Effects of combined physical exercise on plasma lipid variables, paraoxonase 1 activity, and inflammation parameters in adults with obesity: a randomized clinical trial

OBJECTIVE

We aimed to investigate whether combined physical exercise may affect plasma lipid variables, paraoxonase 1 (PON1) activity, and inflammation parameters in adults with obesity.

METHODS

Thirty-six participants were recruited to complete the study protocol. The mean age was 37 ± 1 years, and the baseline body mass index was 33.0 ± 0.4 kg/m². Participants were allocated to the control group (CG) and the exercise group (EG). The EG performed three weekly sessions of combined physical exercise for 16 weeks. Plasma lipid variables, PON1 activity, and inflammatory profile were determined before and after intervention.

RESULTS

Total cholesterol levels decreased in both groups, without intergroup difference (time p = 0.001). Non-high-density lipoprotein cholesterol (HDL-C) levels decreased in both groups (time p = 0.001); however, they were lower in the EG than in the CG (p = 0.038). The EG had increased HDL-C levels, but the CG had decreased HDL-C levels (time*group p = 0.011). PON1 activity was reduced in both groups (time, p = 0.001). The Castelli risk Index I and II reduced in the EG and increased in the CG (time*group, p = 0.008 and p = 0.011, respectively). The inflammatory markers were not modified.

CONCLUSION

Adults with obesity may benefit from regular practice of combined physical exercise training in many metabolic aspects that are related to protection against the development of cardiovascular disease.

Recommendation and physical activity practice in Brazilians with chronic diseases

OBJECTIVE

To analyze the prevalence and factors associated with professional recommendation and leisure-time physical activity (LTPA) in Brazilian individuals diagnosed with hypertension (HBP), diabetes, and/or hypercholesterolemia.

METHODS

This is a cross-sectional population-based study with a representative sample of the Brazilian population (aged ≥20 years) in 2013, with self-reported HBP (n=11.098), diabetes (n=3.176), and/or hypercholesterolemia (n=7.252). Prevalence and gross odds ratios were estimated and adjusted for both outcomes.

RESULTS

Professional recommendation and LTPA were more prevalent in individuals who received recommendation and presented with hypercholesterolemia (85.9 and 23.4%, respectively). Adjusted analysis showed an association in people 40 to 59 years of age and public programs in most diseases. Higher educational level was associated with receiving recommendations in all non-communicable diseases (NCDs). LTPA was associated in people 40 to 59 years of age for HBP and diabetes and in all investigated NCDs, higher educational level, positive perception of health, and a favorable environment in those who received recommendation.

CONCLUSIONS

Education presented the greatest magnitude in the associations, clearly showing the need for equitable methods to increase recommendation and LTPA levels for the most vulnerable population. Further studies analyzing other variables and NCD are needed, corroborating the Ministry of Health.

Auriculotherapy in primary health care: A large-scale educational experience in Brazil

Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy. It consisted of 75 h of distance learning (five sequential modules) and 5 h of on-site learning. The modules included the following items: (1) introduction to integrative practices; (2) ear reflexology; (3) introduction to TCM; (4) biomedical view of auriculotherapy; and (5) auriculotherapy in PHC. The teaching material included a workbook for each module, 14 video lectures and an interactive ear (online resource) to study location and application to the main auricular points. The on-site lectures follow a structured script of ear palpation techniques, auricular seed insertion practice and clinical case discussions, under the supervision of trained instructors. The course was offered in 2016 and 2017 and on-site lectures took place in 25 cities, covering all Brazilian regions, in coordination with municipal or state boards of health. A total of 4273 health professionals concluded the training and their evaluation of the course was highly positive. The Brazilian experience of large-scale training shows the potential to disseminate auriculotherapy in the context of PHC, given that its practice is fast, easy to learn, safe, effective for different health problems and well accepted by the patients.

Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

Objective

analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil.

Methods

a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests.

Results

differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001), have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001) and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001) than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years.

Conclusion

this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

Integrated predictive model for prostatic cancer using clinical, laboratory and ultrasound data

OBJECTIVE

to develop a predictive model to estimate the probability of prostate cancer prior to biopsy.

METHODS

from September 2009 to January 2014, 445 men underwent prostate biopsy in a radiology service. We excluded from the study patients with diseases that could compromise the data analysis, who had undergone prostatic resection or used 5-alpha-reductase inhibitors. Thus, we selected 412 patients. Variables included in the model were age, prostate specific antigen (PSA), digital rectal examination, prostate volume and abnormal sonographic findings. We constructed Receiver Operating Characteristic (ROC) curves and calculated the areas under the curve, as well as the model's Positive Predictive Value (PPV) .

RESULTS

of the 412 men, 155 (37.62%) had prostate cancer (PC). The mean age was 63.8 years and the median PSA was 7.22ng/ml. In addition, 21.6% and 20.6% of patients had abnormalities on digital rectal examination and image suggestive of cancer by ultrasound, respectively. The median prostate volume and PSA density were 45.15cm3 and 0.15ng/ml/cm3, respectively. Univariate and multivariate analyses showed that only five studied risk factors are predictors of PC in the study (p<0.05). The PSA density was excluded from the model (p=0.314). The area under the ROC curve for PC prediction was 0.86. The PPV was 48.08% for 95%sensitivity and 52.37% for 90% sensitivity.

CONCLUSION

the results indicate that clinical, laboratory and ultrasound data, besides easily obtained, can better stratify the risk of patients undergoing prostate biopsy.

Infecções comunitárias do trato urinário: prevalência e susceptibilidade aos antimicrobianos na cidade de Florianópolis

Objetivo: Determinar a frequência de isolamento dos uropatógenos e avaliar o perfil de sensibilidade antimicrobiana in vitro das bactérias isoladas em uroculturas de pacientes ambulatoriais atendidos em Florianópolis no ano de 2014, correlacionando tais dados com sexo e idade do paciente. Métodos: Estudo observacional, descritivo do tipo transversal, que incluiu uroculturas positivas de pacientes ambulatoriais realizadas em um único laboratório seguindo a mesma metodologia. Realizaram-se análises de estatísticas descritivas e testes de associação entre as variáveis classificatórias: sexo, idade, agente etiológico e sensibilidade aos antimicrobianos. Resultados: Foram registradas 1035 uroculturas positivas, das quais 89,66% de pacientes femininas. Microrganismos Gram-negativos foram os patógenos mais isolados, com destaque para a Escherichia coli (77,10%), principal agente causal. Proteus mirabilis foi significativamente mais prevalente no sexo masculino e o principal microrganismo isolado nas uroculturas dos meninos de 1 a 5 anos. A E. coli foi significativamente mais prevalente no sexo feminino e apresentou o perfil mais amplo de resistência. Evidenciaram-se diferenças estatisticamente significativas nas resistências às fluoroquinolonas entre os gêneros, com maiores prevalências de resistência em homens e entre as faixas etárias, com maior resistência entre idosos. Conclusões: Idade e sexo são variáveis determinantes na frequência de isolamento dos uropatógenos e na prevalência da susceptibilidade antimicrobiana; e os microrganismos mais prevalentes já não respondem satisfatoriamente a parte dos antimicrobianos amplamente utilizados. É fundamental que o médico considere tais informações no momento da decisão terapêutica e preze pelo uso racional dos antimicrobianos, sobretudo aqueles de largo espectro como as fluoroquinolonas.

Mortality due to cervical cancer, 1996-2011, Santa Catarina, Brazil

Population-based quantitative study. This study's objectives were to examine the influence of regions, age, and time on cervical cancer mortality. We analyzed cervical cancer mortality rates in the State of Santa Catarina, Brazil between 1996 and 2011. Data were obtained from the Mortality Information System from the Brazilian Ministry of Health in 2013. Data were analyzed based on descriptive epidemiology. Cervical cancer mortality rates ranged from 3.6 to 5.0/100,000 women. Rates were higher among older women, with the highest rates after the age of 70. Women's awareness regarding the importance of the Pap smear test in their health checkups may differ across ages and regions of residence. The frequency of Pap smears should change due to the trend of mortality rates observed over time.

Sobrepeso em crianças menores de 6 anos de idade em Florianópolis, SC

Verificou-se a prevalência de sobrepeso através do índice de peso para altura, classificação expressa em escore-Z, padrão de referência do National Center for Health Statistics, em 3 806 crianças menores de seis anos de idade, residentes no município de Florianópolis, Estado de Santa Catarina, Brasil. Obteve-se uma prevalência de 1,9% de desnutrição e 6,8% de sobrepeso, sendo este predominante em crianças residentes em áreas não carentes, do sexo feminino e menores de dois anos de idade. A prevalência de sobrepeso deste estudo foi comparada com aquelas encontradas em outras regiões do Brasil e em outros países. Aplicou-se o teste chi2 (Mantel-Haenszel), para verificar a associação de casos com sobrepeso entre áreas carentes e não carentes, sexo e faixa etária. Observou-se associação estatisticamente significante (p<0,05) entre as crianças menores de dois anos de idade, resultado semelhante ao encontrado pela Pesquisa Nacional sobre Saúde e Nutrição para o Brasil em 1989.

[Evaluation of severity of illness in the emergency service of the university hospital of UFSC]

In order to determine whether emergency wards are inappropriately used we undertook a prospective study to evaluate the severeness of condition of patients seen at the UFSC University Hospital Emergency Ward. The time required for adequate therapeutic intervention was used as the main criterion of severity. Patients considered themselves to be emergencies in 16.6% of cases, whereas physicians thought so in only 2.6% (initial evaluation) and 1.0% (final evaluation) of cases. Sixty five percent of the patients could have been taken care of at a primary care site. The main reasons that prevented the use of a primary care unit were the more rapid and more convenient emergency room facilities. We conclude that the UFSC University Hospital Emergency Room is inappropriately used and suggest possible measures to improve health care delivery to the general public.