The impact of patient navigation on glycemic control, adherence to self-care and knowledge about diabetes: an intervention study

BACKGROUND

Patient navigation helps with better adherence to treatment, as well as better knowledge about diabetes and greater interest in performing, monitoring, and seeking health care. Therefore, this study aims to evaluate the effect of patient navigation on glycemic control, disease knowledge, adherence to self-care in people with type 1 diabetes mellitus.

METHODS

This is an intervention study using a single group pre-test post-test design, carried out in a tertiary public teaching hospital in Southern Brazil. Participants over 18 years of age and diagnosed with type 1 diabetes were included. In total, three teleconsultations and one face-to-face consultation were carried out, with three-month intervals, until completing one year of follow-up. The nurse navigator conducted diabetes education based on the guidelines of the Brazilian Diabetes Society and the Nursing Interventions Classification. The differences between glycated hemoglobin, adherence to self-care, and knowledge about initial and final diabetes were estimated to verify the effect of patient navigation by nurses, according to the tool applied in the first and last consultations. Interaction analyses between variables were also performed. Student's t-test, Generalized Estimating Equations, Wilcoxon test, and McNemar test were used.

RESULTS

The final sample consisted of 152 participants, of which 85 (55.9%) were women, with a mean age of 45 ± 12 years, and diabetes duration of 23.6 ± 11.1 years. Nurse navigators conducted 812 teleconsultations and 158 face-to-face consultations. After the intervention, glycemic control improved in 37 (24.3%) participants (p < 0.001), and knowledge about diabetes also improved in 37 (24.3%) participants (p < 0.001). Adherence to self-care increased in 82 (53.9%) patients (p < 0.001). The analysis of the interaction between glycemic control and the results from the questionnaire of knowledge about diabetes showed an interaction effect (p = 0.005). However, we observed no interaction effect between glycemic control and the results from the questionnaire on adherence to self-care (p = 0.706).

CONCLUSIONS

Our results showed improvement in glycemic control, adherence to self-care, and knowledge of diabetes in the study participants. In addition, they suggest that patient navigation performed by nurses is promising and feasible in improving care for patients with type 1 diabetes.

Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil

Objective

To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus.

Subjects and methods

A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants' profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression.

Results

Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705).

Conclusion

Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control.

Correction: da Silva et al. Increased Sulphur Amino Acids Consumption as OH-Methionine or DL-Methionine Improves Growth Performance and Carcass Traits of Growing-Finishing Pigs Fed under Hot Conditions. Animals 2022, 12, 2159

In the original publication [...].

Quality of care in patients with type 1 diabetes during the COVID-19 pandemic: a cohort study from Southern Brazil

BACKGROUND

Optimal glycemic control is the main goal for patients with diabetes. The results of type 1 diabetes patients' neglected demands during the pandemic can determine a long-term negative clinical, social, and economic impact, and result in worse diabetes control and a higher incidence of chronic complications. Therefore, this study aims to evaluate the impact of the COVID-19 outbreak in the quality of care of patients with type 1 diabetes in Southern Brazil.

METHODS

Cohort study based on electronic medical records of patients with type 1 diabetes, with scheduled appointments between January 1st 2020, and November 6th 2020, at a university public hospital. The quality indicators used were: assessment of albuminuria and/or serum creatinine, lipid profile, thyroid-stimulating hormone, glycated hemoglobin, retinopathy, and neuropathy. McNemar test was used to analyze categorical variables and the Wilcoxon test for continuous variables.

RESULTS

Out of 289 patients, 49.5% were women aged 40 ± 12 years old. During the pandemic, 252 patients had at least one face-to-face appointment canceled. The quality of care indicators showed a significant worsening during the COVID-19 pandemic compared to the previous year (p < 0.001). In 2019, 23.2% of the participants had all the indicators evaluated, while in 2020, during the pandemic, only 3.5% had all of them evaluated.

CONCLUSION

The COVID-19 pandemic hindered the offer of comprehensive and quality care to patients with type 1 diabetes.

Quality of life and eating habits of patients with obesity during the COVID-19 pandemic

Objective:

to verify the quality of life and eating habits of patients with obesity during the COVID-19 pandemic.

Method:

cross-sectional study with 68 outpatients, candidates for bariatric surgery, at university hospital in the Southern Brazil. Data collection was carried out by telephone, with questions about the profile of the participants and social distancing; questionnaires on quality of life and eating habits were also used. The data analysis, the logistic regression model, Spearman correlation, Mann-Whitney U and Student t-tests were used for independent samples.

Results:

the general quality of life was 57.03 points and the eating habit with the highest score was cognitive restraint (61.11 points). Most patients (72.1%) were socially distancing themselves and 27.9% had not changed their routine. The chance of isolation was 3.16 times greater for patients who were married. There is a positive correlation between the domains of the Quality of Life questionnaire and cognitive restraint from the questionnaire about eating habits.

Conclusion:

we found that the participants tended to have a better quality of life as cognitive restraint increased.

Dynamics and Site Isolation: Keys to High Propane Dehydrogenation Performance of Silica-Supported PtGa Nanoparticles

Nonoxidative dehydrogenation of light alkanes has seen a renewed interest in recent years. While PtGa systems appear among the most efficient catalyst for this reaction and are now implemented in production plants, the origin of the high catalytic performance in terms of activity, selectivity, and stability in PtGa-based catalysts is largely unknown. Here we use molecular modeling at the DFT level on three different models: (i) periodic surfaces, (ii) clusters using static calculations, and (iii) realistic size silica-supported nanoparticles (1 nm) using molecular dynamics and metadynamics. The combination of the models with experimental data (XAS, TEM) allowed the refinement of the structure of silica-supported PtGa nanoparticles synthesized via surface organometallic chemistry and provided a structure-activity relationship at the molecular level. Using this approach, the key interaction between Pt and Ga was evidenced and analyzed: the presence of Ga increases (i) the interaction between the oxide surface and the nanoparticles, which reduces sintering, (ii) the Pt site isolation, and (iii) the mobility of surface atoms which promotes the high activity, selectivity, and stability of this catalyst. Considering the complete system for modeling that includes the silica support as well as the dynamics of the PtGa nanoparticle is essential to understand the catalytic performances.

Increasing doses of phytase from Citrobacter braakii in diets with reduced inorganic phosphorus and calcium improve growth performance and lean meat of growing and finishing pigs

The objective of this study was to evaluate the effect of increasing doses of bacterial phytase (RONOZYME HiPhos) on performance and carcass characteristics of growing and finishing pigs. The study included 120 castrated males with initial weight of 23.21 ± 1.91 kg and 68 days of age, distributed in a randomized block design with five treatments and eight replicates with three animals each. The pigs were fed five corn-soybean meal-based diets: positive control (PC), supplemented with inorganic phosphorus and calcium; negative control (NC), with 0.13% reduction in available phosphorus and 0.11% in calcium; and three NC diets supplemented with 1,000, 2,000, and 3,000 phytase units (FYT)/kg in the feed. Compared with the NC diets without phytase, diets with 1,000, 2,000, and 3,000 FYT/kg inclusion increased the daily weight gain by +12% (quadratic, p<0.05) during the growing I period; +2.9, +2.9, and +10.5% (linear, p<0.01), respectively, during the growing II period; and +4.1, +5.1, and +8.2% (linear, p<0.001), respectively, over the entire experimental period. The daily feed intake increased by 0, +2.8, and +4.3% (linear, p<0.05), respectively, considering the entire experimental period; and the final live weight increased by +3.2, +4.2, and +6.1% (linear, p<0.001), respectively. The phytase treatments did not influence feed conversion ratio, carcass weight and yield, backfat thickness, loin depth and carcass lean meat. According to the European Carcass Classification (SEUROP), however, the animals fed the PC diet and the three phytase levels had more carcasses classified as E (between 55–60% lean meat) when compared to carcasses of pigs fed the NC. Supplementing increasing levels of phytase to a corn- and soybean meal-based diet with inorganic P and Ca reduction improved daily weight gain and feed intake of growing pigs, and such effects were maintained until slaughter age.

Gestão por competências: preparo do processo avaliativo pelos enfermeiros de uma unidade de internação

Resumo OBJETIVO Compreender como ocorre o preparo do processo avaliativo dos técnicos e auxiliares de enfermagem pelos enfermeiros de uma unidade de internação clínica adulto, na perspectiva da gestão por competências. MÉTODO Estudo descritivo, qualitativo, desenvolvido com 13 enfermeiros de um hospital universitário. Os dados coletados entre maio e junho de 2017, por meio de entrevistas semiestruturadas, foram submetidos à análise de conteúdo temática. RESULTADOS Emergiram duas categorias: gestão por competências, um novo modelo de avaliação; e, processo avaliativo, uma trajetória a ser discutida. CONCLUSÃO O planejamento da avaliação ao longo do ano por meio de reuniões periódicas sobre a temática é importante para o preparo do processo avaliativo. Além disso, o conhecimento prévio dos percalços avaliativos subsidia o enfermeiro na organização da avaliação.

ENRIQUECIMENTO AMBIENTAL E COMPORTAMENTO DE SUÍNOS: REVISÃO

É cada vez maior a preocupação da comunidade científica e do mercado consumidor em relação aos métodos que os animais são produzidos. As novas exigências do mercado externo, em relação à qualidade ética dos produtos disponibilizados para o consumo, requerem novas técnicas direcionadas ao bem-estar animal. Na suinocultura industrial, os animais, geralmente, vivem confinados em todas as fases da vida. Portanto, estudos vêm sendo realizados para minimizar os efeitos do estresse gerados pelos monótonos ambientes de confinamento. O uso de objetos de enriquecimento ambiental pode ser uma alternativa viável de adaptação ao sistema de produção de suínos presente no Brasil. Contudo, sua eficácia ainda é limitada devido à rápida habituação dos suínos aos objetos disponibilizados. O objetivo deste artigo é revisar alternativas de enriquecimento ambiental usadas na suinocultura.

Piglets' surface temperature change at different weights at birth

The study was carried out in order to verify the effects of piglets’ weight at birth on their surface temperature change (ST) after birth, and its relationship with ingestion time of colostrum. Piglets from four different sows were weighed at birth and divided into a totally randomized design with three treatments according to birth weight (PBW): T1 - less than 1.00 kg, T2 - 1.00 to 1.39 kg, and T3 - higher than or equal to 1.40 kg. The time spent for the first colostrum ingestion was recorded (TFS). Images of piglets’ surface by thermal imaging camera were recorded at birth (STB) and 15, 30, 45, 60, and 120 min after birth. The air temperature and relative humidity were recorded every 30 min and the indexes of temperature and humidity (THI) were calculated. A ST drop after 15 min from birth was observed, increasing again after sixty minutes. Positive correlations were found between the PBW and the ST at 30 and 45 min after birth. The PBW was negatively correlated with the TFS. The THI showed high negative correlations (−0.824 and −0.815) with STB and after 15 min from birth. The piglet’s surface temperature at birth was positively correlated with temperature thereof to 15 min, influencing therefore the temperatures in the interval of 45 to 120 min. The birth weight contributes significantly to postnatal hypothermia and consequently to the time it takes for piglets ingest colostrum, requiring special attention to those of low birth weight.

Microbiological growth in normal and PSE pork stored under refrigeration

The study was conducted to evaluate the microbiological development in PSE pork compared with normal meat and the effect of season of the year on the rate of proliferation of the same. Longissimus dorsi muscle samples from carcasses classified as PSE slaughter (pH45 <5.8) and normal (pH45 > 5.8) were collected after 24 hours of refrigeration, at the time of deboning, in a commercial slaughterhouse, with service federal inspection, located in the Grande Dourados region (MS). The samples (12 normal and 12 PSE) were collected at two different times of the year (fall and winter) for analysis of total and 45ºC coliforms, mesophylls, psychotropic, pseudomonas, yeasts and molds at 0, 5, 10 and 15 days of storage under refrigeration. Microbial growth behaved similarly between the two types of meat throughout the storage period, except for the count of mesophilic aerobic microorganisms, whose development was superior in PSE meat until the 5th day storage, matching between both types of meat later. Was no effect of season on the count of total coliforms and 45ºC, and their proliferation rate higher in meat from the slaughtered animals the warmer season (autumn).

Brief communication: smoking and duodenal blood flow

Smoking promotes an increase in both the incidence and the recurrence of duodenal ulcers, but the mechanisms responsible for its adverse effects on the duodenal mucosa are still poorly understood. The aim of the present study was to investigate the effect of chronic cigarette smoking on duodenal blood flow. In 20 dyspeptic patients (10 non-smokers and 10 smokers) with endoscopically normal duodenum, mucosal blood flow was measured in the duodenal bulb by laser Doppler flowmetry during endoscopy. Basal bulbar perfusion was found to be significantly lower (P < 0.05) in smokers. Our results suggest that duodenal blood flow is reduced in heavy smokers. This may promote duodenal damage because of both local ischaemia and the reduced secretion of protective bicarbonate.

Surgical treatment of gastric adenocarcinoma: impact on survival and quality of life. A prospective ten year study

BACKGROUND/AIMS

The objective of this prospective study was to compare the results of total (TG) versus subtotal (SG) gastrectomy in patients with adenocarcinoma of the lower two-thirds of the stomach.

PATIENTS AND METHODS

Two hundred and twenty-seven patients underwent curative operation. Preoperative nutritional assessment, postoperative tumor stage, postoperative morbidity/mortality, five-year survival, postgastrectomy dietary intake and nutritional sequelae were recorded in all patients.

RESULTS

Postoperative mortality rate was 2.8% in the TG group and 1.1% in the SG group. The number of reoperations, anastomotic dehiscence rate and the length of postoperative stay were higher in the TG group. Five-year survival was closely related to lymph node involvement and gastric wall invasion. The extent of gastric resection did not influence survival when patients were matched for cancer stage. In the SG group, no recurrence in the gastric stump was observed. SG group showed a higher dietary energy intake than the TG group (p < 0.01). This might explain the ability of the SG group to increase body weight more than the TG group (p < 0.01). Only the TG group needed a monthly parenteral vitamin B12 supplements starting 36 months after surgery.

CONCLUSION

The results suggest that SG should be considered the treatment of choice of the gastric adenocarcinoma when a cancer-free proximal resection margin can be guaranteed.

Congestive gastropathy versus chronic gastritis: a comparison of some pathophysiological aspects

In order to investigate some pathophysiological aspects of the two diseases, 15 patients with congestive gastropathy and 15 with chronic gastritis have been studied and compared with 15 healthy controls. Gastric blood flow as determined during endoscopy by means of laser Doppler flowmetry was found to be significantly increased (p < 0.001) in congestive gastropathy, whereas a significant reduction (p < 0.001) was noted in chronic gastritis. On the other hand, Helicobacter pylori was detected in 80% of cases in chronic gastritis, while the prevalence of the microorganism in congestive gastritis was similar to that in healthy controls. It is concluded that chronic gastritis and congestive gastropathy are related to different pathogenetic factors and require different therapeutic approaches.

Breakdown of mucosal defences in congestive gastropathy in cirrhotics

The gastric mucus-bicarbonate barrier, the first line of mucosal defence, has been evaluated in patients with congestive gastropathy and cirrhosis of the liver. Fourteen cirrhotic patients of both sexes (Child's class A or B), with or without oesophageal varices, but with endoscopic signs of congestive gastropathy, and a matched group of healthy controls were studied. The amount of luminal mucoproteins, a Mucoprotective Index as a qualitative assessment of mucus secretion and the output of gastric bicarbonate were determined in basal conditions. In patients with congestive gastropathy a significant (p < 0.01) reduction in all the above parameters was observed, suggesting a substantial impairment of the gastric mucus-bicarbonate barrier. Whether this is an independent phenomenon or a consequence of altered local microcirculation remains to be determined.

[Malnutrition after total gastrectomy]

We studied food intake and nutritional status of 28 patients who had undergone total gastrectomy for gastric cancer. At discharge, patients were instructed to keep a high protein, high calorie diet and to record food intake on a specific form, twice weekly. Nutritional follow-up, consisting in a computerized determination of dietary intake and nutritional assessment was performed monthly during the first postoperative year. The average calorie intake was 1,431.8 Kcal/day one month after operation and 2,225.4 Kcal/day one year after surgery (p less than 0.001). In particular, only one patient exceeded 2,000 Kcal/day one month after total gastrectomy, while 21 patients exceed 2,00 Kcal/day one year after operation. The evaluation of nutritional parameters in the postoperative course showed that a significant increase in body weight, serum albumin and total iron binding capacity was observed only in patients who exceed 2,000 Kcal/day one year after operation. These results indicate that malnutrition is not an inevitable consequence of total gastrectomy; in fact, a close relationship between calorie intake and the variations of nutritional parameters was observed.

Food intake and nutritional status after total gastrectomy: results of a nutritional follow-up

We studied dietary intake and nutritional status of 23 patients for 6 months after total gastrectomy with Roux-en-Y reconstruction. At discharge, patients were instructed to keep to recommended dietary allowances (RDA) and to record food intake on a specific form twice weekly. Nutritional follow-up was performed monthly and consisted of a computerized determination of food intake and of a nutritional assessment. The average daily energy intake was 6.10 MJ (1457.9 kcal) in the first postoperative month and 8.87 MJ (2118.4 kcal) in the sixth (P less than 0.0005). In the first monthly follow-up no patient reached RDA. By the sixth month mean daily calorie intake was greater than or equal to RDA in 14 patients (group A), while 9 patients (group B) did not reach RDA. A significant increase in body weight, serum albumin, total iron binding capacity and arm muscular circumference was observed in group A, while a significant decrease in body weight and arm muscular circumference was noted in group B. Moreover, of the seven patients who showed weight loss at 6 months only one was group A. These data indicate that malnutrition is not an inevitable consequence of total gastrectomy and can be prevented by an adequate calorie intake. A close relationship between dietary intake and postoperative nutritional parameters was observed. In gastrectomized patients a strict nutritional follow-up is very important to obtain an adequate dietary intake.