Ischemic Heart Disease in German Immigrants and Their Descendants in a Region of Southern Brazil: A Comparison of Initial Symptoms Reported between two Generations

Abstract Background Nothing is known about ischemic heart disease (IHD) in the Germans who emigrated to Brazil during the last century. Objective We sought to compare age at diagnosis and IHD manifestations between German immigrants and their first-generation descendants in the region of Blumenau, Brazil. Methods We reviewed medical records of hospitals in Blumenau. Comparison of the groups in the evaluation times was made by analysis of variance (ANOVA) with repeated measures, and comparison of two factors was made by two-way ANOVA. The level of significance was set at p <0.05. Results Study population comprised 68 patients who were born in Germany (group G) and 99 descendants (group D). Twenty-nine patients of group D had two German parents and 70 had one. Mean age at diagnosis was 66.8 ± 10.6 years, with a significant difference between the groups, four years higher in Group G than group D (69.0 ± 8.8 vs 65.4 ± 11.5 years old) (p = 0.025). There was no significant difference in risk factors or coronary angiography data between the groups. HDL cholesterol levels were significantly higher in group G than in group D (48.4 ± 11.1 mg/dL vs 43.3 ± 11.2 mg/dL, p = 0.005). Conclusion At the time of first IHD diagnosis, mean age of the group G was significantly higher than group D, with no differences between groups in sex, risk factors, LDL levels, or clinical and angiographic manifestations. An earlier manifestation of the disease could be part of lifestyle changes in descendants, in this population that mantained eating habits characterized by high saturated fat consumption.

The lack of knowledge on acute stroke in Brazil: A cross-sectional study with children, adolescents, and adults from public schools

Abstract Objective: Stroke is an important cause of disability and death in adults worldwide. However, it is preventable in most cases and treatable as long as patients recognize it and reach capable medical facilities in time. This community-based study investigated students' stroke knowledge, Emergency Medical Services (EMS) activation, associated risk factors, warning signs and symptoms, and prior experience from different educational levels in the KIDS SAVE LIVES BRAZIL project. Methods: The authors conducted the survey with a structured questionnaire in 2019‒2020. Results: Students from the elementary-school (n = 1187, ~13 y.o., prior experience: 14%, 51% women), high-school (n = 806, ~17 y.o., prior experience: 13%, 47% women) and University (n = 1961, ~22 y.o., prior experience: 9%, 66% women) completed the survey. Among the students, the awareness of stroke general knowledge, associated risk factors, and warning signs and symptoms varied between 42%‒66%. When stimulated, less than 52% of the students associated stroke with hypercholesterolemia, smoking, diabetes, and hypertension. When stimulated, 62%‒65% of students recognized arm weakness, facial drooping, and speech difficulty; only fewer identified acute headache (43%). Interestingly, 67% knew the EMS number; 81% wanted to have stroke education at school, and ~75% wanted it mandatory. Women, higher education, and prior experience were associated with higher scores of knowing risk factors (OR = 1.28, 95% CI: 1.10‒1.48; OR = 2.12, 95% CI: 1.87‒2.40; OR = 1.46, 95% CI: 1.16‒1.83; respectively), and warning signs- symptoms (OR = 2.22, 95% CI: 1.89‒2.60; OR = 3.30, 95% CI: 2.81‒3.87; OR = 2.04, 95% CI: 1.58‒2.63; respectively). Conclusion: Having higher education, prior experience, and being a woman increases stroke-associated risk factors, and warning signs and symptoms identification. Schoolchildren and adolescents should be the main target population for stroke awareness. HIGHLIGHTS Higher education, prior experience, and being women improved the odds of identifying stroke warning signs and symptoms as associated risk factors Improving knowledge, skills, and attitude on acute stroke in the school community may represent a significant advance in public health management Future stroke awareness campaigns and educational efforts should focus on schoolchildren and adolescents, especially in low-income countries

Treinamento de Não-Cardiologistas pode Melhorar os Resultados do Tratamento de Infarto Agudo do Miocárdio com Supra de ST / Training Non-Cardiologists Could Improve the Treatment Results of ST Elevation Myocardial Infarction

Resumo Fundamento De acordo com a Organização Mundial da Saúde, países emergentes terão um crescimento considerável no número de ataques cardíacos e mortes relacionadas. Um dos principais problemas médicos no Brasil é a mortalidade causada por infarto agudo do miocárdio com supra de ST (IAMCSST). A Sociedade de Cardiologia do Estado de São Paulo nunca treinou não-cardiologistas para atendimentos de emergência. Os pacientes normalmente buscam ajuda em prontos-socorros, em vez de chamar a ambulância. Objetivo Nosso objetivo foi reduzir as taxas de mortalidade hospitalar causada por infarto agudo do miocárdio ao treinar profissionais da emergência na cidade de São Paulo. Métodos Utilizamos um programa de treinamento para as equipes de cinco hospitais com > 100 pacientes internados com IAMCSST por ano, e pelo menos 15% de mortes hospitalares relacionadas ao IAMCSST. Realizamos treinamentos online, organizamos de dois a quatro eventos para até 400 participantes, fizemos folders e panfletos informativos. A análise estatística utilizou o teste para comparação de duas proporções, com p <0,05. Resultados Quase 200 médicos e 350 enfermeiros participaram de pelo menos um treinamento de maio de 2010 até dezembro de 2013. Inicialmente, muitos médicos da emergência não reconheciam um infarto agudo do miocárdio no eletrocardiograma, mas a tele-ecocardiografia é usada em alguns departamentos da emergência para determinar o diagnóstico. A taxa de mortalidade nos cinco hospitais caiu de 25,6%, em 2009, para 18,2%, em 2010 (p=0,005). Depois da conclusão do período de treinamento, as mortes relacionadas ao IAMCSST em todos os hospitais públicos de São Paulo diminuíram de 14,31%, em 2009, para 11,25%, em 2014 (p<0,0001). Conclusão Mesmo programas simplificados de treinamento de pessoal da emergência pode reduzir muito as taxas de morte por infarto agudo do miocárdio em países em desenvolvimento.

Abstract Background According to the World Health Organization, emerging countries will have an enormous growth in the number of heart attacks and related deaths. The main medical issue in Brazil is mortality caused by acute ST elevation myocardial infarction (STEMI). The Society of Cardiology in the State of São Paulo has never trained non-cardiologists as emergency personnel. Patients usually seek help from emergency departments instead of calling for an ambulance. Objectives We aimed at reducing in-hospital death rates from acute myocardial infarction by training emergency personnel in the city of Sao Paulo. Methods We used a training program for the personnel of five hospitals with >100 patients admitted with STEMI per year, and at least 15% in-hospital STEMI-associated mortality rate. We performed internet training, biannual-quarterly symposia for up to 400 participants, informative folders and handouts. Statistical analysis used the two proportion comparison test with p <0.05. Results Nearly 200 physicians and 350 nurses attended at least one training from May 2010 to December 2013. Initially, many emergency physicians could not recognize an acute myocardial infarction on the electrocardiogram, but tele-electrocardiography is used in some emergency departments to determine the diagnosis. The death rate in the five hospitals decreased from 25.6%, in 2009, to 18.2%, in 2010 (p=0.005). After the entire period of training, the STEMI-associated death rate in all public hospitals of São Paulo decreased from 14.31%, in 2009, to 11.25%, in 2014 (p<0.0001). Conclusion Even simple training programs for emergency personnel can greatly reduce acute myocardial infarction death rates in undeveloped countries.

Taxas de mortalidade por doenças cardiovasculares e câncer na população brasileira com idade entre 35 e 74 anos, 1996-2017 / Cardiovascular and cancer death rates in the brazilian population aged 35 to 74 years, 1996-2017

Resumo Fundamento: As doenças cardiovasculares (DCV) e câncer são as principais causas de morte no mundo. Essas doenças apresentam muitos fatores de risco em comum, e o controle de fatores de risco tradicionais para DCV foi associado com menor incidência de câncer. Objetivo: Analisar tendências nas taxas de mortalidade por câncer na população brasileira com idade entre 35 e 74 anos de 1996 a 2017. Métodos: As tendências nas taxas de mortalidade (bruta e ajustada por idade) foram analisadas quanto a todas as causas de morte, DCV e câncer. Os dados foram obtidos do banco de dados de mortalidade do Ministério da Saúde. O programa Joinpoint Regression foi usado para análise das tendências e ajustes nas taxas de saúde. O grau de mudanças nas taxas foi determinado pela variação percentual anual média (VPAM). O nível de significância estatística foi estabelecido em p<0,05. Resultados: A mortalidade por todas as causas (VPAM=-1,6%; p<0,001), CVD (VPAM =-2,3; p<0,001), doenças isquêmicas do coração (DIC) (VPAM =-1,6; p<0,001) e doenças cerebrovasculares (DCbV) (VPAM =-3.7; p<0.001) diminuiu. As mesmas tendências foram observadas para DCV em homens e mulheres (p<0,001). As taxas de mortalidade por todos os tipos de câncer (AAPC=-0,1; p=0,201), em homens (VPAM =-0,1; p=0,193) e mulheres (VPAM =-0,1; p=0,871) permaneceram inalteradas. Em 2002, a mortalidade por câncer excedeu a soma de mortes por DIC e DCbV. Se as tendências continuarem, a mortalidade por câncer também excederá a mortalidade por DCV até 2024. Nas mulheres, a mortalidade por câncer de mama, pulmão e cólon, aumentou, e a mortalidade por câncer de colo de útero e de estômago diminuiu. Nos homens, a mortalidade por câncer de pulmão, estômago, e esôfago diminuiu, e por câncer de próstata permaneceu inalterada. Conclusão: As DCV são atualmente as principais causas de morte no Brasil, mas as taxas de morte por câncer irão superar as taxas por DCV em poucos anos.

Abstract Background: Cardiovascular diseases (CVD) and cancer are the main causes of death worldwide. These diseases share many risk factors. Control of traditional risk factors for CVD was associated with lower incidence of cancers. Objective: To analyze CVD and cancer mortality rate trends in Brazilian population aged 35-74 years from 1996 to 2017. Methods: Crude and age-adjusted death rate trends were analyzed for all causes of death, CVD, and cancer. Data were obtained from mortality database of the Ministry of Health. Joinpoint Regression Program performed analysis of trends and adjustments in death rates. The degree of changes was determined by the average annual percent change (AAPC). Level of statistical significance was set at p <0.05. Results: Mortality from all causes of death (AAPC=-1.6%; p<0.001), CVD (AAPC=-2.3; p<0.001), ischemic heart disease (IHD) (AAPC=-1.6; p<0.001) and stroke (AAPC=-3.7; p<0.001) declined. Same trends were observed for CVD (p<0.001) in men and women. Death rates from all causes of cancer (AAPC=-0.1; p=0.201), in men (AAPC=-0.1; p=0.193) and in women (AAPC=-0.1; p=0,871) remained unchanged. In 2002, mortality from cancer exceeded the sum of deaths from IHD and stroke. If trends continue, cancer mortality will also exceed mortality from CVD by 2024. In women, death rates from breast, lung and colon cancer increased, and from cervical and gastric cancers decreased. In men, mortality from lung, stomach and esophagus cancer decreased, and from prostate cancer remained unchanged. Conclusion: CVD are currently the leading cause of death in Brazil, but death rates from cancer will exceed those from CVD in a few years.

Quality of Life Score as a Predictor of Death in Dogs with Degenerative Mitral Valve Disease / Escore de Qualidade de Vida como Preditor de Mortalidade em Cães com Doença Degenerativa da Valva Mitral

Abstract Background: The knowledge of the variables predicting mortality is important in clinical practice and for therapeutic monitoring in mitral valve disease. Objectives: To determine whether a quality of life score evaluated with the Functional Evaluation of Cardiac Health questionnaire would predict mortality in dogs with degenerative mitral valve disease (DMVD). Methods: Thirty-six client-owned dogs with mitral valve disease underwent clinical, laboratory, and echocardiographic evaluations at baseline and were monitored for 6 months. Cardiovascular death was the primary outcome. Results: The 36 dogs were classified as survivors or nonsurvivors. Higher values of the following variables were obtained at baseline in the nonsurviving group (12 dogs): amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, plasma norepinephrine, heart rate, quality of life score, diastolic left ventricular internal dimension to aortic root ratio, systolic left ventricular internal dimension to aortic root ratio, and left atrium to aortic root ratio. NT-proBNP levels and quality life score were independently associated with death in the multivariable analysis. Conclusion: The quality life score was an independent variable for cardiac death in dogs with DMVD. This result is encouraging, as this score is easy to apply and does not require any technology, only a veterinarian and an observant owner.

Resumo Fundamento: O conhecimento das variáveis preditoras de mortalidade é importante para a prática clínica e para o acompanhamento terapêutico na doença da valva mitral. Objetivos: Determinar se um escore de qualidade de vida avaliado com o Functional Evaluation of Cardiac Health poderia auxiliar na predição de mortalidade em cães com doença degenerativa da valva mitral (DDVM). Métodos: Trinta e seis cães de estimação com doença valvar mitral foram submetidos a avaliação clínica, laboratorial e ecocardiográfica no início do estudo e monitorizados durante 6 meses. A morte cardiovascular foi o desfecho primário. Resultados: Os 36 cães foram classificados como sobreviventes ou não sobreviventes. Os valores mais elevados das seguintes variáveis foram obtidos no início do estudo no grupo de não sobreviventes (12 cães): fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP), norepinefrina plasmática, frequência cardíaca, escore de qualidade de vida, razão da dimensão interna diastólica do ventrículo esquerdo e raiz aórtica, razão da dimensão interna sistólica do ventrículo esquerdo e raiz aórtica e a relação da dimensão do átrio esquerdo e a raiz aórtica. Concentrações de NT-proBNP e o escore de qualidade de vida foram independentemente associados com morte na análise multivariada. Conclusão: O escore de qualidade de vida foi uma variável independente para a morte por doença cardíaca em cães com DDVM. Este resultado é encorajador, pois este escore é de fácil aplicação e não requer o emprego de tecnologia, necessitando apenas de um veterinário e um dono observador.

Mortality due to Cardiovascular Diseases in Women and Men in the Five Brazilian Regions, 1980-2012 / Mortalidade por Doenças Cardiovasculares em Mulheres e Homens nas cinco Regiões do Brasil, 1980-2012

Abstract Background: Studies have shown different mortalities due to cardiovascular diseases (CVD), ischemic heart disease (IHD) and cerebrovascular diseases (CbVD) in the five Brazilian regions. Socioeconomic conditions of those regions are frequently used to justify differences in mortality due to those diseases. In addition, studies have shown a reduction in the differences between the mortality rates of the five Brazilian regions. Objective: To update CVD mortality data in women and men in the five Brazilian regions. Methods: Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and Ministry of Health. Risk of death was adjusted by use of the direct method, with the 2000 world standard population as reference. We analyzed trends in mortality due to CVD, IHD and CbVD in women and men aged ≥ 30 years in the five Brazilian regions from 1980 to 2012. Results: Mortality due to: 1) CVD: showed reduction in the Northern, West-Central, Southern and Southeastern regions; increase in the Northeastern region; 2) IHD: reduction in the Southeastern and Southern regions; increase in the Northeastern region; and unchanged in the Northern and West-Central regions; 3) CbVD: reduction in the Southern, Southeastern and West-Central regions; increase in the Northeastern region; and unchanged in Northern region. There was also a convergence in mortality trends due to CVD, IHD, and CbVD in the five regions. Conclusion: The West-Central, Northern and Northeastern regions had the worst trends in CVD mortality as compared to the Southeastern and Southern regions. (Arq Bras Cardiol. 2016; [online].ahead print, PP.0-0).

Resumo Fundamento: Estudos mostraram diferentes mortalidades por doenças cardiovasculares (DCV), doença isquêmica do coração (DIC) e doenças cerebrovasculares (DCbV) nas cinco regiões do Brasil. Particularidades socioeconômicas entre as cinco regiões são frequentemente usadas para justificar diferenças na mortalidade por essas doenças. Estudos também mostraram redução das diferenças entre as taxas de mortalidade das cinco regiões do Brasil. Objetivo: Atualizar os dados de mortalidade por DCV em mulheres e homens nas cinco regiões do país. Métodos: Os dados populacionais e de mortalidade foram obtidos do Instituto Brasileiro de Geografia e Estatística e do Ministério da Saúde. O risco de morte foi ajustado pelo método da padronização direta, tendo como referência a população mundial em 2000. Foram analisadas as tendências da mortalidade por DCV, DIC e DCbV em mulheres e homens com ≥ 30 anos de idade nas cinco regiões do Brasil no período de 1980-2012. Resultados: Observou-se na mortalidade: 1) por DCV: redução nas regiões Norte, Centro-Oeste, Sul e Sudeste; aumento na região Nordeste; 2) por DIC: redução nas regiões Sudeste e Sul; aumento na região Nordeste; e inalterada nas regiões Norte e Centro-Oeste; 3) por DCbV: redução nas regiões Sul, Sudeste e Centro-Oeste; aumento na região Nordeste; e inalterada na região Norte. Observou-se também convergência das tendências da mortalidade por DCV, DIC e DCbV nas cinco regiões. Conclusão: As regiões Centro-Oeste, Norte e Nordeste tiveram as maiores taxas de mortalidade por DCV comparadas às regiões Sudeste e Sul. (Arq Bras Cardiol. 2016; [online].ahead print, PP.0-0).

Trends in Mortality Rate from Cardiovascular Disease in Brazil, 1980-2012 / Tendências da Taxa de Mortalidade por Doenças Cardiovasculares no Brasil, 1980-2012

Abstract Background: Studies have questioned the downward trend in mortality from cardiovascular diseases (CVD) in Brazil in recent years. Objective: to analyze recent trends in mortality from ischemic heart disease (IHD) and stroke in the Brazilian population. Methods: Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. Risk of death was adjusted by the direct method, using as reference the world population of 2000. We analyzed trends in mortality from CVD, IHD and stroke in women and men in the periods of 1980-2006 and 2007-2012. Results: there was a decrease in CVD mortality and stroke in women and men for both periods (p < 0.001). Annual mortality variations for periods 1980-2006 and 2007-2012 were, respectively: CVD (total): -1.5% and -0.8%; CVD men: -1.4% and -0.6%; CVD women: -1.7% and -1.0%; DIC (men): -1.1% and 0.1%; stroke (men): -1.7% and -1.4%; DIC (women): -1.5% and 0.4%; stroke (women): -2.0% and -1.9%. From 1980 to 2006, there was a decrease in IHD mortality in men and women (p < 0.001), but from 2007 to 2012, changes in IHD mortality were not significant in men [y = 151 + 0.04 (R2 = 0.02; p = 0.779)] and women [y = 88-0.54 (R2 = 0.24; p = 0.320). Conclusion: Trend in mortality from IHD stopped falling in Brazil from 2007 to 2012.

Resumo Fundamento: Estudos questionaram a tendência de queda da mortalidade por doenças cardiovasculares (DCV) no Brasil nos últimos anos. Objetivo: analisar as tendências recentes na mortalidade por doença isquêmica do coração (DIC) e doenças cerebrovasculares (DCbV) na população brasileira. Métodos: dados de mortalidade e população foram obtidos do Instituto Brasileiro de Geografia e Estatística e Ministério da Saúde. O risco de morte foi ajustado pelo método direto, tendo como referência a população mundial de 2000. Foram analisadas, nos períodos de 1980-2006 e 2007-2012, as tendências da mortalidade em mulheres e homens. Resultados: houve diminuição da mortalidade por DCV e DCbV em mulheres e homens para ambos os períodos (p < 0,001). As variações anuais de mortalidade para os períodos de 1980-2006 e 2007-2012 foram, respectivamente: DCV total: -1,5% e -0,8%; DCV homens: -1,4% e -0,6%; DCV mulheres: -1,7% e -1,0%; DIC homens: -1,1% e 0,1%; DIC mulheres: -1,5% e 0,4%; DCbV homens: -1,7% e -1,4%; DCbV mulheres: -2,0% e -1,9%. De 1980 a 2006, houve diminuição da mortalidade por DIC em homens e mulheres (p < 0,001), mas de 2007-2012, as mudanças na mortalidade por DIC não foram significativas em homens [y = 151 + 0.04 (R2 = 0.02; p = 0,779)] e mulheres [y = 88-0.54 (R2 = 0,24; p = 0,320)]. Conclusão: A tendência da mortalidade por DIC parou de cair no Brasil de 2007 a 2012.

Gene mutations of platelet glycoproteins and response to tirofiban in acute coronary syndrome / Mutações gênicas das glicoproteínas plaquetárias e resposta ao tirofiban na síndrome coronariana aguda

CONTEXT AND OBJECTIVES: Glycoprotein inhibitors (abciximab, eptifibatide and tirofiban) are used in patients with unstable angina and non-ST-segment elevation myocardial infarction before percutaneous coronary intervention. Of these, tirofiban is the least effective. We hypothesized that the response to tirofiban might be associated with glycoprotein gene mutations. DESIGN AND SETTING: Prospective study at Emergency Unit, Heart Institute (InCor), University of São Paulo. METHOD: Intrahospital evolution and platelet aggregation in response to tirofiban were analyzed in relation to four glycoprotein mutations in 50 patients indicated for percutaneous coronary intervention: 17 (34%) with unstable angina and 33 (66%) with non-ST-segment elevation myocardial infarction. Platelet aggregation was analyzed using the Born method. Blood samples were obtained before and one hour after tirofiban infusion. Glycoproteins Ia (807C/T ), Ib (Thr/Met) , IIb (Ile/Ser ) and IIIa (PIA ) were the mutations selected. RESULTS: Hypertension, dyslipidemia, diabetes, smoking, previous coronary artery disease and stroke were similar between the groups. Mutant glycoprotein IIIa genotypes had lower platelet aggregation before tirofiban administration than that of the wild genotype (41.0% ± 22.1% versus 55.9% ± 20.8%; P = 0.035). Mutant glycoprotein IIIa genotypes correlated moderately with lower platelet inhibition (r = -0.31; P = 0.030). After tirofiban administration, platelet glycoprotein Ia, Ib, IIb and IIIa mutations did not influence the degree of inhibition of platelet aggregation or intrahospital mortality. CONCLUSIONS: Mutations of glycoproteins Ia, Ib, IIb and IIIa did not influence platelet aggregation in response to tirofiban in patients with unstable angina and non-ST-segment elevation myocardial infarction.

RESUMO CONTEXTO E OBJETIVOS: Inibidores da glicoproteína (abciximab, eptifibatide, tirofiban) são utilizados em pacientes com angina instável e infarto do miocárdio sem elevação do segmento ST (IAMSSST) antes da intervenção coronária percutânea. Dentre eles, o tirofiban é o menos eficaz. Nossa hipótese é que a resposta ao tirofiban possa estar associada a mutações no gene da glicoproteína. DESENHO E LOCAL: Estudo prospectivo na Unidade de Emergência do Instituto do Coração (InCor), Universidade de São Paulo (USP). MÉTODOS: Foram analisadas a evolução intra-hospitalar e agregabilidade plaquetária em resposta ao tirofiban de 4 mutações da glicoproteína em 50 pacientes com indicação para intervenção coronária percutânea, 17 (34%) com angina instável e 33 (66%) com IAMSSST. A agregação plaquetária foi analisada pelo método de Born. Amostras de sangue foram obtidas antes e uma hora após infusão do tirofiban. As glicoproteínas Ia (807C/T ), Ib (Thr/Met ), IIb (Ile/Ser ) e IIIa (PIA ) foram as mutações selecionadas. RESULTADOS: Hipertensão, dislipidemia, diabetes, tabagismo, doença coronariana e acidente vascular cerebral prévios foram semelhantes entre os grupos. Observou-se menor agregabilidade plaquetária dos genótipos mutantes da glicoproteína IIIa antes da administração de tirofiban do genótipo selvagem (41% ± 22% versus 56% ± 21%; P = 0,035). Genótipos mutantes da glicoproteína IIIa correlacionaram-se moderadamente com menor inibição plaquetária (r = -0,31; P = 0,030). Após a administração tirofiban, as mutações das glicoproteínas Ia, Ib, IIb, e IIIa não influenciaram o grau de inibição da agregação plaquetária e mortalidade intra-hospitalar. CONCLUSÕES: Mutações das glicoproteínas Ia, Ib, IIb e IIIa não influenciaram a agregação plaquetária em resposta ao tirofiban nos pacientes com angina instável e IAMSSST.

Risk Factors for Cardiovascular Disease, Metabolic Syndrome and Sleepiness in Truck Drivers / Fatores de Risco para Doença Cardiovascular, Síndrome Metabólica e Sonolência em Motoristas de Caminhão

Abstract Background: Truck driver sleepiness is a primary cause of vehicle accidents. Several causes are associated with sleepiness in truck drivers. Obesity and metabolic syndrome (MetS) are associated with sleep disorders and with primary risk factors for cardiovascular diseases (CVD). We analyzed the relationship between these conditions and prevalence of sleepiness in truck drivers. Methods: We analyzed the major risk factors for CVD, anthropometric data and sleep disorders in 2228 male truck drivers from 148 road stops made by the Federal Highway Police from 2006 to 2011. Alcohol consumption, illicit drugs and overtime working hours were also analyzed. Sleepiness was assessed using the Epworth Sleepiness Scale. Results: Mean age was 43.1 ± 10.8 years. From 2006 to 2011, an increase in neck (p = 0.011) and abdominal circumference (p < 0.001), total cholesterol (p < 0.001), triglyceride plasma levels (p = 0.014), and sleepiness was observed (p < 0.001). In addition, a reduction in hypertension (39.6% to 25.9%, p < 0.001), alcohol consumption (32% to 23%, p = 0.033) and overtime hours (52.2% to 42.8%, p < 0.001) was found. Linear regression analysis showed that sleepiness correlated closely with body mass index (β = 0.19, Raj2 = 0.659, p = 0.031), abdominal circumference (β = 0.24, Raj2 = 0.826, p = 0.021), hypertension (β = -0.62, Raj2 = 0.901, p = 0.002), and triglycerides (β = 0.34, Raj2 = 0.936, p = 0.022). Linear multiple regression indicated that hypertension (p = 0.008) and abdominal circumference (p = 0.025) are independent variables for sleepiness. Conclusions: Increased prevalence of sleepiness was associated with major components of the MetS.

Resumo Fundamento: A sonolência de motoristas de caminhão, que pode resultar de diferentes causas, é a principal causa de acidentes com veículos. Obesidade e síndrome metabólica (SMet) estão associadas a distúrbios do sono e fatores de risco primários para doença cardiovascular (DCV). Este estudo verificou a relação entre essas condições e a prevalência de sonolência em motoristas de caminhão. Métodos: Este estudo analisou os principais fatores de risco para DCV, dados antropométricos e distúrbios do sono em 2.228 motoristas de caminhão do sexo masculino a partir de informação coletada de 148 paradas efetuadas em rodovias pela Polícia Rodoviária Federal entre 2006 e 2011. Consumo de álcool e de drogas ilícitas e excesso de horas trabalhadas também foram analisados. Sonolência foi avaliada com a Escala de Sonolência de Epworth. Resultados: A idade média foi de 43,1 ± 10,8 anos. De 2006 a 2011, observou-se aumento de: circunferências cervical (p = 0,011) e abdominal (p < 0,001); colesterol total (p < 0,001); níveis séricos de triglicerídeos (p = 0,014); sonolência (p < 0,001). Além disso, houve redução de hipertensão (de 39,6% para 25,9%, p < 0,001), consumo de álcool (de 32% para 23%, p = 0,033) e excesso de horas trabalhadas (de 52,2% para 42,8%, p < 0,001). A análise de regressão linear mostrou correlação íntima de sonolência com índice de massa corporal (β = 0,19, Raj2 = 0,659, p = 0,031), circunferência abdominal (β = 0,24, Raj2 = 0,826, p = 0,021), hipertensão (β = -0,62, Raj2 = 0,901, p = 0,002) e triglicerídeos (β = 0,34, Raj2 = 0,936, p = 0,022). Regressão linear múltipla indicou que hipertensão (p = 0,008) e circunferência abdominal (p = 0,025) são variáveis independentes para sonolência. Conclusões: Elevada prevalência de sonolência foi associada com os principais componentes da SMet.

The involvement of multiple thrombogenic and atherogenic markers in premature coronary artery disease

OBJECTIVE: To examine the association of atherogenic and thrombogenic markers and lymphotoxin-alfa gene mutations with the risk of premature coronary disease. METHODS: This cross-sectional, case-control, age-adjusted study was conducted in 336 patients with premature coronary disease (<50 years old) and 189 healthy controls. The control subjects had normal clinical, resting, and exercise stress electrocardiographic assessments. The coronary disease group patients had either angiographically documented disease (>50% luminal reduction) or a previous myocardial infarction. The laboratory data evaluated included thrombogenic factors (fibrinogen, protein C, protein S, and antithrombin III), atherogenic factors (glucose and lipid profiles, lipoprotein(a), and apolipoproteins AI and B), and lymphotoxin-alfa mutations. Genetic variability of lymphotoxin-alfa was determined by polymerase chain reaction analysis. RESULTS: Coronary disease patients exhibited lower concentrations of HDL-cholesterol and higher levels of glucose, lipoprotein(a), and protein S. The frequencies of AA, AG, and GG lymphotoxin-alfa mutation genotypes were 55.0%, 37.6%, and 7.4% for controls and 42.7%, 46.0%, and 11.3% for coronary disease patients (p = 0.02), respectively. Smoking, dyslipidemia, family history, and lipoprotein(a) and lymphotoxin-alfa mutations in men were independent variables associated with coronary disease. The area under the curve (C-statistic) increased from 0.779 to 0.802 (p<0.05) with the inclusion of lipoprotein(a) and lymphotoxin-alfa mutations in the set of conventional risk factors. CONCLUSIONS: The inclusion of lipoprotein(a) and lymphotoxin-alfa mutations in the set of conventional risk factors showed an additive but small increase in the risk prediction of premature coronary disease. .

Mortalidade por doenças cardiovasculares no Brasil e na região metropolitana de São Paulo: atualização 2011 / Mortality due to cardiovascular diseases in Brazil and in the metropolitan region of São Paulo: a 2011 update

FUNDAMENTO: As doenças cardiovasculares (DCV) são as principais causas de morte na população brasileira. Observou-se redução progressiva da mortalidade por tais doenças até o ano de 2005. OBJETIVO: Atualizar as tendências da mortalidade das DCV no Brasil e na região metropolitana de São Paulo (RMSP) de 1990 a 2009. MÉTODOS: Dados populacionais e de mortalidade foram obtidos do Instituto Brasileiro de Geografia e Estatística e do Ministério da Saúde. O risco de morte foi ajustado pelo método direto, tendo como referência a população mundial de 2000. RESULTADOS: Observou-se progressiva redução do risco de morte por doenças isquêmicas do coração (DIC) e por doenças cerebrovasculares (DCbV) no Brasil e na RMSP. De 1990 a 2009, constatou-se redução da mortalidade por DIC e DCbV em mulheres e homens no Brasil e na RMSP. Observou-se maior redução da mortalidade por DIC nos homens na RMSP do que no Brasil (36,24% vs. 23,35%; p < 0,001) e nas mulheres na RMSP (44,55% vs. 29,5%; p < 0,001). Foi registrada maior redução da mortalidade por DCbV nos homens na RMSP que no Brasil (42,43% vs. 34,9%; p = 0,036) e igual redução nas mulheres na RMSP e no Brasil (42,98% vs. 36,15%; p = 0,082). A redução da mortalidade foi significativa para todas as faixas etárias analisadas. CONCLUSÃO: Observamos uma progressiva redução na mortalidade por DCV, DIC e DCbV no Brasil e na RMSP. Apesar dessa redução, ainda apresentamos taxas elevadas de morte por tais doenças.

BACKGROUND: Cardiovascular diseases (CVD) are the leading causes of death in our population. There was a progressive decrease in mortality due to CVD up to 2005. OBJECTIVE: To update the trends in mortality from cardiovascular diseases in Brazil and in the metropolitan region of São Paulo (MRSP) from 1990 to 2009. METHODS: Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. The risk of death was adjusted by the direct method, having as reference the world population in 2000. RESULTS: There was a progressive decrease in the risk of death from ischemic heart disease (IHD) and stroke in Brazil and in the MRSP. From 1990 to 2009, there was a decrease in mortality from IHD and stroke in men and women in Brazil and in the MRSP. There was a greater reduction in mortality from IHD in men in the MRSP than in Brazil (36.24% vs. 23.35%, p <0.001) and in women in the MRSP (44.55% vs. 29.5%; p <0.001). The highest reduction in stroke mortality was observed in men in the MRSP, when compared to Brazil (42.43% vs. 34.9%, p = 0.036) and an equal reduction in women in the MRSP and in Brazil (42.98% vs. 36.15%, p = 0.082). The decrease in mortality was significant for all age groups. CONCLUSION: We observed a progressive decrease in mortality from CVD, IHD and stroke in Brazil and in the MRSP. In spite of this decrease, we still have high rates of mortality from these diseases.

Perfil diagnóstico de enfermagem em mulheres com cardiopatias em atendimento ambulatorial / Nursing diagnosis profile of women with heart disease under outpatient treatment

O objetivo deste estudo foi identificar os diagnósticos de enfermagem (DE) de mulheres com cardiopatias, em atendimento ambulatorial, bem como as características definidoras e fatores relacionados de risco dos DE com prevalência acima de 50% nessa população. Trata-se de estudo descritivo, transversal, com abordagem quantitativa, realizado com mulheres com mais de 18 anos e atendidas no ambulatório de cardiopatia da mulher em um hospital especializado em cardiologia. Para a coleta de dados, foi utilizado o "instrumento de coleta de dados" (histórico de enfermagem). Os DE foram estabelecidos por consenso entre as investigadoras principais, utilizando-se a classificação de diagnósticos de enfermagem da NANDA-Internacional. Os dados foram analisados por meio de estatísticas descritiva. Foram estudados 21 mulheres (76,0 + 10 anos), para os quais foram identificados 7,9 DE/paciente. Houve quatro DE com prevalência > 50%: estilo de vida sedentário (85,7%), autocontrole ineficaz da saúde (85,7%), risco de quedas (81,0%) e dor crônica (57,1%). Para os DE reais, as carcterísticas definidoras mais frequentes foram cansaço aos esforços (72,2%), última consulta ao dentista há mais de 1 ano (94,4%) e relato verbal de dor (100%), respectivamente. para o DE de risco, idade acima de 65 anos (954,1%) e uso de anti-hipertensivo (94,1%) foram os principais fatores de risco. Conclui-se que foi possível identificar as necessidades de cuidados das mulheres com cardiopatias avaliadas neste estudo. Ressalta-se que a validade externa do estudo é limitada, devido ao tamanho amostral e, portanto, novos estudos são necessários.

This study identifies Nursing Diagnoes (ND) of women with heart diseases in ambulatory care and corresponding defining characteristics and related factors with prevalence above 50%. This descriptive, cross-sectional and quantitative study addressed women 18 years old or older being cared for in a cardiac outpatient clinic from a hospital specialized in cardiology. Data were collected through the "Data Collection Instrument" (patients history). ND were established after consensus was achieved among the main researchers according to the NANDA-International Nursing Diagnosis classification. Data were analyzed through descriptive statistics. A total of 21 women (76,0% + 10 years) were studied and 7,9 ND were identified per patient. The prevalence of four ND was > 50%: Sedentary Lifestyle (85,7%); Ineffective Self-Health Management (85,7%); Risk for falls (81,0%); and Chronic Pain (57,1%). the most frequent defining characteristics for the real ND included fatigue due to effort (72,2%), last consultation to a dentist was more than one year ago (94,4%), and verbal report of pain (100%). Age above 65 years old (94,1%) and the use hypertensive medication (94,1%) were among the main risk factors. This study enable the identification of he health needs of women with heart diseases. The study's external validity is limited due to the sample size; further research is needed.

Hora da admissão na unidade de emergência e mortalidade hospitalar na síndrome coronária aguda / Emergency service admission time and in-hospital mortality in acute coronary syndrome

FUNDAMENTO: Há controvérsias sobre a hora da admissão e os desfechos hospitalares da síndrome coronária aguda (SCA). A admissão em horários não regulares seria associada ao pior prognóstico dos pacientes. OBJETIVO: Analisar a influência da hora da admissão na internação prolongada e na mortalidade de pacientes com SCA, segundo os períodos diurno (das 7h às 19h) e noturno (das 19h às 7h). MÉTODOS: Foram avaliados, prospectivamente, 1.104 pacientes consecutivos com SCA. O óbito intra-hospitalar e a internação igual ou superior a cinco dias foram os desfechos analisados. RESULTADOS: A admissão no período diurno foi maior em comparação ao noturno (63 por cento vs. 37 por cento; p < 0,001). A angina instável foi mais prevalente no período diurno (43 por cento vs. 32 por cento; p < 0,001) e o infarto sem supradesnivelamento do segmento ST (IAMssST) no noturno (33 por cento vs. 43 por cento; p = 0,001). Não se observaram diferenças na mortalidade e no tempo de internação nos períodos estudados. Os fatores de predição de internação igual ou superior a cinco dias foram: idade [OR 1,042 (IC 95 por cento 1,025 - 1,058), p < 0,001]; fração de ejeção (FE) [OR 0,977 (IC 95 por cento 0,966 - 0,988), p < 0,001]; IAMssST [OR 1,699 (IC 95 por cento 1,221 - 2,366), p = 0,001]; e tabagismo [OR 1,723 (IC 95 por cento 1,113 - 2,668), p = 0,014]. Para o óbito intra-hospitalar, foram: idade [OR 1,090 (IC 95 por cento 1,047 - 1,134), p < 0,001]; FE [OR 0,936 (IC 95 por cento 0,909 - 0,964), p < 0,001]; e tratamento cirúrgico [OR 3,781 (IC 95 por cento 1,374 - 10,409), p = 0,01]. CONCLUSÃO: A internação prolongada e óbito intra-hospitalar em pacientes com SCA independem do horário de admissão.

BACKGROUND: The relationship between admission time to an emergency service and in-hospital outcomes in acute coronary syndrome (ACS) is controversial. Admission during off-hours would be associated with worse prognosis. OBJECTIVE: To assess the influence of admission time on prolonged hospitalization and mortality for ACS patients, regarding regular hours (7AM-7PM) and off-hours (7PM-7AM). METHODS: The study assessed prospectively 1,104 consecutive ACS patients. In-hospital mortality and length of hospital stay > 5 days were the outcomes analyzed. RESULTS: Admission during regular hours was greater as compared with that during off-hours (63 percent vs. 37 percent; p < 0.001). Unstable angina was more prevalent during regular hours (43 percent vs. 32 percent; p < 0.001), while non-ST-segment elevation myocardial infarction (NSTEMI) was during off-hours (33 percent vs. 43 percent; p = 0.001). Differences in neither mortality nor length of hospital stay were observed in the time periods studied. Predictive factors for length of hospital stay > 5 days were as follows: age [OR 1.042 (95 percentCI: 1.025 - 1.058), p < 0.001]; ejection fraction (EF) [OR 0.977 (95 percentCI: 0.966 - 0.988), p < 0.001]; NSTEMI [OR 1.699 (95 percentCI: 1.221 - 2.366), p = 0.001]; and smoking [OR 1.723 (95 percentCI: 1.113 - 2.668), p = 0.014]. Predictive factors for in-hospital mortality were as follows: age [OR 1.090 (95 percentCI: 1.047 - 1.134), p < 0.001]; EF [OR 0.936 (95 percentCI: 0.909 - 0.964), p < 0.001]; and surgical treatment [OR 3.781 (95 percentCI: 1.374 - 10.409), p = 0.01]. CONCLUSION: Prolonged length of hospital stay and in-hospital mortality in ACS patients do not depend on admission time.

Warfarin doses for anticoagulation therapy in elderly patients with chronic atrial fibrillation

OBJECTIVE: Anticoagulation is a challenge for the prophylaxis of thromboembolic events in elderly patients with chronic atrial fibrillation. Stable anticoagulation is defined as the time within >70% of the therapeutic range. However, the dosage required to achieve stable anticoagulation remains unknown. The aim of this study was to analyze the warfarin dose necessary for the maintenance of stable oral anticoagulation therapy in elderly patients. METHODS: We analyzed 112 consecutive outpatients with atrial fibrillation who were >65 years of age, had received anticoagulation therapy with warfarin for more than 1 year and had a stable international normalized ratio between 2.0 and 3.0 for >6 months. The international normalized ratio was measured in the central laboratory using the traditional method. RESULTS: The patients were stratified according to the following age groups: <75 or >75 years and <80 or >80 years. The mean daily doses of warfarin were similar for patients <75 or >75 years (3.34+1.71 versus 3.26 +1.27 mg/ day, p = 0.794) and <80 or >80 years (3.36+ 1.49 versus 3.15 + 1.23 mg/day, p = 0.433). In 88 (79%) patients, the daily warfarin dose was between 2 and 5 mg/day; in 13 (11%) patients, the daily warfarin dose was <2.0 mg/day; and in 11 (10%) patients, the daily warfarin dose was >5.0 mg/day. The correlation between the daily warfarin dose and the international normalized ratio was 0.22 (p = 0.012). CONCLUSION: Stable anticoagulation was achieved in 80% of patients who received doses of 2 to 5 mg/day of warfarin, and the mean daily dose was similar across the age groups analyzed.