A Atenção Primária em Saúde é considerada o principal modelo de organização da atenção à saúde e a via de acesso mais adequada a população. Este nível de atenção tem a capacidade de responder de forma contínua, sistematizada e equânime, à maior demanda de saúde no âmbito individual e coletivo. O Brasil assume compromisso com uma proposta de vigilância em saúde voltada para a infecção humana pelo SARS-CoV-2 (infecção respiratória pelo novo coronavírus), apoiada pela consolidação de informações da OMS e novas evidências técnicas e científicas. Com a rápida disseminação do vírus os serviços da APS tornam-se essenciais para o enfrentamento do agravo. Mas o impacto da mudança no financiamento da Atenção Primária em Saúde, pode gerar sobrecarga à rede de atenção à saúde, que vive em um panorama marcado por instabilidade e precarização das relações de trabalho.
Chronic diseases that are typical of adulthood may originate in intra-uterine life through inadequate fetal development. The present epidemiological cohort study of 506 healthy children aged 5-8 years evaluated the relationship between birth weight and insulin resistance in an age group that has been assessed in few similar studies. Insulin concentration was determined by chemiluminescence and insulin resistance by the homeostasis model assessment (HOMA). Blood glucose, total cholesterol and fractions (LDL cholesterol and HDL cholesterol) and TAG concentrations were determined by automated enzymatic methods. Linear regression analysis investigated the relationship between birth weight (assessed as a continuous variable and in three categories: small for gestational age, SGA; adequate for gestational age and large for gestational age) and the HOMA index, using backward stepwise selection and biological models to explain the causal pathway of the relationship. There were negative associations between birth weight (P, 0·001), SGA (P¼ 0·027) and the HOMA index, and a positive association between waist circumference (P, 0·001) and the HOMA index. Considering the significant associations between birth weight and waist circumference (P,0·001) and waist circumference and insulin resistance (P, 0·001), we can probably suspect that lower birth weight is a common cause of higher waist circumference and insulin resistance. In summary, the results of the present study showed increased insulin resistance in apparently healthy, young children, who had lower weight at birth and higher measurements of waist circumference. There is a need to develop public health policies that adopt preventive measures to promote adequate maternal-fetal and child development and enable early diagnosis of metabolic abnormalities.
Background The world guidance on the measures of social distancing for prevention of COVID-19 has changed the daily habits of great part of the population, and this could influence the care and resilience with diabetes during situations of adversity. This study aimed at assessing the characteristics of diabetic individuals and self-care practices and resilience with diabetes in the context of the COVID-19 pandemic in Brazil. Methods This is a cross-sectional web survey study carried out among adults with diabetes, in which a structured 43-item questionnaire was conducted on the REDCap plataform, including the Diabetes Self-Care Activities Questionnaire and Connor-Davidson Resilience Scale, to measure socio-demographic and clinical characteristics. The web survey was disseminated through the main social media and data were collected from September 1st to October 19th, 2020. Data analysis was performed according to type of diabetes mellitus (DM) and at a significance level of 5% (p < 0.05). Results Of the 1633 participants, 67.5% were women, 43.2% aged between 35 and 59 years old, 68.0% lived in the south-eastern region of Brazil, 57.1% had a high education level, 49% reported to have DM1 and 140 participants reported to have had COVID-19. Diabetes care mostly involved the use of medications (93%), whereas the least used ones were physical activity (24.6%) and examination of the shoes (35.7%). About 40% of the participants reported to be followed up by telemedicine, 61.5% monitored the glycaemic levels, 61.2% followed a healthy diet and 43.4% left home only to go to the supermarket and drugstore. The mean resilience was 25.4 (SD = 7.7). Conclusions In Brazil, individuals with diabetes followed social distancing and maintained their medication treatment for DM. However, practice of physical activity and foot examination was little followed by the participants, who also had a low level of resilience. These findings showed the importance of patient follow-up in the healthcare services, meaning that telemedicine should be improved and support provided for adaptation in view of the therapeutic setbacks.
Objetivo: Analisar as Relações Municipais de Medicamentos Essenciais (Remumes) do estado de São Paulo e estimar a prevalência dos grupos de medicamentos. Métodos: Trata-se de um estudo transversal realizado com 17 Remumes dos municípios sede dos Departamentos Regionais de Saúde (DRS) e 24 Remumes de municípios do DRS XIII do estado de São Paulo. Verificaram-se dados sobre os medicamentos de acordo com o primeiro nível da classificação Anatomical Therapeutic Chemical. Resultados: Os municípios sedes apresentaram entre 128 (Piracicaba) e 396 (Santos) medicamentos listados, com média de 272,3 (DP=71,1) medicamentos. Os municípios da DRS XIII apresentaram entre 32 (Luiz Antônio) e 403 (Cássia dos Coqueiros) medicamentos, com média de 198 (DP=111,4). Predominaram os medicamentos que atuavam no sistema nervoso seguidos pelos cardiovasculares e anti-infecciosos sistêmicos. Conclusões: As Remumes mostraram elevada variação no número de medicamentos e grupos farmacológicos e a necessidade de qualificação da assistência farmacêutica municipal.
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Objetivo: Descrever as intervenções farmacêuticas realizadas em conjunto à equipe multiprofissional para otimizar a adesão ao tratamento medicamentoso de um paciente idoso. Métodos: Estudo de caso realizado em um Hospital Público de Atenção Secundária com coleta de dados a partir de prontuário eletrônico, teste de adesão BMQ e consulta ao Micromedex®. Resultados: Paciente analfabeto, com potencial baixa adesão ao tratamento medicamentoso, devido a problemas no uso correto e acesso na rede pública de saúde. Os farmacêuticos analisaram aspectos da terapia farmacológica e identificou as principais causas da baixa adesão ao tratamento. Posteriormente, foram apresentadas estratégias para otimizar a utilização de medicamentos juntamente com a equipe multiprofissional e garantia da continuidade do cuidado pós-internação na Atenção Primária à Saúde através do Núcleo de Apoio à Saúde da Família do município de origem do paciente. Conclusão: As ações farmacêuticas destinadas à melhoria da adesão ao tratamento medicamentoso do paciente idoso tornam-se essencial na atenção hospitalar, garantindo efetividade da assistência prestada. O hospital é um importante espaço de promoção e educação em saúde.
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