Analysis of Heart Rate Variability in Individuals Affected by Amyotrophic Lateral Sclerosis.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) produces alterations in the autonomic nervous system (ANS), which explains the cardiac manifestations observed in patients. The assessment of heart rate variability (HRV) is what best reflects the activity of the ANS on heart rate. The Polar H7 Bluetooth® device proves to be a non-invasive and much faster technology than existing alternatives for this purpose. OBJECTIVE: The goal of this study is to determine HRV using Polar H7 Bluetooth technology in ALS patients, comparing the obtained measurements with values from healthy individuals. METHOD: The sample consisted of 124 participants: 68 diagnosed with ALS and 56 healthy individuals. Using Polar H7 Bluetooth technology and the ELITE HRV application, various HRV measurements were determined for all participants, specifically the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, LF, HF, LF/HF ratio, HR average, and HF peak frequency. RESULTS: Statistically significant differences were observed between ALS patients and healthy individuals in the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, HF, and LF, where healthy individuals exhibited higher scores. For the HR average, the ALS group showed a higher value. Values were similar when comparing men and women with ALS, with only a higher HF peak frequency observed in women. CONCLUSION: The Polar H7 Bluetooth® device is effective in determining heart rate variability alterations in ALS, being a promising prognostic tool for the disease.

Predictive Model of Anxiety and Depression Perception in Multiple Sclerosis Patients: Possible Implications for Clinical Treatment.

Multiple Sclerosis (MS) is a neurodegenerative disease characterized by motor and non-motor symptoms, including emotional distress, anxiety, and depression. These emotional symptoms currently have a pharmacological treatment with limited effectiveness; therefore, it is necessary to delve into their relationship with other psychological, functional, or prefrontal alterations. Additionally, exploring non-pharmacological therapeutic alternatives that have shown benefits in addressing emotional distress in MS patients is essential. AIM: To establish a predictive model for the presence of anxiety and depression in MS patients, based on variables such as psychological well-being, functional activity, and prefrontal symptoms. Additionally, this study aimed to propose non-pharmacological therapeutic alternatives based on this model. MATERIALS AND METHODS: A descriptive, observational, and cross-sectional study was conducted with a sample of 64 diagnosed MS patients who underwent functional and cognitive assessments using the following questionnaires and scales: Functional Activities Questionnaire (FAQ), Acceptance and Action Questionnaire (AAQ-II), Experiences Questionnaire (EQ), Self-Compassion Scale Short Form (SCS-SF), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI), and Prefrontal Symptoms Inventory (PSI). RESULTS: The model showed an excellent fit to the data and indicated that psychological well-being was the most significant predictor of the criteria (ß = -0.83), followed by functional activity (ß = -0.18) and prefrontal symptoms (ß = 0.15). The latter two are negatively related to psychological well-being (ß = -0.16 and ß = -0.75, respectively). CONCLUSIONS: Low psychological well-being is the variable that most significantly predicts the presence of anxiety and depression in MS patients, followed by functional activity and prefrontal alterations. Interventions based on mindfulness and acceptance are recommended, along with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group physical exercise.

Spanish adaptation and validation of the ALS Depression Inventory-12 (ADI-12) in patients with Amyotrophic Lateral Sclerosis.

BACKGROUND: Patients with Amyotrophic Lateral Sclerosis (ALS) have a higher prevalence of mood disorders, including depression, than the general population. Non-specific measurement instruments have been used to evaluate depression in these patients, which complicates accurate diagnosis. The ALS Depression Inventory (ADI-12) exclusively assesses depressive symptoms in patients with ALS. AIM: To adapt and validate the ADI-12 in a Spanish sample. METHODS: A selective design was used with 74 patients with ALS, using the ADI-12 questionnaire. The original instrument was translated and back-translated into Spanish. The internal structure, temporal stability, convergent, and discriminant validity of the instrument were analyzed. RESULTS: Two confirmatory models showed internal validity (p = 0.502 for the one-factor model, p = 0.507 for the two-factor model). The Cronbach's alpha (0.900 in the first measurement and 0.889 in the second one) indicated a high internal consistency of the test. The Pearson correlation (0.90) indicated high temporal stability. In terms of convergent validity, the ADI-12 showed moderate correlations with the Beck Anxiety Inventory (BAI) (0.51-0.58), and low correlations with time since ALS diagnosis (-0.26 to -0.27). LIMITATIONS: The main limitation of the present study was the small sample size. CONCLUSIONS: The ADI-12 is fitted to a single general factor of depression, and the scale shows high internal consistency and high temporal stability, therefore, its use is recommended for the diagnosis of depression in patients with ALS.

Fear of Falling Score Is a Predictor of Falls in Community-Dwelling Pre-Frail and Frail Older People.

Identifying frail older people at risk of falling is a priority in order to apply preventive strategies. This cross-sectional study included community-dwelling pre-frail and frail people (Fried's criteria) aged 70 years and older to assess the prevalence of falls and identify screening strategies based on comprehensive geriatric assessments to detect an increased risk of falling and recurrent falling in community-dwelling frail and pre-frail old people. Of the 229 participants, 121 (54.9%) had fallen in the previous 12 months, and 20 of these (16.5%) were recurrent fallers (≥2 falls). A score of 20 points or more on the Falls Efficacy Scale International was predictive of falling (area under the receiver-operating characteristics curve 0.67, 95% confidence interval: 0.61-0.74, p < 0.001) with a sensitivity of 51.7% and a specificity of 73.9%. Polypharmacy, Short Physical Performance Battery score of 8 points or less, and Falls Efficacy Scale International score of 20 points or more show an area under the curve of 0.78 (95% confidence interval: 0.67-0.89, p < 0.001) for recurrent falling.

Impact of Family Function on the Quality of Life and Health Perception of Non-Institutionalized Dementia Patients.

BACKGROUND: Dementia is one of the pathologies that has increased the most among the older population (mainly Alzheimer's disease), and it has a direct impact on the quality of life (QoL), cognitive performance, and health of these patients. Family functionality can play a role in this QoL if these patients are not institutionalized. OBJECTIVE: To analyze the role of family function in the QoL and health perception of non-institutionalized dementia patients, as well as related variables such as anxiety, depression, optimism, or pessimism. METHODS: Cross-sectional study with a sample of 54 patients diagnosed with some type of dementia, non-institutionalized, or in outpatient care, from different centers in the province of Valencia (Spain). The EQ-5D, MMSE, Apgar Family or general health, and Goldberg anxiety and depression questionnaires were utilized. RESULTS: The correlation of the Apgar Family with the General Health Questionnaire-new onset problems variable (GHQ) and Chronicity and General Health Questionnaire-chronic problems (CGHQ) of the Goldberg Quality of Life questionnaire was statistically significant and negative (GHQ r = -0.310; p = 0.034. CGHQ r = -0.363; p = 0.012); as well as between Apgar Family and Anxiety-Depression (r = -0.341; p = 0.020). The correlation of the Apgar Family with the Life Orientation Test-Pessimism variable (LOT) was statistically significant and negative (r = -0.270; p = 0.061). Finally, severe dysfunction of Apgar Family has a negative correlation with self-perception of health (p = 0.036 B = -16.589) determined by the Visual Analogue Scale (VAS). CONCLUSION: Family functionality directly influences anxiety, depression, optimism, and pessimism. This could explain why family function is related to the QoL of patients and their self-perception of health.

Importance of Soft Skills in Health Sciences Students and Their Repercussion after the COVID-19 Epidemic: Scoping Review.

Soft skills (SKs) are skills related to the interaction among people and their way of dealing with tasks. Increasingly valued in the workplace, they are especially relevant in health professionals due to the importance of the relationship among them and their patients and families. Given their importance, the university training of healthcare professionals must promote the development of SKs. The COVID-19 pandemic has been a turning point in many areas, changing the learning process and, even more, the use of these soft skills as a fundamental ingredient in human relationships. The aim of this study was to analyse the available evidence regarding SKs in health science students, specifically nursing students, and to describe whether there is a worsening in the development of such skills after the COVID-19 pandemic. According to the PRISMA-ScR methodology for systematic reviews, this study included articles on social skills and possible changes in these skills as a consequence of the pandemic in health sciences students The results highlight the importance of these emotional competences for future nurses, being particularly relevant for communication and emotional self-awareness and showing their influence on academic aspects, such as academic performance or mental health and coping skills. A major limitation of the present study was not considering aspects such as compassion or empathy. However, the novelty provided by this work is the analysis of the changes in SKs produced as a consequence of the pandemic. It is definitely clear that there is a need to enhance emotional intelligence, and thus soft skills, in future health professionals.

In Situ Simulation: A Strategy to Restore Patient Safety in Intensive Care Units after the COVID-19 Pandemic? Systematic Review.

BACKGROUND: Patient safety is a public health problem worldwide. In situ simulation (ISS) arises as a learning strategy that allows health professionals to immerse themselves in a real environment without endangering the patients until they have learned the skills needed, thus increasing the quality of care. This systematic review aimed to verify the efficacy of the use of "in situ simulation" as a method that will allow health professionals to increase patient safety in Intensive Care Units after the situation experienced during the pandemic caused by the COVID-19 virus. METHODS: Seven studies were reviewed using the PRISMA methodology for systematic reviews. The CASPe guide was used to assess the quality of the manuscripts. RESULTS: The main topics that emerged from this review in relation to in situ simulation were as follows: looking at aspects such as patient self-perception of safety, adverse events, interprofessional communication and health system organization in relation to in situ simulation. CONCLUSIONS: The adequate implementation of in situ simulation after the COVID-19 pandemic in ICU services is shown to be an efficient and effective strategy to promote improvement in the attitudes on a culture of safety and teamwork of professionals.

Relationship of Motor Impairment with Cognitive and Emotional Alterations in Patients with Multiple Sclerosis.

Introduction. Multiple sclerosis (MS) is a neurodegenerative disease that, despite mainly affecting women, is more severe in men and causes motor, cognitive and emotional alterations. The objective of this study was to determine the possible relationship between motor, cognitive and emotional alterations. Materials and Methods. This is a descriptive, observational and cross-sectional study, with 67 patients with MS (20 men and 47 women), who were given the following questionnaires: Expanded Disability Status Scale (EDSS), Two-Minute Walk Test (2MWT), Berg Balance Scale, Beck's Depression Inventory (BDI-II), State-Trait Anxiety Inventory (STAI) and Prefrontal Symptoms Inventory (PSI) to analyze their cognitive level, body mass index (BMI) and percentage of muscle mass. In addition, regression analysis was conducted to study the relationship among variables. Results. No significant differences were found between men and women in any of the variables. Regarding the relationship between parameters, the regression analysis was statistically significant, showing an effect of age on the walking and balance performance (ß â‰… −0.4, p < 0.05); in addition, there was a relationship between 2MWT and STAI A/S, indicating that both older age and a high anxiety state could impact walking performance. On the other hand, prefrontal symptoms showed moderate relationships with both anxiety and depression (ß â‰… 0.6, p < 0.05); thus, high levels of anxiety and depression could increase prefrontal alterations. Conclusions. There is a relationship between motor and emotional variables. Specifically, state anxiety is related to walking resistance. No relationship was found between depression and cognitive alteration and balance or walking ability. Only age has an effect in these relationships.

Educational Needs in Oncology Nursing: A Scoping Review.

Care in oncology requires both technical and psychosocial skills by nursing staff, so continuous learning is necessary. Evidence suggests there are some educational gaps in oncology nursing staff, and continuing educational interventions have been effective in overcoming these deficiencies. Aim: to determine the basic educational lines that a continuous training program should have for oncology nurses. A bibliographic review study was carried out in two phases from October 2020 to January 2021. In a first phase, the main databases were analyzed: PubMed, Web of Science, Dialnet and Medline, following the PRISMA methodology; and subsequently, an analysis of the most important thematic nuclei that a training program in cancer nursing should contain. The DAFO matrix and the Hanlon prioritization method were used. Four competencies that every oncology nurse should have were described: communication, coping, self-direction of learning and technical health. The thematic contents that a training program should contain were then determined, and aspects such as stress prevention and burnout, adequate communication with patient and family, and continuous educational and technical skills were considered. The results found suggest that there are deficiencies in the education of nursing staff. Continuing education programs are effective in supplementing them. They should develop the four skills described in the results section.

Pattern of mobile phone and internet use among 11-15-years-old.

OBJECTIVE: To assess the pattern of problematic internet and mobile use in a sample of adolescents. METHOD: Cross-sectional descriptive study in 8 primary and secondary education centres attached to a semi-rural health centre serving 21,000 inhabitants. Two-stage, cluster and systematic sampling, with a final sample size of 446 participants. Sociodemographic variables and data related to the questionnaire for mobile phone-related experiences (CERM) and questionnaire on internet-related experiences (CERI) were collected. RESULTS: 446 valid surveys were obtained, 228 boys (51.1%) and 218 girls (48.9%) 11-15 years old. A total of 418 (93.7%) had their own mobile. Median mobile usage was 12h on weekdays and 10 at weekends. The most used platforms were WhatsApp (53.6%) and social media (31.4%). Criteria for problematic internet use (CERI>26) were observed in 15.7%, more in 2nd and 3rd ESO. Girls had higher CERI -interpersonal conflict scores (p=.04). Regarding mobile use, girls had higher scores in total CERM (p=.001) and CERM-communicative and emotional use (p=.001). CONCLUSIONS: The results indicate early onset of problems with internet and mobile use, probably related to the accessibility of the new technologies. No parental control was observed. More problematic use of mobile and internet in second and third compulsory secondary education and higher scores in the group of girls related to communication, emotional use and interpersonal conflicts were observed. The findings can help to raise awareness of this problem, detect it early and prevent the effects of addiction to technologies in adolescents.

Possible Role of Butyrylcholinesterase in Fat Loss and Decreases in Inflammatory Levels in Patients with Multiple Sclerosis after Treatment with Epigallocatechin Gallate and Coconut Oil: A Pilot Study.

(1) Background. Multiple sclerosis (MS) is characterised by the loss of muscle throughout the course of the disease, which in many cases is accompanied by obesity and related to inflammation. Nonetheless, consuming epigallocatechin gallate (EGCG) and ketone bodies (especially ß-hydroxybutyrate (ßHB)) produced after metabolising coconut oil, have exhibited anti-inflammatory effects and a decrease in body fat. In addition, butyrylcholinesterase (BuChE), seems to be related to the pathogenesis of the disease associated with inflammation, and serum concentrations have been related to lipid metabolism. Objective. The aim of the study was to determine the role of BuChE in the changes caused after treatment with EGCG and ketone bodies on the levels of body fat and inflammation state in MS patients. (2) Methods. A pilot study was conducted for 4 months with 51 MS patients who were randomly divided into an intervention group and a control group. The intervention group received 800 mg of EGCG and 60 mL of coconut oil, and the control group was prescribed a placebo. Fat percentage and concentrations of the butyrylcholinesterase enzyme (BuChE), paraoxonase 1 (PON1) activity, triglycerides, interleukin 6 (IL-6), albumin and ßHB in serum were measured. (3) Results. The intervention group exhibited significant decreases in IL-6 and fat percentage and significant increases in BuChE, ßHB, PON1, albumin and functional capacity (determined by the Expanded Disability Status Scale (EDSS)). On the other hand, the control group only exhibited a decrease in IL-6. After the intervention, BuChE was positively correlated with the activity of PON1, fat percentage and triglycerides in the intervention group, whereas these correlations were not observed in the control group (4). Conclusions. BuChE seems to have an important role in lipolytic activity and the inflammation state in MS patients, evidenced after administering EGCG and coconut oil as a ßHB source.

The Impact of Epigallocatechin Gallate and Coconut Oil Treatment on Cortisol Activity and Depression in Multiple Sclerosis Patients.

(1) Background: Multiple sclerosis (MS) is pathogenically characterized by high oxidative stress and symptomatically by progressive muscle loss and increased body fat associated with the presence of depression. Epigallocatechin gallate (EGCG) (particularly present in green tea) and ketone bodies (in particular beta-hydroxybutyrate (BHB)), whose main source is coconut oil, have shown emotional benefits and body fat loss. The aim of this study was to assess the impact of EGCG and coconut oil on cortisol activity related to fat loss and depression in MS patients. (2) Methods: The study involved 51 MS patients who were randomly divided into an intervention group or a control group. The intervention group received 800 mg of EGCG and 60 mL of coconut oil, which were included in their daily diet for four months. The control group received placebo and all patients followed an isocaloric diet. A blood sample was collected before and after the four-month period, and levels of cortisol, albumin and BHB were measured in serum. In addition, immediately before and after the intervention, anthropometric variables were measured: waist-to-hip ratio (WHR), body fat mass percentage, fat weight, total weight, and muscle mass percentage. Depression was assessed with the Beck Depression Inventory II (BDI-II). (3) Results: No significant changes were obtained in cortisol levels in any of the groups, and there was a significant increase in albumin in the blood of the intervention group only that could lead to a decrease in serum free cortisol. In addition, it was observed a significant decrease in levels of depression and abdominal fat. (4) Conclusions: EGCG combined with coconut oil increase the concentration of albumin in blood and produce less depression in MS patients.

Reporting of workplace violence towards nurses in 5 European countries - a cross-sectional study.

OBJECTIVES: This study aimed to assess country-specific evidence of physical and non-physical acts of workplace violence towards nurses working in the health sector in 5 European countries, and then to identify reasons for not reporting violence experienced at work. MATERIAL AND METHODS: This retrospective cross-sectional study was conducted in 5 participating countries (Poland, the Czech Republic, the Slovak Republic, Turkey, and Spain). All registered nurses working in selected healthcare settings for at least 1 year were invited to participate in the study. A questionnaire adapted from the Workplace Violence in the Health Sector Country Case Study - Questionnaire, developed jointly by the International Labour Office, the International Council of Nurses, the World Health Organization and Public Services International, was used. The selection of healthcare settings and the distribution of the questionnaire were conducted according to the recommendations of the questionnaire authors. RESULTS: In total, 1089 nurses submitted completed questionnaires which could be included in the study. Of these, 54% stated that they had been exposed to non-physical violence and 20% had been exposed to physical violent acts. A total of 15% of the surveyed nurses experienced both forms of workplace violence. In addition, 18% of the respondents confirmed having witnessed physical violence in their workplace. The most common perpetrators were patients and patients' relatives. In about 70% of these cases, no actions were taken after the act of violence to investigate its causes. About half of the study group did not report workplace violence as they believed it was useless or not important. The most common consequences of workplace violence included being "superalert" or watchful and on guard. CONCLUSIONS: Nurses internationally are both victims of and witnesses to workplace violence. Workplace violence is often seen by nurses as an occupational hazard and, as such, it remains not reported. The first step in preventing workplace violence is not only to acknowledge its existence but also to ensure the appropriate reporting of violent acts. Int J Occup Med Environ Health. 2020;33(3):325-38.

Violence against nurses working in the health sector in five European countries-pilot study.

AIM: To provide initial data regarding country-specific evidence of workplace violence towards nurses working within the health sector in five European countries. METHODS: This is a descriptive and cross-sectional pilot study, conducted in June 2016. The sample consisted of 260 nurses working in selected health care settings in five participating countries (Poland, Czech Republic, Slovakia, Turkey, and Spain). The questionnaire used was adapted from the International Labour Office/International Council of Nurses/World Health Organisation/Public Services International Workplace Violence in the Health Sector Country Case Study-Questionnaire. RESULTS: A large number of participants confirmed that they had been physically attacked or verbally abused in the workplace in the last 12 months. In most cases, the physical and verbal abuse was inflicted by patients and to a lesser degree by relatives of patients, staff members, or managers/supervisors. In the majority of cases, no action was taken to investigate the causes of the incidents. In most cases, participants believed there was no point in reporting the incidents. However, the reasons for not reporting or discussing incidents of workplace violence varied depending on the country. CONCLUSION: Workplace violence towards nurses is a serious problem internationally, and violence prevention strategies need to be implemented.

Improvement of Main Cognitive Functions in Patients with Alzheimer's Disease after Treatment with Coconut Oil Enriched Mediterranean Diet: A Pilot Study.

BACKGROUND: Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder (mainly in women), and new therapies are needed. In this way, ketone bodies are a direct source of cellular energy and can be obtained from coconut oil, postulating that coconut oil could be a new non-pharmacological alternative in AD patients. OBJECTIVE: The aim of this study is to detect changes in the main cognitive functions of patients with AD after following a coconut oil enriched Mediterranean diet, and to determine whether there are differences in function of stage or sex. METHODS: A prospective, longitudinal, qualitative, analytic, experimental study was carried out in 44 patients with AD, who were randomly divided into two homogenous groups of 22 patients each: an experimental group of patients who followed a coconut oil enriched Mediterranean diet for 21 days and a control group. In order to determine the cognitive changes after the intervention, we carried out the 7 Minute Screen, which analyses temporal orientation, visuospatial and visuoconstructive abilities, and semantic and episodic memory. RESULTS: After intervention with coconut oil, improvements in episodic, temporal orientation, and semantic memory were observed, and it seems that the positive effect is more evident in women with mild-moderate state, although other improvements in males and severe state were also shown. CONCLUSIONS: The isocaloric coconut oil enriched Mediterranean diet seems to improve cognitive functions in patients with AD, with differences according to patient sex and degree of severity of the disease, although more studies in this line are needed.

Ischemic heart disease in women / A cardiopatia isquêmica na mulher / La cardiopatía isquémica en la mujer

Nowadays, Coronary Diseases (CDs) represent the main mortality cause in men and women, but there are gender differences regarding their presentation, progression and the way the disease is tackled. This study mainly focuses on reviewing literature about the CD and its gender approach. The authors carried out a search of texts that use qualitative methodology, published between 2003 and 2009 in the following databases: PUBMED, IME, CUIDEN and CINAHL. Factors that hinder the early diagnosis of Ischemic Heart Disease in women are identified as the main findings, and the possible consequences are pointed out. In the fifty-six texts that were selected initially, we can see the difficulty women face to recognize early symptoms of the CD and their low risk perception of this disease. Greater awareness on Ischemic Heart Disease is needed, so that the high morbidity and mortality rates can be reduced.

As doenças coronárias (DC) são o principal motivo de mortalidade no sexo feminino e masculino. Existem diferenças de gênero na apresentação, na evolução e na maneira como a doença é abordada. Este trabalho teve como objetivo principal revisar a literatura sobre a DC e o seu enfoque de gênero. Os autores pesquisaram diferentes textos caracterizados por uma abordagem qualitativa, publicados entre 2003 e 2009, nas bases de dados PubMed, IME, CUIDEN e CINAHL. Como principais resultados são identificados os fatores que dificultam o diagnóstico precoce da doença isquêmica nas mulheres, e as possíveis consequências desse diagnóstico tardio são apontadas. Nos 56 textos selecionados, inicialmente mostra-se a dificuldade da mulher relacionada ao reconhecimento dos primeiros sintomas da doença coronária, e a baixa percepção do risco dessa doença. É necessária maior sensibilização sobre a cardiopatia isquêmica (CI), para se reduzir o elevado índice de morbidade e mortalidade.

Las Enfermedades Coronarias (EC) suponen la principal causa de mortalidad en el sexo femenino y masculino, pero existen diferencias de género en aspectos como la presentación, evolución o el abordaje de la enfermedad. Este trabajo se centra principalmente en revisar la literatura sobre la EC y el enfoque de género. Los autores han realizado una búsqueda de artículos que utilizan metodología cualitativa publicados entre 2003 y 2009 en las bases de datos PUBMED, IME, CUIDEN y CINAHL. Como hallazgos principales se identifican los factores que dificultan el diagnóstico precoz de la cardiopatía isquémica en la mujer, y se apuntan las posibles consecuencias que puede comportar. En los 56 textos seleccionados, inicialmente se evidencia la dificultad de la mujer para reconocer los síntomas iniciales de EC, así como la baja percepción de riesgo sobre dicha enfermedad. Es necesaria una mayor concienciación sobre la CI con la finalidad de reducir las altas cifras de morbimortalidad.

Ischemic heart disease in women.

Nowadays, Coronary Diseases (CDs) represent the main mortality cause in men and women, but there are gender differences regarding their presentation, progression and the way the disease is tackled. This study mainly focuses on reviewing literature about the CD and its gender approach. The authors carried out a search of texts that use qualitative methodology, published between 2003 and 2009 in the following databases: PUBMED, IME, CUIDEN and CINAHL. Factors that hinder the early diagnosis of Ischemic Heart Disease in women are identified as the main findings, and the possible consequences are pointed out. In the fifty-six texts that were selected initially, we can see the difficulty women face to recognize early symptoms of the CD and their low risk perception of this disease. Greater awareness on Ischemic Heart Disease is needed, so that the high morbidity and mortality rates can be reduced.