RESUMO
ABSTRACT This article attempts to reflect on the importance of thinking in general about illness and about cancer, from an ethical perspective. This approach reveals the central role of personal dignity and the moral relevance that supports the reasons for respecting people. The ethical values that sustain the practice of medicine must aim at uplifting this dignity and seeking situations of justice, since living in a community expresses intersubjectivity that cannot be truncated by illnesses like cancer. Therefore, situations involving poverty cannot justify the lack of health care, and if such lacks occur, they run counter to ethical awareness in the deepest sense and destroy intersubjectivity. As a result, cancer is suffered as a vital experience, in a framework of lives that are lived and are not simply objects of study; those stricken with cancer are individuals who are denied the human right to health, and undergo the elimination of their dignity, the cancelation of justice, and a death sentence. Society is part of these actions and at the same time, suffers from the disappearance of hope. In this sense, the process of informed consent is used as a tool that encourages dialog and understanding between doctors and patients during proper treatment, on a shared path.(AU)
RESUMEN El artículo pretende hacer una reflexión sobre la importancia de pensar, en general, la enfermedad y, en particular, el cáncer, desde una perspectiva ética. Este acercamiento permite vislumbrar el papel central que tiene la dignidad de las personas y la relevancia moral que apuntalan las razones por las cuales ellas han de ser respetadas. Los valores éticos que sustentan la práctica médica han de apelar a enaltecer dicha dignidad y buscar situaciones de justicia, dado que vivir en comunidad da cuenta de una intersubjetividad que no puede ser truncada por enfermedades como el cáncer. Esto evidencia que las situaciones de pobreza no pueden justificar la carencia de cuidados de salud y que, cuando esto sucede, se contraviene, desde lo más hondo, una conciencia de carácter ético y se rompe la intersubjetividad. El cáncer se sufre en tanto experiencia vital, en un marco de vidas vividas y no simplemente de objetos de estudio; los enfermos son personas a quienes se les niega el derecho humano de la salud, se les borra su dignidad, se cancela la justicia y se les condena a la muerte. La sociedad es parte de estas acciones y a la vez sufre la cancelación de esperanzas. En este sentido, se retoma el proceso del consentimiento informado (CI) como una herramienta que permite el diálogo y la comprensión entre médicos y pacientes en la atención digna, en un camino compartido.(AU)
Assuntos
Justiça Social/ética , Pessoalidade , Consentimento Livre e Esclarecido/ética , Neoplasias/psicologia , Relações Médico-Paciente/ética , PobrezaRESUMO
This article attempts to reflect on the importance of thinking in general about illness and about cancer, from an ethical perspective. This approach reveals the central role of personal dignity and the moral relevance that supports the reasons for respecting people. The ethical values that sustain the practice of medicine must aim at uplifting this dignity and seeking situations of justice, since living in a community expresses intersubjectivity that cannot be truncated by illnesses like cancer. Therefore, situations involving poverty cannot justify the lack of health care, and if such lacks occur, they run counter to ethical awareness in the deepest sense and destroy intersubjectivity. As a result, cancer is suffered as a vital experience, in a framework of lives that are lived and are not simply objects of study; those stricken with cancer are individuals who are denied the human right to health, and undergo the elimination of their dignity, the cancelation of justice, and a death sentence. Society is part of these actions and at the same time, suffers from the disappearance of hope. In this sense, the process of informed consent is used as a tool that encourages dialog and understanding between doctors and patients during proper treatment, on a shared path.
Assuntos
Neoplasias , Respeito , Humanos , Consentimento Livre e Esclarecido , Justiça Social , Atenção à Saúde , Neoplasias/terapiaRESUMO
La obesidad es un problema de salud pública, que particularmente se ha incrementando en la edad escolar. El objetivo de la investigación, fue establecer la relación entre indicadores antropométricos y factores de riesgo cardiovascular en escolares obesos, a través de un estudio descriptivo-correlacional, en 160 prepúberes. Se evaluaron condición socioeconómica, estado nutricional por el índice de masa corporal (IMC), Circunferencia de Cintura (CC) e Índice de Conicidad (IC), presión arterial, glicemia e insulinemia basal, CT, LDL-c, VLDL-c, HDL-c, triglicéridos (TG) e índices CT/HDL, LDL/HDL y TG/HDL. Fueron incluidos 88 escolares obesos y 72 controles. La mayoría fueron categorizados en los estratos socioeconómicos III- IV. Se consiguieron valores elevados de IMC, CC, IC, tensión arterial sistólica y diastólica, insulina basal, VLDL-c y TG en menores 10 años, entre los obesos (Mann-Whitney: p<0,05) con relación a los controles. Además, la existencia de menores promedios de glicemia y HDL-c, y mayores promedios de TG (> 10 años), CT/HDL, LDL/HDL y TG/HDL en los obesos, con diferencias estadísticamente significativas (t de Student: p<0,05) entre los grupos. El IMC y la CC tuvieron correlación significativa (p<0,05) con la presión arterial sistólica y diastólica y con la insulina basal; el IC solo con la presión diastólica y la insulina basal. Se concluye que existió una relación entre los indicadores antropométricos en estudio y factores de riesgo cardiovascular como fueron la tensión arterial y la insulinemia basal(AU)
The obesity is a public health concern that particularly has been increasing in school-age children. The objective of this research was to establish the relationship between anthropometric indicators and cardiovascular risk factors in obese school age children, through a descriptive-correlational study in 160 prepubertal children. Socio-economic status, nutritional status by the index of body mass (BMI), waist circumference (WC) taper index (TI), blood pressure, basal insulinemia, glycemia, total cholesterol (TC), LDL-c, VLDL-c, HDL-c, triglycerides (TG) and TC/HDL, LDL/HDL and TG/HDL levels, were assessed. 88 school age children obese and 72 controls were included. The majority of children were categorized as Graffar III-IV socio-economic stratum. It was found increased values of BMI, WC, TI, systolic and diastolic blood pressure, basal insulin, VLDL-c and TG in less than 10 years, between the obese (Mann-Whitney: p<0,05) in relation to the controls. Further, the existence of lower blood glucose and HDL averages, as well as higher averages of TG in the over 10 years in the obese, TC/HDL, LDL/HDL y TG/HDL with statistically significant differences (Students t: p<0,05) between the groups. BMI and the WC had significant correlation (p<0,05) with systolic and diastolic blood pressure and the basal insulin; TI only with diastolic pressure and basal insulin. It is concluded that there was a relationship between anthropometric indicators in study and cardiovascular risk factors as basal insulinemia and blood pressure(AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Doenças Cardiovasculares , Índice de Massa Corporal , Fatores de Risco , Diabetes Mellitus Tipo 2 , Obesidade Infantil , Condições Sociais , Antropometria , Saúde Pública , Doença CrônicaRESUMO
The non alcoholic fatty liver disease (NAFLD) manifests with liver damage and it is associated with obesity. The objective of this work was to detect the risk of obese school students of developing NAFLD, through an analytical, observational study, comparing their liver function with that of a control group, and its relationship with physical activity, dietary, biochemical and anthropometric variables. One hundred and sixty school students (ages 7-11) were evaluated according to their socio-economic status; nutritional status by the body mass index (BMI) and mid-upper arm fat area (MUAC) (Project Venezuela 1994); body fat percentage by anthropometry (% BF), waist circumference (WC); and metabolism by oral glucose tolerance, basal insulin and post-load glucose, total cholesterol (TC), cLDL, cVLDL, cHDL, triglycerides (TG), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma glutamil transpeptidasa (GGTP) and albumin. Their diet was analyzed by the 24-hour recall and their physical activity by a clinical trial. Mean levels of GPT (p < 0.05), greater frequencies of elevated GOT and GPT (p < 0.05) and lower albumin levels (p < 0.05) were observed in 88 obese school students when compared to controls. The GPT correlated significantly with the BMI, MUAC, % BF, WC, basal insulin and post-load glucose, HOMA, cVLDL, cHDL and TG, while the GOT correlated with MUAC and the GGTP with MUAC, basal insulin, HOMA and cLDL. Albumin was negatively correlated with BMI, MUAC, % BF and WC. TGP reflected better the hepatic compromise of obesity. To assess the risk of NAFLD, the TGO/TGP values should be standardized according to age, gender and race.
Assuntos
Obesidade Infantil/fisiopatologia , Criança , Estudos Transversais , Feminino , Humanos , Testes de Função Hepática , MasculinoRESUMO
La enfermedad de hígado graso no alcohólico (EHGNA) se manifiesta con daño hepático y se asocia a la obesidad. El objetivo fue detectar en escolares obesos el riesgo para desarrollar EHGNA, a través de un estudio observacional analítico, comparando el funcionalismo hepático con un grupo control y su relación con variables antropométricas, bioquímicas, dietéticas y actividad física. Se evaluaron en 160 escolares (7-11 años) la condición socioeconómica, el estado nutricional por el índice de masa corporal (IMC), área grasa (AG) del brazo (Proyecto Venezuela 1994), porcentaje de grasa corporal por antropometría (% GC), circunferencia de cintura (CC), tolerancia oral a la glucosa, insulinemia basal y postcarga de glucosa, CT, cLDL, cVLDL, cHDL, triglicéridos (TG), TGO, TGP, gammaglutamiltranspeptidasa (GGTP) y albúmina. La dieta se analizó por el recordatorio de 24 horas y la actividad física por una prueba clínica. En 88 escolares obesos se observaron mayores promedios (p<0,05) de TGP, mayor frecuencia (p<0,05) de TGO y TGP elevadas y de albúmina baja (p<0,05), que en los controles. La TGP se correlacionó significativamente con el IMC, AG, % GC, CC, insulina basal y postcarga de glucosa, HOMA, cVLDL, cHDL y TG, mientras que la TGO con el AG y la GGTP con AG, insulina basal, HOMA y cLDL. La albúmina se correlacionó negativamente con el IMC, AG, % GC y CC. La TGP fue la que más reflejó el compromiso hepático de la obesidad. Para evaluar el riesgo de EHGNA, se debe estandarizar los valores de TGO/TGP según edad, género y raza.
The non alcoholic fatty liver disease (NAFLD) manifests with liver damage and it is associated with obesity. The objective of this work was to detect the risk of obese school students of developing NAFLD, through an analytical, observational study, comparing their liver function with that of a control group, and its relationship with physical activity, dietary, biochemical and anthropometric variables. One hundred and sixty school students (ages 7-11) were evaluated according to their socio-economic status; nutritional status by the body mass index (BMI) and mid-upper arm fat area (MUAC) (Project Venezuela 1994); body fat percentage by anthropometry (% BF), waist circumference (WC); and metabolism by oral glucose tolerance, basal insulin and post-load glucose, total cholesterol (TC), cLDL, cVLDL, cHDL, triglycerides (TG), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma glutamil transpeptidasa (GGTP) and albumin. Their diet was analyzed by the 24-hour recall and their physical activity by a clinical trial. Mean levels of GPT (p < 0.05), greater frequencies of elevated GOT and GPT (p < 0.05) and lower albumin levels (p < 0.05) were observed in 88 obese school students when compared to controls. The GPT correlated significantly with the BMI, MUAC, % BF, WC, basal insulin and post-load glucose, HOMA, cVLDL, cHDL and TG, while the GOT correlated with MUAC and the GGTP with MUAC, basal insulin, HOMA and cLDL. Albumin was negatively correlated with BMI, MUAC, % BF and WC. TGP reflected better the hepatic compromise of obesity. To assess the risk of NAFLD, the TGO/TGP values should be standardized according to age, gender and race.
Assuntos
Criança , Feminino , Humanos , Masculino , Obesidade Infantil/fisiopatologia , Estudos Transversais , Testes de Função HepáticaRESUMO
La obesidad tiene en su desarrollo un componente ambiental vinculado al sedentarismo y a hábitos dietéticos que favorecen el depósito de masa grasa. El objetivo de la investigación fue describir el estilo de vida de un grupo de escolares obesos de Valencia. Se realizó un estudio descriptivo-comparativo con un grupo control bajo un diseño no experimental, transeccional, en 160 niños prepúberes (88 obesos y 72 eutróficos), que acudieron al Ambulatorio El Concejo, de la Universidad de Carabobo y al servicio de Gastroenterología y Nutrición Pediátrica de la Ciudad Hospitalaria "Dr. Enrique Tejera" de Valencia, entre Enero a Noviembre de 2011. Se evaluaron datos socio-demográficos, antropometría a través del índice de masa corporal, antecedentes personales y familiares, conductas y hábitos de alimentación, dieta y actividad física. Para el análisis estadístico se utilizaron cuadros de distribución de frecuencias con valores absolutos y porcentajes y las pruebas paramétricas y no paramétricas requeridas. Se encontró que los eutróficos recibieron más lactancia materna exclusiva y menos artificial (p<0,05). El antecedente familiar de obesidad fue más frecuentes en los obesos (p<0,05). Los obesos tenían una velocidad para comer más rápida y prefirieron más los alimentos chatarra que los eutróficos (p<0,05). Se observó mayores promedios de consumo de calorías y de grasas, así como mayor sedentarismo en los obesos (p<0,05). El menor consumo de lactancia materna, el antecedente familiar de obesidad, algunas conductas y hábitos alimentarios, la dieta que consumieron y la menor actividad física, identificaron un estilo de vida no saludable en estos escolares obesos.
Overview obesity is developing an environmental component linked to sedentary lifestyle and dietary habits that favour the deposit of fat mass. The objective of the research was to describe the lifestyle of a group of obese children located of Valencia. Was a descriptive-comparative study with a group control under a non-experimental design, transactional, 160 prepubertal children (88 obese and eutrophic 72) who came to the ambulatory Council, of the University of Carabobo and gastroenterology and Pediatric Hospital city nutrition service "Dr. Enrique Tejera" of Valencia, between January to November 2011. Socio-demographic data were evaluated with anthropometry through the index of body mass, personal and family history, behaviors and habits of food, diet and physical activity. Frequency distribution boxes with absolute values and percentages and required parametric and non-parametric tests, were used for statistical analysis. It was found that the eutrophic received more exclusive and less artificial breastfeeding (p<0,05). The family history of obesity was most common in the obese (p<0,05). Obese had a speed to eat faster and more preferred food scrap to the eutrophic (p<0,05). It was observed higher average consumption of calories and fat as well as more sedentary in the obese (p<0,05). Lower consumption of breastfeeding, the family history of obesity, some behaviors and eating habits, the diet who consumed and less physical activity identified an unhealthy lifestyle in these obese children.
RESUMO
UNLABELLED: Obesity leads to a deterioration of glucose tolerance and the action of insulin. The purpose of this study was to determine insulin resistance (IR) by indirect methods, and its correlation with clinical, anthropometric and biochemical variables in obese normoglycemic school children. This was a descriptive-correlational study of 72 school prepubescent children, who attended the ambulatory "El Concejo" of the University of Carabobo (UC) and at the Gastroenterology and Pediatric Nutrition service of the city hospital "Enrique Tejera" (CHET), in Valencia, Venezuela, between January-April 2011. INCLUSION CRITERIA: exogenous obesity. We assessed personal and family history, presence of Acanthosis Nigricans and nutritional and biochemical status. We found a higher percentage of IR, through the use of the QUICKI method (66.7%), followed by the HOMA (55.6%) and basal insulin (45.9%). The mean (chi) indexes of body mass and waist circumference were significantly greater (p < 0.05) in patients with IR, by HOMA and QUICKI techniques. The QUICKI method detected significant differences (p < 0.05) in the values of glycemia, basal insulin and postprandial insulin, among patients with diminished and normal insulin sensitivities. While HOMA, detected these differences (p < 0.05) in the values of glycemia and basal insulin. A statistically significant relationship was observed (p < 0.05), between the presence of Acanthosis Nigricans and IR, by the HOMA, QUICKI and basal insulin methods. In conclusion, the evaluated techniques, QUICKI, HOMA and basal insulin indexes, were most effective for detecting the IR.
Assuntos
Resistência à Insulina , Obesidade/sangue , Acantose Nigricans/sangue , Acantose Nigricans/epidemiologia , Glicemia/análise , Composição Corporal , Índice de Massa Corporal , Lista de Checagem , Criança , Diabetes Mellitus Tipo 2/genética , Jejum/sangue , Feminino , Homeostase , Humanos , Insulina/sangue , Insulina/metabolismo , Secreção de Insulina , Lipídeos/sangue , Masculino , Modelos Biológicos , Estado Nutricional , Período Pós-Prandial , Coxa da Perna/anatomia & histologia , Venezuela/epidemiologia , Circunferência da CinturaRESUMO
El incremento de la adiposidad, conduce a un deterioro de la tolerancia a la glucosa y de la acción de la insulina. Se determinó la resistencia a la insulina (RI) por métodos indirectos y se correlacionó con variables clínicas, antropométricas y bioquímicas en escolares obesos normoglicémicos. Estudio descriptivo-correlacional, realizado en 72 escolares, que acudieron al ambulatorio El Concejo de la Universidad de Carabobo (UC) y al servicio de Gastroenterología y Nutrición Pediátrica de la Ciudad Hospitalaria Enrique Tejera (CHET), de Valencia, Venezuela, entre enero y abril de 2011. Criterio de Inclusión: obesidad exógena. Se evaluaron antecedentes personales y familiares, presencia de acantosis nigricans y valoración nutricional y bioquímica. Se encontró mayor porcentaje de RI, a través de la utilización del método QUICKI (66,7%), seguido del HOMA (55,6%) y la insulina basal (45,9%). Las medias de índice de masa corporal y circunferencia de cintura, fueron significativamente mayores (p<0,05), en pacientes con RI, estimadas por los métodos HOMA y QUICKI. El método QUICKI, detectó diferencias significativas (p<0,05), entre las glicemias e insulinas basales y entre las insulinas postprandiales, de los pacientes con sensibilidades insulínica disminuida y normal; mientras que el HOMA, detectó estas diferencias (p<0,05), en las glicemias e insulinas basales. Se observó una correlación estadísticamente significativa (p<0,05), entre la presencia de acantosis nigricans y la RI, estimada por los métodos HOMA, QUICKI e insulina basal. En conclusión, de los métodos evaluados, los índices QUICKI, HOMA y la insulina basal, fueron los más eficaces para detectar la RI.
Obesity leads to a deterioration of glucose tolerance and the action of insulin. The purpose of this study was to determine insulin resistance (IR) by indirect methods, and its correlation with clinical, anthropometric and biochemical variables in obese normoglycemic school children. This was a descriptive-correlational study of 72 school prepubescent children, who attended the ambulatory El Concejo of the University of Carabobo (UC) and at the Gastroenterology and Pediatric Nutrition service of the city hospital Enrique Tejera (CHET), in Valencia, Venezuela, between January-April 2011. Inclusion criteria: exogenous obesity. We assessed personal and family history, presence of Acanthosis Nigricans and nutritional and biochemical status. We found a higher percentage of IR, through the use of the QUICKI method (66.7%), followed by the HOMA (55.6%) and basal insulin (45.9%). The mean (c) indexes of body mass and waist circumference were significantly greater (p < 0.05) in patients with IR, by HOMA and QUICKI techniques. The QUICKI method detected significant differences (p < 0.05) in the values of glycemia, basal insulin and postprandial insulin, among patients with diminished and normal insulin sensitivities. While HOMA, detected these differences (p < 0.05) in the values of glycemia and basal insulin. A statistically significant relationship was observed (p < 0.05), between the presence of Acanthosis Nigricans and IR, by the HOMA, QUICKI and basal insulin methods. In conclusion, the evaluated techniques, QUICKI, HOMA and basal insulin indexes, were most effective for detecting the IR.
Assuntos
Criança , Feminino , Humanos , Masculino , Resistência à Insulina , Obesidade/sangue , Acantose Nigricans/sangue , Acantose Nigricans/epidemiologia , Composição Corporal , Índice de Massa Corporal , Glicemia/análise , Lista de Checagem , /genética , Jejum/sangue , Homeostase , Insulina/sangue , Insulina , Lipídeos/sangue , Modelos Biológicos , Estado Nutricional , Período Pós-Prandial , Coxa da Perna/anatomia & histologia , Venezuela/epidemiologia , Circunferência da CinturaRESUMO
To address obesity and related morbidities, community-based participatory research (CBPR) strategies were employed to design and evaluate a Spanish-language media campaign promoting physical activity and healthful food choices among Mexican Americans. Process evaluation including content analyses on types and focus of media messages was conducted. Focus groups assessed appeal and trustworthiness of messages. All media campaign products featured role models and experts. Campaign messages primarily (91%) appeared in TV morning show segments. Newsletters presented individual and family role model stories. A majority of newsletters (68%) were distributed through churches and "promotora" outreach efforts. CBPR lends itself to the selection and tailoring of evidence-based media campaigns. Moreover, CBPR guidance resulted in media messages that were credible and appealing to audience. Process evaluation strategies that gather information from the community provide solid evidence for how to modify the campaign to best meet audience expectations.
Assuntos
Educação em Saúde/métodos , Promoção da Saúde/métodos , Meios de Comunicação de Massa/estatística & dados numéricos , Americanos Mexicanos/psicologia , Obesidade/prevenção & controle , Adulto , Pesquisa Participativa Baseada na Comunidade , Exercício Físico , Comportamento Alimentar/etnologia , Comportamento Alimentar/psicologia , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , México/etnologia , Pessoa de Meia-Idade , Atividade Motora , TexasRESUMO
El péptido natriurético cerebral (BNP) es producido en el ventrículo cardíaco como un precursor de 108 aminoácidos, conocido como proBNP el cual cuando se secreta es desdoblado en BNP biológicamente activo y en el fragmento N-terminal (NT-proBNP), considerado biológicamente inactivo, pero que es el que se valora cuantitativamente debido a su mayor estabilidad en suero. Dado que el NT-proBNP tiene un papel importante en la defensa del cuerpo contra la hipertensión y la expansión de volumen plasmático, podría jugar un papel importante en el diagnóstico temprano de falla cardiaca asintomática, ya que el mismo se eleva en aquellas situaciones que cursan con aumento de la tensón parietal de los ventrículos. Se plantearon como objetivos de la investigación comparar los valores séricos de NT-proBNP de pacientes hipertensos y normotensos mayores de 45 años, y luego correlacionarlos con los hallazgos electrocardiográficos registrados en estos pacientes. El estudio versó en una investigación no experimental, que incluyó 50 pacientes con diagnóstico de HTA esencial y 30 pacientes normotensos aparentemente sanos. Los resultados obtenidos muestran que el sexo predominante fue el femenino, con un rango de edad entre 45 y 54 años, en ambos grupos, con cifras controladas de presión arterial para los pacientes hipertensos y con diferencias significativas (p<0,05) al comparar los valores séricos de NT-proBNP en ambos grupos, así como al correlacionarlos con los hallazgos electrocardiográficos evidenciados. Se concluye, que valores séricos incrementados de NT-proBNP apoyan de una forma estadísticamente significativa la presencia de hallazgos electrocardiográfico de los pacientes hipertensos