Effect of nursing telemonitoring on the knowledge of obese women: clinical trial.

OBJECTIVE: To assess the effectiveness of remote monitoring in the knowledge of overweight women. METHOD: Randomized clinical trial with 101 women, randomly assigned to the control group (CG=50) and to the intervention group (IG=51). The IG received educational intervention over the telephone, during three months and routine follow-up in the service, while the CG only received conventional follow-up. The knowledge was assessed by a specific questionnaire. Data were analyzed by the Robust Linear Regression Model, adopting a statistical significance of 5%. RESULTS: In the intragroup assessment, an increase in the correct answers with a statistically significant difference was observed only for the IG in the domains: "Concept and causes of overweight," "Complications of overweight" and "Eating habits." In the intergroup comparison, an increase in the average knowledge was verified in the same domains for the IG (p≤0.005). CONCLUSION: nursing telemonitoring contributed positively to the improvement of women's knowledge.

Effect of nursing telemonitoring on the knowledge of obese women: clinical trial / Resultado del telemonitoreo de enfermería en el conocimiento de mujeres obesas: un ensayo clínico / Efeito do telemonitoramento de enfermagem no conhecimento de mulheres obesas: ensaio clínico

ABSTRACT Objective: To assess the effectiveness of remote monitoring in the knowledge of overweight women. Method: Randomized clinical trial with 101 women, randomly assigned to the control group (CG=50) and to the intervention group (IG=51). The IG received educational intervention over the telephone, during three months and routine follow-up in the service, while the CG only received conventional follow-up. The knowledge was assessed by a specific questionnaire. Data were analyzed by the Robust Linear Regression Model, adopting a statistical significance of 5%. Results: In the intragroup assessment, an increase in the correct answers with a statistically significant difference was observed only for the IG in the domains: "Concept and causes of overweight," "Complications of overweight" and "Eating habits." In the intergroup comparison, an increase in the average knowledge was verified in the same domains for the IG (p≤0.005). Conclusion: nursing telemonitoring contributed positively to the improvement of women's knowledge.

RESUMEN Objetivo: Evaluar la eficacia del monitoreo a distancia de enfermería en la mejora del conocimiento de mujeres con sobrepeso. Método: Ensayo clínico aleatorizado, realizado con 101 mujeres, asignadas aleatoriamente en grupo control (GC =50) y en grupo de intervención (GI =51). El GI recibió intervención educativa por teléfono, durante tres meses, y seguimiento de rutina en el servicio, mientras que el GC recibió solo el seguimiento convencional. Se evaluó el conocimiento mediante un cuestionario específico. Los datos se analizaron utilizando el Modelo de Regresión Linear Robusto, adoptando la significancia estadística del 5%. Resultados: En la evaluación intragrupal, hubo un aumento en los aciertos con una diferencia estadísticamente significante solo para el GI en los dominios: "Concepto y causas del sobrepeso", "Complicaciones del sobrepeso" y "Hábitos alimenticios". En la comparación intergrupal, se verificó que el GI aumentó la media del conocimiento en los mismos dominios (p≤0,005). Conclusión: el telemonitoreo de enfermería contribuyó positivamente a la mejora del conocimiento de las mujeres.

RESUMO Objetivo: Avaliar a efetividade do monitoramento remoto de enfermagem na melhora do conhecimento de mulheres com excesso de peso. Método: Ensaio clínico randomizado, com 101 mulheres, alocadas aleatoriamente no grupo controle (GC = 50) e no grupo intervenção (GI = 51). O GI recebeu intervenção educativa por telefone durante três meses e acompanhamento de rotina no serviço, e o GC, apenas acompanhamento convencional. O conhecimento foi avaliado por questionário específico. Os dados foram analisados pelo Modelo de Regressão Linear Robusto, adotando-se significância estatística de 5%. Resultados: Na avaliação intragrupo houve aumento de acertos com diferença estatisticamente significante apenas para o GI nos domínios: "Conceito e causas do excesso de peso", "Complicações do excesso de peso" e "Hábitos alimentares". Na comparação intergrupos, verificou-se para o GI aumento na média do conhecimento nos mesmos domínios (p ≤ 0,005). Conclusão: o telemonitoramento de enfermagem contribuiu positivamente para a melhora do conhecimento das mulheres.

Percepções acerca da condição de saúde de pessoas com obesidade / Perceptions about the health condition of people with obesity

Compreender as percepções de pessoas com obesidade sobre esta condição de saúde. Métodos: pesquisa qualitativa realizada em ambulatório para acompanhamento de pessoas com obesidade. Foram entrevistadas 15 pessoas com diagnóstico de obesidade. Dados coletados por entrevistas e submetidos à Análise de Conteúdo Temática. Resultados: emergiram três categorias: Significando a obesidade, Afetando a vida cotidiana e a saúde e Enfrentando a obesidade. Na primeira categoria, a maioria dos entrevistados significou negativamente a própria obesidade; na segunda, perceberam-na como condição capaz de provocar dano à saúde e à capacidade laboral; e, na terceira, como condição que precisa ser enfrentada e tratada. Conclusão:as percepções da obesidade refletiram, sobretudo, sentimentos negativos, acompanhados de algum grau de sofrimento físico, psíquico e social.

Objective: to understand the perceptions of people with obesity on this health condition. Methods: qualitative research conducted in an outpatient clinic for follow-up of people with obesity. 15 people diagnosed with obesity were interviewed. Data were collected by interviews and submitted to thematic content analysis. Results: three categories emerged: Giving meaning to obesity, Affecting everyday life and health and Facing obesity. In the first category, the majority of respondents gave negative meaning to their own obesity; in the second, they perceived it as a condition capable of causing damage to health and labor capacity; and in the third, it was referred as a condition that must be faced and treated. Conclusion: perceptions on obesity reflected, above all, negative feelings, accompanied by some degree of physical, mental and social suffering.

Fatores de risco cardiovascular em pacientes submetidos à cirurgia de revascularização miocárdica / Cardiovascular risk factors in patients submitted to coronary bypass graft surgery / Factores de riesgo cardiovascular em pacientes sometidos a cirugía de revascularización del miocardio

Objetivo: descrever a prevalência de fatores de risco cardiovascular em pacientes no pré-operatório decirurgia de revascularização do miocárdio (CRM). Método: estudo transversal, descritivo, com avaliação ecoleta de dados de 165 pacientes em um hospital de referência da rede SUS, em Salvador-Bahia/Brasil.Resultados: a maioria da população de idosos, 103(62,4 %), homens, 102(61,8%), raça autodeclaradanegra/parda, 129(78,2%), com ensino fundamental, 105(63,6%) e da classe social E, 141(85,5%). Fatores derisco cardiovascular mais prevalentes: hipertensão136(82,4%), circunferência da cintura >84cm em 57(90,4%)mulheres e >88cm em 87(85,2%) homens, sedentarismo 135(81,8%), tabagismo 88(53,3%), LDL-c elevado105(69,5%), HDL-c baixo 84(53,8%), triglicérides elevado, 81(51,6%), sobrepeso 77 (46,7%), obesidade42(25,5%) e DM2, 80(48,8%). Conclusão: pacientes no pré-operatório de CRM em hospital público da rede SUSsão, em sua maioria, idosos, negros e pardos, estrato social baixo e com elevada prevalência de fatores derisco cardiovascular.(AU)

Objective: describing the prevalence of cardiovascular risk factors in patients in preoperative care for coronary bypass graft surgery (CABG). Method: cross-sectional descriptive study, with collection and assessment of data for 165 patients in a reference hospital of the SUS network (public health system), in Salvador-Bahia/Brazil. Results: the majority of the population of elderly, 103(62,4%), male, 102(61,8%), selfdeclared race black or mulatto, 129(78.2%), with primary education, 105(63,6%) and social class E, 141(85,5%). Most prevalent cardiovascular risk factors: hypertension 136(82,4%), waist circumference >84cm in 57(90,4%) women and >88cm in 87(85,2%) men, sedentarism 135(81,8%), smoking 88(53,3%), high LDL-c 105(69,5%), low HDL-c 84(53,8%), high triglycerides, 81(51,6%), overweight 77 (46,7%), obesity 42(25,5%) and DM2, 80(48,8%). Conclusion: patients in preoperative care for CABG in a public hospital of the SUS network are, in their majority, elderly, black and mulattos, low social class and with high prevalence of cardiovascular risk factors.(AU)

Objetivo: describir la prevalencia de factores de riesgo cardiovascular en pacientes en lo preoperatorio de cirugía de revascularización del miocardio (CRM). Método: estudio transversal, descriptivo, con evaluación y recolección de datos de 165 pacientes en un hospital de referencia de la red SUS, en Salvador-Bahia/Brasil. Resultados: la mayoría de la población de ancianos, 103(62,4 %), hombres, 102(61,8%), raza auto declarada negra/parda, 129(78,2%), con enseñanza fundamental, 105(63,6%) y de la clase social E, 141(85,5%). Factores de riesgo cardiovascular más prevalentes: hipertensión 136(82,4%), circunferencia de la cintura >84cm en 57(90,4%) mujeres y >88cm en 87(85,2%) hombres, sedentarismo 135(81,8%), tabaquismo 88(53,3%), LDL-c alto 105(69,5%), HDL-c bajo 84(53,8%), triglicéridos elevados, 81(51,6%), sobrepeso 77 (46,7%), obesidad 42(25,5%) y DM2, 80(48,8%). Conclusión: pacientes en lo preoperatorio de CRM en hospital público de la red SUS son, en su mayoría, ancianos, negros y pardos, estrato social bajo y con elevada prevalencia de factores de riesgo cardiovascular.(AU)

Endothelial Effect of Statin Therapy at a High Dose Versus Low Dose Associated with Ezetimibe.

BACKGROUND: The effect of statins on the endothelial function in humans remains under discussion. Particularly, it is still unclear if the improvement in endothelial function is due to a reduction in LDL-cholesterol or to an arterial pleiotropic effect. OBJECTIVE: To test the hypothesis that modulation of the endothelial function promoted by statins is primarily mediated by the degree of reduction in LDL-cholesterol, independent of the dose of statin administered. METHODS: Randomized clinical trial with two groups of lipid-lowering treatment (16 patients/each) and one placebo group (14 patients). The two active groups were designed to promote a similar degree of reduction in LDL-cholesterol: the first used statin at a high dose (80 mg, simvastatin 80 group) and the second used statin at a low dose (10 mg) associated with ezetimibe (10 mg, simvastatin 10/ezetimibe group) to optimize the hypolipidemic effect. The endothelial function was assessed by flow-mediated vasodilation (FMV) before and 8 weeks after treatment. RESULTS: The decrease in LDL-cholesterol was similar between the groups simvastatin 80 and simvastatin 10/ezetimibe (27% ± 31% and 30% ± 29%, respectively, p = 0.75). The simvastatin 80 group presented an increase in FMV from 8.4% ± 4.3% at baseline to 11% ± 4.2% after 8 weeks (p = 0.02). Similarly, the group simvastatin 10/ezetimibe showed improvement in FMV from 7.3% ± 3.9% to 12% ± 4.4% (p = 0.001). The placebo group showed no variation in LDL-cholesterol level or endothelial function. CONCLUSION: The improvement in endothelial function with statin seems to depend more on a reduction in LDL-cholesterol levels, independent of the dose of statin administered, than on pleiotropic mechanisms.

Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort.

BACKGROUND: Few studies have evaluated the association between delivery by cesarean section (CS) and asthma, allergic rhinitis and chronic rhinitis and whether this association is different in children with and without a family history of asthma. This study aims to investigate whether children born by CS have a higher chance to develop asthma, allergic rhinitis and chronic rhinitis and to evaluate the influence of parental history of asthma on these associations. METHODS: This is a cross-sectional study of 672 children nested in a birth cohort evaluated at 6-years of age. Asthma and chronic/allergic rhinitis were identified by means of the mother's responses to the ISAAC questionnaire. The association between CS, asthma, chronic rhinitis and allergic rhinitis was evaluated by multivariable logistic regression. The evidence of effect modification of parental history of asthma on the association CS and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders. RESULTS: Asthma was not associated with birth by CS irrespective of parental history of asthma (odds ratio (OR) 1.03; 95 % CI 0.61-1.74). Chronic rhinitis and allergic rhinitis were both significantly associated with birth by CS but only in the subgroup of children with by parental history of asthma (OR 1.56; 95 % CI 1.04-2.34) and (OR 1.60; 95 % CI 1.01-2.55) respectively, after adjustment for confounders. The parental history of asthma was a effect modifier in the association between CS, chronic rhinitis and allergic rhinitis (p for effect modification = 0.10 and 0.02, respectively). CONCLUSION: CS increases the risk of chronic rhinitis and allergic rhinitis in children at 6 years of age with parental history of asthma. Health professionals must be alerted with regard to the increased risk of allergic rhinitis and made aware this is another reason to avoid unnecessary CS.

Endothelial Effect of Statin Therapy at a High Dose Versus Low Dose Associated with Ezetimibe / Efeito Endotelial da Terapia com Estatina em Alta Dose versus Baixa Dose Associada à Ezetimiba

Abstract Background: The effect of statins on the endothelial function in humans remains under discussion. Particularly, it is still unclear if the improvement in endothelial function is due to a reduction in LDL-cholesterol or to an arterial pleiotropic effect. Objective: To test the hypothesis that modulation of the endothelial function promoted by statins is primarily mediated by the degree of reduction in LDL-cholesterol, independent of the dose of statin administered. Methods: Randomized clinical trial with two groups of lipid-lowering treatment (16 patients/each) and one placebo group (14 patients). The two active groups were designed to promote a similar degree of reduction in LDL-cholesterol: the first used statin at a high dose (80 mg, simvastatin 80 group) and the second used statin at a low dose (10 mg) associated with ezetimibe (10 mg, simvastatin 10/ezetimibe group) to optimize the hypolipidemic effect. The endothelial function was assessed by flow-mediated vasodilation (FMV) before and 8 weeks after treatment. Results: The decrease in LDL-cholesterol was similar between the groups simvastatin 80 and simvastatin 10/ezetimibe (27% ± 31% and 30% ± 29%, respectively, p = 0.75). The simvastatin 80 group presented an increase in FMV from 8.4% ± 4.3% at baseline to 11% ± 4.2% after 8 weeks (p = 0.02). Similarly, the group simvastatin 10/ezetimibe showed improvement in FMV from 7.3% ± 3.9% to 12% ± 4.4% (p = 0.001). The placebo group showed no variation in LDL-cholesterol level or endothelial function. Conclusion: The improvement in endothelial function with statin seems to depend more on a reduction in LDL-cholesterol levels, independent of the dose of statin administered, than on pleiotropic mechanisms.

Resumo Fundamento: O efeito das estatinas na função endotelial em seres humanos permanece em discussão. Particularmente, ainda carece resposta se a melhora na função endotelial deve-se à redução do LDL-colesterol ou a um efeito pleiotrópico arterial. Objetivo: Testar a hipótese de que a modulação da função endotelial promovida por estatinas é prioritariamente mediada pelo grau de redução do LDL-colesterol, independente da dose de estatina utilizada. Métodos: Ensaio clínico randomizado com dois grupos de tratamento hipolipemiante (16 pacientes/cada) e um grupo placebo (14 pacientes). Os dois grupos ativos foram desenhados para promover graus semelhantes de redução de LDL-colesterol: o primeiro utilizou estatina em alta dose (80 mg, grupo sinvastatina 80) e o segundo em baixa dose (10 mg) associada a ezetimiba (10 mg, grupo sinvastatina 10/ezetimiba) para otimizar o efeito hipolipemiante. A função endotelial foi analisada pela vasodilatação mediada por fluxo (VMF) antes e após 8 semanas de tratamento. Resultados: A redução no LDL-colesterol foi semelhante entre os grupos sinvastatina 80 e sinvastatina 10/ezetimiba (27% ± 31% e 30% ± 29%, respectivamente, p = 0,75). O grupo sinvastatina 80 apresentou incremento da VMF de 8,4% ± 4,3% no basal para 11% ± 4,2% após 8 semanas (p = 0,02). Da mesma forma, o grupo sinvastatina 10/ezetimiba apresentou melhora da VMF de 7,3% ± 3,9% para 12% ± 4,4% (p = 0,001). O grupo placebo não apresentou variação no nível de LDL-colesterol ou da função endotelial. Conclusão: A melhora da função endotelial com uso de estatina parece depender mais da redução do LDL-colesterol, independente da dose de estatina utilizada, do que de mecanismos pleiotrópicos.

[Environmental factors associated with the decision time for seeking care in myocardial infarction]. / Fatores ambientais associados ao tempo de decisão para procura de atendimento no infarto do miocárdio.

The purpose was to estimate the decision time (DT) for searching for attendance for men and women suffering from acute myocardial infarction (AMI); and to analyze the influence of surrounding variables in the DT. Transversal study, involving one hundred patients interviewed in hospitals of Salvador-BA, Brazil. For data analysis, it was used the chi-squared or Fisher's exact test, and the Robust Linear Regression Model. AMI at the home predominated, with family members and patients receiving mistaken actions. A high DT was observed both, for women (0.9h) and men (1.4h). Those at home during the initial symptoms had higher DT, compared to those at work; and lower in relation to those in public spaces (p=0.047). Statistically significant interaction occurred among gender and the fact of living with company; and among gender and having a companion and children, for the outcome of the DT. Nursing care focused on the specificity of surrounding factors and gender can optimize early attendance.

Fatores ambientais associados ao tempo de decisão para procura de atendimento no infarto do miocárdio / Environmental factors associated with the decision time for seeking care in myocardial infarction / Factores ambientales asociados con el tiempo de decisión para la búsqueda de atención en el infarto de miocardio

Objetivou-se estimar o tempo de decisão para procura de atendimento (TD) para homens e mulheres com infarto agudo do miocárdio (IAM); analisar a influência de variáveis ambientais no TD e a interação entre gênero e variáveis ambientais para o desfecho TD. Estudo transversal, envolvendo cem pacientes, entrevistados em hospitais de Salvador. Na análise dos dados empregou-se o Qui-quadrado ou Exato de Fisher e o Modelo de Regressão Linear Robusto. Predominou o IAM ocorrido no domicílio, familiares no entorno, e os pacientes sendo alvo de ações equivocadas. Observou-se TD elevado para mulheres (0,9h) e homens (1,4h). Aqueles em casa no início dos sintomas tiveram maior TD, comparados aos no trabalho e menor em relação aos em via pública (p=0,047). Houve interação estatisticamente significante entre gênero e viver acompanhado; e entre gênero e ter companheiro e filhos no entorno, para o desfecho TD. O cuidar em enfermagem focalizado nas especificidades de fatores ambientais e de gênero pode otimizar o atendimento precoce.

The purpose was to estimate the decision time (DT) for searching for attendance for men and women suffering from acute myocardial infarction (AMI); and to analyze the influence of surrounding variables in the DT. Transversal study, involving one hundred patients interviewed in hospitals of Salvador-BA, Brazil. For data analysis, it was used the chi-squared or Fisher’s exact test, and the Robust Linear Regression Model. AMI at the home predominated, with family members and patients receiving mistaken actions. A high DT was observed both, for women (0.9h) and men (1.4h). Those at home during the initial symptoms had higher DT, compared to those at work; and lower in relation to those in public spaces (p=0.047). Statistically significant interaction occurred among gender and the fact of living with company; and among gender and having a companion and children, for the outcome of the DT. Nursing care focused on the specificity of surrounding factors and gender can optimize early attendance.

Se objetivó estimar el tiempo de decisión para buscar atendimiento (TD) para hombres y mujeres con infarto agudo de miocardio (IAM); analizar la influencia de variables ambientales en TD y la interacción entre genero y variables ambientales para el desfecho del TD. Estudio transversal, envolviendo cien pacientes entrevistados en hospitales de Salvador-BA, Brasil. En el análisis se utilizó el chi-cuadrado o el Teste Exacto de Fisher y el Modelo de Regresión Linear Robusto. Predominó el IAM en el domicilio, familiares en el entorno y con pacientes siendo objeto de acciones equivocadas. Se observó TD elevados para mujeres (0,9h) y hombres (1,4h). Aquellos en sus casas en el inicio de los síntomas tuvieron mayor TD, comparados a los en el trabajo, y menor en relación aquellos en vía pública (p=0,047). Hubo interacción estadísticamente significante entre genero y vivir acompañado y entre genero y tener compañero e hijos en el entorno, para el desfecho del TD. El cuidar en enfermería focalizado en especificidades de factores ambientales y de géneros puede optimizar el atendimiento precoce.

Quality of life of patients after an acute coronary event: hospital discharge.

BACKGROUND: The acute coronary syndrome (ACS) has a high morbi-mortality rate, including physical deficiencies and functional limitations with impact on quality of life. Cardiovascular rehabilitation 1 (CVR1) should begin as early as possible, to enable improvement in functional capacity and quality of life. Previous studies have shown association of cardiovascular diseases with quality of life, in which depression and anxiety are the domains most altered. The aim of the study is to verify the impact of an acute coronary event on quality of life at the moment of hospital discharge. METHODOLOGY: This was a cross-sectional study, with ACS patients hospitalized in ICU of a private hospital in the city of Salvador, Brazil, submitted to CVR1. The quality of life questionnaire Euroqol-5D was applied on discharge from hospital. Patients included in the study were those with ACV, who had medical permission to walk, had not been submitted to acute surgical treatment, were time and space oriented, and over the age of 18 years. Patients excluded from the study were those with cognitive, orthopedic and neurological problems, who used orthesis on a lower limb, and were in any condition of risk at the time of beginning with CVR1. Data were collected by a previously trained ICU team. RESULTS: Data were collected of 63 patients who revealed compromise in the domains of pain/feeling ill (20.63%) and anxiety/depression (38.09%). Statistical significance was observed in the association between sex and pain/feeling ill (P < 0.01), sex and anxiety/depression (P < 0.01), diabetes and mobility (P < 0.01), hereditary factors and anxiety/depression (p < 0.01), BMI and pain/feeling ill (P < 0.01). CONCLUSION: In this sample of patients, on discharge from hospital after ACS, the pain/feeling ill and anxiety/depression domains were shown to be compromised.

Acurácia e precisão do método ultrassonográfico manual de aferição da espessura mediointimal carotídea tendo como referência o método semiautomático / Accuracy and precision of ultrasound manual measurement of carotid intima-media thickness having semiautomatic method as reference / Exactitud y Precisión del Método Ecográfico Manual de Medición del Espesor Mediointimal Carotideo, teniendo como referencia el Método Semiautomático

Fundamento: A tecnologia semiautomática de detecção de bordas para aferição da Espessura Mediointimal Carotídea (EMIC), além de oferecer menor tempo de exame, apresenta mínima variabilidade das medidas.Objetivo: Testar a acurácia e a reprodutibilidade do método manual, tendo o semiautomático como referência.Métodos: Selecionadas mulheres do Ambulatório de Obesidade para aferição da EMIC. A avaliação do método manual (EMICmanual) foi realizada tomando-se a medida máxima do método semiautomático (EMICsamax) como referência, sendo utilizados teste de correlação de Pearson, grau de concordância e variabilidades inter e intraobservador nos dois modelos, além do teste de Kappa. Resultados: Na amostra de 59 participantes, houve forte correlação da medida de EMICmanual com EMICsamax (r = 0,84, p < 0,0001) e boa concordância entre ambos os métodos, dada a pequena média das diferenças de 0,06 ± 0,04 mm das medidas, com limites de concordância no nível 95 por cento entre -0,02 a 0,14 mm. A concordância na definição de aterosclerose subclínica foi moderada, de 53 por cento , (Kappa de 52 por cento p < 0,0001). Observou-se forte correlação com os métodos manual e semiautomático, entre as medidas intra e interobservador e boa reprodutibilidade intraobservador das medidas de EMICmanual, com diferença média de 0,04 ± 0,03 mm e limites de concordância no nível 95 por cento entre -0,02 a 0,10 mm, semelhantemente às medidas de EMICsamax, que se repetiu na reprodutibilidade interobservador. Conclusão: O método manual de aferição da EMIC pôde ser validado como método alternativo ao semiautomático.

Background: The semiautomated ultrasound border detection technology for measurement carotid intima-media thickness (CIMT) provides shorter time of exam and minimal variability measures.Objective: To evaluate the accuracy of the manual method, taking the semiautomated as reference and the reproducibility of the methods.Methods: Data were obtained from women of Ambulatory of Obesity directed to CIMT measurements determination. The evaluation of the manual method (manualCIMT) was performed, taking the maximum thickness of the semiautomated method (samaxCIMT) as reference. The statistical analyses used Pearson correlation, degree of agreement and inter and intraobserver variabilities in the two models and Kappa test.Results: In the sample of 59 women, there was a strong correlation of manualCIMT with samaxCIMT (r = 0.84, p <0.0001) and a good agreement between both methods, given the small mean difference of measures (0.06 ± 0.04 mm), with limits of agreement at 95 percent level between -0.02 to 0.14 mm. The agreement on the definition of subclinical atherosclerosis was moderate, 53 percent (kappa 52 percent, p <0.0001). The correlation between manual and semiautomated measurements in intra and inter-observer analyses was strong. The intraobserver reproducibility for manualCIMT measures was good and similar of interobserver, with a mean difference of 0.04 ± 0.03 mm and limits of agreement at 95 percent level between -0.02 to 0.10 mm. For EMICsamáx similar result was observed. Conclusion: The Manual method of measuring carotid intima-media thickness could be validated as na alternative to semi-automated.

Justificación: La tecnología semiautomática de detección de bordes para medición del Espesor Mediointimal Carotideo (EMIC), además de ofrecer un menor tiempo de examen, presenta mínima variabilidad de las medidas. Objetivo: Poner a prueba la exactitud y la reproducibilidad del método manual, tomando el semiautomático como referencia. Métodos: Se han seleccionadas mujeres en la Clínica de Obesidad para medición de EMIC. La evaluación del método manual (EMICmanual) ha sido realizada tomándose la medida máxima del método semiautomático (EMICsamax) como referencia, ya que se utiliza prueba de correlación de Pearson, grado de concordancia y variabilidades inter e intraobservador en los dos modelos, además de la prueba de Kappa. Resultados: En la muestra de 59 participante, hubo fuerte correlación de la medida de EMICmanual con EMICsamax (r = 0,84, p < 0,0001) y una buena concordancia entre los dos métodos, dado el pequeño promedio de las diferencias de 0,06 ± 0,04 mm de las medidas, con límites de concordancia al nivel del 95% entre -0,02 a 0,14 mm. La concordancia en la definición de aterosclerosis subclínica ha sido moderada, del 53%, (Kappa del 52% p < 0,0001). Se ha observado una fuerte correlación con los métodos manual y semiautomático, entre las medidas intra e interobservador y buena reproducibilidad intraobservador de las medidas de EMICmanual, con diferencia media de 0,04 ± 0,03 mm y límites de concordancia al nivel del 95% entre -0,02 a 0,10 mm, de forma similar a las medidas de EMICsamax, que se repitió en la reproducibilidad inter-observador. Conclusión: El método manual de medición de EMIC puede evaluarse como método alternativo al semiautomático

Sociodemographic and clinical factors associated with the decision time for seeking care in acute myocardial infarction / Fatores sociodemográficos e clínicos associados ao tempo de decisão para a procura de atendimento no infarto agudo do miocárdio / Factores sociodemográficos y clínicos asociados al tiempo de decisión para la búsqueda de atención en el infarto agudo del miocardio

OBJECTIVE: this study aimed to analyze the interaction of gender in the association between decision time for seeking healthcare services and the sociodemographic and clinical variables. METHOD: this exploratory, cross-sectional study was performed with 100 individuals interviewed in hospitals in Salvador, Bahia. The chi-square test or Fisher's exact test and the robust linear regression model were used in the analysis. A statistical significance of 5% was adopted. RESULTS: men and women presented long decision times. The decision time was less for smokers and those with constant and/or severe pain. There was an interaction between gender and smoking and between gender and pain radiating to the neck or jaw for the decision time outcome. CONCLUSION: decision times were long and were influenced by clinical and gender variables. The study provides support for nursing care practices focused on the specificity of these factors and of the genders aiming to reduce the decision time. .

OBJETIVO: analisar a interação do sexo na associação entre o tempo de decisão para a procura de serviço de saúde e as variáveis sociodemográficas e clínicas. MÉTODO: estudo exploratório, transversal, com 100 indivíduos entrevistados em hospitais de Salvador, BA. Na análise, empregou-se o teste qui-quadrado ou exato de Fisher e o modelo de regressão linear robusto. A significância estatística adotada foi de 5%. RESULTADOS: Resultados: homens e mulheres apresentaram tempos de decisão elevados. Houve menor tempo de decisão para tabagistas, com dor constante e de forte intensidade. Houve interação entre sexo e tabagismo e entre sexo e dor irradiada para o pescoço ou a mandíbula para o desfecho tempo de decisão. CONCLUSÃO: os tempos de decisão foram elevados e sofreram influência de variáveis clínicas e do sexo. O estudo oferece subsídios para práticas de cuidar em enfermagem, focalizadas na especificidade desses fatores e dos gêneros, visando-se obter êxito na redução do tempo de decisão. .

OBJETIVO: analizar la interacción del género en la asociación entre el tiempo de decisión para la búsqueda de servicio de salud y las variables sociodemográficas y clínicas. MÉTODO: estudio exploratorio, transversal, con 100 individuos entrevistados en hospitales de Salvador-BA. En el análisis se empleó el test Chi-cuadrado o Exacto de Fisher y el modelo de regresión linear robusto. La significancia estadística adoptada fue de 5%. RESULTADOS: hombres y mujeres presentaron tiempos de decisión elevados. Hubo menor tiempo de decisión para tabaquistas, con dolor constante y de fuerte intensidad. Hubo interacción entre género y tabaquismo y entre género y dolor irradiado para el cuello o mandíbula para el desenlace del tiempo de decisión. CONCLUSIÓN: los tiempos de decisión fueron elevados y sufrieron influencia de variables clínicas y de género. El estudio ofrece subsidios para prácticas de cuidar en enfermería enfocadas en la especificidad de esos factores y de los géneros objetivando obtener éxito en la reducción del tiempo de decisión. .

Sociodemographic and clinical factors associated with the decision time for seeking care in acute myocardial infarction.

OBJECTIVE: this study aimed to analyze the interaction of gender in the association between decision time for seeking healthcare services and the sociodemographic and clinical variables. METHOD: this exploratory, cross-sectional study was performed with 100 individuals interviewed in hospitals in Salvador, Bahia. The chi-square test or Fisher's exact test and the robust linear regression model were used in the analysis. A statistical significance of 5% was adopted. RESULTS: men and women presented long decision times. The decision time was less for smokers and those with constant and/or severe pain. There was an interaction between gender and smoking and between gender and pain radiating to the neck or jaw for the decision time outcome. CONCLUSION: decision times were long and were influenced by clinical and gender variables. The study provides support for nursing care practices focused on the specificity of these factors and of the genders aiming to reduce the decision time.

C-reactive protein is not correlated with endothelial dysfunction in overweight and obese women.

BACKGROUND: Obesity is a complex and multifactorial disease, has an inflammatory pattern and is associated with higher cardiometabolic risk. There are recent reports associating an elevated C-Reactive Protein (CRP) with a microscopic endothelial dysfunction. The objective is to evaluate if there is an association between serum levels of CRP and endothelial function in women with overweight/obesity, as well as the correlation between CRP and anthropometric variables. METHODS: This is a cross-sectional study that analyzed secondary data from patients treated in an institution of tertiary education, as part of the weight excess and cardiometabolic disease survey. The study included patients with overweight/obesity who had CRP and endothelial function tests already made and inserted into the survey database. The endothelial function was evaluated by: reactive hyperemia test (endothelium-dependent vasodilation). All tests were recorded and later analyzed by the same echocardiographer who performed the examination. Statistical analyses were realized in the Statistical Package for the Social Sciences (SPSS) version 14. It was considered statistically significant a P value < 0.05. RESULTS: This study included 47, nonsmoker women. with a BMI of 32.37 ± 5.06 kg/m(2), median of CRP of 2.59 mg/L and flow-mediated dilation (FMD) of 8.75% ± 5.22%. There was no correlation between CRP and endothelial dysfunction in this population (rs = 0.08, P = 0.64). No correlation was observed between CRP and BMI. There were no differences of endothelial dysfunction variables and CRP in groups in use or not of medications (Hypolipidemic, antihypertensives and hypoglycemic agents). CONCLUSION: There was no association between CRP and FMD and this can suggest that it is possible that the level of eNOS dysfunction associated with increased CRP is not enough to lead to macroscopic changes and harm vasodilation.

Associação entre peso de nascimento e fatores de risco cardiovascular em adolescentes / Association between birth weight and cardiovascular risk factors in adolescents

FUNDAMENTO: Peso ao nascer (PN) é um determinante de risco a médio e longo prazo de fatores de risco cardiovascular. OBJETIVO: Estudar a associação entre peso ao nascer e fatores de risco cardiovascular em adolescentes de Salvador. MÉTODOS: Estudo de corte transversal com grupos de comparação por PN. Amostra composta de 250 adolescentes, classificados segundo IMC: normal alto (>p50 e

BACKGROUND: Birth weight (BW) is a medium- and long-term risk determinant of cardiovascular risk factors. OBJECTIVE: To assess the association between BW and cardiovascular risk factors in adolescents of the city of Salvador, Bahia state. METHODS: Cross-sectional study with comparison of BW groups. Sample comprising 250 adolescents classified according to the BMI as follows: high-normal (> 50th percentile and < 85th percentile); overweight (> 85th percentile and < 95th percentile); and obesity (> 95th percentile). The risk variables compared were as follows: waist circumference (WC); arterial blood pressure; lipid profile; glycemia; serum insulin; HOMA-IR; and metabolic syndrome. The BW was informed by parents and classified as follows: low (BW < 2,500g); normal (BW > 2,500g and < 4,000g); and high (BW > 4,000g). RESULTS: One hundred and fifty-three (61.2%) girls, age 13.74 ± 2.03 years, normal BW 80.8%, low BW 8.0%, and high BW 11.2%. The high BW group as compared with the normal BW group showed a higher frequency of obesity (42.9%, p=0.005), elevated SBP and DBP (42.9%, p=0.000 and 35.7%, p=0.007, respectively), and metabolic syndrome (46.4%, p=0.002). High BW adolescents as compared with normal BW adolescents had a prevalence ratio for high SBP 3.3 (95% CI: 1.7-6.4) and obesity 2.6 (95% CI: 1.3-5.2). The WC of high BW adolescents was 83.3 ± 10.1 (p=0.038). The lipid profile showed no statistically significant differences. CONCLUSION: Our findings suggest that obesity, elevated SBP and DBP, and metabolic syndrome during adolescence might be associated with high BW.

Association between birth weight and cardiovascular risk factors in adolescents.

BACKGROUND: Birth weight (BW) is a medium- and long-term risk determinant of cardiovascular risk factors. OBJECTIVE: To assess the association between BW and cardiovascular risk factors in adolescents of the city of Salvador, Bahia state. METHODS: Cross-sectional study with comparison of BW groups. Sample comprising 250 adolescents classified according to the BMI as follows: high-normal (> 50th percentile and < 85th percentile); overweight (> 85th percentile and < 95th percentile); and obesity (> 95th percentile). The risk variables compared were as follows: waist circumference (WC); arterial blood pressure; lipid profile; glycemia; serum insulin; HOMA-IR; and metabolic syndrome. The BW was informed by parents and classified as follows: low (BW < 2,500g); normal (BW > 2,500g and < 4,000g); and high (BW > 4,000g). RESULTS: One hundred and fifty-three (61.2%) girls, age 13.74 ± 2.03 years, normal BW 80.8%, low BW 8.0%, and high BW 11.2%. The high BW group as compared with the normal BW group showed a higher frequency of obesity (42.9%, p=0.005), elevated SBP and DBP (42.9%, p=0.000 and 35.7%, p=0.007, respectively), and metabolic syndrome (46.4%, p=0.002). High BW adolescents as compared with normal BW adolescents had a prevalence ratio for high SBP 3.3 (95% CI: 1.7-6.4) and obesity 2.6 (95% CI: 1.3-5.2). The WC of high BW adolescents was 83.3 ± 10.1 (p=0.038). The lipid profile showed no statistically significant differences. CONCLUSION: Our findings suggest that obesity, elevated SBP and DBP, and metabolic syndrome during adolescence might be associated with high BW.

Crenças e comportamentos de pessoas com doença arterial coronária / Beliefs and behavior patterns of individuals with coronary artery disease

O estudo descreveu crenças e comportamentos sobre causas e medidas de controle da doença arterial coronária (DAC). Cem adultos foram entrevistados em ambulatório público, em Salvador (BA). Os resultados foram analisados em percentuais, médias e por técnica de análise de dados qualitativos. Predominaram homens, idade < 60 anos, cor negra, baixas escolaridade e renda, casados e sem ocupação. A média de crenças para a causa da DAC foi de 1,53 por participante incluindo fatores comportamentais, biológicos, relacionais e religiosos e representaram sobretudo acúmulo de excessos quanto às tensões cotidianas e alimentação. A maioria dos participantes não considerou a enfermidade de caráter crônico acreditando que o tratamento não duraria a vida toda e na cura da doença. A média de crenças para medidas de controle foi de 1,45 prevalecendo seguimento do regime alimentar e uso das medicações. Predominou sedentarismo, redução do tabagismo e consumo de bebida alcoólica, preparo de alimentos com menos sal e gordura saturada, maior consumo de carnes brancas, alimentos cozidos e industrializados. Apenas 66% cumpriam a receita médica. O entendimento insatisfatório sobre causas e medidas de controle da DAC torna essencial a implementação de cuidados contemplando as distintas condições de vida e saúde e projetos para o cuidar de si.

The study described beliefs and behavior patterns related to causes and control measures of coronary artery disease (CAD). A hundred adults in an outpatient clinic in Salvador in the state of Bahia were interviewed. The results were analyzed via the qualitative analysis technique. It predominantly involved married and unemployed black men, aged <60 years, with low schooling and income. The average beliefs on the cause of CAD was 1.53 per participant and blamed behavioral, biological, relational and religious factors, and represented excesses related to day-to-day tensions and eating habits. Most of the participants did not consider the disease to be chronic and believed that treatment would be temporary and they would be cured. The average beliefs for control measures were of 1.45, with dietary measures and medication. A sedentary lifestyle was the norm and reducing smoking and alcohol, using less salt and saturated fat in the preparation of meals, consuming white meat, cooked and industrialized food was seen as the answer. Only 66% complied with medical prescriptions. Lack of understanding of the causes and control measures of CAD makes the implementation of medical care, better living and health conditions and self-care essential.

Effects of neuromuscular electrostimulation in patients with heart failure admitted to ward.

BACKGROUND: Neuromuscular electrostimulation has become a promising issue in cardiovascular rehabilitation. However there are few articles published in the literature regarding neuromuscular electrostimulation in patients with heart failure during hospital stay. METHODS: This is a randomized controlled pilot trial that aimed to investigate the effect of neuromuscular electrostimulation in the walked distance by the six-minute walking test in 30 patients admitted to ward for heart failure treatment in a tertiary cardiology hospital. Patients in the intervention group performed a conventional rehabilitation and neuromuscular electrostimulation. Patients underwent 60 minutes of electrostimulation (wave frequency was 20 Hz, pulse duration of 20 us) two times a day for consecutive days until hospital discharge. RESULTS: The walked distance in the six-minute walking test improved 75% in the electrostimulation group (from 379.7 ± 43.5 to 372.9 ± 46.9 meters to controls and from 372.9 ± 62.4 to 500 ± 68 meters to electrostimulation, p<0.001). On the other hand, the walked distance in the control group did not change. CONCLUSION: The neuromuscular electrostimulation group showed greater improvement in the walked distance in the six-minute walking test in patients admitted to ward for compensation of heart failure.

[Beliefs and behavior patterns of individuals with coronary artery disease]. / Crenças e comportamentos de pessoas com doença arterial coronária.

The study described beliefs and behavior patterns related to causes and control measures of coronary artery disease (CAD). A hundred adults in an outpatient clinic in Salvador in the state of Bahia were interviewed. The results were analyzed via the qualitative analysis technique. It predominantly involved married and unemployed black men, aged <60 years, with low schooling and income. The average beliefs on the cause of CAD was 1.53 per participant and blamed behavioral, biological, relational and religious factors, and represented excesses related to day-to-day tensions and eating habits. Most of the participants did not consider the disease to be chronic and believed that treatment would be temporary and they would be cured. The average beliefs for control measures were of 1.45, with dietary measures and medication. A sedentary lifestyle was the norm and reducing smoking and alcohol, using less salt and saturated fat in the preparation of meals, consuming white meat, cooked and industrialized food was seen as the answer. Only 66% complied with medical prescriptions. Lack of understanding of the causes and control measures of CAD makes the implementation of medical care, better living and health conditions and self-care essential.

[Profile of gestational and metabolic risk in the prenatal care service of a public maternity in the Brazilian Northeast]. / Perfil de risco gestacional e metabólico no serviço de pré-natal de maternidade pública do Nordeste do Brasil.

PURPOSE: To assess the prevalence of obstetric risk factors and their association with unfavorable outcomes for the mother and fetus. METHODS: A longitudinal, descriptive and analytical study was conducted on 204 pregnant women between May 2007 and December 2008. Clinical and laboratory assessments followed routine protocols. Risk factors included socio-demographic aspects; family, personal and obstetric history; high pre-gestational body mass index (BMI); excessive gestational weight gain and anemia. Adverse outcomes included pre-eclampsia (4.5%), gestational diabetes mellitus (3.4%), premature birth (4.4%), caesarian birth (40.1%), high birth weight (9.8%) and low birth weight (13.8%). RESULTS: The average age was 26±6.4 years; the mothers were predominantly non-white (84.8%), 51.8% had incomplete or complete secondary level schooling, 67.2% were in a stable marital relationship and 51.0% had a regular paid job; 63.7% were admitted to the prenatal clinic during the second trimester and 16.7% during the first, with 42.6% being primiparous. A past history of chronic hypertension was reported by 2.9%, pre-eclampsia by 9.8%, excessive gestational weight gain by 15.2% and former gestational diabetes mellitus by 1.0%. In the current pregnancy, elevated pre-gestational BMI was found in 34.6%; 45.5% presented with excessive gestational weight gain, 25.3% with anemia and 47.3% with dyslipidemia. Of the 17.5% of cases with altered blood glucose, gestational diabetes mellitus was confirmed in 3.4% and proteinuria occurred in 16.4% of all cases. Adverse maternal fetal outcomes included pre-eclampsia (4.5%), gestational diabetes mellitus (3.4%), premature birth (4.4%), caesarean birth (40.1%) and high and low birth weight (9.8% and 13.8%, respectively). Independent predictors of adverse maternal fetal outcomes were identified by Poisson multivariate regression analysis: pre-gestational BMI>25 kg/m² was a predictor for pre-eclampsia (RR=17.17; 95%CI 2.14-137.46) and caesarian operation (RR=1.79; 95%CI 1.13-2.85), previous caesarean was a predictor for present caesarean operation (RR=2.28; 95%CI 1.32-3.92) and anemia and high gestational weight gain were predictors for high birth weight (RR=3.38; 95%CI 1.41-8.14 and RR=4.68; 95%CI 1.56-14.01, respectively). CONCLUSION: Pre-gestational overweight/obesity, previous caesarean, excessive weight gain and anemia were major risk factors for pre-eclampsia, caesarean operations and high birth weight.