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D Sigulem

Publications and source records attributed to D Sigulem.

24 records · Page 2Linked to original sources
PubMedDate not supplied

A Web-based distance education course in nutrition in public health: case study.

BACKGROUND: Strict work timetables, personal and professional duties or an inability to be absent from home or work can all represent major constraints for those wishing to improve their professional skills. Within this context, the World Wide Web can allow people to conveniently follow distance courses from their homes. OBJECTIVE: To present an experience in the use of the Web in the continuing education of healthcare professionals in Brazil. METHODS: A Web-based distance education course in nutrition in public health was developed. The methodology was an adaptation of both problem-based and task-based learning. At the end of the course an evaluation questionnaire which covered the course s contents, the educational methodology and resources, the duration and schedule, and the use of the Web as a tool for distance education was given to the students. RESULTS: There were 83 on line registrations from 13 states, 73 of the applicants were female, 62 had a degree in nutrition and 18 were physicians. From these; eleven students from ten states were chosen: nine female nutritionists, two female physicians, and one male physician. Seven students completed the course, took and passed the final exam. Of the other four students, two failed to follow the schedule, one had health problems, and one did not obtain the minimal score for sitting the final exam. The students had a mean age of 35, and a mean of ten years in practice. They all stated that they were unable to attend a regular course, even though they felt that they needed to improve their professional skills. Most of them studied seven days a week for between two and four hours a day. The students also felt that their professional skills had improved and each reported having made changes in their practice as a result of their participation. The students approved of the course s contents, methodology and resources, however they were divided about its duration. The Web as a tool in distance education was approved by the students. If it was not for the Web they could not have taken part in a continuing education program. All students said they would attend another virtual course, if available. Even though most of them did not have difficulty adapting to the virtual environment, they did feel that an adaptation period would be of value. CONCLUSIONS: A Web-based course may be more effective than other distance education methodologies because it is more interactive and dynamic. On-line material can be constantly reviewed and updated, and the students can have the opportunity to submit commentaries or questions directly to the teaching staff. A Web-based course also allows the students to go beyond the course content as they learn how to search and take advantage of the huge resources of information available on the Internet.

Adult↗
PubMedDate not supplied

[Nutritional assessment of chronic renal patients in hemodialysis programs. A multicenter study].

The food intake and the nutritional status of 100 chronic renal failure patients on maintenance hemodialysis in 10 facilities in the city of São Paulo were studied. The average food intake obtained through 3 days of dietary diaries showed a caloric intake of 26.6 +/- 10kcal/kg/day (mean +/- SD), 24% below the minimum daily caloric intake recommendation and a protein intake of 1.03 +/- 1.4g/kg/day which averaged the minimum recommended for chronic renal patients on hemodialysis. The average intakes of calcium (418.6 +/- 294.9mg), phosphate (813.5 +/- 335.2mg) and iron (10.5 +/- 4.9mg) were also low. Mean serum albumin was 3.9 +/- 0.7g/dl and only 3.1% of the patients had albumin levels below 3.0g/dl. There was no difference between the real and ideal body weight. On the other hand 69% of women and 25% of men had the triceps skin fold (TSF) in the 5th percentile while 24% of women and 79% of men exhibited values of the muscle arm circumference (MAC) in the same percentile. Moreover there were inverse and significant correlations between the time on dialysis and TSF for women (r = -0.19) and the time on dialysis and MAC for men (r = -0.16). This study shows that our patients on hemodialysis have a poor food intake, with marked reduction of fat and muscle stores. The undernourished state observed tended to be more pronounced with the duration of the dialysis treatment and could influence negatively on the morbidity and mortality of these patients.

Adult↗
PubMedDate not supplied

A microcomputer-based transplantation registry.

We describe a microcomputer-based program developed for the Brazilian Kidney Transplant Registry. The system can construct life tables and survival curves online, without the need to export the database. From 1987 through 1993, 6069 kidney transplants were reported; 3485 (57.4%) were from living donors and 2584 from cadavers. The proportion of cadaveric transplants increased from 28.5% in 1987 to 58.1% in 1993. Overall kidney transplantation activity was 8.1 patients per million population per year. Sixty-four percent of the patients were male, and 71% were white. The mean age was 33.4 years. The primary renal diseases most frequently reported were glomerulonephritis (43.6%) and hypertensive renal disease (13.6%). Only 3.6% of the recipients were diabetic. Patient and graft survival rates have improved in recent years. We expect that cadaveric organ procurement programs will continue to develop in our country, increasing the number of organ transplantations and creating a more equal distribution of cadaveric organs.

Adolescent↗
PubMedDate not supplied

[Access to chronic dialysis treatment: deficient and unequal].

OBJECTIVE: To determine the fraction of patients with end-stage renal disease (ESRD) who received dialysis treatment in the city of São Paulo in 1991 and to investigate the influence of age in the access to dialysis. MATERIAL AND METHODS: All patients who received dialysis for ESRD in the city of São Paulo during 1991, and were registered in the Secretary of Health of São Paulo files were included in the study. In the same year, information was also collected on individuals who died having as basic cause of death a disease related to chronic renal failure. These data were obtained from death certificates files. Using simultaneously information from both data bases it was possible to ascertain the patients who died without receiving dialysis and to calculate the treated fraction in several age groups. RESULTS: Overall 25.6% of ESRD patients did not receive treatment. There was a progressive reduction in the fraction of patients treated for those older than 40 years. In children less or equal to 9 years of age the percentage of treatment was also reduced (29%). Individuals in the age groups 60-69 and 70-79 years had a chance about 5 and 11 times greater, respectively, of dying without receiving dialysis than those in the 20-29 years group. CONCLUSIONS: We estimate that at least one fourth of the ESRD patients died in São Paulo in 1991 without receiving dialysis treatment. Age is a major factor of discrimination for acceptance in chronic dialysis programs.

Adolescent↗