Stage progression and need for renal replacement therapy in a renal protection programme in Colombia. A cohort study. / Progreso de estadio y requerimiento de terapia de reemplazo renal en un programa de protección renal en Colombia. Estudio de cohorte.

BACKGROUND: Due to the global burden represented by chronic kidney disease (CKD), the World Health Organization encouraged the implementation of renal protection programmes (RPP) to affect its incidence through prevention and control measures. OBJECTIVES: To assess the effectiveness of a Colombian RPP in terms of its effect on the stage progression of CKD and the need for renal replacement therapy (RRT). METHODS: An analytical study that monitored 2cohorts of patients diagnosed with CKD. The study compares the behaviour of clinical and renal impairment indicators from patients exposed to a RPP with that of patients following conventional treatment (CT). The population of both intervention groups was considered when determining the sample size. The incidence rate was calculated as well as patient survival (Kaplan Meier). In addition, a multivariate analysis (Cox) was used to calculate the influence that exposure to the RPP had on the outcomes of the patients following the RPP and those following CT. RESULTS: The patients exposed to the RPP took longer to advance to the next CKD stage and require RRT. The incidence rate for progression is higher for the patients following CT (0.050, IC 95%: 0.040-0.064) compared to those in the RPP (0.034, IC 95%: 0.030-0.039). The ratio of incidence rates was 1.480 (IC 95% 1.21-1.90). The hazard of progression was lower for the RPP (HR: 0.855, IC 95%: 0.74- 0.98), as was the hazard of requiring RRT (HR: 0.797, IC 95%: 0.606-1.049). CONCLUSIONS: The RPP is a secondary prevention strategy against CKD which has an effect on the stage progression of CKD and the need for RRT. Early patient detection has a positive effect on the outcomes studied.

Promoting healthful diet and physical activity in the Mexican school system for the prevention of obesity in children / Promoción de actividad física adecuada y alimentación saludable en el sistema educativo mexicano para la prevención de la obesidad infantil

Objective. This paper describes the rationale, design, and methods of a two-year randomized controlled trial conducted to evaluate the effectiveness of an environmental intervention in 27 elementary schools in Mexico City. Materials and methods. There were two units of analysis, school level addressing changes in elementary public part-time schools, and individual-level addressing behavioral changes in students 9 to 11 years of age. Two intensities of an intervention program were implemented (basic and plus), each containing two intervention components: physical activity and nutrition, supported by a communication/education component. Evaluation of the intervention was carried out during the school cycles 2006-2007 and 2007-2008. Results. Primary outcomes were overweight and obesity prevalence and fitness; environmental and behavioural measures were also examined. Conclusions. This is the first institutional multilevel, multifactorial project, consistent with the best practices available in current literature, carried out in Mexico to prevent childhood obesity in schools.

Objetivo. El presente trabajo describe el protocolo, objetivo, el diseño y los métodos de un ensayo controlado aleatorio de dos años realizados para evaluar la efectividad de una intervención ambiental en 27 escuelas primarias de la Ciudad de México. Material y métodos. El protocolo consta de dos unidades de análisis: el nivel escolar donde se evaluaron los cambios en el entorno escolar de escuelas primarias publicas de medio tiempo y el nivel individual que evaluó los cambios de comportamiento en alumnos de 9 a 11 años de edad. Se implementaros dos tipos de intervenciones: nutrición y actividad física apoyadas de una estrategia de educación/comunicación. Las intervenciones tuvieron dos intensidades: básica y plus. La evaluación de la efectividad se llevó a cabo durante los ciclos escolares 2006-2007 y 2007-2008. Resultados. Los resultados iniciales reportan los métodos de evaluación de conducta individual así como la prevalencia de sobrepeso y obesidad. La evaluación ambiental reporta el protocolo de evaluación del entorno escolar. Conclusiones. Este es el primer proyecto de la de intervención escolar con un diseño multinivel, multifactorial, basado en literatura científica disponible y en investigación formativa para prevenir la obesidad infantil en las escuelas de la Ciudad de México.

Impact of a school-based intervention program on obesity risk factors in Mexican children / Impacto de un programa de intervención en escuelas para la prevención de factores de riesgo de la obesidad en niños mexicanos

Objective. To evaluate the impact of an 18-month school obesity prevention intervention on the health behaviors of 4th and 5th grade students based on ecological principles and formative research conducted in Mexico. Materials and methods. A Randomized Control Trial (RCT), design was used to assign 27 schools to one of three conditions: basic or plus interventions and control. School environment measures, children's eating and physical activity behaviors, and body mass index were assessed four times over a 2-year period in a sample of 830 students. Results. In the intervention schools, the availability of healthy foods increased with a concomitant decrease in unhealthy food availability. Food intake showed the same trend. In the intervention schools, children did not engage in more moderate to vigorous physical activity (MVPA) in physical education (PE) class or recess but increased steps taken. Obesity prevalence did not change. Conclusion. The intervention improved the school food environment and child healthy behaviors.

Objetivo. Evaluar el impacto de una intervención de 18 meses para la prevención de obesidad en escolares de 4o y 5o grados basada en el modelo ecológico en conductas saludables en México. Material y métodos. Diseño experimental para asignar 27 escuelas a uno de los tres tratamientos: intervenciones básicas, intervenciones plus y control. Se midió el impacto en el ambiente escolar, la alimentación y la actividad física e índice de masa corporal en niños. La evaluación se llevó a cabo en dos años en 830 estudiantes. Resultados. En las escuelas de intervención, la disponibilidad de alimentos sanos aumentó y la disponibilidad de alimentos poco saludables disminuyó. La ingesta de alimentos en niños no mostraron las mismas tendencias. En las escuelas de intervención, los niños no participaron más en actividad física moderada y vigorosa. La prevalencia de obesidad no se modificó. Conclusión. La intervención mejoró el entorno alimentario escolar y las conductas saludables de alimentación y actividad física.

Segurança e efetividade da fisioterapia respiratória em abscesso pulmonar: estudo de casos / Safety and effectiveness of chest physiotherapy in lung abscess: a two-case study

O abscesso pulmonar é uma lesão necrótica geralmente devida a germes piogênicos. A fisioterapia respiratória (FR) é indicada, porém há poucos relatos na literatura, não havendo consenso quanto ao uso e às técnicas de FR para esse caso. O objetivo deste estudo de dois casos foi verificar a segurança e efetividade da FR no tratamento do abcesso pulmonar. O caso 1 foi um paciente de 30 anos, internado; a terapia consistiu em posicioná-lo em Trendelenburg semi-lateral direito para ventral por 30 minutos, três vezes ao dia, com saída de grande quantidade de secreção. Após 5 dias, o radiograma de tórax demonstrou redução de 90% do nível hidroaéreo, verificando-se o esvaziamento completo do abscesso após 14 dias de internação. O caso 2 foi uma paciente de 28 anos igualmente com diagnóstico de abscesso pulmonar, também tratada com drenagem postural, nos mesmos posicionamento e freqüência que o caso 1, sendo drenada grande quantidade de secreção amarelada e fluida. Após 7 dias de tratamento evidenciou-se redução importante do nível líquido do abscesso pulmonar. Conclui-se que a drenagem postural isoladamente é uma técnica de fisioterapia efetiva e segura no tratamento do abcesso pulmonar.

Lung abscess is a necrotic lesion mostly caused by pyogenic germs. Chest physical therapy (CPT) is indicated, but there are few studies available and no consensus on CPT use and techniques for theses cases. The purpose of this study was to assess safety and effectiveness of postural drainage in treating lung abscess in two cases. Patient 1, male, 30 years old, was laid in Trendelenburg, in semi-lateral to ventral decubitus for 30 minutes, three times a day. After five days of therapy, X-ray showed a 90% decrease of sputum, and on the 14th day full drainage was achieved. Case 2 was a female patient, 28 years old, treated at the same position and frequency as case 1. After seven days of therapy, exams showed a great decrease of pus from the abscess. It may thus be said that postural drainage alone is a safe and effective chest physical therapy technique for treating lung abscesses.