Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-20Bitstream added on 2014-06-13T19:07:29Z : No. of bitstreams: 1 suman_p_me_botfm.pdf: 1196436 bytes, checksum: 8dcde5816493bed62c06995c961056df (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A relação entre a doença renal crônica (DRC) e a deficiência auditiva (DA) vem sendo estabelecida através de estudos na área. Apesar de a hipertensão arterial e diabetes mellitus estarem frequentemente relacionados às duas patologias, poucos estudos levam em consideração seus efeitos sobre os achados audiológicos dessa população. O efeito do tipo de tratamento para DRC sobre a audição, bem como a localização da perda auditiva ainda são inconclusivos. O objetivo deste trabalho foi de verificar o efeito da DRC e dos tratamentos conservador, diálise peritoneal e hemodiálise, sobre a cóclea e nervo auditivo, levando-se em consideração o efeito das variáveis hipertensão arterial e diabetes mellitus. Sujeitos com idade acima de 60 anos, deficiência auditiva congênita, síndromes genéticas e/ou submetidos a transplante renal foram excluídos. Foram realizados Audiometria Tonal Limiar (ATL), Timpanometria, Emissões Otoacústicas Evocadas Transientes (EOAET) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE) em 101 sujeitos com DRC, subdivididos em 03 grupos, de acordo com o tipo de tratamento (A1: hemodiálise/ n=35; A2: diálise peritoneal/ n=15 e A3: conservador/ n=51) e um grupo controle foi formado por 27 sujeitos saudáveis (B). Entre os portadores de DRC, a hipertensão esteve presente em 86,1% dos sujeitos e o diabetes em 29,7%. A idade média dos doentes foi 46,7 (±12,3) anos enquanto que a do controle foi 36,6 (±12). Apresentaram DA uni ou bilateral 32,7% dos sujeitos do grupo A e não houve diferença estatisticamente significante da sua frequência entre os subgrupos A. Quanto ao tipo da perda, 92% das orelhas (n=45) foi neurossensorial e 8% mista (n=4). Quanto ao grau, 67% das orelhas (n=33) apresentaram perda leve, 20% (n=10) moderada, 5% (n=2) grave e 8% (n=4) profunda e não houve diferença significante do grau entre os subgrupos A. / The relation between chronic renal disease (CRD) and hearing loss (HL) has been determined by studies in the field. Despite arterial hypertension (AH) and diabetes melitius (DM) are frequently associated to both conditions, few studies considered their effects on the audiological findings in this population. The effects of the type of treatment for CRD on the hearing as well as on the site of the hearing loss are still inconclusive. The aim of this study was to verify the effect of the CRD, of different treatments: conservative, peritoneal dialysis and hemodialysis on the cochlea and on the auditory nerve, considering the effects of AH and DM. Subjects over 60 years, with born hearing deficiency, genetic syndromes and/or submitted to renal transplant were excluded. The 101 subjects with CRD were tested with Pure Tone Audiometry (PTA), Tympanometry, Transitory Evoked Otoacoustic Emissions (TEOE) and Auditory Brainstem Response (ABR). Subjects were divided in 3 groups according to the type of treatment (A1: hemodialysis/ N=35; A2: peritoneal dialysis/ N=15; A3: conservative/ N=51). The control group constituted of 27 health individuals (B). Among the individuals with CRD, 86.1% presented AH and 29.7% presented DM. The mean age was 46.7 y (± 12.3) in the group with CRD and 36.6 y (± 12) in the control group. In group A 32.7% of the subjects presented uni- or bilateral HL with no statistical difference between sub-groups. In what refers to the type of hearing loss, in 92% of the ears (N=45) it was neuro-sensorial and in 8% (N=4) it was mixed. The degree was mild in 63% (N=33) of the ears, moderate in 20% (N=10), severe in 5% (N=2) and profound in 8% (N=4), without significant differences between subgroups. When compared to group B, the group A presented significantly lower hearing thresholds on the PTA, smaller amplitude on the TEOE and more alterations on the ABR (10.4%/ N = 21 ears).

Purpose: Cardiovascular events and complications are the major causes of death in patients with end-stage renal disease (ESRD)¹⁻³. Antihypertensive agents that block the renin-angiotensin-aldosterone system (RAAS) are considered first-line therapy in patients with ESRD as these patients have a propensity for RAAS overactivation⁴⁻⁷. Studies show that aldosterone receptor blockade reduces BP in patients with chronic kidney disease (CKD) and helps prevent negative outcomes from continued renal cellular damage⁸⁻¹⁰. Spironolactone, an aldosterone antagonist, has the potential to provoke hyperkalemia. Consequently, current guidelines do not recommend spironolactone to manage hypertension in ESRD because of this risk⁶⁻⁷. Our primary objectives were to determine the change in BP and serum potassium levels following spironolactone use. Methods: This study was a retrospective, pre-post cohort study in ESRD patients with difficult-to-control BP receiving HD. Patients prescribed spironolactone (25 mg to 50 mg) between January 2009 and January 2013 were identified using an e-prescribing record from three HD clinics in San Antonio, TX. Patients were included if they were prescribed spironolactone as 'add-on' therapy to control BP for at least 8 weeks. Results: Seventy patients were evaluated and the majority of them were overweight, diabetic, Hispanic females with a mean 65 years of age. Mean SBP and DBP decreased from baseline to week 8 [-20.74 mmHg (p < 0.0001) and -9.7 mmHg (p < 0.0426), respectively]. Mean serum potassium levels increased by an average of 0.18 mEq/L (4.5 mEq/L to 4.68 mEq/L, p = 0.09). Data analysis revealed that only 9 of 70 patients had a serum potassium level > 5.5 mEq/L at week 8. There were no adverse cardiac events reported as a result of these potassium concentrations. A two-fold decrease in SBP was seen in patients with a body mass index (BMI) > 25 kg/m² compared to patients with a BMI of ≤ 25 kg/m². At the end of the study, 23 patients (33%) achieved the goal BP for healthy adults of < 140/90 mmHg. Conclusion: These findings demonstrated that using spironolactone use in ESRD patients receiving HD can be effective and safe. / text

Background: The growth in the number of individuals with end-stage renal disease has implications in terms of both the health of individuals, especially older adults (aged 65 years and older), and the capacity of the health care system to provide adequate treatment needed by these patients. Much has been written regarding the pathophysiology of end-stage renal disease as well as how modern advances in technology have contributed to the ‘dialysis world’. However, the literature is sparse in relation to how older adults experience end-stage renal disease and the technological complexity of dialysis in their daily lives. Objective: The purpose of this study was to explore the meaning of being hemodialysis-dependent for the older adult living with end-stage renal disease. Method: A descriptive method using a qualitative interviewing approach was used. Systematic focused thematic analysis guided by the Crisis of Physical Illness conceptual model allowed for the findings to surface. Data sources included individual interviews, direct observation of participants and the hemodialysis unit, along with field notes. A purposive sample of nine participants was obtained from two different hemodialysis units, both operated by Kingston General Hospital. Data were analyzed using the Colaizzi method. Findings: Five themes were identified by the participants: The Will to Live, Recognition of a Lifetime Commitment, Learning to Live with Technology, The Yin and Yang of Dialysis, and Transcending Dialysis. Conclusions: End-stage renal disease and thrice weekly hemodialysis treatment have an impact on the daily life of older adults and their ability to cope with the changes. This study revealed that despite the restrictions of being on hemodialysis, all of the participants had the will to live and some expressed the need for further education using a variety of strategies that would meet the specific needs of this population. A more in-depth understanding of how older adults experience hemodialysis is needed to provide adequate care/resources for this special population. / Thesis (Master, Nursing) -- Queen's University, 2011-09-15 13:02:28.548

Aim: - This research project was a community based intervention study of the impact of increased access to exercise opportunities and kangaroo meat on diabetes and cardiovascular disease risk factors in the Aboriginal community of Woorabinda. The exercise and dietary interventions were based on principles of community development including: training of community members to conduct exercise programmes; supply of exercise equipment; training of community members to harvest kangaroos; establishment of a butcher’s apprenticeship; and establishment of the kangaroo meat processing in the community. Methodology: - The impact of the kangaroo meat and exercise interventions on diabetes and cardiovascular disease risk factors was determined by pre- and post-intervention assessment. Pre-intervention baseline data was obtained by community clinical assessment, household meat surveys,and community exercise surveys. The post-intervention assessment was a repeat of modified meat and exercise surveys. A post-intervention community clinical assessment was not conducted due to unresolved difficulties encountered in conducting the research project. The Study Population: - The study population for the community clinical assessment and exercise surveys were volunteer adults B 15 years of age. Approximately one third of the adult population participated in the community clinical screening, 29% in the pre-intervention exercise survey, and 20.2% in the post-intervention exercise survey. The meat surveys were conducted on a household basis. There was 84% household participation in the pre-intervention meat survey and 44.3% postintervention. Findings and Discussion: - It was found that the exercise and kangaroo meat interventions did not follow the planned linear trajectory but rather proceeded in an episodic and incremental manner. The community clinical assessment found a high prevalence of diabetes (18.6%; 95% CI, 13.04 – 24.36%) and impaired glucose tolerance (13.2%; 95% CI, 8.3 – 18.1%) comparable to that found in other Indigenous communities. There was a low prevalence of hypercholesterolaemia (30.9%; 95% CI, 24.2 – 37.6%) and hypertension (19.7%; 95% CI, 13.9 – 25.5%). High prevalence for other diabetes and cardiovascular disease risk factors were found including: current smoking (48.3%;95% CI, 40.95 – 55.64%); and obesity as measured by body mass index (35%; 95% CI, 27.9 – 42%), waist circumference (83.7%; 95% CI, 76.5 - 90.86% in women; and 55.5%; 95% CI, 43.9 – 61.1% in men), and waist / hip ratio (75.5%; 95% CI, 66.9 – 84% in women; and 57.1%; 95% CI,46 – 68% in men). A high prevalence of abnormal ACR was found: the prevalence ACR 3.4 – 33.9g/mol was 11.7% (95% CI, -ve2.39 – 25.7%), and the prevalence ACR B 34g/mol was 7.6% (95% CI, -ve6.8 – 22%). The prevalence of proteinuria was 67.8% (95% CI, 59.3 – 76.3%). It was found that this high prevalence of renal disease indicators coincided with an escalating incidence of end-stage renal disease in the community. Analysis of the kangaroo meat surveys found evidence of positive dietary change including reduction in the amount of fat used to cook non-kangaroo meats, and a positive shift in stage of change for cooking for family health. In regard to kangaroo meat however it was found that the most common cooking method was unfavourable with the nutritional value of the meat being compromised by a significantly higher prevalence of frying than other meats. It was further found that this method for cooking kangaroo meat was unchanged by the research intervention. Evidence of positive change was also seen in analysis of the exercise surveys. It was found that at baseline, and post-intervention, that the majority of adults in the community met the recommended duration for exercise per week through activities of daily living. There was a positive shift in stage of change for exercise behaviour with a significant movement beyond the ‘precontemplation' towards the ‘action’ and ‘maintenance’ stages of change. This positive shift in thinking about exercise corresponded with a significant increase in the proportion of people exercising specifically for health and fitness. Conclusion: - Though not all the proposed intervention objectives were accomplished the research project contributed to furthering community aspirations and capacity. The community clinical assessment provided a useful overview of the health status of Woorabinda, and an opportunity of a thorough health check for community members. The community clinical assessment drew attention to future projections of disease in Woorabinda and prompted a concentrated health system response. Evidence of positive change in regard to meat consumption and exercise behaviours were found, changes however were slow and uneven. Improved infrastructure was important to increasing community capacity for kangaroo meat supply and exercise, but essential to the sustainability of community initiatives is skilled people, and on-going maintenance and support. The findings of this study indicate that simplistic assumptions around the health benefits of ‘traditional’ diet need to be reconsidered cognisant that communities such as Woorabinda are cultures in transition. Whilst limitations in the methodology require the findings to be considered with caution, this study provides useful evidence for planning future health education and health promotion initiatives for Woorabinda.

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Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-07-13Bitstream added on 2014-06-13T18:59:07Z : No. of bitstreams: 1 paduan_vc_me_botfm.pdf: 638955 bytes, checksum: cc8b28021cf5c063ee4a99457f91c5f5 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A doença renal crônica terminal caracteriza-se pela perda da função do rim, exigindo terapias renais substitutivas (TRS), como a diálise peritoneal, hemodiálise, ou transplante. O transplante renal parece ser o tratamento que proporciona melhor qualidade de vida (QV) aos pacientes, porém características sociodemográficas, clínicas e psicossociais devem ser identificadas, pois também podem interferir na QV dessas pessoas. Avaliar índices de QV de pacientes submetidos ao transplante renal, e estudar a associação desses índices com condições de vida e saúde. Num estudo observacional de corte transversal, descritivo e analítico, foram avaliados 165 pacientes adultos, que haviam sido submetidos a transplante renal, e estavam em acompanhamento no ambulatório de pós-transplante renal do Hospital das Clínicas da Faculdade de Medicina de Botucatu- UNESP. Foi utilizado um formulário padronizado para obter informação sobre aspectos sociodemográficos e clínicos, e instrumentos específicos para avaliar QV - Short-Form Health Survey (SF-36), sintomas depressivos - Inventário de Depressão de Beck (BDI), ansiedade - Inventário de Ansiedade Traço-Estado (IDATE), e apoio social - Medical Outcomes Study (MOS). Para a realização das análises estatísticas foi adotado o nível de significância estatístico padrão de p<0,05 para rejeição da hipótese de nulidade. Foi realizada a análise bivariada estudando-se a associação das diferentes variáveis de exposição com os componentes da qualidade de vida por meio dos testes não-paramétricos de Mann-Whitney ou Kruskal–Wallis, ou pela correlação linear de Spearman, quando adequado. Tais resultados foram posteriormente submetidos à análise multivariada por meio da regressão linear múltipla para obtenção de... / Terminal chronic renal disease is characterized by the loss of the kidney function and demands renal replacement therapies (RRT) as peritoneal dialysis, hemodialysis, or transplantation. Renal transplantation seems to be the treatment that provides the best quality of life (QL) to patients, but socio-demographic, clinical and psycho-social characteristics must be identified because they may also interfere in these people’s QL. To evaluate QL indices of patients submitted to renal transplantation, and to study the association of these indices with life and health conditions. In an observation study of transverse, descriptive and analytical cut, 165 adult patients, submitted to renal transplantation, were evaluated, and were followed in the renal post-transplantation clinic of the Clinical Hospital of the Botucatu Medical School - UNESP. A standardized form was used to obtain information on the social demographic and clinical aspects, and specific tools to assess QL - Short-Form Health Survey (SF-36), depression symptoms - Beck Depression Inventory (BDI), anxiety – State-Trait Anxiety Inventory (STAI), and social support - Medical Outcomes Study (MOS). In order to do the statistical analysis, the level of standard statistical significance of p<0.05 was adopted to reject the null hypothesis. A bivariate analysis was done studying the association of different exposure variables with components of quality of life through Mann-Whitney or Kruskal–Wallisnon-parametric tests, or though Spearman correlation when appropriate. Such results were afterwards submitted to multivariate analysis through multiple linear regression to obtain association estimates without misunderstandings. In the bivariate analysis, it was observed that different social demographic, clinical and psychosocial characteristics were associated significantly with the different... (Complete abstract click electronic access below)

Resumo: A relação entre a doença renal crônica (DRC) e a deficiência auditiva (DA) vem sendo estabelecida através de estudos na área. Apesar de a hipertensão arterial e diabetes mellitus estarem frequentemente relacionados às duas patologias, poucos estudos levam em consideração seus efeitos sobre os achados audiológicos dessa população. O efeito do tipo de tratamento para DRC sobre a audição, bem como a localização da perda auditiva ainda são inconclusivos. O objetivo deste trabalho foi de verificar o efeito da DRC e dos tratamentos conservador, diálise peritoneal e hemodiálise, sobre a cóclea e nervo auditivo, levando-se em consideração o efeito das variáveis hipertensão arterial e diabetes mellitus. Sujeitos com idade acima de 60 anos, deficiência auditiva congênita, síndromes genéticas e/ou submetidos a transplante renal foram excluídos. Foram realizados Audiometria Tonal Limiar (ATL), Timpanometria, Emissões Otoacústicas Evocadas Transientes (EOAET) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE) em 101 sujeitos com DRC, subdivididos em 03 grupos, de acordo com o tipo de tratamento (A1: hemodiálise/ n=35; A2: diálise peritoneal/ n=15 e A3: conservador/ n=51) e um grupo controle foi formado por 27 sujeitos saudáveis (B). Entre os portadores de DRC, a hipertensão esteve presente em 86,1% dos sujeitos e o diabetes em 29,7%. A idade média dos doentes foi 46,7 (±12,3) anos enquanto que a do controle foi 36,6 (±12). Apresentaram DA uni ou bilateral 32,7% dos sujeitos do grupo A e não houve diferença estatisticamente significante da sua frequência entre os subgrupos A. Quanto ao tipo da perda, 92% das orelhas (n=45) foi neurossensorial e 8% mista (n=4). Quanto ao grau, 67% das orelhas (n=33) apresentaram perda leve, 20% (n=10) moderada, 5% (n=2) grave e 8% (n=4) profunda e não houve diferença significante do grau entre os subgrupos A. / Abstract: The relation between chronic renal disease (CRD) and hearing loss (HL) has been determined by studies in the field. Despite arterial hypertension (AH) and diabetes melitius (DM) are frequently associated to both conditions, few studies considered their effects on the audiological findings in this population. The effects of the type of treatment for CRD on the hearing as well as on the site of the hearing loss are still inconclusive. The aim of this study was to verify the effect of the CRD, of different treatments: conservative, peritoneal dialysis and hemodialysis on the cochlea and on the auditory nerve, considering the effects of AH and DM. Subjects over 60 years, with born hearing deficiency, genetic syndromes and/or submitted to renal transplant were excluded. The 101 subjects with CRD were tested with Pure Tone Audiometry (PTA), Tympanometry, Transitory Evoked Otoacoustic Emissions (TEOE) and Auditory Brainstem Response (ABR). Subjects were divided in 3 groups according to the type of treatment (A1: hemodialysis/ N=35; A2: peritoneal dialysis/ N=15; A3: conservative/ N=51). The control group constituted of 27 health individuals (B). Among the individuals with CRD, 86.1% presented AH and 29.7% presented DM. The mean age was 46.7 y (± 12.3) in the group with CRD and 36.6 y (± 12) in the control group. In group A 32.7% of the subjects presented uni- or bilateral HL with no statistical difference between sub-groups. In what refers to the type of hearing loss, in 92% of the ears (N=45) it was neuro-sensorial and in 8% (N=4) it was mixed. The degree was mild in 63% (N=33) of the ears, moderate in 20% (N=10), severe in 5% (N=2) and profound in 8% (N=4), without significant differences between subgroups. When compared to group B, the group A presented significantly lower hearing thresholds on the PTA, smaller amplitude on the TEOE and more alterations on the ABR (10.4%/ N = 21 ears). / Orientador: Jair Cortez Montovani / Coorientador: Luis Cuadrado Martin / Banca: Kátia de Freitas Alvarenga / Banca: Paschoal Barretti / Mestre

Orientador: Maria Fernanda Cordeiro de Carvalho / Banca: Maria Cristina Ribeiro de Castro / Banca: Marilza Mazalli / Resumo: Não disponível. / Abstract: Not available. / Mestre

Background: End-stage renal disease (ESRD) is a chronic medical condition where 90% or more of the kidneys are nonfunctional (Doig & Huether, 2014). The current treatment for ESRD is Hemodialysis [HD] (National Institute of Diabetes and Digestive and Kidney Disease [NIDDK], 2013). Individuals who have ESRD who undergo HD suffer from tremendous symptom and treatment burden that affects various facets of life (Axelsson, Klang, Hagelin, Jacobson, & Gleissman, 2014; Axelsson et al., 2012; Tamura & Cohen, 2010). Unfortunately, the symptom and treatment burden associated with ESRD are underrecognized and undertreated (Feely et al., 2016; Gelfman & Meyer, 2012; Murtagh, Addington-Hall, & Higginson, 2007; Russon & Mooney, 2010; Tamura & Meier, 2013). Purpose: The purpose of this quality improvement project is to explore if ESRD patients in Davita Desert Dialysis are knowledgeable about palliative care and if providing education might change their behavior. The primary aim is to create awareness in patients about PC services in an effort to improve their quality of care through education. Design: A quantitative pre- and post survey approach using qualtrics software was utilized to assess the baseline and post-education knowledge of patients who met the inclusion criteria. Setting: DaVita Desert Dialysis, Sun City, AZ. Intervention: The educational intervention is the viewing of a three-minute voice over presentation about palliative care. Limitations: The sample size was small and exposes this study to marked bias and non-generalizability due to the limited number of recruited individuals. Results: One hundred percent of the individuals in the posttest had better awareness about and knowledge about PC. Conclusion: PC can improve the quality of life of patients that suffer from the undertreated and underrecognized symptom and treatment burden (Tamura & Meier, 2013). Further data and studies will be needed to establish PC in the field of nephrology as it relates to the ESRD population undergoing HD. However, the quality improvement focus of increasing PC awareness among ESRD patients undergoing HD has shown great promise as all participants had increased awareness, knowledge availability, and readiness for PC services.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22123号 / 社医博第98号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 柳田 素子, 教授 長船 健二 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM