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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
161

Nutritional status of children in Khulna and Sylhet divisions in Bangladesh : a comparative analysis from the Bangladesh demographic and health survey 1996-97 /

Khanum, Parveen A., Gray, Alan Noel, January 1999 (has links) (PDF)
Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 1999.
162

Nutritional status and related factors among elementary school students in Banda Aceh Municipality, Nangroe Aceh Darussalam province, Indonesia /

Badrialaily, Jutatip Sillabutra, January 2008 (has links) (PDF)
Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.
163

Body composition, dietary intake and supplement use among triathletes residing in the Western Cape Region

Bam, Sunita 12 1900 (has links)
Thesis (MNutr(Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objective: The aim of this study was to determine the body composition, dietary intake and supplement use among training olympic and ironman distance triathletes residing in the Western Cape region. Design: Descriptive, analytical, cross-sectional study design Setting: Western Cape Province (South Africa) Subjects: Triathletes residing in the Western Cape region registered with Triathlon South Africa (N = 26) Outcome measures: Percentage body fat, total energy intake, macro– and micronutrient intake, use and reasons for use of nutritional supplements or nutritional ergogenic aids. Results: The mean age of the men and women was 37.9 [Standard Deviation (SD) 6.82] and 37.5 (9.6) years respectively. The corresponding mean amount of training per week for men and women respectively were 15.1 (4.1) and 15.3 (4.7) hours. The percentage body fat as determined by multi-frequency bio-electrical impedance analysis of the men and women were 12.97% (4.3) and 21.4% (6.3) respectively. The mean dietary macronutrient intake as determined by a three day food record for men was for total energy intake 14 534.7kJ (4509.8), carbohydrate intake 5.3g/kg body weight (BW) (1.9), protein intake 2.0g/kg BW (0.5) and fat intake 34.6% (10.31) of total energy requirements. Dietary micronutrients not reaching 67% of dietary reference intakes (DRI) from food alone included iodine (44%) and fluoride (49%). Vitamin C (154%). Micronutrient intake above upper limit (UL) was sodium (213%), manganese (162%) and niacin (228%). The dietary macronutrient intake for women was for total energy intake 9004.1kJ (2368.8), carbohydrate intake 3.5g/kg BW (1.0), protein intake 1.2g/kg BW (0.2) and fat intake 29.8% of total energy intake (6.0). Micronutrients not reaching 67% of the DRI were chloride (61%), iodine (31%) and fluoride (52%). Micronutrient intake above the UL was vitamin C (218%) and manganese (174%). The dietary intake of the men was inadequate in carbohydrate, provided sufficient energy and protein and excessive fat. The dietary intake of the women was inadequate in total energy and carbohydrate, with an adequate protein intake and excessive fat intake. Although the sample size was very small, some associations were found between dietary intake and clinical health status. Seventy three percent of the triathletes use over the counter dietary supplements. The supplements used most often included carbohydrate supplements (81%), multivitamin and mineral supplements (81%) single vitamins (65%), protein supplements (100%), single minerals (58%), antioxidants (54%) and herbal supplements (42%). Most popular reasons for consuming supplements included recovery (62%), increasing energy supply (61%), enhancing immune function (50%), exercise performance enhancement (46%), increasing muscle mass (54%) and to make up for an inadequate diet or nutrient replacement (31%). Conclusion: Percentage body fat of the men and women were at the upper end of the range associated with elite athletes. The athletes have a fairly good intake of macro– and micro-nutrients. Inadequate habitual carbohydrate intake can be attenuated by the vast majority of the triathletes taking additional carbohydrate supplementation. Supplements were used widely among the athletes, whether it is scientifically proven to be beneficial or not.
164

Growth and nutritional status of formula-fed infants aged 2-10 weeks in the Prevention of Mother-to-Child Transmission (PMTCT) Programme at the Dr George Mukhari Hospital, Gauteng, South Africa

MacDougall, Caida 12 1900 (has links)
Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / INTRODUCTION: Since the start of the Prevention of Mother-to-Child Transmission (PMTCT) Programme at Dr George Mukhari Hospital in 2001, there has been no evaluation of the effect of formula feeding on the growth and dietary intakes of enrolled infants. AIM: The aim of this study was to determine the short-term growth, anthropometry and dietary intake of infants from two to ten weeks of age were entered into the PMTCT Programme at the Department of Human Nutrition at Dr George Mukhari Hospital from two to ten weeks of age. METHODS: This was a descriptive, longitudinal (eight weeks duration) study. Anthropometric assessment including length and head circumference was performed at two weeks of age and thereafter at ten weeks of age. Weight measurement was performed at age two weeks (visit 1), six weeks (visit 2) and ten weeks (visit 3). Anthropometric measurements were compared with CDC 20003 growth charts. Feeding practices and dietary intake (24 hour diet recall interview) were assessed at each of the four week interval visits and evaluated according to the DRIs59. At the third visit, a socio-demographic interview and a usual food intake interview were performed. RESULTS: A total of 151 [male (N = 75) and female (N = 76)] infants completed the study. A total of 110 (72%) mothers resided in the Soshanguve area and 138 (91%) of the mothers had attended high school. The majority (75%) of mothers was not generating an income from employment. Generally, mothers had access to safe drinking water and all (99%) but two mothers used pre-boiled water before preparing infant formula. The accuracy and correctness of reconstituting infant formula decreased with each visit as feeds were increasingly made too dilute. A total of 124 (82%) infants were exclusively formula fed. The remainder received water, water with sugar and/or complementary feeds. Mean energy and macronutrient intakes of both males (N = 65, 87%) and females (N = 61, 80%) were below recommendations at age two weeks. Of all the macronutrients, fats were consumed the least by both males (N = 67, 89%) and females (N = 66, 87%) at visit 1. Catch up growth was evident and nutrient intakes improved as the study progressed. The mean weight gain of all infants from visit 1 to 2 was 1.2 (SD 0.3) kg and 0.9 (SD 0.3) kg from visit 2 to 3 (exceeding the CDC 20003 recommendation for both male and female infants). The incidence of underweight, wasting and head circumference-for-age below the third percentile decreased from visit 1 to 3, but the number of stunted infants increased towards visit 3. The majority of infants in this study grew well in their first ten weeks of life. Growth accelerated as infants became older and growth faltering improved by ten weeks of age. CONCLUSION: Overall, the growth of the infants referred to the PMTCT Programme at the Department of Human Nutrition at Dr George Mukhari Hospital would appear to be adequate but mothers’ approach to formula feeding practices needs to be improved in some aspects of feeding their infants.
165

Consumo alimentar familiar e indicadores antropométricos do estado nutricional de escolares de Piracicaba-SP

Alves, Roselene Valota [UNESP] 18 May 2009 (has links) (PDF)
Made available in DSpace on 2014-06-11T19:23:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-18Bitstream added on 2014-06-13T20:11:03Z : No. of bitstreams: 1 alves_rv_me_arafcf.pdf: 416426 bytes, checksum: 32bf2f1cca119f33163b397f1ed1313b (MD5) / Unimep / Diversas medidas no combate à fome vêm sendo discutidas nos últimos anos na busca de se garantir, a todos, condições de segurança alimentar e nutricional e assim, formular políticas públicas para este que é um dos maiores problemas do país. A nutrição adequada está diretamente relacionada às dimensões físicas e à composição corporal, principalmente no processo de crescimento e desenvolvimento da criança. Nesse sentido, o presente trabalho teve por objetivo estudar a relação do consumo alimentar familiar com os indicadores antropométricos do estado nutricional e o perfil socioeconômico de escolares do ensino fundamental de escolas públicas do município de Piracicaba-SP. O estudo foi realizado com 283 famílias de escolares distribuídas proporcionalmente entre as cinco regiões administrativas da cidade, por meio de medidas quali-quantitativas da aquisição de alimentos em inquérito que contempla o registro da freqüência de consumo de alimentos no domicílio e também dados socioeconômicos para uma melhor compreensão desse consumo. Na avaliação do estado nutricional dos escolares, distribuídos segundo a renda, 5,1% deles apresentaram baixa estatura para a idade, com prevalência significativa de crianças mais baixas no primeiro tercil de renda (10,8%) e, em todos os tercis, apresentaram valores acima do esperado na distribuição percentilar do índice de massa corpórea para idade, tanto no indicativo de baixo peso como no de excesso de peso. Entre as famílias dos escolares foi encontrada uma mediana de 4,0 pessoas por domicílio, com uma mediana de rendimento familiar de 0,8 salários mínimos per capita, com diferença significativa entre os tercis sendo que 38% da renda eram destinados à alimentação aumentando conforme diminui a renda. O consumo de energia e proteínas pelas famílias dos escolares atende aos valores recomendados e aumenta conforme... / Many measures to fight hunger have been discussed in recent years to assure conditions of food and nutrition security to everyone and thereby devise public policies for what is one of the greatest problems of the country. Proper nutrition is directly related to body size and composition, especially in the process of growth and development of the child. Thus, this study aimed to study the relationship between household food consumption and the anthropometric indicators of nutritional status and socioeconomic profile of elementary schoolchildren attending public schools in the city of Piracicaba, SP. The study included 283 families of elementary schoolchildren proportionally distributed within the five administrative regions of the city. A questionnaire that investigates meal frequency per household and socioeconomic data to better understand food consumption was used to determine food quality and amount. Nutritional assessment of the schoolchildren distributed according to income showed that 5.1% of them were stunted, with a significant prevalence of stunted children in the first income tercile (10.8%). All income terciles presented distribution percentages of BMI-for-age beyond the expected values, that is, both underweight and overweight children were more common than expected. The median family size of the schoolchildren was 4.0 individuals per household and the median family income was 0.8 minimum wages per capita. There was a significant difference between the terciles. A minimum of 38% of the family income went to food and this percentage increased as family income decreased. Energy and protein intakes met the recommended values and increased with income. Calcium and vitamin A intakes were low, decreased with income and differed significantly between the terciles. Among the assessed nutrients, there was a weak positive correlation between calcium and vitamin A intakes...(Complete abstract click electronic access below)
166

Avaliação nutricional de pacientes com câncer

Prado, Corina Dias do [UNESP] 10 June 2009 (has links) (PDF)
Made available in DSpace on 2014-06-11T19:23:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-10Bitstream added on 2014-06-13T18:50:52Z : No. of bitstreams: 1 prado_cd_me_arafcf.pdf: 343315 bytes, checksum: 55167744aca71f0e9ff073df79cd2825 (MD5) / Universidade Estadual Paulista (UNESP) / O objetivo deste trabalho foi estudar vários métodos de avaliação nutricional aplicados a pacientes oncológicos. No primeiro capítulo, discutiu-se a literatura existente sobre o tema, a fim de servir de subsídio para alertar os profissionais de saúde sobre a importância e as implicações do estado nutricional do paciente para seu prognóstico e qualidade de vida. No segundo capítulo, realizou-se a adaptação cultural da Avaliação Subjetiva Global – Produzida pelo Paciente (ASG-PPP) e estimou-se sua reprodutibilidade. No terceiro capítulo, calculou-se as medidas estimadas de peso e altura de 62 pacientes, avaliou-se sua correlação e concordância com as medidas reais e identificou-se o risco de desnutrição de pacientes oncológicos, o qual foi aferido a partir de diferentes métodos. No quarto capítulo, investigou-se as características clínicas, sócio-demográficas e o estado nutricional de 134 pacientes oncológicos atendidos no Hospital Amaral Carvalho- Jaú, SP, no período de abril a novembro de 2008 / The aim of this study was to describe the several methods of nutritional assessment applied in patients with cancer. In the first chapter, the current literature on this topic is described in order to make health professionals aware of the importance and implications of the nutritional status for the prognosis and quality of life of patients with cancer. In the second chapter, the transcultural adaptation of the “Patient-Generated Subjective Global Assessment (PG-SGA) was performed and its reliability was estimated. In the third chapter, the estimated measures of weight and height (n=62) were calculated, the correlation and concordance with real measurements were assessed, and the risk of malnutrition of patients with cancer was identified by means of different methods of evaluation. In the fourth chapter, the clinical and demographic characteristics, and the nutritional status of 134 oncologic patients at Amaral Carvalho Hospital-Jaú, SP, are investigated between April and November 2008
167

Violência familiar e estado nutricional de adolescentes numa unidade de saúde / Family violence and nutritional status of adolescents in health unit

Ana Maria Vieira Lourenço da Silva 27 August 2010 (has links)
O presente trabalho teve como objetivos verificar a possível associação entre violência intrafamiliar sofrida por adolescentes e estado nutricional. Foram investigadas as prevalências de agressão verbal, violências física, abuso psicológico e de estado nutricional inadequado dos adolescentes. Para tanto, foi realizado um estudo observacional de corte transversal numa amostra de 201 adolescentes de 10 a 19 anos cadastrados no Programa Bolsa Família e monitorados pelo Serviço de Nutrição de uma unidade de saúde do município do Rio de Janeiro. Junto aos adolescentes foi realizada avaliação antropométrica, e para a determinação do estado nutricional foi analisado o Índice de Massa Corporal (IMC) pelo parâmetro adotado pela OMS a partir de 2007. A violência familiar foi investigada por meio de dois instrumentos. O Conflict Tactics Scales Form R (CTS1) foi utilizado para avaliar os conflitos intrafamiliares no relacionamento entre pais e filhos e a escala de violência psicológica contra adolescentes para identificar a presença de violência psicológica contra os adolescentes. Além disso, foram avaliadas outras co-variáveis que pudessem influenciar a associação entre violência e situação nutricional da população estudada como informações sobre maturação sexual, sócio-demográficas e percepção corporal. No que diz respeito ao IMC, foram identificados 4,5% de baixo peso, 13,4% de sobrepeso e 5% de obesidade. No que se refere à violência familiar, foram observados 83,1% de agressão verbal, 50,2% de violência psicológica, 32,8% de agressão física grave e 48,3% de abuso físico menor. Através da regressão linear múltipla foi observada um associação entre violência familiar e o IMC em adolescentes do sexo feminino. A presença de agressão verbal perpetrada tanto pelo pai como pela mãe está relacionado ao IMC de forma estatisticamente significativa para as meninas. Já para os adolescentes masculinos não foi encontrada nenhuma associação significativa entre os diferentes tipos de violência familiar e o IMC, mas aponta para a redução do IMC. Outras estratégias de pesquisa de natureza qualitativa devem ser realizadas para esclarecer sobre os efeitos desfavoráveis do abuso verbal sobre o IMC junto aos pais e a sociedade já que a agressão verbal é um tipo de abuso normalmente utilizado no ambiente familiar e considerado como algo natural e aceitável / This work aimed to verify the possible association between violence experienced by adolescents and nutritional disorders. We investigated the prevalence of verbal agression, physical violence, psychological abuse and nutritional status of adolescents. For this, we performed a cross sectional observational study on a sample of 201 adolescents aged 10 to 19 years enrolled in the Programa Bolsa Família and monitored by the Nutrition Service of a Health Unit in the city of Rio de Janeiro. With adolescents was conducted anthropometric measurements, and for determining the nutritional status was assessed Body Mass Index (BMI) by the parameter adopted by WHO from 2007. Family violence was investigated by using two instruments. The Conflict Tactics Scales Form R (CTS 1) was used to evaluate the family conflicts in the relationship between parents and children and the scale of psychological violence against adolescents to identify the presence of psychological violence against adolescents. Additionally, we assessed other covariates that could influence the association between violence and nutritional status of the population with information on sexual maturation, socio-demographic information and body image. With respect to BMI, were identified prevalence of underweight (4,5%), overweight (13,4%) and obesity (5%). With regard to family violence were observed 83,1% verbal aggression, 50,2% of psychological violence, 32,8% of lower physical aggression and severe physical abuse 48,3%. Through multiple linear regression was observed an association between domestic violence and BMI in female adolescents. The presence of verbal aggression perpetrated by both the father and the mother is related to BMI were statistically significant for girls. As for the male adolescents did not find any association between different types of family violence and BMI, but points to a reduction in IMC. Other strategies for qualitative research should be conducted to clarify the adverse effects of verbal abuse on BMI with parents and society since the verbal abuse is a type normally used in the family environment and considered as something natural and acceptable
168

Ansiedade, consumo alimentar e o estado nutricional de adolescentes

Bosa, Vera Lúcia January 2010 (has links)
Esta tese aborda um tema pouco explorado na literatura: ansiedade, consumo alimentar e o estado nutricional de adolescentes. O objetivo foi estudar a relação entre ansiedade e consumo alimentar e seu impacto no estado nutricional em adolescentes escolares. Realizou-se um estudo transversal com adolescentes escolares de 10 a 19 anos que apresentaram triagem positiva para ansiedade, de acordo com a escala de autorrelato para transtornos relacionados à ansiedade na infância (SCARED-C), bem como uma amostra de controles sem transtornos de ansiedade. Na avaliação do consumo de energia e macronutrientes, utilizou-se o questionário de frequência alimentar para adolescentes (QFAA). A avaliação nutricional consistia em avaliação antropométrica e medida de bioimpedância elétrica (BIA), avaliação dos caracteres sexuais secundários e atividade física habitual. O teste qui-quadrado avaliou a associação entre variáveis categóricas e ansiedade ou gênero, e o teste t de Student ou ANOVA, a associação entre variáveis categóricas e o consumo de energia e macronutrientes. Para avaliar a relação entre o consumo, a ansiedade e as características biológicas, comportamentais e sociais, realizou-se análise de regressão, utilizando o método de Equações de Estimação Generalizadas (GEE). Foram avaliados 706 adolescentes com média de idade 13,9±2,4 anos. Desses, 149 (21,1%) apresentaram sobrepeso e 92 (13,0%), obesidade. A composição corporal revelou excesso de gordura em 235 (33,3%), acúmulo de gordura abdominal em 157 (22,2%) e, quanto ao nível de atividade física, 429 (60,8%) eram inativos, sendo que as meninas apresentam maior prevalência do que os meninos (p < 0,001). Na análise não ajustada, os ansiosos apresentaram, em média, maior consumo diário de energia total e carboidrato quando comparados aos não ansiosos (p = 0,039 e p = 0,037, respectivamente), quanto à proteína e à gordura, não apresentaram associação. Após ajuste de coeficientes, o efeito da energia persistiu, demonstrando que ser ansioso implica num consumo diário adicional de 246,5 kcal. Para o consumo de carboidratos com o ajuste pelas calorias totais, esse efeito desaparece. Não se observou relação entre a ansiedade e o estado nutricional e seus determinantes. Concluindo, evidenciou-se que, entre os adolescentes que apresentaram ansiedade, a ingestão de energia total foi superior àqueles não ansiosos, embora exista consumo proporcional de macronutrientes. Neste estudo, ao contrário de alguns achados da literatura, a ansiedade não teve relação com o sobrepeso e a obesidade. / The association between anxiety, food consumption and the nutritional status of adolescents has not been fully explored in the literature. This cross-sectional study evaluated this association in a group of adolescent students aged 10 to 19 years who had positive results for anxiety in a self-report questionnaire for anxiety disorders in childhood (SCARED-C), as well as in a control group of adolescents with no anxiety disorders. A food frequency questionnaire for adolescents (QFAA) was used to evaluate energy and macronutrient intakes. Nutritional status was assessed according to anthropometric parameters, electrical bioimpedance (BIA) measurements, secondary sexual characteristics and habitual physical activities. A chi-square test was used to evaluate the association between the categorical variables and anxiety or sex, and the Student t test or ANOVA, for the association between categorical variables and calorie and macronutrient intake. Regression analysis with generalized estimating equations (GEE) was used to evaluate the association between intake, anxiety and biological, behavioral and social characteristics. Mean age of the 706 adolescents evaluated was 13.9±2.4 years; 149 (21.1%) were overweight, and 92 (13.0%) were obese. The analysis of body composition revealed that 235 (33.3%) had excessive fat, and 157 (22.2%), excessive abdominal fat. The analysis of physical activity revealed that 429 (60.8%) were inactive, and the prevalence was greater for girls than for boys (p < 0.001). In the nonadjusted analysis, adolescents with anxiety had a greater mean total daily calorie and carbohydrate intake than adolescents without anxiety (p = 0.039 and p = 0.037); protein and fat were not significantly associated. After coefficient adjustments, the effect of calorie intake remained significant, which indicated that being anxious led to an additional daily consumption of 246.5 kcal. For the consumption of carbohydrates, this effect disappeared after the adjustment to total calories. There were no associations between anxiety and the nutritional status or its determinant factors. In conclusion, we found that, among adolescents with anxiety, total caloric intake was greater than for adolescents without anxiety, although macronutrient intake was not significantly different. In this study, contrary to several findings reported in the literature, anxiety was not associated with overweight or obesity.
169

Desenvolvimento de um novo instrumento de avaliação nutricional de adultos hospitalizados baseado nas questões da avaliação subjetiva global

Fink, Jaqueline da Silva January 2015 (has links)
Base teórica: Desnutrição é mundialmente prevalente em hospitais, e contribui para o aumento da morbimortalidade dos pacientes. Métodos de avaliação do estado nutricional estão disponíveis, mas são limitados quanto à viabilidade em contexto hospitalar. A Avaliação Subjetiva Global (ASG) é uma ferramenta válida que, na falta de um padrão-ouro, é considerada padrão de referência para avaliação nutricional de pacientes hospitalizados. Entretanto, a validade da ASG limita-se à experiência do avaliador em lidar com a subjetividade do método, para a correta elaboração do diagnóstico. Objetivo: Desenvolver e verificar o desempenho de um novo instrumento de avaliação nutricional, com base na Teoria de Resposta ao Item (TRI), a partir das questões da ASG, em pacientes adultos hospitalizados. Métodos: Estudo de coorte retrospectivo, composto por base secundária de dados, formada por adultos hospitalizados incluídos entre outubro de 2005 e junho de 2006. Os pacientes foram avaliados nas primeiras 72 horas após sua admissão hospitalar quanto a características clínicas e nutricionais, incluindo a aplicação da ASG, conforme prevista pelos seus autores de origem. Dividiu-se a amostra aleatoriamente, de maneira que dois terços dos pacientes compusessem a amostra de desenvolvimento do novo instrumento, e um terço a amostra de verificação do seu desempenho. O instrumento de avaliação nutricional proposto foi desenvolvido através da utilização dos modelos cumulativos da TRI. A capacidade do instrumento em diagnosticar corretamente o estado nutricional foi comparada a valores de exames laboratoriais, índice de massa corporal e ocorrência de desfechos clínicos, por meio de testes para igualdade de proporções. Resultados: De um total de 1503 pacientes avaliados, a média de idade foi de 55,5±16,1 (19-94) anos, 52,7% do sexo feminino. Primeiramente, mantiveram-se no modelo estatístico as questões da ASG qualitativas e mais informativas, excluindo-se as quantitativas e que apresentassem informações semelhantes. Pacientes com dados faltantes também foram excluídos, compondo uma amostra de 826 indivíduos para o desenvolvimento do novo instrumento de avaliação nutricional e 407 para a amostra de verificação do seu desempenho. A etapa de ajuste dos itens demonstrou pouca contribuição de questões relativas à diarreia, capacidade funcional e edemas para o diagnóstico nutricional. Ainda, itens relativos à perda de peso, ingestão alimentar e demanda metabólica apresentaram melhor desempenho dicotomizados. As questões mais informativas para a diferenciação do estado nutricional entre os pacientes foram, respectivamente, perda de gordura, perda muscular e perda de peso. Após ajuste dos itens, propôs-se o “Escore de Avaliação Nutricional” (Nutritional Assessment Score - NAS), com reduzido número de questões, e menos itens politômicos, em comparação à ASG. O NAS mostrou-se relacionado a variáveis clinicamente relevantes (óbito, infecção, longa permanência hospitalar, albumina sérica e índice de massa corporal), em ambas as amostras. Conclusão: Os resultados apontam para a validade do NAS em detectar, de maneira acurada, o estado nutricional de pacientes hospitalizados. Seu desenvolvimento sinaliza avanço na busca por um método de avaliação nutricional factível e com menos suscetibilidade a erros decorrentes de subjetividade, em comparação à ASG. / Background: Malnutrition is prevalent in hospitals worldwide, and contributes to an increase of morbidity and mortality in patients. Nutritional status evaluation methods are available, but are limited as to their feasibility in hospital environment. The Subjective Global Assessment (SGA) is a valid tool that, in the absence of a “gold” standard tool, is considered the “reference standard” for nutrition assessment in hospitalized patients. Nevertheless, the validity of SGA is limited to the expertise of the evaluator in dealing with the method’s subjectivity, for the correct elaboration of the diagnosis. Objective: To develop and verify the performance of a new nutrition assessment tool, based in the Item Response Theory (IRT), from the SGA questionnaire, in hospitalized adults. Methods: Retrospective cohort study, composed by secondary database, formed by hospitalized adults included between October 2005 and June 2006. Patients were evaluated in the first 72 hours of hospital admission as to their clinical and nutritional characteristics, including the use of SGA, in accordance to its original authors. The sample was divided at random in a way that two-thirds of the patients made up the sample for the development of the new tool, and the remaining one-third of the sample for the performance verification tool. The proposed nutritional assessment tool was developed using cumulative models of the IRT. The tool’s capacity in diagnosing correctly the nutritional status was compared to laboratorial data, body mass index and occurrence of clinical outcomes through proportion equality tests. Results: From a total of 1503 evaluated patients, the average age was 55,5±16,1 (19-94), and 52,7% were women. First of all, the qualitative and more informative questions in SGA were kept in the statistic model, excluding the quantitative questions and those which presented similar information. Patients with missing data were also excluded, leaving a sample of 826 individuals for the development of the new assessment tool, and 407 for the performance verification tool. In the item adjustment stage, questions related to diarrhea, functional capacity and edemas were of little contribution to the nutritional diagnosis. Moreover, items related to weight loss, food intake and metabolic demand showed better performance dichotomized. The most informative questions to perceive nutritional status amongst patients were, respectively, fat loss, muscle wasting and weight loss. After adjusting the items, the Nutritional Assessment Score – NAS was suggested, with a reduced number of questions and less polytomic items in comparison to SGA. The NAS was related with clinically relevant variables (death, infection, long length of stay, serum albumin and body mass index), in both samples. Conclusion: The results point to the validity of NAS in detecting, accurately, the nutritional status of hospitalized patients. Its development signals a breakthrough in the search for a nutritional assessment method feasible and less susceptible to errors due to subjectivity, in comparison to SGA.
170

En journalgranskning om risk för undernäring hos inneliggande patienter

Julia, Olsson, Frida, Engelmann January 2018 (has links)
Bakgrund: Undernäring definieras av att energi- och näringsintaget understiger behovet. Tillståndet resulterar i bl.a. viktnedgång. Ett mått för att mäta undernäring är kroppsmasseindex (BMI). Vid sjukdom ökar kroppens metabolism som gör att energi- och näringsbehovet ökar samtidigt som sjukdomen i sig försvårar matintaget. Riskbedömning är ett hjälpmedel för sjuksköterskor som bör utföras vid varje patient. Sjuksköterskan är enligt lag skyldig till att tidigt upptäcka undernäring eller risk för undernäring och sätta in relevanta åtgärder för att förhindra försämring.   Syfte: Syftet med studien var att belysa i vilken utsträckning sjuksköterskan dokumenterar riskbedömning för undernäring samt vilka åtgärder som utförs för att förebygga och/eller behandla undernäring under sjukhusvistelsen.   Metod: Studien har kvantitativ, prospektiv och deskriptiv design och har utförts genom journalgranskning.   Resultat: Resultatet visade att 31% av de inneliggande patienterna hade undernäring eller risk för undernäring. De tre vanligaste åtgärderna som sattes in mot undernäring var kostregistrering, beräknat energibehov samt daglig vikt. Riskbedömning utfördes på 47% av alla patienter, det innebär att ungefär hälften av alla patienter inte fått någon riskbedömning. Uppföljning av insatta åtgärder förekom inte i någon journal.   Slutsats: Endast 47% av alla inneliggande patienter hade fått en fullständig riskbedömning dokumenterad i journalen. De flesta insatta åtgärder är standardiserade evalueringar och motverkar i sig inte undernäring utan kräver kompletterande åtgärder. / Background: Malnutrition is defined by deficits in the energy- and nutrition levels. This state results in weight loss. One way to measure malnutrition is through a body-mass index (BMI). During illness, the body’s metabolism increases, which in return requires a greater intake of energy- and nutrition. At the same time, the state of the illness may make the food intake more difficult. Risk evaluation is an aid for nurses that should be performed with every patient. The nurse is required by law to discover malnutrition or risk of malnutrition at an early stage and put in relevant interventions to prevent deterioration of the patients’ physical health.   Objective: The aim of the study was to highlight to what extent the nurses document risk evaluation for malnutrition and what interventions were used to prevent malnutrition during the hospital stay.   Method: The study has a quantitative, prospective and descriptive design and was performed as a journal evaluation.   Result: The results showed that 31% of the inpatients suffered of malnutrition or risk thereof. The three most common interventions against malnutrition were: nutritional dietary records, estimated energy requirements and daily weight. Risk evaluation was performed on 47% of all patients, which means that half of the studied patients receive no evaluation at all. Follow up of the interventions were not presented in any journal.   Conclusion: Only 47% of all inpatients had a complete risk evaluation documented in their journal. Most of the interventions are standardized evaluations and do not in itself counteract malnutrition but need complementary interventions.

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