Dialysis treatment is demanding for adult patients let alone for children. The families can have financial problems and the relations within the family are disrupted. The school attendance of children on dialysis is affected by the treatment. Because of the insertion of a peritoneal catheter and the necessity to wear a mouthpiece among other children the children can feel "different". The aim of the thesis is to determine the needs of child patients on dialysis and the views of their families regarding the illnesses and the dialysis treatment. A further goal was to examine the life of the dialysed children and their families with regards to social elements and how the dialysed children perceive the treatment. We have set down five questions. How do the dialysed children and their families adapt? How does dialysis of the child patients affect their families? How do the dialysed children perceive their illness? What information do the children have about their medical condition? What is the difference between the children with inherent and acquired illness? A qualitative research was used to assess the data acquired by semi-structured interviews. Two sets of questions for the dialysed children and their parents were created for the interviews. The interviews helped to find out how the children spend their time and how they perceive their regular visits to the dialysis centres and the process of dialysis itself. The questions for parents focused on issues regarding family, personal and social situations and the life of their dialysed children. The first research group was composed of 8 children of different ages and the criterion for including them into the group was their treatment by elimination methods. The second research group was formed by 8 parents who regularly accompany their children to the dialysis centres. The research group thus represented 53 % of the possible respondents in the Czech Republic. The chapter on data categorization defines several issues that were most problematic for the respondents. The information acquired from children and parents show that the children in the chronic dialysis program and their parents are subject to involuntary changes in their lives. The changes affect the social inclusion of the children, relations within the family; the school attendance of the children is limited due to their visits of the dialysis centres or hospitalisations. The children are separated from their families, peers and the financial situation is of the family is also affected as the mother often has to stay at home and take care of the child. There are, of course, efforts to improve not only the results of the treatment but also the subjective perception of the patient. The results of the research indicate that the children treated by peritoneal dialysis have thanks to better time options more opportunities to join a collective e.g. in school. An interesting fact is that the children often handle the dialysis process better than their parents because they support their children who rely on them. This thesis should help not only the medical staff in everyday contact with dialysed patients but can also serve as a basis for improvement in other areas of care of chronically ill children. Chapter Recommendations for practice lists sets of activities that with the help of the whole team of doctors and non-doctors contribute to the treatment. The care must always revolve around the question "What can I do to help"? The most important areas are psychical suffering of the children and their families, the dialysed patients? discomfort, dietary restrictions and problematical areas of care.

Nutrition plays a major role in the treatment and preventing the progression of renal disease. Malnutrition is the determining factor for morbidity and mortality in dialysis patients. Patients with renal disease tend to have reduced food intake, due to loss of appetite, depression, but also as a consequence of chronic inflammation or lack of antioxidant mechanisms. Poor nutritional status of these patients must be recognized early and treated. It is important to ensure adequate intake of energy, protein and calcium, and at the same time to reduce intake of potassium, sodium, phosphate and fluids. A supplementation of vitamins and micronutrients may be appropriate. The nutritional status should be checked regularly. The research part demonstrates the dependence of laboratory values on nutritional status and a positive effect of education on patients' compliance with the recommended diet.

Made available in DSpace on 2014-06-11T19:32:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-28Bitstream added on 2014-06-13T20:42:58Z : No. of bitstreams: 1 antunes_aa_dr_botfm.pdf: 341028 bytes, checksum: 77e0edbeb31c062a9b5b2f0b7e56f7ae (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Desnutrição e sobrecarga líquida têm sido apontadas como fatores que contribuem para o pior prognóstico cardíaco da população em diálise. A bioimpedância é opção para avaliação da composição corporal e monitoramento do estado de hidratação, entretanto faltam estudos que investiguem a relevância dos parâmetros da bioimpedância em relação ao prognóstico cardiovascular. O objetivo deste trabalho foi identificar a importância do monitoramento seriado por bioimpedância na ocorrência de eventos cardiovasculares. Avaliou-se por bioimpedância 145 indivíduos prevalentes em diálise, em intervalos de quatro meses, investigando as relações entre parâmetros da bioimpedância e prognóstico cardiovascular fatal e não fatal. O período de seguimento foi de 23(12; 34) meses, com 27,6% dos pacientes acometidos por eventos cardiovasculares. Análise comparativa entre os pacientes que apresentaram e os que não apresentaram evento cardiovascular revelou que menores valores de ângulo de fase, massa celular corporal e água intracelular e maiores valores das relações massa extracelular/ massa celular corporal e água extracelular/ água corporal total foram indicativos de pior prognóstico cardiovascular. A análise de sobrevida por modelo de Cox convencional considerando unicamente parâmetros obtidos na inserção do paciente no estudo reforçou esses achados, exceto para relação água extracelular/ água corporal total. Na monitoração seriada por bioimpedância, analisada por modelo de Cox com covariável dependente do tempo, os parâmetros não foram preditores de eventos cardiovasculares. Esse conjunto de achados sugere a associação da desnutrição e da sobrecarga líquida com a ocorrência de eventos cardiovasculares, o que reforça a aplicação da bioimpedância em diálise / Malnutrition and fluid overload have been pointed as contribution factors to the poor cardiovascular prognosis of dialysis population. Bioimpedance is an option for both body composition and hydration status evaluations, however there are few studies that have investigated the relevance of the bioimpedance parameters in relation to cardiovascular prognosis. The purpose of this study was identify the importance of continued monitoring by bioimpedance in the prediction of cardiovascular events. One hundred forty five prevalent dialysis patients were evaluated every four months by bioimpedance, and the relations between its parameters and fatal and nonfatal cardiovascular events were investigated. During the follow-up of 23(12; 34) months, 27.6% of patients had cardiovascular events. The comparative analysis between patients that had no events and those that had cardiovascular events showed that lower values of phase angle, body cell mass and intracellular water and higher values of the relation between extracellular water/ total body water and between extracellular mass/ body cell mass pointed to a worse cardiovascular prognosis. The survival analysis by traditional Cox regression considering parameters obtained in first evaluation reinforced these findings, except for extracellular water/ total body water relation. In serial monitoring by bioimpedance, analyzed by time-dependent Cox regression, the parameters were not identify as cardiovascular predictors. This set of findings suggests the association of malnutrition and fluid overload with cardiovascular events occurrence and reinforces the usefulness of bioimpedance in dialysis

I takt med att befolkningen blir allt äldre och bakomliggande sjukdomar som hypertoni och diabetes ökar i samhället kommer allt fler drabbas av kronisk njursvikt. Något som kommer ställa krav på sjukvården både ekonomiskt och resursmässigt. Leva med kronisk njursvikt och dialysbehandling kan komma att påverka flera aspekter av patientens liv både psykiskt, fysiskt och socialt. Det är därför av vikt att sjuksköterskan har förmåga att individanpassa undervisning och omvårdnad utifrån patientens behov samt finnas till som stöd och vägledare. Studiens syfte var att beskriva patienters upplevelser av att leva med peritonealdialys (PD). Studien är utförd som en allmän litteraturstudie med systematisk metod. Genom bearbetning av vetenskapliga artiklar framkom tre kategorier. Att anpassa livet, att kroppen förändras och att relationer förändras. I resultatet framkom en bred variation av hur patienterna valde att integrera PD som en del av livet och hur de utformade strategier för att bemästra den nya situationen.  Hur patienterna upplevde sin behandling och dess påverkan på det vardagliga livet sågs olika bland deltagarna. Även sjuksköterskans roll visade sig mångdimensionell och betydande för denna patientgrupp. Ur resultatet framgick det att sjukvården behöver optimera patientundervisningen, person-centrera omvårdnaden och eliminera osäkerhet och rädsla hos patienter och anhöriga relaterat till okunskap. / In a society where people get older and conditions such as hypertension and diabetes is on the rise more people will get afflicted by chronic renal failure. Something that will make huge demands on healthcare, both financially and resourcefully. Living with chronic renal failure and dialysis treatment may affect several aspects of the patient's life, both mentally, physically and socially. It is therefore important that the nurse has the ability to individualize education and nursing according to the needs of the patient, as well as being able to support and guide. The aim of this study was to describe patients' experiences of living with peritoneal dialysis (PD). The study is conducted as a literature review with an systematic method. By processing scientific articles five categories revealed: to adapt life, the body changes and relationships takes new turns. In the result there was a broad variation of how the patients choose to integrate PD as a part of their lives and how they formed strategies to master their new situation. How the patients perceived their treatment and their impact on everyday life were seen differently among the participants. The nurse's role also turned out to be multidimensional and of great importance for this patient group.  From the results it emerged that health care has some work to do to optimize education, individualize nursing and eliminate the uncertainty and fear of patients and relatives related to the lack of knowledge.

Introdução: A hemodiálise (HD) requer um acesso vascular funcionante para sua realização. A fístula arteriovenosa nativa (FAV) constitui-se no acesso ideal para essa prática, com menores índices de morbidade e trombose e melhor qualidade de vida. A estenose da FAV é a maior causa de trombose e perda do acesso vascular. A monitorização continuada dos acessos através de diferentes métodos pode reduzir a incidência de trombose da FAV, conforme indicado por estudos com controle histórico e não-randomizados. Objetivos: Avaliar se uma estratégia intervencionista através de ecografia com Doppler (ED), angiografia digital (AD) e angioplastia (ATP) reduz a incidência de trombose e necessidade do uso de cateter em veia central temporário (CVC) em relação ao manejo conservador em pacientes com FAV em programa de HD. Métodos: Estudo prospectivo randomizado controlado de 108 pacientes e 111 FAV em programa de HD durante 11 meses. No grupo controle, foram realizadas mensurações quinzenais de parâmetros hemodinâmicos durante sessões de HD. No grupo intervenção, além da mensuração dos parâmetros hemodinâmicos, foi realizada ED a cada três meses, seguido de AD em casos de disfunção do acesso, definida pela ocorrência de pelo menos 1 dos seguintes critérios: redução do frêmito da FAV, aumento das pressões venosas, pobre fluxo arterial ou formação de hematoma ou edema no membro superior recorrentes durante HD, e/ ou pela presença de estenose vascular maior que 50% e/ou um fluxo estimado inferior à 500ml/min na ED. Em estenoses angiográficas superiores a 50% foi realizada ATP. Os desfechos avaliados foram trombose e necessidade de implantação de CVC, bem como desfecho composto, dado pela associação dos desfechos referidos. Resultados: Foram randomizadas 58 FAV para o grupo controle e 53 FAV para o grupo intervenção. Não foram observadas diferenças significativas entre os grupos em relação aos dados demográficos, comorbidades e características do acesso. O tempo médio de seguimento foi de 7,5 meses. No grupo intervenção, foram realizadas 97 ED, com média de 1,83 exame por paciente. Foram indicadas 14 AD, sendo que um paciente não compareceu ao estudo. Foi evidenciada trombose da FAV em 4 casos, e estenose não-significativa em 1. Estenose significativa foi observada em 8 pacientes, sendo então realizada ATP nesses casos. Não houve diferença significativa entre os grupos quanto à incidência de trombose (24,1% vs 17,0% p=ns). A estratégia intervencionista determinou redução significativa na incidência de necessidade de CVC (25,9% vs 7,5%, p=0,021), e na incidência do desfecho composto (44,8% vs 20,8%, p=0,033). Conclusões: A estratégia intervencionista no manejo das FAV promoveu uma redução significativa da necessidade de CVC e do desfecho composto de trombose e CVC. / Background: Hemodialysis (HD) requires a functioning vascular access in appropriate conditions. Native arteriovenous fistulae (NAF) provide the ideal access for that practice. Stenosis of the NAF is the highest cause of thrombosis and loss of the HD vascular access. The continuous monitorization of the NAF through different methods reduce the incidence of thrombosis according to non-randomized studies with historical control. Objective: To evaluate an interventionist strategy through the follow up of the NAF with Color Flow Doppler ultrasound (US), digital angiography and transluminal angioplasty (ATP), when suitable, to reduce the thrombosis and need for the use of a temporary central vein catheter (CVC) rates in relation to the conservative strategy. Methods: A prospective randomized controlled study of 108 patients and 111 permanent vascular access in an HD program. In the control group, assesment of the hemodynamic parameters of the vascular access were performed every fiftheen days. In the intervention group , besides the assesment of the hemodynamic parameters, was submitted to US every three months, as well as with angiography in cases that presented criteria for dysfunction of the access, defined by the occurrence of at least 1 of the following: reduction of the thrill; increase of the vein pressure during HD sessions; impossibility of obtaining a flow of 300 ml/min during HD; recurring hematoma or edema formation and/or the presence of larger vascular stenoses than 50% or a flow lower than 500ml/min at the US. The patients that presented angiographic evidence of hemodymically significant stenoses were submitted to ATP. The primary outcomes were need for temporary CVC during the follow up, FAV thrombosis and composite outcome. The outcomes were compared between the groups at the end of a 11 months period of follow-up. Results: Fifht eight FAV were randomized to control group and 53 FAV to interventional group. No significant differences were observed between the groups in relation to the demographic data, comorbidities and characteristics of the access. The NAF studied were followed up for a mean time of 7,5 months. In the interventional group, 97 US were performed, with an average of 1,83 exam per patient. A total of 14 digital angiography were required, and evidenced thrombosis in 4 patients and nonsignificant stenosis in 1. Significant stenosis was observed in 8 patients, and ATP was performed in those cases. No statistically significant difference was observed between the groups in thrombosis rates 24,1% vs 17,0%, p=ns). The interventional strategy showed statistically significant redution in the incidence of the need for placement of CVC (25,9% vs 7,5%, p=0,021). The differences in the composite outcome was statistically significant (44,8% vs 20,8%, p=0,033). Conclusions : The interventional strategy promoted a significant reduction rates for the need of placement of central vein catheter and of the combined outcome in the studied sample, showing benefits in patients with FAV in hemodialysis program.

Made available in DSpace on 2016-08-12T18:48:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-06-21. Added 1 bitstream(s) on 2016-08-12T18:50:58Z : No. of bitstreams: 1 000865115.pdf: 1167817 bytes, checksum: d666ddace602ebad1f4085e5014c5972 (MD5) / A doença cardiovascular é a principal causa de mortalidade nos pacientes com doença renal crônica (DRC) em programa de hemodiálise e a calcificação vascular (CV) é comum nesta população. O principal objetivo deste estudo foi avaliar a associação de marcadores do metabolismo mineral e ósseo com a presença e progressão da CV em uma coorte de pacientes em diálise; secundariamente, objetivou identificar as associações clínicas, laboratoriais e da composição corporal sobre a presença e progressão da CV. Foram incluídos maiores de 18 anos em diálise crônica há mais de 90 dias. Os pacientes foram submetidos à biópsia óssea no início do seguimento e analisados dados de histomorfometria. Para investigar CV foi utilizada a somatória dos índices radiológicos de Kauppila e Adragão em dois momentos, no início, coincidindo com a realização da biópsia óssea e após 12 meses. Além da investigação para CV foram realizadas avaliações clínicas, hormonais, inflamatórias, bioquímicas e nutricionais. Resultados: 60 pacientes completaram o estudo, 41,7 % do sexo feminino, 43,4% diabéticos, média de idade de 56 anos, variação de 25 a 89 anos. No seguimento, 75% dos pacientes apresentavam CV e a progressão ocorreu em 56,86%. Na análise multivariada, a idade > 60 anos (Odds ratio=50.2, 95%CI= 4.1-618,4, p=0.002), FGF23 > 3000 Ru/ml (Odds ratio=5.7, 95%IC= 1,00-329, p=0.05), e fetuína A >673 μ/l (Odds ratio=7.34, 95%CI= 1,26-43,7, p=0.03) estiveram associados com a CV. Para progressão da CV, a associação foi mostrada para idade > 60 anos (Odds ratio=4.3, 95%CI= 1.003-18.5, p=0.049), fetuína A >673 μ/l (Odds ratio=6.4, 95%CI= 1.47-27.9, p=0.01), e o não uso de estatinas (Odds ratio=5.6, 95%CI= 1.13-28.1, p=0.03). Não foi possível mostrar associações com os marcadores da remodelação óssea ou com os parâmetros achados de histomorfometria tanto no diagnostico como na progressão da CV. Conclusão: O presente... / Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD) in hemodialysis and vascular calcification (VC) is common in this population. The main objective of this study was to evaluate the association of markers of mineral and disorder on the presence and progression of VC in a cohort of dialysis patients. Secondarily, it was intended to identify associations between clinical, laboratory and body composition markers with the presence and progression of VC. There were included patients aged over 18 years on chronic dialysis for more than 90 days. The patients were submitted to bone biopsy at the beginning of the follow-up and histomorphometric data analyzed. To investigate VC a sum of radiological scores of Kauppila and Adragão were obtained in two occasions: at the beginning of the follow-up and after 12 months. In addition, clinical, hormonal, inflammatory, biochemical and nutritional evaluation were performed. Results: Sixty patients completed the study; 41.7% were female, 43.4% diabetics, and the average age was 56.7 years (range 25 to 89 years). At the beginning of the follow-up, 75% of the patients showed VC and its progression was observed in 56.8%. At multivariate analysis, age > 60 years (Odds ratio = 50.2, 95% CI=4.1-618.4, p=0.002), FGF23>3000 Ru/mL (Odds ratio = 5.7, 95% CI=1.00-329, p=0.05), and fetuin A>673 g/l (Odds ratio = 7.34, 95% CI=1.26-43.7, p=0.03) were associated with VC. As for the VC progression, the association was shown to age>60 years old (Odds ratio = 4.3, 95% CI=1.003-18.5, p=0.049), fetuin A> 673 g/l (Odds ratio = 6.4, 95% CI = 1.47-27.9, p=0.01), and the non-use of statins (Odds ratio = 5.6, 95% CI=1.13-28.1, p=0.03). It was not possible to show the association with bone turnover markers and the histomorphometric findings both in diagnosis and progression of VC. In conclusion, the present study reinforces the role of aging, the FGF23 level and the statin protection in ...

Made available in DSpace on 2015-05-08T14:47:38Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1077820 bytes, checksum: 833fc676cf6372c570a341689c54ee81 (MD5) Previous issue date: 2013-01-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Population aging is a meaningful growing phenomenon, what makes the individual more vulnerable to acute non transmitted diseases such as chronic renal disease that predispose elderly to the need of hemodialysis to survive, demanding a constant adaptive process due to the modifications provoked by such illness and its therapeutics. Despite this, there are few studies that approach the phenomenon. Considering what has been exposed, the present study aims analyzing, in the light of Roy s model, the elderly adaptive process when submitting to hemodialysis. This is an exploratory study involving fifteen elderly people suffering chronic renal disease treated at a specialized Clinic in the city of João Pessoa, Paraíba. The data was collected in the period of January to April of 2012, by recorded interviews having a semi-structured script. The analysis of the corpus was carried by a qualitative approach using the content analysis technique and the guiding principle were four pre-established thematic categories corresponding to the adaptive modes proposed by Roy: physiologic, self-concept, function in the real life and interdependence. In relation to the physiological mode were identified inefficient responses related to oxygen components, nutrition, elimination, fluids, electrolytes, endocrine function, activity and repose/rest, protection and senses. Regarding the relative category to the self-concept mode, the elderly showed inefficient behavior related to the physiological self such as the feeling of despair, sadness and death, embarrassment and stigma related to the modification in their body image provoked by the both the illness and the treatment. As to the personal self, some elderly presented an efficient coping of the illness and therapeutics, what favored a positive adaptive process manifested by feelings of hope, cure, dreams, desire and faith in God. Concerning the representative category of the function mode of real life/interdependence, the elderly showed inefficient behavior such as feeling of impotence due to the loss of their social role, dissatisfaction, changes in the social and family living, and bonds of friendships. In this category were also observed positive affective behavior to face the illness situation, such as the support from their family, friends and the Health professionals that promoted improvement in the adaptive process of the elderly. The results of the present study allowed us to infer that the elderly undergoing hemodialysis present difficulties to adapt to the illness and the treatment. In view of this finding, the present research can give support to the health staff, in especial to the Nursing, to the planning of interventions that can contribute to the help the elderly to cope with the difficulties provoked by the treatment of the analyzed phenomenon, what implies in improvement in their lives. / O envelhecimento populacional é um fenômeno que vem crescendo significativamente, o que torna o indivíduo mais vulnerável às doenças crônicas não transmissíveis, como a doença renal crônica, que predispõe os idosos à necessidade de tratamento hemodialítico para sobreviver, o que demanda um processo adaptativo constante ante as modificações geradas por essa enfermidade e sua terapêutica. A despeito disso, há poucos estudos que abordam o fenômeno. Considerando o exposto, este estudo teve como objetivo analisar, à luz do Modelo de Roy, o processo adaptativo de idosos frente ao tratamento hemodialítico. Estudo exploratório, que envolveu quinze idosos com doença renal crônica, atendidos numa Clínica especializada do município de João Pessoa, Paraíba. Os dados foram coletados no período de janeiro a abril de 2012, por meio de entrevista gravada, utilizando-se como instrumento um roteiro semiestruturado. A análise do material empírico foi feita mediante uma abordagem qualitativa, por meio da técnica de análise de conteúdo, e o eixo norteador foram quatro categorias temáticas pré-estabelecidas, correspondentes aos modos adaptativos propostos por Roy: fisiológico, autoconceito, função na vida real e interdependência. Em relação à categoria modo fisiológico, foram identificadas respostas ineficazes relacionadas aos componentes oxigenação, nutrição, eliminação, fluidos, eletrólitos, função endócrina, atividade e repouso/descanso, proteção e sentidos. No que tange à categoria relativa ao modo autoconceito, os idosos evidenciaram comportamentos ineficazes relacionados ao self físico, como sensação de desespero, tristeza, morte, vergonha e estigma relacionados às modificações na imagem corporal advindas da doença e do tratamento. Quanto ao self pessoal, alguns idosos evidenciaram um enfrentamento eficaz da doença e a terapêutica, o que favoreceu um processo adaptativo positivo, expresso por sentimentos de esperança, cura, sonhos, desejos e fé em Deus. No concernente à categoria representativa do modo função na vida real/interdependência, os idosos demonstraram comportamentos ineficazes, como sentimentos de impotência, devido à perda de seu papel social, insatisfação, desvalorização, dependência, mudanças no convívio social, familiar e nos laços de amizades. Nessa categoria, também foram observados comportamentos afetivos positivos para enfrentar tal situação, como: apoio de familiares, de amigos e de profissionais de saúde, que promoveram melhora no processo adaptativo dos idosos. Os resultados do estudo permitiram inferir que os idosos em tratamento hemodialítico apresentam dificuldades para se adaptar à doença e ao tratamento. Tendo em vista esse achado, esta pesquisa pode servir de suporte para a equipe de saúde, em especial, para a de Enfermagem, para o planejamento de intervenções que possam contribuir para que o idoso enfrente as dificuldades relativas ao tratamento do fenômeno analisado, o que implica melhora em sua vida.

Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-16Bitstream added on 2014-06-13T20:38:54Z : No. of bitstreams: 1 queiroz_cmt_me_botfm.pdf: 835935 bytes, checksum: af572634a1bee4fdb6e1307ddb73c204 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O presente estudo teve como objetivo estimar a prevalência de comprometimento cognitivo, sintomas depressivos e avaliar a qualidade de vida de pacientes com insuficiência renal crônica em três formas de tratamento: pré-diálise, diálise peritoneal e hemodiálise; estudou ainda a associação desses desfechos com variáveis sócio-demográficas e clínicas. Este estudo de corte transversal avaliou 182 pacientes (75,2%) dos 242 em tratamento na Unidade de Diálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP, em 2008. Destes, 39 realizavam diálise peritoneal, 112 realizavam hemodiálise e 31 estavam em pré-diálise. Os instrumentos utilizados para obtenção dos dados foram: o formulário sócio-demográfico e clínico; o Mini-Exame do Estado Mental (MEEM) e o teste de Fluência Verbal (Categoria Animais) para avaliação da função cognitiva; o inventário de depressão de Beck (BDI), para avaliação de sintomas depressivos e o Self-Reporting Questionnaire–20 (SRQ-20) para avaliação de transtorno mental comum e o The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) para avaliação da qualidade de vida (QV). Verificou-se que 55.0% dos indivíduos estudados eram homens e a idade média era de 57,5 anos. Diabetes foi a doença de base predominante (32,5%) e o tempo médio de tratamento era de 36 meses. A prevalência de comprometimento cognitivo foi de 56,6%. Cerca da metade dos pacientes (44,9%) apresentava sintomas depressivos e 44.0% Transtorno Mental Comum. A partir do resultado da análise univariada, que estimou a associação dos casos de comprometimento cognitivo com variáveis sócio-demográficas e clínicas, elaborou-se o modelo de regressão logística (stepwise forward). Constatou-se que os prováveis fatores de risco, após se ajustar para idade, sexo e renda, foram: apresentar baixa escolaridade... / The present study aimed to estimate the prevalence of cognitive impairment compromise, depressive symptoms and evaluate the quality of life of patients with chronic kidney disease (CKD) under three forms of treatment: predialysis, peritoneal dialysis and hemodialysis. The association of these outcomes with sociodemographic and clinical variables was also studied. This cross-sectional study evaluated 182 patients (75.2%) of the 242 being treated at the Dialysis Unit of the Clinics Hospital of the Botucatu Medical School, UNESP, in 2008. Of these, 39 were being treated by peritoneal dialysis, 112 by hemodialysis and 31 were in predialysis. The instruments used to obtain the data were: the sociodemographic and clinical form; the Mini-Mental State Examination (MMSE) and Verbal Fluency Test (animal category) to evaluate cognitive function; the Beck Depression Inventory (BDI) to evaluate depressive symptoms; the Self-Reporting Questionnaire 20 (SRQ-20) to evaluate common mental disorders; and The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to evaluate the quality of life (QL). Data analysis verified that 55.0% of the individuals studied were men and patient mean age was 57.5 years-old. Diabetes (32.5%) was the predominant underlying disease and the mean treatment time was 36 months. The prevalence of cognitive compromise was 56.6%. Almost half the patients (44.9%) presented depressive symptoms and 44.0% common mental disorders. Based on the results of univariate analysis, which estimated the association of cognitive impairment cases with sociodemographic and clinical variables, the logistic regression model (stepwise forward) was elaborated. The probable risk factors determined after adjusting for age, sex and income were: having low education (OR 3.05; IC 1.38-6.77); having diabetes mellitus (OR 2.34; IC 1.24-9.02); being treated by hemodialysis ... (Complete abstract click electronic access below)

?rea de concentra??o: C?nica Odontol?gica. / Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-06-28T12:17:12Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_de_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-06-28T12:56:27Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_de_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) / Made available in DSpace on 2016-06-28T12:56:27Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_de_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) Previous issue date: 2015 / Justificativa: Considerou-se que o impacto do tratamento odontol?gico na qualidade de vida e na autoestima de pacientes submetidos ? hemodi?lise ainda n?o est? esclarecido, sendo necess?rios novos estudos de base populacional para melhor conhecimento dos efeitos dessa patologia. Objetivo: Verificar se o tratamento odontol?gico minimamente invasivo ? capaz de gerar melhoria na qualidade de vida e na autoestima de pacientes submetidos a hemodi?lise. M?todos: Realizou-se um estudo intervencional com 46 pacientes Submetidos ? hemodi?lise na cidade de Diamantina, Brasil. Os pacientes foram divididos em dois grupos de acordo com a presen?a ou n?o de dentes; dentados e desdentados. Os pacientes desdentados receberam informa??o sobre higiene bucal e realizaram bochechos com gluconato de clorexidina a 0,12%. O grupo dentado recebeu raspagem em sess?o ?nica de 45 minutos e tamb?m realizou o bochecho, caso fosse necess?rio tamb?m eram realizados: resinas anteriores, recontorno de restaura??es, fechamento de cavidades com cimento de ion?mero de vidro e exodontias de emerg?ncia. As informa??es sobre as condi??es de sa?de bucal e fatores socioecon?micos foram obtidas atrav?s de um prontu?rio aplicado por um cirurgi?o dentista. A qualidade de vida foi avaliada atrav?s do instrumento Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) e Oral Health Impact Profile (OHIP) na sua vers?o 14. J? para a autoestima utilizou-se a Escala de Autoestima de Rosenberg. Os question?rios foram aplicados antes do tratamento e ap?s 45 dias. As an?lises estat?sticas foram efetuadas com o pacote estat?stico SPSS? para Windows? (Statistical Package for the Social Sciences Inc., IBM) na vers?o 22.0. Foram realizadas an?lises descritivas, teste de Wilcoxon, Mann_Whitney e Spearman. O n?vel de signific?ncia adotado foi de 5% (p<0,05). Resultados: A m?dia de idade foi 50,24 anos (?15,60) e o ?ndice CPO-D m?dio foi de 21,83 (?11,12). Houve signific?ncia estat?stica nas dimens?es do SF-36 no grupo ed?ntulo e dentado. O grupo dentado apresentou signific?ncia em quase todas as dimens?es do OHIP-14 e melhora da autoestima. Conclus?es: O tratamento odontol?gico gerou melhora significativa da qualidade de vida e da autoestima dos pacientes submetidos ? hemodi?lise, sendo o impacto maior nos pacientes que possuem dentes. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Odontologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / Background: The impact of dental treatment on quality of life and self-esteem of patients undergoing hemodialysis is not clear, requiring population-based studies to better understand the effects of this disease. Objective: To verify if the minimally invasive dental treatment is able to improve quality of life and self-esteem of hemodialysis patients. Methods: It was an interventional study with 46 patients subjected to hemodialysis in the city of Diamantina, Brazil. The patients were divided into two groups according to the presence or absence of teeth; toothed and toothless. The edentulous patients received information about oral hygiene and performed mouthwash with 0.12% chlorhexidine gluconate. The dentate group received one session scraping in 45 minutes and also held the mouthwash, if necessary were performed: previous resins, restorations recontouring, closing cavities with glass ionomer cement and emergency extractions. Information on oral health status and socioeconomic factors were obtained through a chart applied by a dentist. Quality of life was assessed using the instrument Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) and Oral Health Impact Profile (OHIP) in their version 14. As for the self-esteem used the Rosenberg Self-Esteem Scale. The questionnaires were applied before treatment and after 45 days. Statistical analyzes were performed with the statistical package SPSS for Windows (Statistical Package for Social Sciences Inc., IBM) in version 22.0. Descriptive analyzes were carried out, Wilcoxon test and Spearman Mann_Whitney. The significance level was 5% (p <0.05). Results: The mean age was 50.24 years (? 15.60) and the average DMFT index was 21.83 (? 11.12). There was statistical significance in the dimensions of the SF-36 in edentulous and dentate group. The dentate group showed significance in almost all dimensions of OHIP-14 and improved self-esteem. Conclusions: The treatment produced a significant improvement in quality of life and self-esteem of patients undergoing hemodialysis. The largest impact occured on patients who have teeth.

?rea de concentra??o: Cl?nica Odontol?gica. / Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-07-12T17:20:30Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-07-12T18:50:51Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) / Made available in DSpace on 2016-07-12T18:50:51Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) Previous issue date: 2015 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (Capes) / Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM) / Justificativa: Considerou-se que o impacto do tratamento odontol?gico na qualidade de vida e na autoestima de pacientes submetidos ? hemodi?lise ainda n?o est? esclarecido, sendo necess?rios novos estudos de base populacional para melhor conhecimento dos efeitos dessa patologia. Objetivo: Verificar se o tratamento odontol?gico minimamente invasivo ? capaz de gerar melhoria na qualidade de vida e na autoestima de pacientes submetidos a hemodi?lise. M?todos: Realizou-se um estudo intervencional com 46 pacientes Submetidos ? hemodi?lise na cidade de Diamantina, Brasil. Os pacientes foram divididos em dois grupos de acordo com a presen?a ou n?o de dentes; dentados e desdentados. Os pacientes desdentados receberam informa??o sobre higiene bucal e realizaram bochechos com gluconato de clorexidina a 0,12%. O grupo dentado recebeu raspagem em sess?o ?nica de 45 minutos e tamb?m realizou o bochecho, caso fosse necess?rio tamb?m eram realizados: resinas anteriores, recontorno de restaura??es, fechamento de cavidades com cimento de ion?mero de vidro e exodontias de emerg?ncia. As informa??es sobre as condi??es de sa?de bucal e fatores socioecon?micos foram obtidas atrav?s de um prontu?rio aplicado por um cirurgi?o dentista. A qualidade de vida foi avaliada atrav?s do instrumento Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) e Oral Health Impact Profile (OHIP) na sua vers?o 14. J? para a autoestima utilizou-se a Escala de Autoestima de Rosenberg. Os question?rios foram aplicados antes do tratamento e ap?s 45 dias. As an?lises estat?sticas foram efetuadas com o pacote estat?stico SPSS? para Windows? (Statistical Package for the Social Sciences Inc., IBM) na vers?o 22.0. Foram realizadas an?lises descritivas, teste de Wilcoxon, Mann_Whitney e Spearman. O n?vel de signific?ncia adotado foi de 5% (p<0,05). Resultados: A m?dia de idade foi 50,24 anos (?15,60) e o ?ndice CPO-D m?dio foi de 21,83 (?11,12). Houve signific?ncia estat?stica nas dimens?es do SF-36 no grupo ed?ntulo e dentado. O grupo dentado apresentou signific?ncia em quase todas as dimens?es do OHIP-14 e melhora da autoestima. Conclus?es: O tratamento odontol?gico gerou melhora significativa da qualidade de vida e da autoestima dos pacientes submetidos ? hemodi?lise, sendo o impacto maior nos pacientes que possuem dentes. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Odontologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2015. / ABSTRACT Background: The impact of dental treatment on quality of life and self-esteem of patients undergoing hemodialysis is not clear, requiring population-based studies to better understand the effects of this disease. Objective: To verify if the minimally invasive dental treatment is able to improve quality of life and self-esteem of hemodialysis patients. Methods: It was an interventional study with 46 patients subjected to hemodialysis in the city of Diamantina, Brazil. The patients were divided into two groups according to the presence or absence of teeth; toothed and toothless. The edentulous patients received information about oral hygiene and performed mouthwash with 0.12% chlorhexidine gluconate. The dentate group received one session scraping in 45 minutes and also held the mouthwash, if necessary were performed: previous resins, restorations recontouring, closing cavities with glass ionomer cement and emergency extractions. Information on oral health status and socioeconomic factors were obtained through a chart applied by a dentist. Quality of life was assessed using the instrument Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) and Oral Health Impact Profile (OHIP) in their version 14. As for the self-esteem used the Rosenberg Self-Esteem Scale. The questionnaires were applied before treatment and after 45 days. Statistical analyzes were performed with the statistical package SPSS for Windows (Statistical Package for Social Sciences Inc., IBM) in version 22.0. Descriptive analyzes were carried out, Wilcoxon test and Spearman Mann_Whitney. The significance level was 5% (p <0.05). Results: The mean age was 50.24 years (? 15.60) and the average DMFT index was 21.83 (? 11.12). There was statistical significance in the dimensions of the SF-36 in edentulous and dentate group. The dentate group showed significance in almost all dimensions of OHIP-14 and improved self-esteem. Conclusions: The treatment produced a significant improvement in quality of life and self-esteem of patients undergoing hemodialysis. The largest impact occured on patients who have teeth.