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.

[(Lack of) control of clinical and anthropometrical parameters in individuals with coronary artery disease]. / (Des)controle de parâmetros clínicos e antropométricos em indivíduos com doença arterial coronária.

This cross-sectional study evaluated the clinical and anthropometrical parameters of 100 individuals with coronary artery disease, who were assisted at preventive cardiology outpatient clinic at a public hospital in Salvador/BA. Data collection was performed through interviews and both clinical and laboratory evaluations. The results were analyzed as averages and percentages. Most participants were black men, aged <60 years, married, low education level and small income, unemployed and diagnosed with myocardial infarction. Most reported having arterial hypertension, dyslipidemia, a sedentary lifestyle, and had quit smoking and drinking. All women and 82% of the men had an increased abdominal circumference, 19% had causal blood glucose>200 mg/dl, 36% was overweight, 28% were obese, 65% were in soma stage of hypertension, 65% had low HDL-C and 43% had high total cholesterol. It was observed that individuals with high cardiovascular risk and deficient socioeconomic conditions show a lack of control of several cardiovascular risk factors, thus demanding effective health care practices to control the illness.

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.

[Control of arterial hypertension in a family care unit]. / Controle da hipertensão arterial em uma unidade de saúde da família.

OBJECTIVE: To assess the impact of the implementation of the Family Health Care Program for arterial hypertension management in a primary care unit. METHODS: There were studied 135 patients with confirmed diagnosis of arterial hypertension (45 patients from each primary care team) who received treatment between December 2003 and December 2004 and were followed up until July 2005 in the city Salvador, Northeastern Brazil. Blood pressure measures were compared at baseline and at the end of the follow-up period, and their association with cardiovascular risk factors and variables such as gender, age, body mass index, number of medical visits, number of antihypertensive drugs taken by patients, education level and family income were evaluated. Data were described as means and standard deviations, absolute and percentual values and the Wilcoxon, Kruskal-Walis and Chi-square tests were performed. RESULTS: Mean blood pressures at baseline and at the end of the follow-up were 155.9+/-24.1/95.3+/-13.9 mmHg and 137.2+/-16.1/86.7+/-8.7 mmHg (p<0.01), respectively. At starting treatment, 28.9% hypertense patients had well-controlled blood pressure levels (<140/90 mmHg) compared to 57% at the end of the follow-up period (p<0.01). The mean number of medical visits was 10.1+/-3.9, with 91.8% compliance. Two antihypertensive drugs were used by 50.4% and one drug by 35.6% of the patients. The prevalences of associated risk factors assessed at entering the program were overweight/obesity (71.9%), dyslipidemia (58.5%) and diabetes/impaired fasting glucose (43.7%). The results of the different care teams were comparable. CONCLUSIONS: The implementation of the Family Health Care Program has provided a better management of arterial hypertension but the associated risk factors have remained at higher levels than those recommended and thus needing better management.

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.

[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.

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.

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.

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.

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.

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.

[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.

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.

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.

Effect of ventilatory support on functional capacity in patients with heart failure: a pilot study.

BACKGROUND: Heart failure (HF) is an important public health problem, of which main clinical symptoms are dyspnea and fatigue. Noninvasive ventilatory support has been used as adjuvant therapy in cardiac rehabilitation in order to improve the functional capacity of patients. OBJECTIVE: To evaluate the functional capacity of patients with HF submitted to ventilatory support. METHODS: We evaluated the sociodemographic information, as well as data on quality of life, blood pressure (BP), peripheral oxygen saturation (SpO2), dyspnea, lactate concentration before and after the 6-minute walk test (6MWT) and the distance walked by patients of both sexes with chronic heart failure (CHF), with left ventricular ejection fraction (LVEF) < 45.0% , randomized in two groups: control and CPAP (the group used CPAP - 10 cmH2O for 30 minutes). RESULTS: A total of 12 patients, of which 8 were males, with CHF functional class II and III (NYHA) participated in the study. The patients had mean LVEF of 35.3 ± 8.7 and mean age was 46.3 ± 10.3 years. When comparing the control group with the CPAP group at the end of the 6th minute, there was a significant difference between the groups regarding SpO2 values ( CONTROL: 93.6 ± 1.5 % vs CPAP: 96.1±1.8%; p = 0.027), index of dyspnea ( CONTROL: 13.1 ± 1.16 vs CPAP: 11 ± 0.8; p = 0.009), lactate concentration ( CONTROL: 3.3 ± 0.7 mmol/l vs CPAP: 2.3 ± 0.5 mmol/l; p = 0.025) and distance walked at the 6MWT (CONTROL: 420.6 ± 73.8 m vs CPAP: 534 ± 89.91 m; p = 0.038). CONCLUSION: The previous use of the CPAP had beneficial effects on SpO2, index of dyspnea, lactate concentration, double product and the distance walked at the 6MWT in patients with CHF when performing the 6MWT.

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.

Global and cardiovascular mortality and risk factors in patients under hemodialysis treatment.

BACKGROUND: There is a high global and cardiovascular mortality rate among patients who need hemodialysis. OBJECTIVE: To assess global and cardiovascular mortality and to identify the risk factors in patients who undergo hemodialysis. METHODS: Observational, prospective study. A total of 334 patients were studied within three years. PRIMARY OUTCOMES: global and cardiovascular mortality. Survival was assessed through Kaplan-Meier method, and the risk variables were identified by means of bivariate and multivariate Cox regression. RESULTS: A total of 189 men (56.6%), aging 48.8 +/- 14.2, majority non-white (295, 88.3%) and who did finished the elementary school (211, 63.2%). Global mortality rate was 21.6%, with a 50% rate of 146-month survival; cardiovascular mortality rate was 41.7% (30/72), with a 75% rate of 141-month survival. In the bivariate analysis, the relative risk (RR) for non-cardiovascular and cardiovascular death increased when age > or =60 years old was Hb < or =9.0 g/dl and fast glycemia > or =126 mg/dl. Only non-cardiovascular death with low school grade and widow, Hb<11.0 g/dl, Ht<33.0%, fast glycemia > or =100 mg/dl, Ca product x P<42 and creatinine > or =9.2 mg/dl decreased with blood pressure (BP) > or =140/90 mmHg (before hemodialysis session) and Ht>36%; Obit due only to cardiovascular factors increased with creatinine > or =9.4 mg/dl. In the multivariate analysis, non-cardiovascular and cardiovascular RR increased with age > or =60 years old and Hb<9 g/dl; cardiovascular death RR increased with glycemia > or =126 mg/dl, and non-cardiovascular death RR increased with urea removal rate in hemodialysis (Kt/V) <1,2. CONCLUSION: Global and cardiovascular mortality of patients who need hemodialysis is high. Independent risk factors for non cardiovascular and cardiovascular causes of death were age >60 years old and Hb<9 g/dl, for cardiovascular cause of death only, was fasting blood glucose > or =126 mg/dL, and for non-cardiovascular cause of death, Kt/V<1,2.

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.