Thesis (M Med (Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / Abundant literature supports the beneficial effects of diet and exercise recommendations for improving and maintaining glycaemic levels of people with type 2 diabetes mellitus. Patient adherence to therapeutic lifestyle measures is notoriously difficult to initiate and sustain; however, reason for non-adherence amongst diabetes population is very complex and multi-faceted in nature. Objectives To determine rates of non-adherence and reasons/barriers for not adhering to diet and exercise recommendations amongst type 2 diabetes mellitus patients attending Extension II clinic in Gaborone, Botswana. Summary of methods Design: descriptive cross-sectional study using self administered questionnaire Setting: Extension II clinic, a public family practice in Gaborone, Botswana. Study population: Consenting adults diagnosed with type 2 diabetes mellitus, aged 30 years or older, diagnosed 2 or more years and on clinic care. Sample selection: Convenience sampling method was used to select 35 subjects per month, over a period of three successive months and a total of 105 participants were recruited into the study, made up of 44 men and 61 women. Results 104 correctly filled questionnaires were included in the data analysis, of which, 59% were female. Estimated rates of non-adherence to diet and exercise were 37.4%; 95% CI, 27.7 – 46.3% and 52%; 95% CI, 42.4 – 61.6% respectively. The main perceived reasons for non-adherence to diet were granting self-permission (36.5%), lack of information (33.3%), eating out (31.7%), financial constraints (28.8%) and poor self control (26.9%); while the main perceived reasons for non-adherence to exercise were lack of information (65.7%), exercise as potentially exacerbating illness (57.6%), lack of exercise partner (24.0%), specific locations away from home (18.0%), and winter weather (15.4%). The overall reasons for not adhering to diet and exercise include lack of moral and emotional supports from the spouse (54.1%), family members (44.8%), and friends (58.7%). 95% and 67.3% of the participants had reported that diet and exercise respectively could improved and maintained their diabetic control. Conclusion Non-adherence to diet and exercise recommendations amongst type 2 diabetes patients is far more prevalent and no particular single reason could be attributed to poor adherence to either diet or exercise recommendations, rather a combination of many factors.

A presente investigação científica visa estabelecer biometricamente a análise comparativa dos elementos estruturais e ultra-estruturais que compõe o músculo cardíaco, em cães sadios e diabéticos, avaliando a proporção existente entre a quantidade de tecido conjuntivo e a de fibras musculares cardíacas, estudando a densidade vascular presente no músculo cardíaco e quantificando a proporção de organelas presentes naquelas fibras. Utilizou-se doze corações de cães, machos e fêmeas, sendo seis animais sadios e seis animais diabéticos, onde efetuou-se a mensuração do coração em seus eixos longitudinal e transversal e, ainda as espessuras das paredes dos ventrículos e do septo interventricular. Submeteu-se o músculo cardíaco ao estudo de seus elementos estruturais a partir do emprego da microscopia de luz analisados com auxílio de Programa de Análise de Imagem e Morfometria KS-400 Zeiss®. Já, os elementos ultra-estruturais foram investigados através do emprego da microscopia eletrônica de transmissão. Os dados obtidos foram tratados estatisticamente considerando-se as variáveis relativas ao sexo na presença ou não de diabetes. / The present scientific inquiry aims at biometrically to establish a comparative analysis of the structural and extreme-structural elements that composes the cardiac muscle in healthy and diabetic dogs. This will be given evaluating the existing ratio enters the conjunctive amount of fabric and of cardiac muscular staple fibers, studying the present vascular density in the cardiac muscle and still quantifying the ratio of organelles existents in those staple fibers. For in such a way we will use twelve hearts of dogs, males and females, being six healthy animals and six diabetic animals. We will effect the mensuration of the heart in its longitudinal and transversal axles, still the thicknesses of the walls of the ventricles and septum to interventricular, with digital aid of electronic paquimeter. The cardiac muscle was submitted to the study of its structural elements using Microscopy of light analyzed with aid of optic microscope Axioscópio Zeiss® and the Program of Analysis of Image and Morfometric Ks-400 Zeiss®. Already, the extreme-structural elements was investigated through the electronic Microscopy of transmission, evaluating themselves thus the ultra fine cuts from the attainment of the electromicrografics gotten in electron microscope Jeol 1010. The gotten data was treated statistically considering the relative variable the sex, in relation to the healthy animals and those diabetic ones.

A presente investigação científica visa estabelecer biometricamente a análise comparativa dos elementos estruturais e ultra-estruturais que compõe o músculo cardíaco, em cães sadios e diabéticos, avaliando a proporção existente entre a quantidade de tecido conjuntivo e a de fibras musculares cardíacas, estudando a densidade vascular presente no músculo cardíaco e quantificando a proporção de organelas presentes naquelas fibras. Utilizou-se doze corações de cães, machos e fêmeas, sendo seis animais sadios e seis animais diabéticos, onde efetuou-se a mensuração do coração em seus eixos longitudinal e transversal e, ainda as espessuras das paredes dos ventrículos e do septo interventricular. Submeteu-se o músculo cardíaco ao estudo de seus elementos estruturais a partir do emprego da microscopia de luz analisados com auxílio de Programa de Análise de Imagem e Morfometria KS-400 Zeiss®. Já, os elementos ultra-estruturais foram investigados através do emprego da microscopia eletrônica de transmissão. Os dados obtidos foram tratados estatisticamente considerando-se as variáveis relativas ao sexo na presença ou não de diabetes. / The present scientific inquiry aims at biometrically to establish a comparative analysis of the structural and extreme-structural elements that composes the cardiac muscle in healthy and diabetic dogs. This will be given evaluating the existing ratio enters the conjunctive amount of fabric and of cardiac muscular staple fibers, studying the present vascular density in the cardiac muscle and still quantifying the ratio of organelles existents in those staple fibers. For in such a way we will use twelve hearts of dogs, males and females, being six healthy animals and six diabetic animals. We will effect the mensuration of the heart in its longitudinal and transversal axles, still the thicknesses of the walls of the ventricles and septum to interventricular, with digital aid of electronic paquimeter. The cardiac muscle was submitted to the study of its structural elements using Microscopy of light analyzed with aid of optic microscope Axioscópio Zeiss® and the Program of Analysis of Image and Morfometric Ks-400 Zeiss®. Already, the extreme-structural elements was investigated through the electronic Microscopy of transmission, evaluating themselves thus the ultra fine cuts from the attainment of the electromicrografics gotten in electron microscope Jeol 1010. The gotten data was treated statistically considering the relative variable the sex, in relation to the healthy animals and those diabetic ones.

The Chronic Noncommunicable Diseases (NCDs), among them cardiovascular disease are present in the population in alarming numbers. Studies show the direct and indirect food intake with the development of these disorders. To do so, they become necessary research to assess the dietary patterns of the population, in order to support the formulation of actions and public health policies to control these diseases. This subject was the focus of this dissertation in order to explore what the main tools and methods that are being used in epidemiological research on the dietary pattern of the population and evaluate the dietary intake of patients seen in Ambulatory NCD Teaching Nutrition, University Hospital Federal University of Alagoas the literature review revealed that the most frequently used instruments for the assessment of food consumption remain the most traditional: food Frequency Questionnaire - FFQ and 24h recall - 24HR evaluated compared to the food groups, and adjustment to DRI's. As for consumer research with patients showed an adequate intake in respect to nutrients, micronutrients in relation to the consumption was only suitable for the vitamins A, B12, C and the mineral selenium compared to RDA and finally assessment performed by the method of RAS as the cutoff, revealed a high proportion of individuals with probability of inadequate intake for micronutrients, except iron and vitamin C. Given the above results, it is possible to realize that nutrition policy and nutrition education activities are necessary and which act continuously and impacting the population. / Conselho Nacional de Desenvolvimento Científico e Tecnológico / As Doenças Crônicas Não Transmissíveis (DCNT), dentre elas, as doenças cardiovasculares, estão presentes na população em números alarmantes. Estudos comprovam a relação direta e indireta do consumo alimentar com o desenvolvimento destas patologias. Para tanto, tornam-se necessárias pesquisas que avaliem o padrão alimentar da população, de forma a subsidiar a formulação de ações e políticas públicas de saúde no controle destas doenças. Esta temática foi o foco desta dissertação com o objetivo de explorar quais os principais instrumentos e métodos que estão sendo utilizados em pesquisas epidemiológicas sobre o padrão dietético da população e avaliar o consumo alimentar de portadores de DCNT atendidos em Ambulatório de Ensino de Nutrição do Hospital Universitário da Universidade Federal de Alagoas A revisão da literatura revelou que os instrumentos mais utilizados para a avaliação do consumo alimentar continuam sendo os mais tradicionais: Questionário de Frequência Alimentar – QFA e o Recordatório 24h – R24h avaliados comparação à grupos alimentares, e adequação à Ingestão Dietética de Referência (Dietary References Intakes – DRI’s). Já a pesquisa de consumo com os pacientes revelou uma ingestão adequada no que se refere a macronutrientes; em relação aos micronutrientes o consumo foi adequado apenas para as vitaminas A, B12, C e para o mineral selênio, quando comparado à ingestão dietética recomendada (Recommended Dietary Allowance / RDA) e por fim, a avaliação realizada através do método da EAR (Estimated Average Requirement/ Necessidade média estimada) como ponto de corte, revelou uma alta proporção de indivíduos com probabilidade de ingestão inadequada para os micronutrientes , à exceção do ferro e vitamina C. Diante dos resultados expostos, é possível perceber que políticas de nutrição e ações de educação nutricional se fazem necessárias e que atuem de maneira contínua e impactante na população.

Made available in DSpace on 2014-12-17T14:16:33Z (GMT). No. of bitstreams: 1 MelinaBL_DISSERT.pdf: 4468439 bytes, checksum: 05a71c9a22430196d211e6d7c8feea61 (MD5) Previous issue date: 2008-09-22 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Diabetes Mellitus (DM) and osteoposes are chronic diseases with great socioeconomic consequences, mainly due to the late complications and consequent disabilities. The potential effects of DM on bone metabolism remain a very conroversial issue, and disagreement exists with regard to the clinical implications of diabetic osteopenia and the mechanism of its ocurrence. The issue is further complicated by the contribuicion of the especific factors, such as duration of disease an dthe degree of metabolic control. The objective of this study is to identify the osteopathy in children and adolescents with DM 1 assisted in the hospital of pediatrics, UFRN, through biochemical markers of bone and mineral metabolism and the extent of bone mineral density. The study was composed by 74 diabetics type 1 patients (DM1) of both gender and aged 6 to 20 yars. Normoglic?mic group was composed by 97 healthy subjects of both genders, which showed the same age range of DM1, in addition to same socioeconomic class. These individuals qere students from the networks of public education in the city of Natal-RN, randomly invited to paticipate in our study. Both groups DM1 and NG were divided intofour subgroups, according to the classification of tanner , T1, T2, T3, T4 for achieving a benchmark. Diabetic individuals showed up with a poor glycemic control. the group DN1 T4 showed an incresead value for total protein, albumin, urea and microalbumiuria are predictors of grumelura injury in DM1 patients . The total alkaline phosphatase activitywas kept on high levels for both groups because they are in a stature development age. For osteocalcin there were decreased levels for groups Dm1 T1, T2, and T3 when compared to their NG (s), suggesting that this decrease could be associated with reduction in the number and/or differentiation os osteoblasts thereby contributing to reducing bone formation. There were no changes in the activity of TRAP. The serum concentrations of total and ionized calcium, phosphorus and magnesium were included within the RV. It was observed that the BMD (Z- SCORE ) has always been within the RV for both groups, despite to DM1 T4. Taking all together, our results support the hypothesis that children and adolescents with type 1 DM present the risk in the long run to suffer a reduction in the bone mass, associated to poor glicemic control and disease duration. It could limit the bone growth and increase the probality of development of osteopenia, as well as other complications surch as retinopathy and renal failure / Diabetes mellitus (DM) a osteoporose s?o doen?as cr?nicas com grandes consequ?ncias socioecon?micas, sobretudo devido ? complica??es tardias e consequente desabilidades. Os efeitos potenciais do DM no metabolismo ?sseo continua a ser uma quest?o controversa, e ainda n?o existe um consenso no que diz respeito ?s implica??es cl?nicas da osteopenia diab?tica e os mecanismos da sua ocorr?ncia. Entretanto, a contribui??o de fatores espec?ficos, tais como a dura??o da doen?a e o grau de controle metab?lico tem sido muito discutidos. O objetivo do presente estudo foi identificar precocemente a osteopatia diab?tica em crian?as e adolescentes com DM 1 atendidos no Hospital de Pediatria da UFRN atrav?s de marcadores bioqu?micos do metabolismo mineral e ?sseo, marcadores da fun??o renal e da medida da densidade mineral ?ssea (DXA; Z-score L1-L4) . O estudo foi constitu?do por uma amostra de 74 pacientes diab?ticos tipo 1 (DM1) de ambos os sexos, com faixa et?ria entre 6 a 20 anos. O grupo normoglic?mico (NG) foi constitu?do por 97 indiv?duos saud?veis, de ambos os sexos, os quais apresentaram a mesma faixa et?ria do DM1, al?m de compreenderem a mesma classe socioecon?mica. Estes indiv?duos eram alunos de escolas da rede p?blica de ensino da cidade de Natal-RN, convidados aleatoriamente a participar do nosso estudo. Tanto o grupo DM1 quanto o NG foram divididos em quatro subgrupos, de acordo com a Classifica??o de Tanner, T1, T2, T3, T4, para viabilizar uma avalia??o comparativa. Os indiv?duos diab?ticos apresentaram um controle glic?mico insatisfat?rio, com valores de glicemia e HbA1C significativamente superiores aos obtidos para os NG. O grupo DM1 T4 apresentou valores aumentados de prote?nas totais, albumina, ur?ia e microalbumin?ria, sugerindo assim um in?cio de comprometimento renal, visto que os valores elevados de microalbumin?ria s?o preditores de les?o glomerular em pacientes DM1. A atividade da fosfatase alcalina total mostrou-se acima dos VR nos grupos DM1 e NG por estes estarem numa faixa et?ria de desenvolvimento estatural. Observa-se uma diminui??o da concentra??o de osteocalcina para os grupos DM1 T1, T2 e T3 quando comparados aos respectivos NG (s), sugerindo que esta diminui??o estaria associada a diminui??o do n?mero e/ou da diferencia??o dos osteoblastos no seu est?gio final de matura??o, contribuindo consequentemente para a redu??o da forma??o ?ssea. N?o foram observadas altera??es na atividade da TRAP. As concentra??es s?ricas de c?lcio total e ionizado, f?sforo e magn?sio estavam compreendidos dentro dos VR, mas os grupos diab?ticos apresentaram hipozincemia e hiperzinc?ria. A DMO (Z-score L1-L4; DXA) esteve sempre dentro dos VR para os grupos estudados, entretanto os grupos DM1 apresentaram sempre valores abaixo do seu respectivo NG, alca?ando uma diferen?a significativa para DM1 T4. O conjunto de resultados obtidos indicam que o baixo controle glic?mico e o tempo de doen?a representaram fatores de risco importantes para o desenvolvimento precoce da osteopenia diab?tica, bem como para o comprometimento renal e sinais de retinopatia.