Repositório RCAAP

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Objective: This study sought to compare acute systemic hemodynamic changes after the infusion of peritoneal dialysis (PD) solution to diabetic and non-diabetic patients. Design: Diabetic and non-diabetic CKD patients receiving PD between July 2011 and August 2012 were selected. Patients: A total of 42 patients undergoing PD were analyzed and divided into 2 groups: diabetics (D) and non-diabetics (ND). Interventions: After echocardiography and clinical evaluation, patients were submitted to thoracic electrical bioimpedance (TEB) cardiography. Two liters of 1.5% glucose PD solution (Dianeal PD-2, Baxter®) at room temperature (25 to 28°C) was then infused into the abdominal cavity. TEB was performed 20 min before and after the initiation of infusion. Outcome measures: The following parameters were measured before and after the infusion of PD solution: systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP) (mmHg); heart rate (HR) (bpm); cardiac index (CI) (L/min/m²); stroke index (SI) (mL/beat/m²); systemic vascular resistance index (SVRI) (dyne·sec·cm&#713;5/m²) and total arterial compliance index (TACI) (mL/mmHg/m²). Results: Significant increases in SAP, DAP, MAP and SVRI were found, as well as a significant decrease in the CI, after the infusion of PD solution to both groups (p < 0.05). The HR values changed from 67 ± 7 to 62 ± 9 bpm (p < 0.05) in the ND group and maintained the baseline values in the D group after the infusion of PD solution. In addition, TACI was reduced from 6.2 ± 2.5 to 5.4 ± 2.4 mL/mmHg/m² (p < 0.05) in the D group but exhibited no alterations in the ND group after the infusion of PD solution. Conclusion: The infusion of PD solution acutely alters left ventricular systolic function in diabetic and non-diabetic patients. Moreover, hemodynamic reflex adaptive processes, such as changes in HR, seem to be attenuated in diabetic patients.

Introduction: The management of patients in intensive care service requires monitoring of hemodynamic parameters, ensuring optimization and control of blood volume. Studies indicate that the correct horizontal positioning is unnecessary to invasive measurement of pressures. However there are few comparisons between the effect of the inclinations of 0°, 30° and 60° on the different types of hemodynamic measurements. Objectives: To investigate the effects of different backrest inclinations on measures of variation in pulse pressure (ΔPP), central venous pressure (CVP), distensibility index of the vena cava (IDVI), cardiac output (CO) and mean arterial pressure (MAP). Compare the predictive value for indicating volume using CVP and ΔPP as a predictor of IDVI. Methods: A prospective study of 31 patients admitted to the intensive care unit of the HCU-UFU. Patients were positioned with backrest inclination of 0°, 30° and 60°. For each inclination, measures ΔPP, CVP, IDVI, CO and MAP were obtained. For comparison of the results between groups was used analysis of variance. Results: There were no significant differences between the measurements obtained on the inclination 0° and 30°. In the inclination of 60°, significant variations in measures of ΔPP and CO were found. Referring to IDVI variable as a predictor of blood volume, when correlated with the CVP and ΔPP variables, the latter showed a strong correlation with the IDVI. Conclusion: The results suggest that the patient can be maintained with the backrest inclination of 30° to measurement of hemodynamic variables. The authors suggest the inclusion of assessments of ΔPP in daily use as a predictor of blood volume, in intensive care units.

Food allergy is the term used to designate the group of adverse reactions to foods, which involves immunological mechanisms and is reproducibly when exposed to a given food. Although several studies suggest the significant increase of food allergy cases in the world in recent decades, the actual prevalence remains unknown and is estimated to affect 6-8% of children. The most prevalent food associated with food allergy is cow\'s milk, affecting 2-3% of children. Food allergy reported by parents is present in about 1.4 to 35% of the population. Objectives: To determine the prevalence of food allergy reported by parents and diagnosed by health professionals, as well as major food and clinical manifestations in infants enrolled at the School District Early Childhood Education from Uberlândia, MG. Methods: This was a cross-sectional study in children 4-23 months who were enrolled at the School District Early Childhood Education Uberlândia by using a self-administered questionnaire to assess the prevalence of food allergy reported by parents and subsequent clinical and laboratory evaluation of infants identified by parents as allergic food in order to meet the prevalence of food allergy diagnosed. Results: Out of 1244 children enrolled, 596 parents responded to the questionnaire. The prevalence of food allergy reported by parents was 23.5% and the incidence of asthma, rhinitis and dermatitis was significantly higher in the group of children with food allergies reported (p = 0.0317, p < 0.0001 and p < 0.0001, respectively). The main foods mentioned were: cow\'s milk, egg, chocolate, pork and fruits. And the main associated symptoms: red spots (55.7 %), diarrhea (43.6 %), vomiting (30.7%), abdominal pain (21.4%) and mouth and eyes swelling. Infants with suspected food alergy reported by parents underwent clinical and laboratory evaluation. The food allergy prevalence was 3.5%, 1.9% of these were confirmed during the study and 1.6% previously. IgE-mediated events occurred in 1.2% of infants while non-IgE mediated events were detected in 0.7% of them. The milk was the major food allergen reaching 1.04% of infants, followed by egg (0.87%), wheat (0.34%), soy, coconut, peanut and tomato (0.17%). The main symptoms were: red spots (90.9%), pruritus (54.5%) and eyes edema (45.5%). Conclusion: The food allergy prevalence reported by parents is high in this age group, and is associated with increased frequency of allergic diseases such as asthma, atopic dermatitis and allergic rhinitis. The main foods reported by parents are part of the usual diet as milk, chocolate, egg, fruit and pork. The diagnosed food allergy prevalence was close to the reported in the literature. It was found lower frequence for milk and peanuts, while eggs and soybeans showed similar average values as found in other studies, and wheat was the only one showing higher prevalence than what reported in the literature. Although numerous studies regarding reported food allergy suggest that food allergens are affected by regional and cultural influences, the foods actually associated to food allergy, the end of the survey, were the same as described in the literature.

Objective: Despite the importance of cesarean section, when appropriately indicated, organs such as the World Health Organization (WHO) are concerned about its increasing incidence worldwide. The objective of this study was to evaluate the effectiveness of an intervention in order to readjust the indications for cesarean sections in a Brazilian teaching hospital. Methods: This study was carried out in three stages: I: Random selection of 160 cesarean records of May, June and July, 2011; II: Implantation of the guideline of cesarean sections indications; III: Random selection of 160 cesarean records of May, June and July, 2012. These records were classified into high and low-risk, according to type of prenatal, and into consistent and inconsistent clinical cases based on the guideline. Statistical analysis: Binomial Test for Two Proportions. P-values under 0.05 were considered statistically significant. Results: Among the lowrisk cesareans, 27 (51.92%) were consistent with the protocol at stage I, and 49 (72.05%) at stage III (p=0.02). Conclusion: The proposed intervention, under the conditions by which it was tested, favors the suitability of indications for cesarean sections in low-risk pregnancies.

Background: The medical literature shows that alcohol consumption is common among diabetic individuals and is associated with poor adherence to treatment, resulting in increased morbidity and mortality. However, no study has assessed the association between high-risk alcohol consumption and the presence of anxiety and depression in individuals with type 1 diabetes mellitus (1DM). Objectives: To know the degree of alcohol use, the prevalence at risk alcohol use and symptoms of anxiety and depression, the level of glycemic control and the association between these variables in adolescents and adults diagnosed with type 1 diabetes treated at the Clinic of Endocrinology Outpatient, Federal University of Uberlândia (UFU) and the Municipal Diabetic Care Center of Uberlândia. Methods: The present cross-sectional study assessed 209 outpatients in regards to alcohol consumption and the presence of anxiety and depression symptoms, using the Alcohol Use Disorders Identification Test (AUDIT), the Hospital Anxiety and Depression (HAD) scale, and glycemic control, according to the levels of glycated hemoglobin (HbA1c). The chi-square test and logistic regression analysis were used to investigate the association between the investigated variables. Results: The prevalence of high-risk alcohol consumption (AUDIT ≥ 8) among individuals with 1DM was high, specifically 24.88% among the entire group of subjects, 12.9% among the adolescents, 14.7% among the females, and 34.6% among the males. Upon comparisons based on gender and age, the odds of high-risk drinking were higher among males and participants aged 30 to 40 years (33.93%). The frequency of high-risk alcohol consumption did not differ as a function of gender among adolescents (females: 9.09%, males: 16.21%; p=0.374). Neither the frequency of anxiety (total: 29.66%, females: 37.25%, males: 22.43%) nor depression (total: 11%, females: 17.65%, males: 4.7%) symptoms exhibited associations with high-risk alcohol consumption. Moreover, the odds of female subjects exhibiting anxiety or depression symptoms were higher (odds ratio OR: 4.37 and OR: 7.4, respectively). Glycemic control was inadequate in most of the sample and did not exhibit an association with high-risk alcohol consumption or the presence of anxiety and depression symptoms. Conclusions: The prevalence of high-risk alcohol consumption and the presence of anxiety and depression symptoms were high in this patient sample. The frequency of high-risk drinking increased together with age and was greater among males; however, this frequency did not exhibit differences in terms of gender among adolescents. Glycemic control was inadequate in most of the sample independent of alcohol consumption and the presence of anxiety and depression symptoms.

Conselho Nacional de Desenvolvimento Científico e Tecnológico

In Brazil, much has been published on the nature of sickness absence of civil servants employed in federal institutions of higher education, but so far, there are few researches that used for such purposes the data base of the Integrated Administration System of Human resources-SIAPE. This study aimed to identify possible diferences between sickness absence of civil servants employed in the health sector and those working in other sectors of a federal institution of higher education located in Minas Gerais, with a corresponding population to 4011 servers.This cross-sectional study, with data collected from the webpage Siapnet health module, includes 1.860 sickness absence for treatment of the server and for sick family care; 1.318 of these sickness absence referred to servants of the health sector (group I) and 542 to servants of other sectors (group II), all of both sexes and holding positions compatible with 2nd and 3rd degree education. These sickness absence were granted between January and June 2012.We classified the diagnosis of the cause of morbidity in accordance with ICD 10. The statistical evaluation included descriptive analysis of the sample. We used the Kolmogorov-Smirnov test to ensure the normality of data. We employed the Mann-Whitney U-test to evaluate the difference between medians, and to verify the associations between variables statistical Pearson s chi-square test or the Binomial test were used. We adopted a significance level of 5% (p ≤ 0,05) for the analyses. In the two groups we investigated, the highest sickness absence rates occured in Group I, among females, and in the 40 to 50 age group. In both groups, were characterized days away with short duration (1 to 14 days). Musculoskeletal and connective tissue disorders are the most frequent causes of sickness absence in the Group I; the factors that are determinants of health, the contact with health services and the respiratory diseases were the main causes of sickness absence in Grupo II. The results presented in this study confirm the health sector, female, aged between 40 and 50 years as predictors of risk of sickness absenteeism factors, as well as increased frequency of musculoskeletal and connective tissue diseases on servers in the health area, tendency corroborated in other studies.

The psoriatic arthritis (PsA) is a rheumatologic disease that affects the musculoskeletal system (arthritis) and the skin (psoriasis). It can have a severe impact on the quality of life of those who suffer from this illness; then, the early detection of the PsA is an extremely important purpose. In 70% of the cases, this disease starts with skin problems, so that the patient monitors it exclusively at a dermatologist s office. However, there are no valid and reliable tools in Portuguese to assist dermatologists in the early diagnosis of PsA. This study aimed to translate, culturally adapt and validate the PASE (Psoriatic Arthritis Screening and Evaluation) in Brazilian Portuguese. This tool is a self-administered questionnaire developed in English to screen arthritis in patients with diagnosis of psoriasis. The process of translation and adaptation followed international protocols on this matter, whose steps included translation, reconciliation, back translation, cognitive interview, independent review and a revision performed by the linguistic team of the author of this questionnaire. After these steps, the translation was pretested on 50 individuals. The final version was applied to 465 patients with psoriasis (158 with psoriatic arthritis and 307 without it) in four Brazilian university hospitals, and the data collected was submitted to quality tests (missing data, floor and ceiling effects). The psychometric properties of the tool were verified by known-groups validity, item-discriminant validity, item-internal consistency, Cronbach\'s alpha, intraclass correlation coefficient and confirmatory factor analysis. In the cognitive interview, some changes were performed in the translation due to cultural adaptation. There was no missing data. The floor effect was present in all the items of the two subscales and the ceiling effect was observed in four items of the first subscale and in two items of the second subscale. The reliability verified through the item-internal consistency (100% success), the Cronbach\'s alpha coefficients (0.92), and the intraclass correlation (0.97) were considered adequate. The known-groups and the item-discriminant validity achieved appropriate results. The confirmatory factor analysis provided a proper fit according to the variables observed (X2 = 247.1, p <0.001; df = 79; X2/df = 3.12; GFI = 0.93, AGFI = 0.90, CFI = 0.95; SRMR = 0.04; RMSEA = 0.07). The results showed that the PASE-P (translated version of the PASE) is a valid and reliable tool to be used in Brazil.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

Cerebral palsy (CP) is a group of motor disorders resulting from a lesion in the developing brain that can cause functional limitations and impair quality of live (QoL). The comparison of results from different studies and the choice of appropriate quality of life questionnaires is limited by the diversity of concepts and dimensions covered by these questionnaires. The International Classification of Functionality (ICF) has been used as a comparative interface in the analysis of QoL questionnaires. This study aimed at verifying and comparing the content of QoL questionnaires used to evaluate children and adolescents with CP according to the ICF. We identified 5 generic instruments and 5 specific ones used to evaluate the QoL of children and adolescents with CP in electronic databases. Two researchers independently analysed all the items and concepts of the questionnaires. Each item was linked to ICF categories by means of internationally recognized rules. The Kappa statistic was used to describe the degree of agreement among researchers. From the 488 items analyzed, 623 concepts were identified and 563 linked with 175 different categories of the ICF: 130 with the body function component, 333 with the activity/participation component, 50 with the environmental factors component and 50 with the personal factor component. Generic instruments, as well as specific ones had a higher number of concepts associated to the component activity/participation. The CP QOL Child was the instrument with the most balanced representation of the body function (20.0% of the concepts), activity/participation (36.2% of the concepts) and environmental factors (26.1% of the concepts) components. It also covered some concepts related to the personal factor component (9.2%) and others not included in the ICF (7.7%). The Kappa coefficients range between 0,80 at the 0,97. The study showed that QoL instruments applied to children and adolescents with CP mainly cover the activity/participation component and the body functions component of the ICF. The environmental factors and personal factors are not much studied. The body structures component was represented in only one item of the questionnaires. This analysis can guide clinicians and researchers in choosing the most appropriate instruments for the content to be evaluated.

Background: Premature birth is associated with increased morbidity and mortality in the neonatal period. Intrauterine growth restriction is an important cause of interruption of gestation resulting in the occurrence of premature birth in addition to interfere in morbidity and mortality during neonatal period. The intraventricular hemorrhage is the most commonly brain injury found in the preterm newborn. The relationship between intrauterine growth restriction and periventricular hemorrhage is controversial in the literature. The present study aims to compare the incidence of intraventricular hemorrhage among preterm newborn with and without intrauterine growth restriction in addition to identify the risk factors for periventricular hemorrhage in these infants. Methods: This is a prospective cohort study and included premature infants that were born at the Clinics Hospital of Federal University of Uberlandia in a 12 months period. Newborns with congenital malformations, genetic syndromes, chromosome disorders, twins and those who died before 48 hours of life were excluded. Newborns were divided into 2 groups, with and without intrauterine growth restriction, based on the relationship between birth weight and gestational age. The ones classified as small for gestational age were considered with intrauterine growth restriction. Cranial ultrasounds were performed of all newborns and Papile (1978) classification was used for the diagnosis and classification of intraventricular hemorrhage. Results: 242 preterm newborns participated in this study being 120 in the group without and 122 in the group with intrauterine growth restriction. When compared maternal and newborn characteristics of the two groups, there were statistically significant difference in the incidence of maternal pre-eclampsia and birth weight. The periventricular hemorrhage was found in 19 (15,8%) preterm newborn without intrauterine growth restriction and in 28 (22,9%) with intrauterine growth restriction without statistically significant difference. In 38 (80.8%) infants the diagnosis of periventricular hemorrhage was made up to 7 days of life and were more common grades I and II. After adjustment for multiple logistic regression model, were defined as risk factors for the occurrence of periventricular hemorrhage thrombocytopenia and Respiratory Distress Syndrome. Conclusion: There was no statistically significant difference in the incidence of intraventricular hemorrhage among preterm newborn with and without intrauterine growth restriction. Logistic regression analysis indicated the Respiratory Distress Syndrome and thrombocytopenia as risk factors for the occurrence of intraventricular hemorrhage.

Introduction: Vascular changes and changes in the image, magnetic resonance imaging (MRI) during neoadjuvant chemotherapy (QTN), have been reported to predict pathological response (PR) in breast cancer breast .Tumors with the same histological types , stages and degrees of differentiation may have different outcomes in relation to prognostic factors and responses to established treatments. Moreover, molecular subtypes respond differently to neoadjuvant chemotherapy. Objective: To evaluate the accuracy of power Doppler (PD) mapping method as a predictor of pathological response in breast cancer, compared to chemotherapy neoadjuvant towards triple negative tumor (TN) subtypes, positive homonal receptor (HR +) and HER2 negative (HER2-) and HER2 positive (HER2+). Methods: Included patients with LABC treated at the Hospital of the UFU. All were subjected to Power Doppler ultrasonography before, after 2-3 cycles and at the end of chemotherapy. Tumor diameters were measured and calculated the rate of vascularization of the tumor mass by the PD. Were classified as responders those who had complete reduction to or greater than 30% of the initial vasculature and diameters. Non-responder that patients with lower than 30% reductions or increases less than 20% or greater increase of 20% compared to the initial evaluation. Tumor subtypes were identified and associated with response patterns. Spearman test was used with p = 0.05. Results: 40 patients enrolled and 26 completed in cases. After 2 or 3 cycles of the VPN QTN was 75% overall, 60% in TN in HER2 + 100% and 80% in RH + HER2 -. The accuracy even this time was 73.91% overall and TN subtypes HER2 + RH + and HER2- was 57.14%, 75% and 83.33% respectively. At the end of chemotherapy general VPN was 92.85% and 83.33%, 100% and 100% for subtypes TN, HER2 + and RH + HER2-, respectively; accurately at the end of treatment 92% of the overall assessment, and 87.50%, 80% and 100% for TN subtypes HER2 + and RH+ HER2-, respectively, when evaluated separately. Conclusion: It appears that ultrasound with power Doppler can be an important tool for evaluation of response to neoadjuvant chemotherapy and its association with breast tumor subtypes can aid in predicting response to chemotherapy and surgical planning in assessing whether or not a conservative surgery.

Ventilator-associated pneumonia (VAP) is the most prevalent nosocomial infection in intensive care unit (ICU), associated with high mortality rate (14-70%). The objective of this study is evaluate the factors that influence the death of patients with VAP, especially bacterial resistance, prescription errors and de-escalation of antibiotics. Was developed a retrospective study in adult ICU of the Federal University of Uberlândia, which included 120 patients with VAP. We used the chi-square test for qualitative variables, the Student t test for quantitative variables and multiple logistic regression to determine the predictors of mortality.Was identified high mortality of VAP (35%), with a high rate of antimicrobial resistance. The de-escalation of antibiotics and the presence of resistant bacteria had no effect on mortality. The more frequent error prescription of antibiotics was the delay in the start of antibiotic (64.4%). Among the antibiotic prescription errors, patients using incorrect attack dose died 4 times more (P = 0.031) and who did not correction by renal function died 3 times more (P = 0.000). The multiple logistic regression analysis found that the incorrect adjustment for renal function was the only factor that interfered in mortality (1,803-42,531, R² de 0,469). In conclusion, antibiotic prescription errors influenced mortality of patients with VAP, stressing that adequate treatment of VAP is still a challenge that deserves to be continually reassessed, so that the expected clínical response to therapy be guaranteed.

Nonalcoholic fatty liver disease (NAFLD) is a prevalent condition and frequently diagnosed in ultrasonography (US). Bidimensional ultrasonography steatosis grading is subjective and subject to interobserver and intraobserver variability. Hepatic biopsy is the standard diagnostic method, but its indication has some controversies. For clinical practice, noninvasive, objective and reproducible steatosis quantification is necessary. The aim of this study is to assess the performance of Doppler US indices of the three major hepatic vessels in steatosis diagnosis and grading, having histological study as reference. Doppler US was performed in 98 volunteers, including 49, with NAFLD who were submitted to liver biopsy. The other 49, without steatosis in US and without risk factors for NAFLD, were included as the healthy group and were not submitted to biopsy due to ethical reasons. Portal venous pulsatility index (PVI) was calculated by subtracting the minimal peak of portal velocity from the maximum peak and dividing the result by the maximum peak. Right hepatic vein waveform pattern (HVWP) was classified as monophasic, biphasic or triphasic. Hepatic artery resistance index (HARI) was calculated by subtracting end diastolic velocity from systolic peak velocity and dividing the result by systolic peak velocity. Hepatic artery pulsatility index (HAPI) was calculated subtracting end diastolic velocity from systolic peak velocity and dividing the result by mean velocity. Hepatic biopsy specimens were classified in mild steatosis (less than 33% of fatty hepatocytes), moderate (33 to 66%) and severe (more than 66%). Inflammation and fibrosis were classified according to intensity and localization in hepatic acini. PVI had inverse and significant correlation with steatosis presence in biopsy (r= - 0.69; p <0.0001). PVI media and standard deviation in healthy group was 0.35 ±0.08 and in steatosis group was 0.21±0.10 (p<0.0001). HVWP was predominantly triphasic in healthy group and in mild steatosis subgroup while monophasic pattern was the most frequent in moderate and severe steatosis. HARI and HAPI did not distinguish healthy from steatosis group. None of the indices significantly correlated with steatosis grading. Hemodynamic changes in portal and hepatic veins allow noninvasive steatosis diagnoses. In order to improve diagnostic capacity, a discriminant function was obtained using these two parameters, resulting in improvement of Doppler specificity, sensibility and accuracy for steatosis diagnostic. This is a simple and clinical applicable analysis. Doppler indices have limitations in quantifying steatosis as in diagnosing inflammation and fibrosis.

Objectives: Psoriasis is a chronic inflammatory disease that affects the skin and joints and has a multifactorial etiology. Recently, it has been suggested that Helicobacter pylori infection may contribute as a trigger for the development of the disease. The aim of this study was to determine the prevalence of Helicobacter pylori seropositivity in patients with psoriasis and to evaluate the relationship between disease severity and H. pylori infection. Methods: H. pylori infection was assessed in psoriatic patients and controls by using H. pylori IgG quantitative enzyme immunoassay (ELISA test). The patients were classified according to the severity of the disease (PASI score). Results: One hundred and twenty six psoriatic patients (73 females and 53 males); mean age 50.48 years; 65 patients (51.59%) had severe psoriasis, 40 (31.75%) moderate psoriasis and 21 (16.67%) mild psoriasis. Twenty one healthy volunteers included as a control group, mean age of 41.05 years, 13 females and 8 males. One hundred and eleven psoriatic patients tested serologically, 80 (72.07%) were seropositive compared to 7 positive volunteers (33.33%) (P = 0.0023). Forty nine (75.38%) patients with severe psoriasis were positive, 25 (62.50%) with moderate psoriasis were positive and 6 (28.57%) with mild psoriasis were positive (P = 0.02). Conclusion: The Helicobacter pylori infection influences the development of psoriasis and severity of the disease.

Introduction: Studies suggest that the high incidence of poor dietary habits in shift workers may be associated with a greater incidence of disease. However, the lack of appropriate methodologies in studies that have evaluated the food intake patterns of this group of individuals is evident. Objective: To assess the macro and micronutrient intake of nursing professionals working different shifts. Methods: Two hundred and twenty two nursing workers were classified into three shifts: day shift (n=112), who worked only during the day (morning or afternoon without night shift); night shift (n=55), who worked only during night shifts; and day-night shift (n=54), who worked during the day (morning or afternoon) plus at least 9 hours a week of night shifts. Volunteers underwent nutritional assessments (24-hour recall on three non-consecutive days, including one day on the weekend) and evaluations of anthropometric variables (weight, height, body mass index and waist circumference) and sleep pattern (Epworth Sleepiness Scale). The food intake assessment was performed by comparison with the reference values recommended by the Dietary Reference Intakes (DRIs). Results: The total time of hours worked per week was significantly higher in the night and day-night shift compared to day shift (p <0.0005). The average sleep time during the working days (minutes) was lower in the night shift compared to day and day-night shift (p <0.0005). Daytime sleepiness was higher in the night shift, when compared to the day and day-night shift (p <0.02). In general, the percentage intake of macronutrients, in relation to caloric intake, was adequate in three groups. An increased consumption of protein and fat was observed in the night workers when compared to the day-night and day workers (protein: 21.2 ± 0.8, 18.2 ± 0.5, 18.1 ± 0.7, respectively, p = 0.01; fat: 35.5 ± 0.8, 32.5 ± 0.5, 31.1 ± 0.8, respectively; p = 0.001). Mean cholesterol intake was significantly lower in day-night workers compared to the day and night workers (188.1 ± 18.9, 239.2 ± 13.2, 248.0 ± 20.5, respectively; p = 0.04). Most workers analyzed showed a mean intake below the recommended allowances for vitamins and micronutrients, independent of the shift work, besides a high frequency of inadequate vitamins and minerals of different adjustment ranges, considering the EAR and RDA values, regardless of the shift. Conclusion: We concluded that nurses working in shifts had adequate macronutrient intake but marked inadequacies in micronutrient intake, independent of the shift work.

Although the use of continuous positive airway pressure (CPAP) has increased considerably, there have been few studies of its hemodynamic effects in patients with healthy cardiopulmonary systems. Objective: To evaluate the hemodynamic effects exerted by different levels of continuous positive airway pressure in healthy individuals using Doppler echocardiography. Methods: This study included 19 healthy volunteers. Three levels of continuous positive airway pressure (5, 10 and 15 cm H2O) were randomly applied for 5 minutes each; 5 minutes of rest were allowed between each application. Echocardiographic variables, vital signs and ventilation were each recorded at baseline and following each pressure application. Results: Continuous positive airway pressures of 10 and 15 cm H2O generated a reduction in the pulmonary velocity-time integral (p=0.01), as well as a reduction in right atrial area (p=0.00). Both cardiac output and heart rate were significantly decreased with each pressure setting (p=0.00 and p=0.00, respectively), whereas stroke volume and blood pressure did not change significantly. Positive correlations were observed between the mitral, pulmonary and aortic velocity-time integrals and both stroke volume and cardiac output. Conclusion: Continuous positive airway pressures of 10 and 15 cm H2O generated reductions in right ventricular preload without changing either left ventricular preload or left ventricular afterload. There was also a decrease in cardiac output due to a reduction in heart rate. A strong correlation was observed between the mitral velocity-time integral and both stroke volume and cardiac output.

Quality of life (QOL) and well-being have been a concern of the population in general, and for many, sport is a means to achieve it. People with physical disabilities in the sport initially sought in sport, a chance of recovery, social integration and well-being. Recently, paralympic sport has become increasingly professional with the presence of paralympians high yield, which has ensured greater opportunities and possibly better QOL for these individuals. The objective of this study was to evaluate quality of life (QOL) of individuals with physical disabilities, practitioners of paralympic athletics, according to the level of competitive sport (elite vs. participation) and compare them with sedentary people with physical disabilities or healthy sedentary. The study included 228 individuals, divided into four groups, matched for age and sex. G1 group - people with physical disabilities practitioners of athletics, elite level; G2 - people with physical disabilities practitioners of athletics, participation level; G3 - sedentary people with physical disabilities and G4 - sedentary healthy people. QOL was measured by the WHOQOL-BREF questionnaire. A comparison of the scores of WHOQOL-BREF was performed by ANOVA with Bonferroni post-test. Each group consisted of 57 volunteers, 41 male and 16 female. The mean age was 31 years (SD = ± 9.6 years). We observed greater overall satisfaction with QOL in G1 compared to G2 (p = 0.00), with no significant difference in domains of the WHOQOL-BREF. Compared with G4, G1 had the best result in the psychological domain and the total score; G2 was better than G4 in the psychological domain, with no difference for the other domains. G1, G2 and G4 groups had higher QOL scores than G3. The results showed that practitioners of athletics with physical disabilities had better QoL compared to sedentary people with physical disabilities or healthy sedentary. The paralympic elite athletes reported better overall satisfaction with QOL than other athletes, however, with no significant difference in QOL domains assessed by the WHOQOL-BREF.