Monitorização residencial da pressão arterial em adultos com hipertensão arterial sistêmica em tratamento medicamentoso, independentemente da pressão arterial do consultório / Residential monitoring of blood pressure in adults with systemic arterial hypertension in medication treatment, regardless of the blood pressure in the office

INTRODUÇÃO: A HAS é uma condição clínica multifatorial caracterizada por níveis elevados e sustentados de PA. Além de ser causa direta de cardiopatia e nefropatia hipertensivas, a HAS é fator de risco linear e contínuo para doenças decorrentes de aterosclerose e trombose, que se manifestam, predominantemente, por doença isquêmica cardíaca, cerebrovascular, vascular periférica e renal, assim como de morte prematura. No Brasil, a prevalência média é estimada em 32%, e pode chegar a mais de 50% em indivíduos com 60 a 69 anos e 75% em indivíduos com mais de 70 anos. Embora as diretrizes atuais recomendem o uso de monitorização ambulatorial da pressão arterial (MAPA) ou MRPA para monitoramento da resposta ao tratamento; este monitoramento é realizado no SUS apenas pela MAPA e medida da PA de consultório, ainda que o primeiro não esteja acessível para toda a população com indicação e o segundo não seja considerado suficientemente confiável para esse monitoram

Low-Sodium Dietary Perceptions and Experiences of African-American Women with Hypertension.

African-Americans are disproportionately affected by hypertension with lower rates of blood pressure control in comparison to the general population (Brennan et al., 2010). Low-sodium dietary intake is one of the most important lifestyle changes that can help control hypertension (Zhang et al., 2013). This qualitative study aimed to explore and describe the perceptions and experiences of low-sodium dietary practices among African-American women with hypertension. The study used a single-category focus group design. The findings suggest that African-American women are attempting to follow a low-sodium diet; however, they are influenced by personal and environmental factors and lack a clear understanding of what a low-sodium diet entails. Therefore, nurses must understand the factors that influence African-American women's ability to follow a low-sodium diet so that effective interventions can be implemented to improve adherence in this population.

Assessment of Hypertension Self-Care Behaviors and Self-Efficacy Among Men in Saudi Arabia.

BACKGROUND AND PURPOSE: Hypertension is rapidly increasing in the Kingdom of Saudi Arabia (KSA), particularly among men. Assessment of hypertension self-care behaviors is a critical step to promoting blood pressure control. This study aimed to evaluate the Hypertension Self-Care Profile (HBP-SCP) among Saudi men in KSA. METHODS: The HBP-SCP self-efficacy and behavior scales were translated into Arabic and tested on a convenience sample of 160 Saudi men with hypertension. Cronbach's alpha and factor analysis were conducted using SPSS. RESULTS: Internal consistency of the Arabic HBP self-care and self-efficacy scales was 0.84 and 0.90, respectively. Factor loading ranged from 0.25 to 0.70 for HBP self-care behaviors and from 0.28 to 0.77 for HBP self-efficacy. CONCLUSIONS: The Arabic HBP-SCP is acceptable in its reliability and validity for measuring HBP self-care behaviors and self-efficacy among Saudi men with hypertension.

Nurse-led interventions in the interim: waiting on universal health coverage.

AIM: The aim of the study was to test a nurse-led intervention to enhance lifestyle modification and improve hypertension outcomes. BACKGROUND: Hypertension is the leading modifiable contributor to non-communicable disease morbidity and mortality affecting more than 25% of adults in Uganda. METHODS: A mixed-method study was conducted to evaluate nurse-led interventions for hypertension. Group education and support with text message follow-up was the bundled interventions implemented in an outpatient clinical setting. CONCLUSION AND IMPLICATIONS: The statistically favourable outcomes of the nurse-led interventions support a cost-effective approach to, with policy support, sustainably improve practice outcomes.

A acupuntura na percepção de indivíduos com hipertensão arterial atendidos em uma unidade de pronto atendimento / Acupuncture in the perception of hypertensive individuals in an emergency medical unit

A hipertensão arterial sistêmica (HAS) é uma condição clínica multifatorial caracterizada por níveis elevados e sustentados de pressão arterial. A acupuntura tanto no tratamento sistêmico, auricular e/ou emergencial, estabiliza os sintomas da HAS e auxilia na redução dos fatores de risco para o desenvolvimento de doenças cardiovasculares. O objetivo do estudo foi compreender a percepção de indivíduos hipertensos, atendidos em uma unidade de pronto atendimento sobre a acupuntura. Trata-se de uma pesquisa descritiva, qualitativa, realizada na cidade de Cascavel ­ PR. Os participantes da pesquisa responderam a seguinte questão norteadora: "O que o sr. (sra.) sabe a respeito da acupuntura?". Participaram do estudo 36 indivíduos, sendo a maioria do sexo feminino, idade média de 52,2 anos e a maior parte com Ensino Fundamental incompleto. Com relação ao conhecimento sobre a acupuntura, 61% dos participantes desconhecem a técnica. As respostas favoráveis corresponderam a 39% e foram agrupadas em categorias: técnica com agulhas; utilizada para o tratamento do estresse; conhecimento por meio da mídia; traz benefícios. Ao final do estudo conclui-se que a maior parte dos indivíduos abordados desconhece a técnica de acupuntura. Os que demonstram conhecimento se limitam nos benefícios e possibilidades da técnica. A divulgação da acupuntura e a sua implantação no Sistema Único de Saúde, colaborariam para que esta visão se ampliasse e mais pessoas dos mais variados níveis socioeconômicos tivessem acesso aos benefícios da técnica.

Systemic arterial hypertension (SAH) is a multifactorial clinical condition characterized by elevated and sustained blood pressure levels. Acupuncture in both systemic, auricular and/or emergency treatment stabilizes the symptoms of SAH and helps to reduce the risk factors for the development of cardiovascular diseases. The aim of the study was to understand the perception of hypertensive individuals attended at an Emergency Medical Unit about acupuncture. This is a descriptive, qualitative research carried out in the city of Cascavel, in the state of Paraná. The survey participants answered the following guiding question: "What do you know about acupuncture?". Thirty-six people took part in the study, most of them were female, average age of 52.2 years and the majority had an incomplete secondary education. In terms of their knowledge about acupuncture, 61% of the participants did not know the technique. The favorable answers corresponded to 39% and were grouped in categories: technique with needles; used for treating stress; knowledge through media; benefits. At the end of the study, it was concluded that most of the participants in the study were unaware of the acupuncture technique. Those who demonstrate knowledge showed that it was limited in the benefits and possibilities of the technique. The dissemination of acupuncture and its implantation in the Public Health System would collaborate so that these thoughts could be further developed, and more people of the most varied socioeconomic levels could have access to its benefits.

Estratégia Saúde da Família e pessoas com hipertensão e diabetes: redes sociais e longitudinalidade / Family Health Care and peaple with hypertension and diabetes: social networks and longitudinally

Este estudo possui como objeto "as relações entre os profissionais da Estratégia de Saúde da Família (ESF) e sua influência na assistência às linhas de cuidado de hipertensão e diabetes, na perspectiva do cuidado e da longitudinalidade, segundo a ótica da Análise de Redes Sociais". Objetivos: Analisar como se configuram as relações entre os profissionais da ESF quanto à assistência aos usuários com hipertensão e diabetes, segundo a ótica da Análise de Redes Sociais; identificar qual a influência destas relações e posições na perspectiva do cuidado e da longitudinalidade. Metodologia: Estudo descritivo, com abordagem qualitativa e quantitativa, possuindo como participantes da pesquisa profissionais da equipe de ESF (enfermeiros, médicos, técnicos de enfermagem, agentes comunitários de saúde e auxiliares administrativos), tendo como cenário duas Unidades de Saúde da Família (USF) de um município de grande porte localizado na região do Médio Paraíba no Sul, no estado do Rio de Janeiro. As unidades foram codificadas como U1 e U2. Para a coleta dos dados, foi utilizada entrevista semiestruturada mediante roteiro, permitindo respostas em narrativa. Foram entrevistados 12 profissionais da U1 e 09 profissionais da U2, totalizando 21 sujeitos entrevistados. Os dados foram analisados, para o segmento quantitativo, mediante Análise de Redes Sociais (ARS), o qual permite gerar medidas de centralidades dos atores e construção do sociograma, utilizando-se para isto, os softwares Ucinet e Netdraw; para o segmento qualitativo, foi utilizada a Análise de Conteúdo Temático-categorial. Resultados: A conformação das redes sociais estudadas, interferem diretamente nos resultados da análise destas. Os conceitos de Pierre Bourdieu quanto aos capitais e habitus foram claramente identificados nas redes no campo da atenção básica das USF estudadas. As relações e posições nas redes pesquisadas parecem interferir positivamente quanto à gestão da equipe, no processo de trabalho desta, e nas tentativas quanto à continuidade do cuidado ao usuário com hipertensão e diabetes. Foi visualizada a dificuldade quanto ao cuidado integral ao usuário ao longo da vida, bem quanto ao estabelecimento de vínculo entre profissionais e usuários. O profissional mais citado e com maior valor central em ambas redes foram as médicas das duas equipes; este fato, atrelado a outros que foram discutidos ao longo do estudo, influencia negativamente no cuidado e longitudinalidade à pessoa com hipertensão e diabetes, apontando para a centralidade do modelo biomédico e para um possível retorno à APS seletiva no contexto da realidade estudada.

The aim of this study is  "relationships between professionals in the Family Health Care Sector (ESF) and the influence on  hypertension and diabetic care given to patients, from the perspective of the longitudinally that the care provides, according to the Social Networks Analysis".  Objectives: Analyze how relationships between ESF professionals and patients with hypertension and diabetes are shaped in the viewpoint of Social Network Analysis and identifying the influence of these relations and positions in the perspective of care and longitudinality. Metodology: The following is a descriptive study, mixed with both a quantitative and qualitative approach, the research participants are professionals from the basic ESF team (nurses, doctors, medical technicians, community health agents, and administrative assistants) having the setting as two Municipal Family Health Care Units, one located in the Middle of Paraíba and the other in the State of Rio de Janeiro. The Units were coded as U1 and U2. To collect data, a semi-structured interview was used according to a script, containing open questions that allowed answers to be responded in a narrative format. There were 12 U1 professionals interviewed as well as 09 U2 professionals, totaling 21 interviews. The interviews/narratives were analyzed and for the quantitative portion, through social media analysis, initiating sociograms in which the position and role of the actors in the networks can be analyzed, according to the measures of centrality and intermediation. This part of the study is conducted using the Ucinet software and its graphic component NetDraw. As for the qualitative approach the analysis of thematic-categorial material was used. Results: The information from the studied social networks, interfere directly with the results from the analysis. Pierre Bourdieu concepts in regard to capitals and habitus were clearly identified in the networks. In regards to relationships and positions in the studied networks, they seem to have a positive effect in the management of the team, in the work process and in attempts regarding the continuity of the patients care with hypertension and diabetes. The difficulty was seen regarding essential care throughout the patient's lifelong, as well as to establish a link between professionals and the patient. The most trusted professionals as well as the ones with a greater central value in both networks were the doctors from both teams. Considering this fact as well as others that were discussed throughout the study , negatively influences the care and longitudinality of the person with hypertension and diabetes, pointing to the centrality of a biomedical model and to a possible return of APS in the context of the reality studied.

Nursing consultation software for hypertensive users of the Family Health Strategy.

OBJECTIVE: To report the development of a nursing consultation software for hypertensive users of the Family Health Strategy. METHOD: Applied methodological research based on Roger Pressman's Software Engineering, developed in three cycles: planning, composed of the definition of the database prototyping and modelling; development of the navigation interface; and development of functional expressions and programming. RESULT: The software consists of administrative and nursing consultation screens. In the history, there is the option of undertaking the first and next consultation; nursing diagnoses are suggested by the system after entering information and can be selected by nurses. Interventions for diagnoses are suggested and can be chosen by nurses after structuring the medical plan. CONCLUSION: It is believed that the introduction of computer technology for nursing consultation brings several contributions, such as standardization, integration with different information systems, and continuous update.

Nursing consultation software for hypertensive users of the Family Health Strategy / Software para consulta de enfermería de los hipertensos en la Estrategia Salud de la Familia / Software para consulta de enfermagem aos hipertensos da Estratégia Saúde na Família

ABSTRACT Objective: To report the development of a nursing consultation software for hypertensive users of the Family Health Strategy. Method: Applied methodological research based on Roger Pressman's Software Engineering, developed in three cycles: planning, composed of the definition of the database prototyping and modelling; development of the navigation interface; and development of functional expressions and programming. Result: The software consists of administrative and nursing consultation screens. In the history, there is the option of undertaking the first and next consultation; nursing diagnoses are suggested by the system after entering information and can be selected by nurses. Interventions for diagnoses are suggested and can be chosen by nurses after structuring the medical plan. Conclusion: It is believed that the introduction of computer technology for nursing consultation brings several contributions, such as standardization, integration with different information systems, and continuous update.

RESUMEN Objetivo: Informar sobre el desarrollo de un software para consulta de enfermería de los hipertensos en la Estrategia Salud de la Familia. Método: Investigación metodológica aplicada, basada en ingeniería de software de Pressman, desarrollada en tres ciclos: planeamiento, integrada por definición del prototipo y diseño del banco de datos; desarrollo de interfaz de navegación; y elaboración de expresiones funcionales y de programación. Resultado: el software posee pantallas administrativas y de consulta de enfermería. El historial permite realizar la primera consulta y/o las subsiguientes; el sistema sugiere los diagnósticos de enfermería una vez cargada la información, también el enfermero puede seleccionarlos. Las intervenciones para diagnósticos son sugeridas y pueden ser elegidas por los enfermeros, estructurándose el plan de atención. Conclusión: Se confía en que contar con un recurso informático para la consulta de enfermería brinde numerosas contribuciones: estandarización, integración con diferentes sistemas de información, y actualización permanente.

RESUMO Objetivo: Relatar o desenvolvimento de um software para consulta de enfermagem aos hipertensos na estratégia saúde da família. Método: Pesquisa metodológica aplicada, baseada na engenharia de software de Pressman, desenvolvida em três ciclos: planejamento, composto pela definição da prototipação e modelagem do banco de dados; desenvolvimento da interface de navegação; e elaboração das expressões funcionais e da programação. Resultado: o software consiste em telas administrativas e telas para a consulta de enfermagem. No histórico, há a opção de realizar a primeira consulta e ou consulta subsequente; os diagnósticos de enfermagem são sugeridos pelo sistema, depois de serem inseridas as informações, e podem ser selecionados pelo enfermeiro. As intervenções para os diagnósticos são sugeridas e podem ser escolhidas pelos enfermeiros estruturando-se o plano assistencial. Conclusão: Acredita-se que a inserção de uma tecnologia computacional à consulta de enfermagem traz inúmeras contribuições: padronização, integração com diferentes sistemas de informação e atualização permanente.

Scale for supported care in primary care: a methodological study. / Escala para o cuidado apoiado na atenção primária: um estudo metodológico.

OBJECTIVE: To develop a predictive scale for determining complications in adults with hypertension and actions for care supported in primary care. METHOD: Methodological research developed in the municipality of Curitiba-PR in 2013 and 2014, carried out in two stages, the first through the collection of data from 387 adults with hypertension through a structured interview and anxiety scales, depression, quality of life, medication adherence and social support. The second step was the construction of the scale from the statistically significant variables in the multivariate analysis. RESULTS: The scale consisted of age, sex, smoking, time of diagnosis, and risk classification in the health unit, medications in use and depression. Later, through literature review, actions were suggested for supported self-care. CONCLUSION: The scale enables identification of factors that may predict the development of complications of hypertension and provides actions to supported care.

Nurse-Led Interventions for Hypertension: A Scoping Review With Implications for Evidence-Based Practice.

BACKGROUND: Hypertension is the leading preventable contributor to cardiovascular morbidity and mortality, affecting 1 billion people globally. Low- and middle-income countries have increasing rates of hypertension, much of it undiagnosed. AIMS: The purpose of the project is to review studies of nurse-led hypertension interventions that have been implemented in East Africa and to inform hypertension interventions in low-resource settings. METHODS: A scoping review was conducted following Arksey and O'Malley's (2005) format. An electronic search in six databases for citations was conducted by the medical librarian author. The parameters for this scoping review were nurse interventions related to hypertension in East Africa. RESULTS: Fourteen full-text articles were identified that met inclusion criteria. Nurse-led interventions for hypertension were found to increase access to care and be cost- effective. Medication Adherence Clubs were an innovative intervention that increased the retention of patients in care. LINKING EVIDENCE TO ACTION: This scoping review provides evidence from studies of nurse-led hypertension interventions in East Africa relevant to implementing or improving hypertension screening, diagnosis, and treatment. Nurses provide 80% of health care in East Africa, and nurse-led hypertension interventions are critically needed to ameliorate the significant hypertension-related increases in morbidity and mortality globally.

Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: A pragmatic cluster randomized trial in Ghana.

BACKGROUND: Poor access to care and physician shortage are major barriers to hypertension control in sub-Saharan Africa. Implementation of evidence-based systems-level strategies targeted at these barriers are lacking. We conducted a study to evaluate the comparative effectiveness of provision of health insurance coverage (HIC) alone versus a nurse-led task shifting strategy for hypertension control (TASSH) plus HIC on systolic blood pressure (SBP) reduction among patients with uncontrolled hypertension in Ghana. METHODS AND FINDINGS: Using a pragmatic cluster randomized trial, 32 community health centers within Ghana's public healthcare system were randomly assigned to either HIC alone or TASSH + HIC. A total of 757 patients with uncontrolled hypertension were recruited between November 28, 2012, and June 11, 2014, and followed up to October 7, 2016. Both intervention groups received health insurance coverage plus scheduled nurse visits, while TASSH + HIC comprised cardiovascular risk assessment, lifestyle counseling, and initiation/titration of antihypertensive medications for 12 months, delivered by trained nurses within the healthcare system. The primary outcome was change in SBP from baseline to 12 months. Secondary outcomes included lifestyle behaviors and blood pressure control at 12 months and sustainability of SBP reduction at 24 months. Of the 757 patients (389 in the HIC group and 368 in the TASSH + HIC group), 85% had 12-month data available (60% women, mean BP 155.9/89.6 mm Hg). In intention-to-treat analyses adjusted for clustering, the TASSH + HIC group had a greater SBP reduction (-20.4 mm Hg; 95% CI -25.2 to -15.6) than the HIC group (-16.8 mm Hg; 95% CI -19.2 to -15.6), with a statistically significant between-group difference of -3.6 mm Hg (95% CI -6.1 to -0.5; p = 0.021). Blood pressure control improved significantly in both groups (55.2%, 95% CI 50.0% to 60.3%, for the TASSH + HIC group versus 49.9%, 95% CI 44.9% to 54.9%, for the HIC group), with a non-significant between-group difference of 5.2% (95% CI -1.8% to 12.4%; p = 0.29). Lifestyle behaviors did not change appreciably in either group. Twenty-one adverse events were reported (9 and 12 in the TASSH + HIC and HIC groups, respectively). The main study limitation is the lack of cost-effectiveness analysis to determine the additional costs and benefits, if any, of the TASSH + HIC group. CONCLUSIONS: Provision of health insurance coverage plus a nurse-led task shifting strategy was associated with a greater reduction in SBP than provision of health insurance coverage alone, among patients with uncontrolled hypertension in Ghana. Future scale-up of these systems-level strategies for hypertension control in sub-Saharan Africa requires a cost-benefit analysis. TRIAL REGISTRATION: ClinicalTrials.gov NCT01802372.

Individual nursing care for the elderly among China's aging population.

By the end of 2014, China had an elderly population age 60 or over totaling 212 million; this group accounted for 15.5% of the country's total population of 1.37 billion, which means that China has passed the threshold for an aging population. As China's population ages and the disease spectrum changes, nursing services for the elderly must be expanded. Given differences in the health status, financial situation, and family composition of each elderly person, modern society is tending towards individual nursing care for the elderly. Adapting to the changing composition of society by age will present new challenges.

Escala para o cuidado apoiado na atenção primária: um estudo metodológico / Escala para el cuidado apoyado en la atención primaria: un estudio metodológico / Scale for supported care in primary care: a methodological study

Resumo OBJETIVO Elaborar uma escala preditiva de determinantes para complicações em adultos com hipertensão e ações para o autocuidado apoiado na atenção primária. MÉTODOS Pesquisa metodológica realizada no município de Curitiba-PR em 2013 e 2014, em duas etapas, a primeira mediante coleta de dados com 387 adultos com hipertensão, por meio de uma entrevista estruturada e escalas de ansiedade, depressão, qualidade de vida, adesão medicamentosa e apoio social. A segunda etapa foi à construção da escala a partir das variáveis estatisticamente significantes após a análise multivariada. RESULTADOS A escala foi composta pelas variáveis: idade, sexo, tabagismo, tempo de diagnóstico, classificação de risco na unidade de saúde, medicamentos em uso e depressão, posteriormente por meio de revisão da literatura foram sugeridas ações para o autocuidado apoiado. CONCLUSÃO A escala permite identificação de fatores que podem predizer o desenvolvimento de complicações da hipertensão e fornece ações para o autocuidado apoiado.

Resumen OBJETIVO Desarrollar una escala predictiva para determinar complicaciones en adultos con hipertensión y acciones para autocuidado apoyado en atención primaria. MÉTODO Investigación metodológica realizada en el municipio de Curitiba-PR en 2013 y 2014 lleva, a cabo en dos pasos, primera a través de recopilación de datos de 387 adultos con hipertensión de forma escalonada, una entrevista estructurada y ansiedad, depresión, calidad de vida, adherencia a la medicación y el apoyo social. El segundo paso fue la construcción de la escala de las variables estadísticamente significativas en el análisis multivariante. RESULTADOS La escala consistieron en edad, sexo, tabaquismo, hora del diagnóstico, la clasificación de riesgo en la unidad de salud, se sugiere el uso de medicamentos y la depresión posterior a través de acciones de revisión de literatura para el autocuidado apoyado. CONCLUSION La escala permite la identificación de los factores que pueden predecir el desarrollo de las complicaciones de la hipertensión y se indican las acciones a la autocuidado apoyado.

Abstract OBJECTIVE To develop a predictive scale for determining complications in adults with hypertension and actions for care supported in primary care. METHOD Methodological research developed in the municipality of Curitiba-PR in 2013 and 2014, carried out in two stages, the first through the collection of data from 387 adults with hypertension through a structured interview and anxiety scales, depression, quality of life, medication adherence and social support. The second step was the construction of the scale from the statistically significant variables in the multivariate analysis. RESULTS The scale consisted of age, sex, smoking, time of diagnosis, and risk classification in the health unit, medications in use and depression. Later, through literature review, actions were suggested for supported self-care. CONCLUSION The scale enables identification of factors that may predict the development of complications of hypertension and provides actions to supported care.

Assessment, Management, and Health Implications of Early-Onset Preeclampsia.

Early-onset preeclampsia is a serious condition of pregnancy with the potential for adverse maternal and fetal health outcomes. A strong body of evidence supports the need for postpartum follow-up and health counseling, because these women and their offspring are at risk for future cardiovascular disease; nurses play a key role in this education. An understanding of the diagnosis, risk screening for, pathogenesis, and management of severe preeclampsia and its sequelae, such as intrauterine growth restriction and pulmonary edema, enables nurses to develop a comprehensive plan of care that will support women and their families through this challenging and dynamic complication of pregnancy.

Programa de gerenciamento de doenças crônicas em um plano de saúde, são paulo, brasil / Programa de gestión de enfermedades crónicas en un seguro salud en el estado de são paulo, brasil / Chronic disease management program in a health plan, são paulo, brazil

RESUMO Atualmente as doenças crônicas não transmissíveis são as principais causas de morte no mundo. Consideradas doenças multifatoriais, têm em comum fatores de riscos modificáveis tais como inatividade física, colesterol elevado, excesso de peso, tabagismo, consumo excessivo de bebidas alcoólicas e alimentação não saudável. Com o objetivo de verificar o impacto por um programa de Gerenciamento de Doenças Crônicas, após dois anos de acompanhamento, surgiu esta pesquisa. Trata-se de programa desenvolvido com um grupo de clientes de uma autogestão localizada no estado de São Paulo. É um estudo transversal realizado durante os anos de 2014-2015 com dados de prontuário eletrônico que foram comparados parâmetros clínicos e hábitos de vida de 1.509 indivíduos participantes de um programa de gerenciamento de doenças em dois momentos: na entrada ao programa e após dois anos de participação. Observaram-se resultados satisfatórios na melhora de parâmetros clínicos relacionados aos níveis pressóricos e à dosagem de glicemia em jejum, assim como diminuição do sedentarismo em indivíduos abaixo dos 60 anos.

RESUMEN Actualmente las enfermedades crónicas no transmisibles son las principales causas de muerte en todo el mundo. Consideradas enfermedades multifactoriales, tienen en común factores de riesgo modificables, tales como inactividad física, colesterol alto, sobrepeso, tabaco, exceso de alcohol y alimentación poco sana. Con el objetivo de averiguar el impacto por un programa de Gestión de Enfermedades Crónicas, tras dos años de acompañamiento, se hizo esta investigación. Se trata de un programa desarrollado con un grupo de clientes de una autogestión ubicada en el estado de São Paulo, Brasil. Es un estudio transversal realizado durante los años de 2014-2015 con datos de registros médicos electrónicos, comparándose los parámetros clínicos y hábitos de vida de 1.509 personas que participan en un programa de gestión de enfermedades en dos ocasiones: cuando entran en el programa y después de dos años de participación. Se observaron resultados satisfactorios en la mejora de los parámetros clínicos relacionados con los niveles de presión arterial y a la dosificación de glucemia en ayunas, así como la disminución de la inactividad física en personas con edad abajo de 60 años.

ABSTRACT Currently, non-transmissible chronic diseases are leading causes of death worldwide. Considered as multifactorial diseases, they have common modifiable risk factors such as physical inactivity, high cholesterol, overweight, smoking, excessive alcohol consumption, and unhealthy diets. Aiming at verifying the impact of theChronic Disease Management program, this study arose after two years of follow-up. This is a program developed with a group of customers in a self-management platform in the state of São Paulo. This was a cross-sectional study carried out during 2014 and 2015 with electronic medical record data through the comparison ofthe clinical and lifestyle parameters of 1,509 individuals participating in a disease management program in two moments: at the program'sentry and two years after participation. Satisfactory results in the improvement of clinical parameters related to blood pressure and blood glucose levels in fasting were observed as well as decreased physical inactivity in individuals under 60 years of age.

Percepção da gestação de risco por um grupo de gestantes hipertensas hospitalizadas / Perception of pregnancy risk by a group of pregnant women hypertensive hospitalized

Neste estudo, objetivou-se compreender a percepção da gestação de risco para um grupo de gestantes hipertensas, descrever o significado da gestação de alto risco para elas e identificar suas dificuldades durante o período de internação e suas necessidades de cuidado. Trata-se de um estudo de caráter exploratório, descritivo e qualitativo, realizado em uma maternidade regional do norte do Paraná, com sete gestantes hipertensas de todas as idades, primíparas e multíparas, no 3º trimestre de gestação. Os dados foram coletados de julho a dezembro de 2013, por meio de entrevista semiestruturada, e submetidos à análise de conteúdo. As sete gestantes, com idade entre 25 e 38 anos, eram multíparas, estavam internadas havia mais de sete dias, relataram preocupação com o bem-estar do filho e dificuldade em permanecer hospitalizadas e ausentes do convívio familiar. Demonstraram sentimentos de medo, ansiedade e indignação perante a infraestrutura hospitalar e o atendimento da equipe. Considera-se que as gestantes tiveram dificuldades em verbalizar o significado da gestação, porém expuseram com facilidade suas necessidades de cuidado. À vista disso, é necessário compreender o processo psicológico dessas mulheres para melhorar a assistência oferecida a elas.

This study aimed to understand the perception of the risk of pregnancy to a group of hypertensive pregnant women, describe the meaning of high-risk pregnancy for them and identify their difficulties during the hospital stay and their care needs. This is an exploratory, descriptive and qualitative, held in a regional maternity northern Paraná, with seven hypertensive pregnant women of all ages, primiparous and multiparous, in the 3rd trimester. Data were collected from July to December 2013, through semi-structured interviews and submitted to content analysis. The seven pregnant women, aged 25 and 38, were multiparous, were interned for more than seven days, reporting concern with the child welfare and difficulty staying hospitalized and away from family. They showed feelings of fear, anxiety and anger at the hospital infrastructure and the service of the medical care team. It is considered that pregnant women had difficulty verbalizing the meaning of pregnancy, but exposed to ease their care needs. In view of this, it is necessary to understand the psychological process of these women to improve the care provided to them.

Can a pharmacy intervention improve the metabolic risks of mental health patients? Evaluation of a novel collaborative service.

BACKGROUND: The pressure on healthcare services worldwide has driven the incorporation of disease state management services within community pharmacies in developed countries. Pharmacists are recognised as the most accessible healthcare professionals, and the incorporation of these services facilitates patient care. In Australia, the opportunity to manage pharmacy patients with mental illness has been underutilised, despite the existence of service models for other chronic conditions. This paper is an independent evaluation of a novel service developed by a community pharmacy in Perth, Western Australia. The service represents collaboration between a nurse practitioner and community pharmacy staff in the management of mental health patients with metabolic risks. METHODS: We applied practice service standards for Australian community pharmacies to develop an evaluation framework for this novel service. This was followed by semi-structured interviews with staff members at the study pharmacy to explore service processes and procedures. Descriptive analysis of interviews was supplemented with analysis of patients' biometric data. All data were evaluated against the developed framework. RESULTS: The evaluation framework comprised 13 process, 5 outcomes, and 11 quality indicators. Interview data from eight staff members and biometric data from 20 community-dwelling mental health patients taking antipsychotics were evaluated against the framework. Predominantly, patients were managed by the pharmacy's nurse practitioner, with medication management provided by pharmacists. Patients' biometric measurements comprised weight, blood pressure, blood glucose levels, lipid profiles and management of obesity, smoking, hypertension and diabetes. Positive outcomes observed in the patient data included weight loss, smoking cessation, and improved blood pressure, blood glucose and lipid levels. CONCLUSIONS: The developed framework allowed effective evaluation of the service, and may be applicable to other pharmacy services. The metabolic clinic met key process, quality and outcomes indicators. The positive patient outcomes may assist in securing further funding.

Transnationalism and Hypertension Self-Management Among Haitian Immigrants.

PURPOSE: Transnationalism--maintenance of transborder activities--has important implications for the health status of contemporary immigrants. Yet little is known about how such interconnectivity interacts with health. DESIGN: In this critical ethnography study, 31 Haitian immigrants discussed the influences of transnationalism on their hypertension management. Transcripts of the semistructured individual interviews were analyzed and coded with the assistance of the Atlas.ti 6 software. FINDINGS: Two major themes emerged: social support and financial obligation, both framed within the obligation to send monetary remittances. A duality emerged where social support facilitated hypertension self-management but consequently represented a financial burden. DISCUSSION AND IMPLICATIONS: The study evidenced that transnationalism, although positively influencing immigrants' psychosocial well-being can negatively affect their experience with disease management. Health providers are urged to account for this transnationalism-disease management interaction when caring for this immigrant group. Future studies are needed to explore this phenomenon among other immigrant populations.

Trabalho noturno e hipertensão arterial em profissionais de enfermagem do município de Belo Horizonte / Night work and hypertension among professionals nursing of Belo Horizonte city

Trata-se de estudo transversal desenvolvido com amostra probabilística de 297 profissionais de enfermagem da rede municipal de saúde de Belo Horizonte, Minas Gerais, Brasil, entre setembro de 2008 e janeiro de 2009. O objetivo foi analisar a associação entre a exposição ao trabalho noturno e hipertensão arterial (HA). A exposição ao trabalho noturno foi mensurada com base na resposta à pergunta: Você trabalha no turno noturno? Nunca, raramente, às vezes e sempre. Para análise, as categorias foram agrupadas em não (nunca) e sim (raramente, às vezes e sempre). A HA foi identificada pelo autor relato de diagnóstico médico da doença ou uso de medicação anti-hipertensiva. Razões de Prevalência (RP) de HA e seus respectivos Intervalos de Confiança de 95% (IC 95%) foram ajustados pela técnica de regressão multivariada de Poisson. Os participantes foram classificados segundo a exposição ao trabalho noturno em não (75,8%) e sim(24,2%). A HA foi diagnosticada em 21,2%. A exposição ao trabalho noturno se associou independentemente à HA após o ajuste multivariado dos dados (RP = 1,76; IC 95% = 1,01-3,11; p = 0,048). Portanto, nossos resultados devem ser considerados na formulação de políticas públicas que envolvam a promoção da saúde de profissionais de enfermagem

This was a cross-sectional study developed using a probabilistic sample of 297 nursing professionals in the municipal healthcare system of Belo Horizonte, Minas Gerais State, Brazil, between September 2008 and January 2009. The aim was to analyze the association between exposure to night work and hypertension among nursing professionals. Exposure to night work was measured based on responses to the question: Do you work in the night shift? (never, rarely, sometimes, always). For the analysis, the categories were grouped as no (never) and yes (rarely, sometimes, always). Hypertension was identified through self-reporting of medical diagnosis of the disease or use of antihypertensive medication. Prevalence ratios (PR) for hypertension and their respective 95% confidence intervals (95% CI) were adjusted using Poisson's multivariate regression technique. The participants were classified according to exposure to night work as no (75.8%) and yes (24.2%). Hypertension was diagnosed in 21.2%. Exposure to night work was associated independently with hypertension after multivariate adjustment of the data (Prevalence Ratio = 1.76; 95% CI = 1.01-3.11; p = 0.048). Therefore, our results should be taken into consideration in formulating public policies that involve health promotion among nursing professionals.

[Health care for women over 50: programmatic vulnerability in the Family Health Strategy]. / Atenção à saúde da mulher após os 50 anos: vulnerabilidade programática na Estratégia Saúde da Família.

OBJECTIVE: To assess the health care process for women over 50 at a Family Health Unit based on the concept of programmatic vulnerability. METHOD: This study is inserted in the field of health care assessments. The framework proposed by Donabedian was used to analyze 90.5% of the 790 records of women registered at the unit. RESULTS: It was observed that none of the women that did not have a diagnosed pathology attended the recommended consultations or underwent the recommended tests. Of the total number of women with hypertension or diabetes, 20.7% were registered in the Hiperdia Programme and less than 1.0% had attended the consultations and undergone the necessary tests. Only 11.9% of the women had had a gynaecological examination, a clinical breast examination and a mammography the year before data collection. CONCLUSION: It is concluded that women over 50 are in a situation of programmatic vulnerability in terms of the indicators established in this study. Knowledge of this reality can help nurses provide care that is best suited for this group.