage of liver disease.

Association between pre-sarcopenia, sarcopenia, and bone mineral density in patients with chronic hepatitis C.

BACKGROUND: Preserved skeletal muscle is essential for the maintenance of healthy bone. Loss of bone mineral density (BMD) and muscle strength, considered a predictor of BMD, have been demonstrated in patients with cirrhosis, but they are poorly studied in chronic hepatitis C (CHC) without cirrhosis. Thus, we aimed to evaluate the prevalence of low BMD and its association with body composition, muscle strength, and nutritional status in CHC. METHODS: One hundred and four subjects [mean age, 50.5 ± 11.3 years; 75.0% males; 67.3% non-cirrhotic; and 32.7% with compensated cirrhosis] with CHC, prospectively, underwent scanning of the lean tissue, appendicular skeletal muscle mass (ASM), fat mass, lumbar spine, hip, femoral neck, and whole-body BMD by dual-energy X-ray absorptiometry. Muscle strength was assessed by dynamometry. Sarcopenia was defined by the presence of both low, ASM/height2 (ASMI) and low muscle strength according to the European Working Group on Sarcopenia in Older People criteria. The cut-off points for low ASMI and low muscle strength, for women and men, were < 5.45 and < 7.26 kg/m2 and < 20 and < 30 kg, respectively. According to the adopted World Health Organization criteria in men aged > 50 years, the T-score of osteopenia is between -1.0 and -2.49 standard deviation (SD) below the young average value and of osteoporosis is ≥-2.5 SD below the young normal mean for men, and the Z-score of low bone mass is ≤-2.0 SD below the expected range in men aged < 50 years and women in the menacme. Nutritional status evaluation was based on the Controlling Nutritional Status score. RESULTS: Low BMD, low muscle strength, pre-sarcopenia, sarcopenia, and sarcopenic obesity were observed in 34.6% (36/104), 27.9% (29/104), 14.4% (15/104), 8.7% (9/104), and 3.8% (4/104) of the patients, respectively. ASMI was an independent predictor of BMD (P < 0.001). Sarcopenia was independently associated with bone mineral content (P = 0.02) and malnutrition (P = 0.01). In 88.9% of the sarcopenic patients and in all with sarcopenic obesity, BMI was normal. The mid-arm muscle circumference was positively correlated with ASMI (r = 0.88; P < 0.001). CONCLUSIONS: This is the first study to demonstrate that ASM is an independent predictor of BMD in CHC. Mid-arm muscle circumference coupled with handgrip strength testing should be incorporated into routine clinical practice to detect low muscle mass, which may be underdiagnosed when only BMI is used. These findings may influence clinical decision-making and contribute to the development of effective strategies to screen the musculoskeletal abnormalities in CHC patients, independently of the stage of the liver disease.

Utilization and fate of phosphorus of different sources applied to cohesive soil of Amazonian periphery

In the Amazonian region, P is often a primary factor limiting sustainable agrosystems. We compared the efficiencies of local aluminous phosphate (ALP) and single superphosphate (SSP) under a cover of leguminous residues to determine the fate of P sources in an Amazonian soil with hardsetting characteristics. The experiment followed a randomized block design with four replications and the following treatments: ALPU, i.e. ALP plus urea (U); ALPL, i.e., ALP plus leucaena (L); SSPU, i.e., SSP plus urea; SSPL, i.e., SSP plus leucaena; and BS, i.e., bare soil (without residues). To assess the residual values of the P sources, we used a sequence of crops consisting of maize, cowpea and cassava. Both ALP and SSP exhibited low P efficiency in BS. The greatest amounts of P and N uptake in the plots where P sources and leucaena residues were added, as in those covered with leucaena residue, resulted in higher productivity levels. These differences are important for the adoption of beneficial soil management practices and the use of P sources to enhance efficiency in tropical soils. The use of residues increased the P use efficiency of both P sources, as it enhanced the uptake of both N and soluble P. The replacement of SSP with ALP may be advantageous in the second year of planting with high-demand crops, but the P of the SSP retained in the minus soluble fractions may be available if the SSP is used in P-depleting crops combined with no-tillage underneath a mulch of residues.

Utilization and fate of phosphorus of different sources applied to cohesive soil of Amazonian periphery

In the Amazonian region, P is often a primary factor limiting sustainable agrosystems. We compared the efficiencies of local aluminous phosphate (ALP) and single superphosphate (SSP) under a cover of leguminous residues to determine the fate of P sources in an Amazonian soil with hardsetting characteristics. The experiment followed a randomized block design with four replications and the following treatments: ALPU, i.e. ALP plus urea (U); ALPL, i.e., ALP plus leucaena (L); SSPU, i.e., SSP plus urea; SSPL, i.e., SSP plus leucaena; and BS, i.e., bare soil (without residues). To assess the residual values of the P sources, we used a sequence of crops consisting of maize, cowpea and cassava. Both ALP and SSP exhibited low P efficiency in BS. The greatest amounts of P and N uptake in the plots where P sources and leucaena residues were added, as in those covered with leucaena residue, resulted in higher productivity levels. These differences are important for the adoption of beneficial soil management practices and the use of P sources to enhance efficiency in tropical soils. The use of residues increased the P use efficiency of both P sources, as it enhanced the uptake of both N and soluble P. The replacement of SSP with ALP may be advantageous in the second year of planting with high-demand crops, but the P of the SSP retained in the minus soluble fractions may be available if the SSP is used in P-depleting crops combined with no-tillage underneath a mulch of residues.(AU)

Microcefalia no Brasil: prevalência e caracterização dos casos a partir do Sistema de Informações sobre Nascidos Vivos (Sinasc), 2000-2015 / Microcephaly in Brazil: prevalence and characterization of cases from the Information System on Live Births (Sinasc), 2000-2015 / Microcefalia en Brasil: prevalencia y caracterización de casos a partir del Sistema de Informaciones sobre Nacidos Vivos (Sinasc), 2000-2015

OBJETIVO: descrever os coeficientes de prevalência e caracterizar os casos de microcefalia ao nascer no Brasil, no período 2000-2015. MÉTODOS: estudo descritivo com dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Foram calculados coeficientes segundo regiões e características das mães e nascidos vivos (NV). RESULTADOS: a média anual de casos de microcefalia foi 164 no período 2000-2014, enquanto em 2015 foram registrados 1.608 casos (54,6 casos por 100 mil NV). Coeficientes mais elevados foram observados entre prematuros (81,7; IC95%72,3; 92,2), nascidos de mães pretas (70,9; IC95%58,5; 85,9) ou pardas (71,5; IC95%67,4; 75,8), com idades ≤19 (70,3; IC95%63,5; 77,8) ou ≥40 anos (62,1; IC95%46,6; 82,6), ≤3 anos de estudo (73,4; IC95%58,2; 92,4) e residentes na região Nordeste (138,7; IC95%130,9; 147,0). CONCLUSÃO: o elevado número de casos de microcefalia registrado em 2015 reforça a importância do Sinasc e do aprimoramento do sistema de vigilância das anomalias congênitas.

OBJECTIVE: to describe the prevalence coefficients and characterize cases of microcephaly at birth in Brazil from 2000-2015. METHODS: this is a descriptive study with data from the Information System on Live Births (Sinasc). The coefficients were calculated by region and characteristics of mothers and live births (LB). RESULTS: the annual average number of microcephaly cases was 164 for the period 2000-2014, whilst in 2015, 1,608 cases were registered (54.6 cases per 100 thousand LB). Higher coefficients were observed among preterm babies (81.7; 95%CI 72.3;92.2), born from black-skinned (70.9; 95%CI 58.5;85.9) or to brown-skinned (71.5; 95%CI67.4;75.8) women, to women aged ≤19 (70.3; 95%CI 63.5;77.8) or ≥40 (62.1; 95%CI 46.6;82.6), with ≤3 years of study (73.4; 95%CI 58.2;92.4) and residents in the Northeast region (138.7; 95%CI 130.9;147.0). CONCLUSION: the high number of microcephaly cases in 2015 reinforces the importance of Sinasc and the need to improve the surveillance of congenital anomalies.

OBJETIVO: describir coeficientes de prevalencia y caracterizar casos de microcefalia al nacer en Brasil, en el periodo 2000-2015. MÉTODOS: estudio descriptivo con datos del Sistema de Informaciones sobre Nacidos Vivos (Sinasc). Los coeficientes fueron calculados según regiones, características maternas y del nacido vivo (NV). RESULTADOS: el promedio anual de casos de microcefalia fue 164 en el periodo 2000-2014, mientras en 2015 fue 1.608 (54,6 casos por 100.000 NV). Coeficientes más elevados fueron observados entre prematuros (81,7; IC95% 72,3-92,2), nacidos de madres negras (70,9; IC95% 58,5-85,9) o pardas (71,5; IC95% 67,4-75,8), con edades ≤19 (70,3; IC95% 63,5-77,8) o ≥40 años (62,1; IC95% 46,6-82,6), ≤3 años de estudio (73,4; IC95% 58,2-92,4), y residentes del Noreste (138,7; IC95% 130,9-147,0). CONCLUSIÓN: el elevado número de casos de microcefalia, en 2015, refuerza la importancia del Sinasc y necesidad de mejorías del sistema de vigilancia de anomalías congénitas.

Microcephaly in Brazil: prevalence and characterization of cases from the Information System on Live Births (Sinasc), 2000-2015. / Microcefalia no Brasil: prevalência e caracterização dos casos a partir do Sistema de Informações sobre Nascidos Vivos (Sinasc), 2000-2015.

OBJECTIVE: to describe the prevalence coefficients and characterize cases of microcephaly at birth in Brazil from 2000-2015. METHODS: this is a descriptive study with data from the Information System on Live Births (Sinasc). The coefficients were calculated by region and characteristics of mothers and live births (LB). RESULTS: the annual average number of microcephaly cases was 164 for the period 2000-2014, whilst in 2015, 1,608 cases were registered (54.6 cases per 100 thousand LB). Higher coefficients were observed among preterm babies (81.7; 95%CI 72.3;92.2), born from black-skinned (70.9; 95%CI 58.5;85.9) or to brown-skinned (71.5; 95%CI67.4;75.8) women, to women aged ≤19 (70.3; 95%CI 63.5;77.8) or ≥40 (62.1; 95%CI 46.6;82.6), with ≤3 years of study (73.4; 95%CI 58.2;92.4) and residents in the Northeast region (138.7; 95%CI 130.9;147.0). CONCLUSION: the high number of microcephaly cases in 2015 reinforces the importance of Sinasc and the need to improve the surveillance of congenital anomalies.

A perspectiva do cuidado para os docentes no ensino de enfermagem na fenomenologia sociológica de Alfred Schutz

Introdução: A educação tem papel relevante no cuidado de enfermagem, uma vez que a práxis pode vir a demonstrar as necessidades de troca de quem ensina e de quem aprende. O objeto deste estudo foi: o significado do ensino do cuidado nas atividades desenvolvidas pelos enfermeiros/docentes de enfermagem. Teve como questão norteadora: Qual a intencionalidade do enfermeiro/docente quando ensina o cuidado de enfermagem? Buscou compreender a vivência desses sujeitos docentes desenvolvendo atividades no ensino do cuidado para os estudantes. Objetivos: Descrever a prática do docente no ensino do cuidado de enfermagem para os estudantes do curso de graduação; compreender o significado do ensino do cuidado de enfermagem para os docentes na prática junto aos estudantes. Método:Pesquisa qualitativa de natureza descritiva exploratória, pautada na fenomenologia compreensiva sociológica de Alfred Schutz. Realizada com 22 Enfermeiros/docentes sendo11 de uma instituição particular (MG) e 11 participantes de instituição pública (ES) de cursos de graduação de enfermagem das duas instituições de ensino, após a autorização do CEP/EEAN. Os dados foram coletados nos meses de setembro e outubro de 2014, após autorização do Comitê de Ética em Pesquisas com Seres Humanos da Universidade Federal do Rio de Janeiro (UFRJ), sob o número CAAE 34762214.6.0000.5238, parecer número:772.61. Os enfermeiros/docentes foram contatados com antecedência e a entrevista ocorreu conforme a disponibilidade dos mesmos. Resultados e discussão: realizada análise compreensiva onde foram extraídos dos relatos motivos para: (projeto para o futuro, identificação do típico e motivos porque: contextualização de experiências passadas)...

Introduction: Education has an important role in nursing care since the practice can come todemonstrate the need for exchange of those who teach and those who learn. The object of thisstudy was: the meaning of care in the teaching activities performed by nurses / nursingteachers. We had the guiding question: What is the intention of the nurse / teacher whenteaching nursing care? Aimed to understand the experiences of these subjects teachersdeveloping activities in care education to students. Objectives: To describe the practice ofteaching in nursing care education for students of the undergraduate course; understand themeaning of nursing care education for teachers in practice with students. Method: Aqualitative study of descriptive exploratory nature, based on the sociological understandingphenomenology of Alfred Schutz. Performed with 22 nurses / teachers and 11 of a particularinstitution (MG) and 11 participants from public institutions (ES) of nursing undergraduatecourses of the two educational institutions, after authorization of the CEP / EEAN. Data werecollected in the months of September and October 2014, after authorization by the EthicsCommittee for Research with Human Beings of the Federal University of Rio de Janeiro(UFRJ), under the CAAE 34762214.6.0000.5238 number, opinion number: 772.61. Nurses /teachers were contacted in advance and the interview took place according to availability.Results and discussion: conducted comprehensive analysis which were extracted from thereasons accounts for: (project for the future, the typical identification and reasons why:contextualization of past experiences)...

O ensino do cuidado nos cursos de graduação em enfermagem do Brasil: revisão integrativa / Teaching in nursing care of undergraduate courses in Brazil: integrative review / La enseñanza del cuidado en los cursos de graduación en enfermería de Brasil: revisión integradora

Objetivo:analisar as publicações científicas da enfermagem brasileira sobre o ensino do cuidado nos cursos de graduação. Método:estudo de revisão integrativa nas bases dados LILACS, MEDLINE e biblioteca virtual SCIELO no período 2003 a 2013. Resultados:a amostra contou com nove estudos abordando ensino do cuidar, elencando três categorias: Distorções entre concepções e práticas docentes; Metodologias para o ensino do cuidar; Professor como mediador no processo ensino-aprendizagem. Conclusão:identificaram-se distorções entre as concepções e as práticas docentes no ensino,revelando docente com concepção adequada de ensino do cuidar, porém com dificuldade em ensinar o cuidado. Docentes utilizam a metodologia tradicional não promovendo a reflexão crítica do discente. Ensinar o cuidado é um desafio. Destacam-se: deficiências na formação como enfermeiro e docente; ausência de fundamentos e teorias como base no ensino do cuidado; desconhecimento de metodologias atuais para favorecer o pensamento crítico do discente.(AU)

Objective: to analyze the scientific publications of Brazilian nursing care about teaching in undergraduate courses. Method: study with an integrative review in the databases of LILACS, MEDLINE and SciELO virtual library in the period from 2003 to 2013. Results: the sample consisted of nine studies addressing education of caring, listing three categories: Distortions between conceptions and teaching practices; Methodologies for the teaching of care; The teacher as a mediator in the teaching-learning process. Conclusion: distortions between the conceptions and teaching practices in teaching were identified, showing the teacher with adequate conception of teaching of care, but with difficulty of teaching care. Teachers use traditional methods not promoting student´s critical reflection. Teaching care is challenging, highlighting: deficiencies in training as a nurse and teacher; lack of fundamentals and theories based on the careful education; lack of current methodologies to foster critical thinking of students.(AU)

Objetivo: analizar las publicaciones científicas de enfermería brasilera sobre la enseñanza del cuidado en los cursos de graduación. Método: estudio de revisión integradora en las bases de datos LILACS, MEDLINE y biblioteca virtual SCIELO en el período de 2003 a 2013. Resultados: la muestra contó con nueve estudios abordando enseñanza del cuidar, listando tres categorías: Distorsiones entre concepciones y prácticas docentes; Metodologías para la enseñanza del cuidar; Profesor como mediador en el proceso enseñanzaaprendizaje. Conclusión: se identificaron distorsiones entre las concepciones y las prácticas docentes en la enseñanza, revelando al docente con concepción adecuada de enseñanza del cuidar, pero con dificultad en enseñar el cuidado. Docentes utilizan la metodología tradicional no promoviendo la reflexión crítica del discente. Enseñar el cuidado es un desafío. Se destacan: deficiencias en la formación como enfermero y docente; ausencia de fundamentos y teorías como base en la enseñanza del cuidado; desconocimiento de metodologías actuales para favorecer el pensamiento crítico del discente.(AU)

Depressão em pessoas diabéticas: desvelando o inimigo oculto / Depression in diabetic people: unveiling the hidden enemy / Depresión en personas diabéticas - develando al enemigo oculto

A depressão ocorre em portadores de DM, sendo frequentemente velada e confundida por profissionais de saúde e pelos próprios pacientes com sensações de angústia, tristeza e melancolia. Estudos mostram que a depressão pode dificultar o enfrentamento da doença. Este estudo teve como objetivo compreender como o portador de diabetes mellitus identifica e vivencia a depressão; descrever sinais e sintomas relacionando-a à vida cotidiana; e identificar os recursos de enfrentamento utilizados. Participaram diabéticos tipo 2 insulino-dependentes, acima de 50 anos acompanhados no programa do serviço de Medicina preventiva da UNIMED GV (Cooperativa de Trabalho Medico de Governador Valadares). O referencial teórico metodológico utilizado foi a história oral temática proposta por Meihy. Dados provenientes de 13 entrevistas foram analisados, os conceitos que emergiram favoreceram a identificação de três temas centrais: condições de vida da pessoa diabética influenciando na depressão, identificação da depressão e o significado da depressão para o diabético. Os sinais e sintomas de depressão indicados pelos diabéticos foram falta de apetite, medo das complicações e outras. Os colaboradores identificaram a depressão com mudanças percebidas no comportamento, melancolia, angústia, choro sem motivo aparente, perda de interesse, dificuldade de concentração, insônia e pensamento de morte. A depressão descrita esteve relacionada a sentimentos de isolamento, problemas financeiros e conjugais. O enfermeiro precisa ser capacitado para perceber e intervir precocemente na depressão, elaborar plano de cuidados efetivos e adesão ao tratamento do diabetes e da depressão a partir de programas educativos e no emprego das mais variadas alternativas terapêuticas.

Depression occurs in Diabetes Mellitus (DM) patients, being often cared for and mistaken by health workers and by patients themselves, as sensations of annoyance, sadness and melancholia. Studies show that depression can be a major difficulty in the coping process of the disease. The aims of this study were to understand how the DM-type 2 patient identifies and experiences depression, describing signs and symptoms present in their daily routine and identify the coping strategies used. The study sample was composed of diabetic type 2 insulin-dependent patients, over fifty years old that attended to the program Preventive Medicine Service – Unimed G.V. (Medical work Co-Operative of Governador Valadares). The methodological and theoretical reference used was the oral thematic history proposed by Meihy. Data from thirteen interviews were analized and the concepts emerged enabled the identification of three central themes: life conditions of a diabetic person that influence depression, identification of depression and the meaning of depression for a diabetic patient. Signals and symptoms of depression indicated by diabetics were: lack of appetite, irritability, fear of complications and others. The participants recognized depression through changes perceived in the behavior, melancholia, anxiety, crying for no apparent reason, loss of interest, difficulty to concentrate, insomnia and thoughts about death. Depression as described was related to feelings of loneliness, financial and marital problems. The nurse must be trained to perceive and interfere early in depression, develop an effective plan of care and of adherence to treatment, using educational programs and utilizing the various therapeutic alternatives.

La depresión en los diébeticos suele estar velada y, en general, los profesionales de la salud y los propios pacientes la confunden con sensasiones de angustia, tristeza y melancolía. Hay estudios que muestran que la depresión puede afectar el tratamiento de la enfermedad. Este trabajo tuvo como objetivo comprender cómo las personas con Diabetes Mellitus detectan y sienten la depresión, describir señales y síntomas que la relacionan con la vida cotidiana y determinar los recursos que se usan para enfrentarla. Participaron diabéticos tipo II con más de 50 años dependientes de insulina con seguimiento en el programa de servicio de medicina preventiva UNIMED GV (Cooperativa de Trabajo Médico Governador Valadares). La historia oral temática, propuesta por Meihy, fue el referente referente teórico metodológico utilizado. Se analizaron los datos recogidos en 13 entrevistas; los conceptos resultantes permitieron identificar tres temas centrales: condiciones de vida del diabético que influyen en la depresión, identificación de la depresión y el sentido de la depresión para los diabéticos. Las señales y síntomas de depresión indicados por los pacientes fueron: falta de apetito y miedo a las complicaciones, entre otros. Para los profesionales, la depresión se manifiesta a través de alteraciones comportamentales, melancolía, angustia, llanto aparentemente sin motivo, pérdida de interés, dificultad para concentrarse, insomnio y pensamientos de muerte. La depresión descrita estaba vinculada a sentimientos de aislamiento, problemas financieros y conjugales. Los enfermeros deben ser capaces de percibir e intervenir temprano en la depresión, elaborar un plan de atención eficaz y adhesión al tratamiento de la diabetes y de la depresión a través de programas educativos y de otras alternativas terapéuticas.