Non-Targeted Self-Measurement of Blood Pressure: Association with Self-Medication, Unscheduled Emergency Visits and Anxiety.

Background and Objective: The routine practice of self-medication of blood pressure (BP) not oriented with pulse devices may not be precisely useful in the control of BP and can lead the patient to self-medicate in error. Thus, we need to evaluate the non-oriented self-assessment of BP in real-life circumstances in hypertensive patients. The objective of this study was to evaluate in hypertensive patients the association of BP self-measurement with its control, as well as the presence of anxiety disorders, the occurrence of unscheduled visits to the emergency room, and self-medication. Materials and Methods: An observational study was carried out with 1000 hypertensive volunteers (age: 61.0 ± 12.5). Using a questionnaire, sociodemographic and clinical data on BP control were collected. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI). Results: The group that performed non-oriented self-measurement of BP, showed that they had higher frequencies of self-medication (57.9%, p < 0.05) and more unscheduled visits to the emergency room (68%, p < 0.05). In addition, a lower level of BP control (46.8%, p < 0.05) was associated with higher levels of anxiety (52.3%, p < 0.05) in the group that performed non-oriented self-measurements of BP. Conclusion: The practice of non-oriented self-assessment of BP was associated with negative factors such as high levels of anxiety and higher frequencies of self-medication and unscheduled emergency visits.

Bariatric Surgery: Late Outcomes in Patients Who Reduced Comorbidities at Early Follow-Up.

Backgroundand Objectives: In severe obesity, a relevant weight loss can promote the reduction of comorbidities, such as systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM2). Bariatric surgery (BS) has been an essential resource in the therapy of this disease with a short-term reduction of cardiometabolic risk (CR). This study aimed to evaluate the reduction of factors associated with the CR in patients undergoing BS at a 5-year follow-up. Materials and Methods: This is a longitudinal, retrospective study carried out with patients undergoing BS by the Brazilian Public Healthcare System (PHS). Anthropometric and clinical parameters related to the CR (DM2, dyslipidemia, and SAH), quantified by the Assessment of Obesity-Related Comorbidities (AORC) score, were evaluated at the following moments: admission and preoperative and postoperative returns (3 months, 6 months, 1 to 5 years). Results: The sample had a mean age of 44.69 ± 9.49 years and were predominantly in the age group 20-29 years (34.80%) and women (72.46%). At admission to the service, 42.3% had DM2, 50.7% dyslipidemia, and 78.9% SAH. Regarding BS, the gastric bypass technique was used in 92.86% of the sample, and the waiting time for the procedure was 28.3 ± 24.4 months. In the pre- and postoperative period of 3 months, there was a significant reduction in the frequency of DM2 (p < 0.003), dyslipidemia (p < 0.000), and SAH (p < 0.000). However, at postoperative follow-up from 6 months to 5 years, there was no significant reduction in the comorbidities studied. After five years, 35.7% had total remission of DM2 and 2.9% partial remission of DM2, 44.2% had control and remission of dyslipidemia, and 19.6% of SAH (AORC score ≤ 2 for the comorbidities). Conclusion: BS promoted a reduction of the CR in the first three months after BS in severely obese PHS users.

Wrist Circumference Cutoff Points for Determining Excess Weight Levels and Predicting Cardiometabolic Risk in Adults.

(1) Background: An elevated wrist circumference may indicate excess weight and cardiometabolic risk. The present study aims to identify wrist circumference cutoff points (WrC) to determine excess weight levels and predict cardiometabolic risk in adults. (2) Methods: A cross-sectional study was conducted with adults aged 20 to 59 years old, attending the outpatient clinic at University Hospital/Federal University of Sergipe HU/UFS-EBSERH. Demographic, anthropometric, biochemical, and blood pressure (BP) data were collected. Cardiometabolic risk was assessed, according to the global risk score (ERG) and Framingham score criteria. The descriptive analysis included calculating medians and frequencies of anthropometric, demographic, biochemical, and blood pressure variables. The gender and age of adult groups were compared using the Mann-Whitney test. Spearman's correlation coefficient and multiple regression analysis were used to assess the association between wrist circumference (WrC) and the variables mentioned above. The predictive validity of WrC in identifying excess weight levels and cardiometabolic risk was analyzed using the ROC curve. The sample consisted of 1487 adults aged 20 to 59 years, 55.7% of whom were female; (3) Results: WrC correlated positively with other adiposity indicators such as waist circumference and Body Mass Index. WrC was the anthropometric indicator most significantly associated with cardiometabolic risk factors. WrC cutoff points identified by the study for determining excess weight were categorized by gender and age group. For males aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 17.1 cm and 17.3 cm, and for obesity, 17.9 cm and 17.5 cm. For females aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 15.6 cm and 15.4 cm, and for obesity, 16.1 cm and 16 cm (4). Conclusions: Wrist circumference showed a significant correlation with other adiposity indicators and can be used to identify adults with excess weight and predict cardiometabolic risk.

Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services.

Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.

Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil.

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Tempo de jejum para exames e as implicações no estado nutricional de pacientes hospitalizados / Fasting time for examinations and implications on the nutritional status of hospitalized patients

Introdução: O comprometimento do estado nutricional em pacientes hospitalizados pode ser desencadeados por diversos fatores, podendo está relacionado com o tempo de jejum prolongado. O jejum extenso para realizações de exames implica em queixas, além de riscos de desequilíbrio hidroeletrolítico, metabólico e nutricional. Objetivo: Avaliar o tempo de jejum para exames e o estado nutricional através de indicadores antropométricos e bioquímicos de pacientes internalizados em um hospital universitário do Nordeste brasileiro. Métodos: Trata-se de um estudo transversal, com pacientes internados em um hospital universitário, no período de março à junho de 2015. Os pacientes foram avaliados em dois momentos distintos: no período que antecede o jejum para o primeiro exame e no momento da alta hospitalar. Foi avaliado o estado nutricional dos pacientes utilizando métodos de triagem nutricional, dados antropométricos, bioquímicos, tempo de internamento, número de episódios em que o paciente ficou em jejum e diagnóstico que motivou o internamento. Os dados foram analisados no programa SPSS 18.0. A Avaliação da evolução nutricional da amostra foi realizada através do teste de 't' de Student e o teste 't'pareado, a associação foi verificada por meio do teste de Correlação de Pearson. Para os resultados foi considerado o nível de significância de 5%. Resultados: Foram analisados 34 pacientes com uma média de idade de 50,4 ± 16,4 anos, sendo 53% do sexo masculino. Os principais diagnósticos de internação foram doenças infectocontagiosas (26,5%) e câncer (23,5%). Encontrou-se uma proporção elevada de pacientes desnutridos por meio da ASG e MAN. O tempo médio de internação foi 18 ± 9 dias e foi observado que esse tempo se correlacionou com IMC final dos adultos (r = 0,830; p <0,001) e idosos (r = 0,990; p <0,001). O tempo de jejum para exames foi aproximadamente 13,84 ± 3,65 horas e esse se correlacionou com IMC final dos adultos (r=0,602; p <0,001). Conclusões: Observou-se que o tempo médio de jejum para exames foi superior ao preparo convencional, a amostra demostrou elevada prevalência de desnutrição e o estudo revela a importância do desenvolvimento de novos trabalhos relacionados ao jejum para exames e a influência no estado nutricional em pacientes hospitalizados e a complementaridade dos métodos aplicados, para prevenir as complicações associadas a desnutrição e permitir a implementação precoce da terapia nutricional (AU)

Introduction: Nutritional state commitment of hospitalized patients can be onset by several factors, potentially related to prolonged fasting periods. The prolonged fasting for examinations implies in complaints, besides hydroelectric unbalance, metabolic and nutritional risk. Goal: Evaluate fasting periods for exams and nutritional state through anthropometric and biochemical indicators in hospitalized patients from a teaching hospital in the northeast of Brazil. Methods: The current study has a transversal model with hospitalized patients in a teaching hospital, during the period between March to June of 2015. Patients were evaluated in two distinct moments: the period before fasting for the first examination and in hospital discharge. Nutritional state of patients were estimated using nutritional screening, anthropometric and biochemical data, hospitalization period, number of episodes in which the patient was submitted to fasting and admission diagnostic. Data were analyzed in SPSS 18.0 software. The Nutritional State Evaluation of the sample was carried out by paired Student t test, association was verified by Pearson Correlation test, considering significance level of 5%. Results: 34 patients were analyzed with an average age of 50.4 ± 16.4 years, being 53% male. The main admission diagnostic were infectious diseases (26.5%) and cancer (23.5%). A high proportion of malnourished patients was found using SGA and MNA. The average hospitalization period was of 18 ± 9 days and it was seen that this period was directly related to final BMI of adults (r = 0.830; p < 0.001) and elderlies (r = 0.990; p < 0.001). Fasting periods for examinations was around 13.84 ± 3.65 hours and this was related to final adult BMI (r = 0.602; p < 0.001). Conclusions: Average fasting period in the exams was superior to conventional, the sample showed a high prevalence of malnourishment and the study highlights the importance of further developing research on fasting for exams and the influence in nutritional state in hospitalized patients besides the relevance of methods used in prevention of complications associated to malnourishment which would further allow the implementation of early nutritional therapy (AU)

Adequação do suporte nutricional em pacientes em uso de terapia nutricional enteral / Nutritional support adequacy in patients under enteral nutritional therapy

Introdução: Pacientes críticos necessitam de um intenso cuidado na oferta de nutrientes devido a estados hipercatabólicos, que comumente levam a prejuízos nutricionais. Objetivo: Analisar, através de indicadores antropométricos e bioquímicos, a evolução nutricional e adequação do suporte nutricional em pacientes críticos em Terapia Nutricional Enteral exclusiva. Métodos: Estudo transversal realizado com pacientes de dois hospitais públicos de Aracaju-SE. Os pacientes foram avaliados em dois momentos: no início e ao final da Terapia Nutricional Enteral. Foram aferidos o peso e a estatura ou estimados por equações preditivas nos acamados. Mediram-se também as circunferências do braço e da panturrilha. Para avaliar a adequação de calorias e macronutrientes foram calculadas as Necessidades Energéticas Estimadas e utilizados os valores de referência de ingestão da Acceptable Macronutrient Distribution Range/ Dietary Reference Intakes e estes foram comparados com a média de valores prescritos. O percentual ≥ 90% foi utilizado como meta para a oferta calórica. Foi adotado um nível de significância de 95% ou p<0,05. Resultados: A amostra foi composta por 50 pacientes. Os diagnósticos mais frequentes foram Hipertensão Arterial Sistêmica, Traumatismo Crânio-Encefálico e Diabetes Mellitus. Apenas 30% dos pacientes atingiram as necessidades energéticas na avaliação inicial, evoluindo para 38% na final. Houve diferença significativa entre a média calórica inicial e final (p = 0,013) e na oferta de carboidratos (p = 0,000) e proteínas (p = 0,000). O percentual médio de adequação calórica inicial foi 73,44%, evoluindo para 79,77%. Discussão: O paciente hospitalizado, frequentemente, se encontra em estado hipermetabólico, tal estado acompanhado de déficit na oferta energética pode participar da gênese ou do agravo do comprometimento nutricional. Conclusão: Encontrou-se um percentual de adequação de calorias inferior à meta. Foram observados baixos valores médios das circunferências mensuradas, indicando a presença de desnutrição nos pacientes do estudo (AU)

Introduction: Critical patients need intensive care on their nutrient income due to hypercatabolic state, which commonly lead to nutritional impairment. Objective: To analyze through anthropometric and biochemical indicators, the nutritional status and adequacy of nutritional support in critically ill patients under exclusive Enteral Nutritional Therapy. Methods: Cross-sectional study of patients from two hospitals of Aracaju-SE, was carried out. Patients were evaluated at two times: at the beginning and the end of Enteral Nutritional Therapy. Weight and height were measured or estimated by predictive equations for the case of bedridden patients. Arm and calf circumferences were measured. To assess the adequacy of calories and macronutrients intake, caloric goal was calculated taking into account the reference values for intake presented at Acceptable Macronutrient Distribution Range/ Dietary Reference Intakes and these were compared with the mean prescribed values. Target for energy intake was considered ≥ 90%. A significance level of 95% or p <0.05 was adopted. Results: The sample consisted of 50 patients. The most frequent diagnoses were systemic hypertension, Traumatic Brain Injury and Diabetes Mellitus. Only 30% of patients met the needs at the initial assessment, by the end this 38% met the calorie intake adequacy. There was a significant difference between the initial and final average caloric intake (p = 0.013) and for carbohydrate (p = 0.000) and protein (p = 0.000) delivery. The average percentage of initial caloric adequacy was 73.44%, evolving to 79.77%. Discussion: Hospitalized patients are frequently in hypermetabolic state, which followed by a deficit in energy delivery can contribute for genesis or the increase in nutritional impairment. Conclusion: A percentage of calories adequacy lower than the target was found. Low values of circumferences measurements indicating the presence of malnutrition in the patients studied were also seen (AU)