Avaliação da adesão às orientações ao manejo da obesidade em pacientes na fila para a cirurgia bariátrica no SUS: um ensaio clínico randomizado
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Data
2019-11-05
Autores
Evangelista, Mayara Martins [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Tendo em conta a demanda premente de alternativas e de aprimoramento das estratégias de cuidado à obesidade grave, dado o elevado número de brasileiros nas filas de espera para a cirurgia bariátrica no Sistema Único de Saúde (SUS), o presente trabalho se propôs a avaliar se o cuidado desenvolvido em grupo de educação em saúde, proporcionado por equipe interdisciplinar sob formação permanente pautada em metodologia ativa promove, no intervalo de um ano, melhora significativa em indicadores de saúde e bem-estar de pacientes da fila de espera para a cirurgia bariátrica, em São José do Rio Preto/SP. Essa pesquisa originou quatro artigos. O primeiro estudo descreveu o protocolo de ensaio clínico randomizado e resultados de linha de base dos efeitos de intervenção interdisciplinar de um ano, com usuários do sistema público de saúde na fila de espera para cirurgia bariátrica. Oitenta e oito participantes foram recrutados e randomizados entre o grupo controle (n=44) que recebe o tratamento habitual e entre o grupo intervenção (n=44) que realizou a intervenção educativa. Foi investigado o consumo alimentar, afetividade negativa e inatividade física/comportamento sedentário, medidas antropométricas e de composição corporal, amostras de sangue e testes de capacidade física. Quando comparados quanto as características demográficas e bioquímicas, não houve diferença entre os grupos, exceto para glicose sérica (GC=110,4 ±46,8mg/dL e GI 93,1±16,9mg/dL; p=0,039). Os resultados mostraram que há semelhança entre os grupos de comparação na linha de base. Objetivo do segundo estudo foi estimar as propriedades psicométricas do Questionário Alimentar de Três Fatores (TFEQ-18) e Escala de Depressão, Ansiedade e Estresse (DASS-21) e verificar a influência da depressão, ansiedade, estresse, variáveis sociodemográficas e presença de doenças pré-existentes nas dimensões do comportamento alimentar de pacientes obesos candidatos à cirurgia bariátrica. Os pacientes preencheram o TFEQ-18, a DASS-21 e um questionário sociodemográfico para caracterização da amostra. Foram testadas as propriedades psicométricas dos instrumentos por meio da análise fatorial confirmatória e um modelo hipotético para pacientes obesos candidatos à cirurgia bariátrica foi desenvolvido e testado. Participaram do estudo um total de 545 pacientes, a maioria mulheres que vivem com um companheiro, recebe entre 3 e 7 salários mínimos, sedentária, não fuma, não bebe, com índice de massa corporal acima de 40 kg/m2 e já apresenta alguma comorbidade. O modelo refinado do instrumento TFEQ-18 explicou 51% da restrição cognitiva, 80% da alimentação emocional e 60% do descontrole alimentar. A escala DASS 21 apresentou variância explicada de 43% para depressão, 33% para ansiedade e 46% para o estresse. A afetividade negativa e as variáveis sociodemográficas, como sexo, idade, IMC e nível de atividade física, foram significativamente importantes nas dimensões do comportamento alimentar. Esses resultados podem auxiliar no diagnóstico e monitoramento das intervenções nutricionais, de modo a evitar ou minimizar consequências ruins para a saúde da pessoa com obesidade. Já o terceiro estudo, apresentou como objetivo analisar os resultados de uma intervenção educativa durante o período pré-operatório, na busca por mudanças de comportamento alimentar, físico e emocional. Oitenta e oito pacientes foram recrutados no ambulatório de cirurgia geral de hospital universitário, divididos igualmente em dois grupos com iguais condições físicas e clínicas, mas apenas um dos grupos participou de atividades educativas com equipe multidisciplinar, imersa em um processo especifico de reflexão da prática e formação. Ao final de 12 meses de formação da equipe e 15 encontros com os pacientes, selecionou-se aleatoriamente 10 pacientes do grupo intervenção e 10 grupo acompanhamento para aplicação do grupo focal e avaliação dos resultados. Análise dos resultados foi realizada com base no conteúdo dos relatos associadas às percepções não verbais identificados nas observações dos grupos focais. Nos relatos analisados, a intervenção promoveu diminuição de medicamentos, melhora na auto percepção e aumento nas atividades envolvendo movimento corporal. Barreiras na mudança de comportamento, preconceito, ansiedade e depressão marcaram fortemente os relatos, fatores amenizados com o apoio da equipe interdisciplinar. A intervenção educativa apresentou resultados promissores no que tange a mudança de comportamento em pacientes obesos, promovendo integração e possibilitando trocas de experiências. O 4º artigo avaliou a efetividade de uma intervenção educacional de longo prazo, sobre a perda de peso corporal em obesos que estão na fila de espera para a cirurgia bariátrica. Foram avaliadas medidas antropométricas, composição corporal, análises bioquímicas e questionários (comportamento alimentar e afetividade negativa), antes e após 6 e 12 meses de intervenção. Embora se tenha observado alguma melhora nas medidas antropométricas, a intervenção educacional multidisciplinar de 12 meses não resultou em alteração quantitativamente significante nas variáveis avaliadas. Mostrou redução do descontrole alimentar após 6 e 12 meses e da depressão após 6 meses. A intervenção educacional multidisciplinar de 12 meses não produziu resultados quantitativamente significativos, sugerindo a necessidade de aprofundamentos nos estudos, com abordagens que levem em conta as causas da não adesão e também a forma de avaliação dos resultados.
Given the urgent demand for alternatives and improvement of care strategies for severe obesity, given the high number of Brazilians waiting for bariatric surgery at SUS, The present work aimed to evaluate if the care developed in a health education group, provided by an interdisciplinary team under permanent training based on active methodology, promotes, over a period of one year, significant improvement in health and well-being indicators of patients waiting for bariatric surgery, in São José do Rio Preto / SP. This research four studies. The first study described the randomized clinical trial protocol and baseline results of the effects of one year interdisciplinary intervention, with public health care users queued for bariatric surgery. Eighty-eight participants were recruited and randomized between the control group (n = 44) receiving the usual treatment and the intervention group (n = 44) participating in the educational intervention. Food intake, negative affectivity and physical inactivity / sedentary behavior were evaluated, anthropometric and body composition measurements, blood samples and physical capacity tests. When comparing demographic and biochemical characteristics, there was no difference between groups, except for serum glucose (CG = 110.4 ± 46.8mg / dL and GI 93.1 ± 16.9mg / dL; p = 0.039). The results showed that there is similarity between the comparison groups at baseline. The objective of the second study was to estimate the psychometric properties of the Three Factors Eating Questionnaire (TFEQ- 18) and the Depression, Anxiety and Stress Scale (DASS-21) and to verify the influence of depression, anxiety, stress, sociodemographic variables and disease presence in the dimensions of eating behavior of obese patients who are candidates for bariatric surgery. Patients completed TFEQ-18, DASS-21 and a sociodemographic questionnaire for sample characterization. The psychometric properties of the instruments were tested by confirmatory factor analysis and a hypothetical model for obese patients candidates for bariatric surgery was developed and tested. A total of 545 patients participated in the study, mostly women, living with a partner, receiving between 3 and 7 minimum wages, sedentary, do not smoke, do not drink, with body mass index above 40 kg / m2 and already have some comorbidity. The refined model of the TFEQ-18 instrument explained 51% of cognitive restriction, 80% of emotional eating and 60% of uncontrolled eating. The DASS 21 scale presented explained variance of 43% for depression, 33% for anxiety and 46% for stress. Negative affectivity and sociodemographic variables such as gender, age, BMI and level of physical activity were significantly important in the dimensions of eating behavior. These results may assist in the diagnosis and monitoring of nutritional interventions to avoid or minimize bad health consequences for the obese person. These results may help in the diagnosis and monitoring of nutritional interventions, in order to avoid or minimize bad consequences for the health of the obese person. The third study aimed to analyze the results of an educational intervention during the preoperative period, seeking changes in eating, physical and emotional behavior. Eightyeight patients were recruited from the general surgery outpatient clinic of a university hospital, divided equally into two groups with equal physical and clinical conditions, but only one group participated in educational activities with a multidisciplinary team, immersed in a specific process of reflection of the practice and formation. At the end of 10 months of team building and 15 patient meetings, 2 subgroups of 10 patients were randomly selected each approach for focus group application and outcome evaluation. Analysis of the results was made based on the content of the reports associated with nonverbal perceptions identified in the focus group. n the reports analyzed, the intervention promoted a decrease in medications, improved selfperception and increased activities involving body movement. Barriers in behavior change, prejudice, anxiety and depression strongly marked the reports, alleviated factors with the support of the interdisciplinary team. The educational intervention presented promising results regarding behavior change in obese patients, promoting integration and enabling exchange of experiences. The 4th article evaluated the effectiveness of a long-term educational intervention, about body weight loss in obese who are waiting for bariatric surgery. Anthropometric measurements, body composition, biochemical analyzes and questionnaires (eating behavior and negative affectivity) were evaluated before and after 6 and 12 months of intervention. Although there was some improvement in anthropometric measurements, the 12-month multidisciplinary educational intervention did not result in a quantitatively significant change in the evaluated variables. It showed a reduction in uncontrolled eating after 6 and 12 months and depression after 6 months. The 12-month multidisciplinary educational intervention did not produce quantitatively significant results, suggesting the need for further study, with approaches that take into account the causes of non-adherence and also the way to evaluate the results.
Given the urgent demand for alternatives and improvement of care strategies for severe obesity, given the high number of Brazilians waiting for bariatric surgery at SUS, The present work aimed to evaluate if the care developed in a health education group, provided by an interdisciplinary team under permanent training based on active methodology, promotes, over a period of one year, significant improvement in health and well-being indicators of patients waiting for bariatric surgery, in São José do Rio Preto / SP. This research four studies. The first study described the randomized clinical trial protocol and baseline results of the effects of one year interdisciplinary intervention, with public health care users queued for bariatric surgery. Eighty-eight participants were recruited and randomized between the control group (n = 44) receiving the usual treatment and the intervention group (n = 44) participating in the educational intervention. Food intake, negative affectivity and physical inactivity / sedentary behavior were evaluated, anthropometric and body composition measurements, blood samples and physical capacity tests. When comparing demographic and biochemical characteristics, there was no difference between groups, except for serum glucose (CG = 110.4 ± 46.8mg / dL and GI 93.1 ± 16.9mg / dL; p = 0.039). The results showed that there is similarity between the comparison groups at baseline. The objective of the second study was to estimate the psychometric properties of the Three Factors Eating Questionnaire (TFEQ- 18) and the Depression, Anxiety and Stress Scale (DASS-21) and to verify the influence of depression, anxiety, stress, sociodemographic variables and disease presence in the dimensions of eating behavior of obese patients who are candidates for bariatric surgery. Patients completed TFEQ-18, DASS-21 and a sociodemographic questionnaire for sample characterization. The psychometric properties of the instruments were tested by confirmatory factor analysis and a hypothetical model for obese patients candidates for bariatric surgery was developed and tested. A total of 545 patients participated in the study, mostly women, living with a partner, receiving between 3 and 7 minimum wages, sedentary, do not smoke, do not drink, with body mass index above 40 kg / m2 and already have some comorbidity. The refined model of the TFEQ-18 instrument explained 51% of cognitive restriction, 80% of emotional eating and 60% of uncontrolled eating. The DASS 21 scale presented explained variance of 43% for depression, 33% for anxiety and 46% for stress. Negative affectivity and sociodemographic variables such as gender, age, BMI and level of physical activity were significantly important in the dimensions of eating behavior. These results may assist in the diagnosis and monitoring of nutritional interventions to avoid or minimize bad health consequences for the obese person. These results may help in the diagnosis and monitoring of nutritional interventions, in order to avoid or minimize bad consequences for the health of the obese person. The third study aimed to analyze the results of an educational intervention during the preoperative period, seeking changes in eating, physical and emotional behavior. Eightyeight patients were recruited from the general surgery outpatient clinic of a university hospital, divided equally into two groups with equal physical and clinical conditions, but only one group participated in educational activities with a multidisciplinary team, immersed in a specific process of reflection of the practice and formation. At the end of 10 months of team building and 15 patient meetings, 2 subgroups of 10 patients were randomly selected each approach for focus group application and outcome evaluation. Analysis of the results was made based on the content of the reports associated with nonverbal perceptions identified in the focus group. n the reports analyzed, the intervention promoted a decrease in medications, improved selfperception and increased activities involving body movement. Barriers in behavior change, prejudice, anxiety and depression strongly marked the reports, alleviated factors with the support of the interdisciplinary team. The educational intervention presented promising results regarding behavior change in obese patients, promoting integration and enabling exchange of experiences. The 4th article evaluated the effectiveness of a long-term educational intervention, about body weight loss in obese who are waiting for bariatric surgery. Anthropometric measurements, body composition, biochemical analyzes and questionnaires (eating behavior and negative affectivity) were evaluated before and after 6 and 12 months of intervention. Although there was some improvement in anthropometric measurements, the 12-month multidisciplinary educational intervention did not result in a quantitatively significant change in the evaluated variables. It showed a reduction in uncontrolled eating after 6 and 12 months and depression after 6 months. The 12-month multidisciplinary educational intervention did not produce quantitatively significant results, suggesting the need for further study, with approaches that take into account the causes of non-adherence and also the way to evaluate the results.
Descrição
Palavras-chave
Cirurgia Bariátrica, Obesidade, Ensaio Clínico, Educação Permanente, Sistema Único de Saúde, Health Unic System, Bariatric Surgery, Clinical trial, Obesity