ABSTRACT
BACKGROUND: Increasing the levels of physical activity (PA) is widely recommended for people with chronic venous insufficiency (CVI). However, studies investigating the patterns of PA and adherence to PA guidelines using objective measures are lacking. OBJECTIVE: The primary aim was to examine the patterns of PA and adherence to PA guidelines among patients with CVI. A secondary aim was to identify whether adherence to PA recommendations differed according to patients' sociodemographic and clinical characteristics. METHODS: This cross-sectional study included 96 patients with CVI with Clinical-Etiology-Anatomy-Pathology (CEAP) C3 to C6 (69.1% women 59 ± 11 years; 51.5% C5-C6 on CEAP classification). Objective time spent in PA was measured by a triaxial accelerometer. To examine adherence to PA guidelines, patients were grouped as meeting (or) the recommendations if they had at least 150 min/week of moderate to vigorous PA. Sociodemographic and clinic characteristics were obtained by self-report. Binary logistic regression was employed to examine whether sociodemographic and clinical characteristics were associated with adherence to PA guidelines. T-tests were employed to compare PA levels at different intensities according to patients' age. RESULTS: Patients spent an average of 311.4 ± 91.5 min/week, 42.1 ± 28.0 min/week, and 19.8 ± 17.8 min/week in low-light PA, high-light PA, and moderate-to-vigorous PA, respectively. The proportion of patients meeting PA recommendations was 36.2%, and older patients had lower odds (OR = 0.94; 95%CI: 0.89 to 0.99). Additional analysis reinforced that by showing lower time in high-light PA (51.2 ± 30.0 min/day vs. 31.9 ± 21.8 min/day; p = .001) and moderate-to-vigorous PA (24.3 ± 15.8 min/day vs. 14.8 ± 18.8 min/day; p = .012) among older patients than their peers younger. CONCLUSION: Our findings showed that 36,2% of CVI patients met PA recommendations, with lower odds found among older patients. Public health interventions to enhance PA engagement among CVI patients should prioritize those who are older.
Subject(s)
Exercise , Venous Insufficiency , Adult , Aged , Female , Humans , Male , Middle Aged , Chronic Disease , Cross-Sectional Studies , Venous Insufficiency/physiopathology , Venous Insufficiency/therapyABSTRACT
Introdução: Diabetes mellitus (DM) é uma doença crônica, não transmissível, cuja prevalência tem aumentado mundialmente. Seu manejo adequado na Atenção Primária à Saúde (APS) pode reduzir suas complicações e as internações por condições sensíveis à atenção primária. Objetivo: Comparar indicadores de qualidade da atenção a pessoas com diabetes atendidas na rede básica de saúde do Brasil e suas diferenças por região. Métodos: Com delineamento transversal, utilizaram-se dados dos Ciclos I e III do Programa de Melhoria do Acesso e da Qualidade (PMAQ). Os desfechos foram indicadores sintéticos, operacionalizados a partir de 24 variáveis: i) acesso; ii) disponibilidade de insumos e equipamentos em condições de uso; iii) disponibilidade de medicamentos em quantidade suficiente; iv) organização e gestão; v) cuidado clínico; e vi) relato de cuidado adequado. Foram calculadas as diferenças em pontos percentuais (p.p.) dos indicadores entre 2012 e 2018, e os dados foram estratificados por região. Resultados: No geral, houve uma melhora no cuidado à pessoa com DM na APS do Brasil e regiões entre as equipes participantes do PMAQ, entre 2012 e 2018. As prevalências de acesso, disponibilidade de insumos/equipamentos, medicamentos, oferta, organização e gestão apresentaram aumento de, no mínimo, 10 p.p. no período de 6 anos, mas podem melhorar. Conclusões: Considerando que a ocorrência de DM está aumentando no país, faz-se necessário maior investimento na estrutura dos serviços e em programas de educação permanente dos profissionais de saúde.
Introduction: Diabetes Mellitus (DM) is a non-communicable chronic disease whose prevalence has been increasing worldwide. Its adequate management in Primary Health Care (PHC) can reduce complications and hospitalizations for conditions sensitive to primary care. Objective: To compare quality indicators for the care of people with diabetes treated in the basic health network in Brazil and their differences by region. Methods: With a cross-sectional design, data from Cycles I and III of the PMAQ were used. The outcomes were synthetic indicators, operationalized from 24 variables: i) access; ii) availability of supplies and equipment in usable conditions; iii) availability of medications in sufficient quantities; iv) organization and management; v) clinical care; and vi ) report of adequate care. Differences in percentage points (p.p.) of the indicators between 2012 and 2018 were calculated, and the data were stratified by region. Results: Overall, there was an improvement in the care of people with DM in PHC in Brazil and regions among the teams participating in PMAQ, between 2012 and 2018. The prevalence of access, availability of supplies/equipment, medications, demand, organization, and management showed an increase of at least 10 p.p. within six years, but they can improve. Conclusions: Considering that the occurrence of DM is increasing in the country, greater investment is necessary in the structure of services and in continuing education programs for health professionals.
La Diabetes Mellitus es una enfermedad crónica no transmisible cuya prevalencia ha aumentado en todo el mundo. Su manejo adecuado en la Atención Primaria puede reducir sus complicaciones y las hospitalizaciones por afecciones sensibles a la Atención Primaria. Objetivo: comparar indicadores de calidad de la atención a personas con diabetes atendidas en la red básica de salud de Brasil y sus diferencias por región. Métodos: Con delineamiento transversal, se utilizaron datos de los Ciclos I y III del PMAQ. Los defectos fueron indicadores sintéticos, operacionalizados a partir de 24 variables: i) acceso, ii) disponibilidad de insumos y equipos en condiciones utilizables, iii) disponibilidad de medicamentos en cantidad suficiente, iv) organización y gestión, v) atención clínica y vi) reporte de atención adecuada. Se calcularon las diferencias en puntos porcentuales (p.p.) de los indicadores entre 2012 y 2018, y los datos se estratificaron por regiones. Resultados: En general, hubo una mejora en la atención a las personas con DM en APS en Brasil y regiones entre los equipos participantes en el PMAQ entre 2012 y 2018. La prevalencia del acceso, la disponibilidad de insumos/equipos, los medicamentos, el suministro, la organización y la gestión mostraron un aumento de al menos 10 p.p. en el periodo de seis años, pero pueden mejorar. Conclusiones: Considerando que la ocurrencia de DM está aumentando en el país, es necesario invertir más en la estructura de los servicios y en programas de educación continuada para los profesionales de salud.
Subject(s)
Humans , Primary Health Care , Diabetes Mellitus , Chronic Disease , Quality Indicators, Health CareABSTRACT
BACKGROUND: This study investigated the self-rated general health, mental health, and work absenteeism among patients with laboratory-confirmed chikungunya. METHODS: Telephone interviews were conducted with 63 patients ≥22 months after infection. RESULTS: Patients who reported (N=42) or did not report (N=21) chronic arthralgia, defined by duration ≥90 days, had different frequencies for low scores for general health (68.3% vs. 30.0%, respectively; prevalence ratio, 95% confidence interval: 2.3, 1.1-4.6), symptoms of depression (31.7% vs. 15.0%; 2.1, 0.7-6.6), symptoms of anxiety (43.9% vs. 35.0%; 1.3, 0.6-2.5), and work absenteeism (76.5% and 40.0%; 1.9, 0.9-4.2). CONCLUSIONS: Chikungunya chronic arthralgia impacts long-term health and work.
Subject(s)
Absenteeism , Arthralgia , Chikungunya Fever , Humans , Male , Female , Chikungunya Fever/complications , Chikungunya Fever/epidemiology , Middle Aged , Adult , Chronic Disease , Mental Health , Cross-Sectional Studies , Depression/etiology , Depression/epidemiology , Young AdultABSTRACT
An immunocompromised patient was infected by the SARS-CoV-2 variant of interest named Zeta (P.2) in February 2021. More than one year later, he suffered from symptomatic COVID-19 and sequencing revealed the same variant, which accumulated 23 substitutions. This case illustrates intra-host evolution of a particular SARS-CoV-2 variant, highlighting the importance of genomic surveillance of immunocompromised patients.
Subject(s)
COVID-19 , Immunocompromised Host , SARS-CoV-2 , Humans , COVID-19/immunology , Male , SARS-CoV-2/immunology , SARS-CoV-2/genetics , Chronic Disease , AdultABSTRACT
Spontaneous non-aneurysmal aortic rupture is rare and is usually attributed to penetrating aortic ulcers, infections, tumor infiltrations, or inflammatory and collagen diseases. Chronic rupture is infrequent but extremely rare in non-aneurysmal aortas, which makes diagnosis difficult because the absence of an aneurysm can mislead the physician to rule out rupture. Here, we describe the case of an 85-year-old male, who was undergoing oncological investigation for weight loss, inappetence, and back pain. Computed tomography and magnetic resonance imaging performed 3 months before admission showed a contained pseudoaneurysm of the infrarenal aorta associated with significant aortoiliac calcification and images suggestive of peritoneal implants. The patient was referred to our oncological center and underwent abdominal computed tomography for oncological investigation and staging. The patient was urgently admitted to the intensive care unit after a critical finding of contained rupture of the infrarenal aorta during the scan. Endovascular repair was indicated, and the patient was successfully treated with implantation of an Endurant IIs 25 × 25 × 70 mm endoprosthesis. No procedural complications were observed. Postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Control computed tomography performed 1 and 6 months after surgery showed no leaks. This case emphasizes the importance of communication between the radiologists and attending physicians. As the rupture was punctual and well defined in the computed tomography and angiography images, endovascular repair with an aortic cuff was safely performed, and the procedure time was reduced.
Subject(s)
Aortic Rupture , Endovascular Procedures , Tomography, X-Ray Computed , Humans , Male , Aged, 80 and over , Endovascular Procedures/methods , Aortic Rupture/surgery , Aortic Rupture/diagnostic imaging , Aneurysm, False/surgery , Aneurysm, False/diagnostic imaging , Chronic Disease , Treatment Outcome , Rupture, Spontaneous/surgery , Rupture, Spontaneous/diagnostic imaging , Aorta, Abdominal/surgery , Aorta, Abdominal/diagnostic imaging , Blood Vessel Prosthesis Implantation/methods , Magnetic Resonance ImagingABSTRACT
OBJECTIVE: To evaluate the association between burden of disease and multimorbidity and absenteeism in Brazil. METHODS: This is a cross-sectional study using data from the National Survey of Health 2019. The assessed outcome was absenteeism from work. The burden of disease was assessed by simply counting a list of 14 morbidities and multimorbidity was defined as: ≥two chronic diseases. Poisson regression models stratified by sex were used to estimate crude and adjusted prevalence ratios and their respective 95% confidence intervals. RESULTS: Of the 96,131,029 employed individuals, 38.5% reported absenteeism (95%CI 32.9-44.3). The most prevalent morbidities among women who reported absenteeism were back problems (50.8%), depression (42.9%), and hypertension (41.6%); and among men, hypertension (39.7%), chronic back pain (34.1%), and dyslipidemia (19.9%), among those who reported absenteeism. Having multimorbidity increased the report of absenteeism among women by 73% (95%CI 1.01-2.96); among men, there was no association after progressive adjustment for sociodemographic and health factors [PR 1.27 (95%CI 0.96-1.71)]. CONCLUSION: The burden of disease and multimorbidity are highly prevalent among employed individuals and are strongly related to absenteeism from work, especially among women. In this sense, workers must be the target of interventions to reduce the impact of chronic noncommunicable diseases.
Subject(s)
Absenteeism , Health Surveys , Noncommunicable Diseases , Humans , Male , Female , Brazil/epidemiology , Cross-Sectional Studies , Adult , Middle Aged , Chronic Disease/epidemiology , Noncommunicable Diseases/epidemiology , Prevalence , Health Surveys/statistics & numerical data , Young Adult , Adolescent , Sex Distribution , Socioeconomic Factors , Cost of Illness , Multimorbidity , Sociodemographic FactorsABSTRACT
OBJECTIVE: To explore the relationship between different patterns of multimorbidity and the use of sleeping medications in women. METHODS: Population-based cross-sectional study with 1,128 women (aged 20-69 years) in Southern Brazil. Data on sleeping medications were obtained from the question "Do you take/use any medication to be able to sleep?" and identified by the Anatomical Therapeutic and Chemical classification. Multimorbidity patterns were derived by the Principal Component Analysis of 26 chronic conditions and two obesity parameters (≥30 kg/m2; ≥40 kg/m2). The association was analyzed by Poisson regression with robust variance using different adjustment models, stratified by age. RESULTS: Three multimorbidity patterns were derived: cardiometabolic, endocrine-articular, and psychosomatic. Age stratification showed a change in effect in the relationship investigated. Women under 45 years and high score of cardiometabolic and endocrine-articular patterns were about twice as likely to use sleeping medications [prevalence ratio (PR) 1.85, 95% confidence interval (CI) 1.09-3.12; PR 2.04, 95%CI 1.18-3.51, respectively]. Those with psychosomatic pattern were around five times more likely [PR 4.91, 95%CI 3.00-8.04]. CONCLUSIONS: The study provided the first evidence on the association researched and demonstrated that young women (<45 years) with a high score of the identified patterns are up to five times more likely to use sleeping medications, configuring early use. This unprecedented finding suggests the need for greater health promotion for young adults and actions to raise awareness about risks and the clear indication of the use of sleeping medications.
Subject(s)
Multimorbidity , Humans , Female , Middle Aged , Adult , Cross-Sectional Studies , Brazil/epidemiology , Aged , Young Adult , Sleep Aids, Pharmaceutical/therapeutic use , Socioeconomic Factors , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/drug therapy , Chronic Disease/drug therapy , Chronic Disease/epidemiology , Age Factors , Sociodemographic FactorsABSTRACT
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but severe condition characterized by persistent obstruction and vascular remodeling in the pulmonary arteries following an acute pulmonary embolism (APE). Although APE is a significant risk factor, up to 25% of CTEPH cases occur without a history of APE or deep vein thrombosis, complicating the understanding of its pathogenesis. Herein, we carried out a narrative review discussing the mechanisms involved in CTEPH development, including fibrotic thrombus formation, pulmonary vascular remodeling, and abnormal angiogenesis, leading to elevated pulmonary vascular resistance and right heart failure. We also outlined how the disease's pathophysiology reveals both proximal and distal pulmonary artery obstruction, contributing to the development of pulmonary hypertension. We depicted the risk factors predicting CTEPH, including thrombotic history, hemostatic disorders, and certain medical conditions. We finally looked at the molecular mechanisms behind the role of endothelial dysfunction, gene expression alterations, and inflammatory processes in CTEPH progression and detection. Despite these insights, there is still a need for improved diagnostic tools, biomarkers, and therapeutic strategies to enhance early detection and management of CTEPH, ultimately aiming to reduce diagnostic delay and improve patient outcomes.
Subject(s)
Hypertension, Pulmonary , Pulmonary Embolism , Humans , Chronic Disease/epidemiology , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Pulmonary Embolism/complications , Pulmonary Embolism/epidemiology , Pulmonary Embolism/physiopathology , Risk FactorsABSTRACT
OBJECTIVE: This study aims to compare liver and spleen stiffness measurements using magnetic resonance elastography with T1 and T2 relaxation times in patients with chronic liver disease. METHODS: A total of 75 chronic liver disease patients and 25 healthy volunteers underwent MR. Patients with significant liver fat and iron accumulation were excluded. Student's t-test was employed to compare magnetic resonance elastography and T1/T2 values. Pearson's correlation test was used to assess the relationship between magnetic resonance elastography and T1/T2 values. RESULTS: Liver magnetic resonance elastography showed a significant moderate positive correlation with liver T1 mapping (r=0.51, p<0.001) and liver T2 mapping (r=0.30, p=0.009) in patients. Spleen magnetic resonance elastography exhibited a significant moderate positive correlation with spleen T2 mapping (r=0.37, p=0.001). However, there was no significant correlation between spleen magnetic resonance elastography and spleen T1 mapping in patients. Spleen magnetic resonance elastography was moderately positively correlated with liver magnetic resonance elastography (r=0.30, p=0.01), and spleen volume showed positive correlations with spleen magnetic resonance elastography, spleen T1 mapping, and spleen T2 mapping. Cut-off values for liver magnetic resonance elastography, liver T1 mapping, and liver T2 mapping in patient and control groups were 2.6 kPa (AUC=0.97), 619 ms (AUC=0.90), and 52.5 ms (AUC=0.62), respectively. CONCLUSION: Relaxation methods offer noninvasive imaging without additional equipment. Liver T1 mapping may serve as an alternative to magnetic resonance elastography for chronic liver patient follow-up, while spleen T1 mapping is not reliable.
Subject(s)
Elasticity Imaging Techniques , Liver , Magnetic Resonance Imaging , Spleen , Humans , Elasticity Imaging Techniques/methods , Spleen/diagnostic imaging , Spleen/pathology , Male , Female , Prospective Studies , Middle Aged , Adult , Liver/diagnostic imaging , Liver/pathology , Case-Control Studies , Magnetic Resonance Imaging/methods , Liver Diseases/diagnostic imaging , Chronic Disease , Aged , Reference Values , Liver Cirrhosis/diagnostic imaging , Reproducibility of ResultsABSTRACT
Observational studies suggest a U-shaped association between serum potassium (Kâº) levels and mortality in patients with chronic heart failure (CHF). However, the mode of death in patients with HF and K⺠disorders remains speculative. To investigate the association between potassium disorders and the mode of death in patients with CHF. A retrospective cohort of 10,378 CHF outpatients was analyzed over an average of 3.28 ± 2.5 years. Kaplan-Meier method, Cox proportional hazards regression models, Poisson regression models adjusting for confounders, and e-value determination (e' > 1.6) were used to observe associations between potassium disorders and outcomes. Chagas etiology (p < 0.01) and triple HF therapy (p < 0.01) were associated with hyperkalemia. Atrial fibrillation was associated with hypokalemia (p < 0.01). Chronic kidney disease (CKD) (p < 0.01) and diabetes (p = 0.03) were associated with both. Hypertension was inversely related to hyperkalemia (p < 0.01); age was inversely related to hypokalemia. Associations with mortality were significant for Chagas (p < 0.01, e-value 2.16), stroke (p < 0.01, e-value 1.85), hypokalemia (p = 0.02, e-value 1.94), severe hyperkalemia (p = 0.08, e-value 1.93), and CKD (p < 0.01, e-value > 1.63). Decompensated HF or cardiogenic shock was the cause of death in 54% of patients with normokalemia, 67.8% with hypokalemia, 44.9% with mild hyperkalemia, 57.8% with moderate hyperkalemia, and 69% with severe hyperkalemia. Most patients with hypokalemia and severe hyperkalemia died from decompensated HF (p = 0.007). Data suggest hypokalemia and severe hyperkalemia, along with Chagas and CKD, are associated with death. Unexpectedly, progressive HF was the most frequent mode of death rather than arrhythmias. Further studies are needed to confirm these findings and explore the underlying mechanisms.
Subject(s)
Heart Failure , Hyperkalemia , Hypokalemia , Potassium , Humans , Heart Failure/mortality , Heart Failure/complications , Male , Female , Aged , Hyperkalemia/mortality , Hyperkalemia/blood , Hyperkalemia/etiology , Hyperkalemia/complications , Hypokalemia/blood , Hypokalemia/complications , Hypokalemia/mortality , Potassium/blood , Middle Aged , Retrospective Studies , Chronic Disease , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/mortality , Renal Insufficiency, Chronic/blood , Cause of Death , Atrial Fibrillation/mortality , Atrial Fibrillation/complications , Proportional Hazards Models , Aged, 80 and overABSTRACT
INTRODUCTION: Chronic pulmonary aspergillosis is a fungal disease that, without specific treatment, generates a slow and progressive destruction of the lung parenchyma. The recommended pharmacological therapy is long-term oral antifungal administration. The efficacy of the treatment (especially with itraconazole) is around 65% and the frequency of recurrences 10-15%. One of the causes could be a deficient plasma level of itraconazole. The objective was to implement therapeutic monitoring (TM) of itraconazole using a sensitive, precise, rapid and reproducible method. Then, based to the results obtained, take a therapeutic approach. MATERIALS AND METHODS: Two venous blood samples of approximately 2 ml were obtained from each patient, which were analyzed by liquid chromatography (HPLC). RESULTS: Samples were taken from 36 patients and mycological, antibody and MT of itraconazole studies were performed. A total of 10 patients (27.8 %) showed levels outside the therapeutic range. DISCUSSION: The TM of itraconazole is a useful tool to improve the effectiveness of chronic pulmonary aspergillosis treatment, the prognosis of the pathology and reduce the percentage of recurrences. The developed method is fast, precise and reproducible, for this reason it can be very useful to be applied in the public hospital setting, where there is precisely no similar one, and thus modify therapeutic behaviors in order to optimize treatments.
Introducción: La aspergilosis pulmonar crónica es una enfermedad fúngica que sin tratamiento específico genera una destrucción lenta y progresiva del parénquima pulmonar. La terapia farmacológica recomendada se basa en la administración de antifúngicos por vía oral de larga duración. La eficacia del tratamiento (especialmente con itraconazol) ronda el 65% y la aparición de recurrencias el 10-15%. Una de las causas podría ser un deficiente nivel plasmático del itraconazol. Se planteó como objetivo implementar el monitoreo terapéutico (MT) de itraconazol en pacientes de un hospital público de la Ciudad de Buenos Aires mediante un método sensible, preciso, rápido y fácilmente reproducible. Luego, con base en los resultados obtenidos, tomar una conducta terapéutica. Materiales y métodos: Se obtuvieron dos muestras de sangre venosa de aproximadamente 2 ml de cada paciente, las cuales fueron analizadas mediante cromatografía líquida (HPLC). Resultados: Se tomaron muestras de 36 pacientes y se realizó estudio micológico, de anticuerpos y el MT de itraconazol. Un total de 10 pacientes (27.8%) mostraron niveles por fuera del rango terapéutico. Discusión: El MT de itraconazol es una herramienta sumamente útil para mejorar la eficacia del tratamiento de la aspergilosis pulmonar crónica, el pronóstico de la enfermedad y reducir el porcentaje de recidivas. El método desarrollado fue rápido, preciso y reproducible, por tal motivo puede ser útil para ser aplicado en el ámbito hospitalario público, donde justamente no existe ninguno similar, y con ello modificar conductas terapéuticas con el fin de optimizar los tratamientos.
Subject(s)
Antifungal Agents , Drug Monitoring , Itraconazole , Pulmonary Aspergillosis , Humans , Itraconazole/therapeutic use , Itraconazole/administration & dosage , Pulmonary Aspergillosis/drug therapy , Antifungal Agents/therapeutic use , Antifungal Agents/administration & dosage , Chronic Disease , Male , Drug Monitoring/methods , Female , Middle Aged , Aged , Chromatography, High Pressure Liquid , Reproducibility of Results , AdultABSTRACT
O desempenho sexual humano é influenciado por uma variedade de fatores biopsicossociais e a prática regular de exercícios pode trazer efeitos benéficos sobre a saúde física e emocional e prevenir disfunções sexuais. Este artigo tem como objetivo analisar a influência do exercício físico no desempenho sexual humano. Para a população feminina, exercitar-se tem efeitos positivos sobre a função sexual pela melhora na excitação sexual em decorrência do aumento na atividade do sistema nervoso simpático e fatores endócrinos. Praticantes de exercícios regulares apresentam melhor função sexual e vascularização clitoriana e menor sofrimento sexual, em comparação com mulheres sedentárias, sendo os benefícios mediados por determinantes biológicos e psicológicos. Para a população masculina, níveis mais altos de atividade física estão associados à melhora da função erétil e ao controle da ejaculação, pelo aumento da consciência interoceptiva e melhor equilíbrio simpático-vagal durante essa atividade, mediados por vias psicológicas e fisiológicas. As evidências sugerem que níveis moderados a altos (mas não excessivos) de atividade física beneficia a saúde sexual, caracterizando uma estratégia não farmacológica para a promoção do bem-estar sexual. A relação entre exercício físico e desempenho sexual reforça a importância de incorporar atividades físicas regulares como parte de um estilo de vida saudável, visando não apenas a saúde geral, mas também o bem-estar sexual. Com a crescente prevalência de disfunções sexuais, o exercício físico emerge como intervenção preventiva e terapêutica promissora, enfatizando a necessidade de mais estudos para explorar plenamente o potencial dessa intervenção.
Subject(s)
Humans , Male , Female , Exercise , Sexual Health , Sexual Dysfunction, Physiological , Chronic Disease , SexualityABSTRACT
Objetivo: verificar a prevalência de diabetes mellitus (DM) autorreferida na população adulta no Brasil. Método: estudo epidemiológico ecológico descritivo realizado no período de 2006 a 2020, com base nos dados do Sistema de Monitoramento de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel), para doenças crônicas não transmissíveis. A população foi constituída por adultos (≥ 18 anos de idade) brasileiros de todas as capitais dos 26 estados brasileiros e o Distrito Federal e que participaram do Vigitel. As variáveis de interesse foram: ano, sexo, faixa etária, escolaridade, região e capital. Resultados: observou-se maior prevalência de DM autorreferida nas capitais do Rio de Janeiro (8,1%) e de São Paulo (7,8%), e a menor taxa em Palmas (4,1%). Com relação às grandes regiões, a maior prevalência foi na região Sudeste (7,1%) e a menor na região Norte (5,1%). Verificou-se ainda, maior prevalência no sexo feminino e entre as pessoas com 0 a 8 anos de estudo (11,7%). Conclusão: a prevalência de diabetes mellitus autorreferida na população adulta no Brasil entre os anos de 2006 e 2020 apresentou crescimento em todas as capitais dos estados brasileiros e o Distrito Federal por triênio, destacando-se as capitais do Rio de Janeiro e de São Paulo com os maiores valores e Palmas com o menor valor.
Objective: to verify the prevalence of self-reported diabetes mellitus (DM) in the adult population in Brazil. Method: descriptive ecological epidemiological study conducted in the period of 2006-2020, based on data from the Surveillance Monitoring System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) for chronic non-communicable diseases. The population Abstract consisted of Brazilian adults (≥ 18 years of age) from all the 26 Brazilian state capitals and the Federal District who participated in Vigitel. The variables of interest were data collection year, sex, age, schooling, region, and capital. Results: there was a higher prevalence of self-reported DM in the capitals of Rio de Janeiro (8.1%) and São Paulo (7.8%), and the lowest rate in Palmas (4.1%). Regarding the five- major geographic regions of Brazil, the highest prevalence was in the Southeast (7.1%) and the lowest in the North (5.1%). There was also a higher prevalence in females and among people between 0 to 8 years of schooling (11.7%). Conclusion: the prevalence of self-reported diabetes mellitus in the adult population in Brazil from 2006 to 2020 showed a growth in all capitals of the Brazilian states and the Federal District every triennium. The capitals of Rio de Janeiro and São Paulo showed the highest values and Palmas the lowest one.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Population , Epidemiologic Studies , Chronic Disease , Risk , Surveys and Questionnaires , Risk Factors , Diabetes Mellitus , PersonsABSTRACT
La transición de la atención pediátrica a la atención de adultos en pacientes con epilepsia de inicio en la infancia es un desafío en el cual deben tenerse en cuenta varios aspectos: síndrome epiléptico, etiología, las comorbilidades, la consecución de hitos sociales y el ajuste de la medicación anticrisis (MAC). Sin embargo, existe poca información sobre la evolución de estos pacientes, tras la transición a la atención de adultos con epilepsia. Métodos: Estudio retrospectivo, revisión de historias clínicas de pacientes con diagnóstico de epilepsia farmacorresistente seguidos en el servicio de neurología, área de epilepsia entre 14 y 17 años que transitaron a la atención de adultos entre 2019 y 2023. Resultados: Se encontraban en seguimiento por el área de epilepsia de difícil control 730 pacientes entre 2019 y 2023. De estos 47 (21 hombres y 26 mujeres) iniciaron el proceso de transición a un centro de atención de adultos. La edad promedio de derivación es de 15,8 años (rango de 14 a 21 años), mediana de 16 y 18 años. De los 47 pacientes, 24 corresponden a encefalopatías epilépticas y del desarrollo,12 epilepsia focal de origen estructural debido a malformaciones del desarrollo cortical, 3 lesiones vasculares; 3 lesiones tumorales y 5 pacientes con Síndrome de Rasmussen (AU)
The transition from pediatric to adult care in patients with childhood-onset epilepsy is a challenge in which several aspects must be considered: epileptic syndrome, etiology, comorbidities, achievement of social milestones, and adjustment of anti-seizure medication (ASM). However, there is limited information regarding the outcomes of these patients following the transition to adult epilepsy care. Methods: Retrospective study, review of medical records of patients with a diagnosis of drug-resistant epilepsy followed in the Epilepsy Unit of the Department of Neurology between the ages of 14 and 17 years and transitioned to adult care between 2019 and 2023. Results: 730 patients were under follow-up in the difficultto-control epilepsy area between 2019 and 2023. Of these, 47 patients (21 males and 26 females) began the process of transitioning to adult care. The mean age at referral was 15.8 years (range, 14 to 21 years; median, 16 and 18 years). Among these 47 patients, 24 had developmental and epileptic encephalopathies, 12 had focal epilepsy of structural origin due to malformations of cortical development, 3 had vascular lesions, 3 had tumors, and 5 had Rasmussen's syndrome (AU)
Subject(s)
Humans , Adolescent , Adult , Patient Care Team , Comorbidity , Epilepsy/therapy , Transition to Adult Care/organization & administration , Chronic Disease , Retrospective StudiesABSTRACT
Oxidative stress promotes T. cruzi growth and development of chronic Chagas heart dysfunction. However, the literature contains gaps that must be fulfilled, largely due to variations in parasite DTU sources, cell types, mouse strains, and tools to manipulate redox status. We assessed the impact of oxidative environment on parasite burden in cardiomyoblasts and the effects of the Nrf2-inducer COPP on heart function in BALB/c mice infected with either DTU-II Y or DTU-I Colombian T. cruzi strains. Treatment with antioxidants CoPP, apocynin, resveratrol, and tempol reduced parasite burden in cardiomyoblasts H9C2 for both DTUI- and II-strains, while H2O2 increased it. CoPP treatment improved electrical heart function when administered during acute stage of Y-strain infection, coinciding with an overall trend towards increased survival and reduced heart parasite burden. These beneficial effects surpassed those of trypanocidal benznidazole, implying that CoPP directly affects heart physiology. CoPP treatment had beneficial impact on heart systolic function when performed during acute and evaluated during chronic stage. No impact of CoPP on heart parasite burden, electrical, or mechanical function was observed during the chronic stage of Colombian-strain infection, despite previous demonstrations of improvement with other antioxidants. Treatment with CoPP also did not improve heart function of mice chronically infected with Y-strain. Our findings indicate that amastigote growth is responsive to changes in oxidative environment within heart cells regardless of the DTU source, but CoPP influence on heart parasite burden in vivo and heart function is mostly confined to the acute phase. The nature of the antioxidant employed, T. cruzi DTU, and the stage of disease, emerge as crucial factors to consider in heart function studies.
Subject(s)
Antioxidants , Chagas Disease , Mice, Inbred BALB C , NF-E2-Related Factor 2 , Oxidative Stress , Trypanosoma cruzi , Animals , Antioxidants/pharmacology , Trypanosoma cruzi/drug effects , Trypanosoma cruzi/physiology , NF-E2-Related Factor 2/metabolism , NF-E2-Related Factor 2/genetics , Mice , Chagas Disease/drug therapy , Chagas Disease/parasitology , Oxidative Stress/drug effects , Heart/parasitology , Heart/drug effects , Colombia , Parasite Load , Chronic Disease , Disease Models, Animal , Chagas Cardiomyopathy/drug therapy , Chagas Cardiomyopathy/physiopathology , Chagas Cardiomyopathy/parasitology , Chagas Cardiomyopathy/metabolism , Male , FemaleABSTRACT
Background: The chikungunya virus (CHIKV), transmitted by infected Aedes mosquitoes, has caused a significant number of infections worldwide. In Brazil, the emergence of the CHIKV-ECSA genotype in 2014 posed a major public health challenge due to its association with more severe symptoms. Objectives/Methods: This study aimed to shed new light on the host immune response by examining the whole-blood transcriptomic profile of both CHIKV-acute and chronically infected individuals from Feira de Santana, Bahia, Brazil, a region heavily affected by CHIKV, Dengue, and Zika virus epidemics. Results: Our data reveal complex symptomatology characterized by arthralgia and post-chikungunya neuropathy in individuals with chronic sequelae, particularly affecting women living in socially vulnerable situations. Analysis of gene modules suggests heightened metabolic processes, represented by an increase in NADH, COX5A, COA3, CYC1, and cap methylation in patients with acute disease. In contrast, individuals with chronic manifestations exhibit a distinct pattern of histone methylation, probably mediated by NCOA3 in the coactivation of different nuclear receptors, KMT2 genes, KDM3B and TET2, and with alterations in the immunological response, majorly led by IL-17RA, IL-6R, and STAT3 Th17 genes. Conclusion: Our results emphasize the complexity of CHIKV disease progression, demonstrating the heterogeneous gene expression and symptomatologic scenario across both acute and chronic phases. Moreover, the identification of specific gene modules associated with viral pathogenesis provides critical insights into the molecular mechanisms underlying these distinct clinical manifestations.
Subject(s)
Chikungunya Fever , Chikungunya virus , Humans , Chikungunya Fever/genetics , Chikungunya Fever/immunology , Chikungunya Fever/virology , Female , Chikungunya virus/genetics , Chikungunya virus/immunology , Male , Adult , Brazil/epidemiology , Middle Aged , Transcriptome/genetics , Chronic Disease , Acute DiseaseABSTRACT
PURPOSE: To assess the concurrent validity and reliability of five mHealth devices (STEPZ, Health, Pacer, Google Fit, and Fitbit Inc.®) in counting steps among individuals with chronic stroke using assistive devices (AD). Our primary objective was to identify significant variations in step counts between AD users and non-users. METHODS: In a cross-sectional study, individuals performed a 2-min walking test while carrying two smartphones (Android OS and iOS) equipped with four different applications (STEPZ, Health, Pacer, and Google Fit), alongside a Fitbit Inc.® device. A visual video recording served as criterion-standard measure for step counting. Each participant completed four walking trials. Two proficient researchers conducted data collection in a controlled environment at a single day. RESULTS: Twenty-four individuals were included. The devices were valid for individuals in individuals with chronic stroke who used AD (0.52 ≤ r ≥ 0.89), except for Health (iOS). There is no agreement between the criterion-standard and Health (iOS), and all other devices showed adequate reliability (0.107 ≤ CCI [2, 1] ≥ 0.701). There was no difference in stepping counting when the individuals used or not the AD. CONCLUSIONS: Health for iOS is neither valid nor reliable for individuals with chronic stroke who are AD users. There is no difference in step counting were when the individuals with chronic stroke are users or non-users of AD.
Subject(s)
Self-Help Devices , Humans , Cross-Sectional Studies , Male , Female , Middle Aged , Reproducibility of Results , Aged , Stroke Rehabilitation/methods , Stroke Rehabilitation/instrumentation , Walking/physiology , Telemedicine/instrumentation , Smartphone , Chronic Disease , Stroke , Adult , Mobile Applications/standards , Walk Test/methods , Fitness TrackersABSTRACT
Objective To evaluate the acute effect of Kinesio Taping® (KT) on peripheral tissue perfusion in women with chronic venous insufficiency (CVI). METHODS: This randomized, double-blind controlled trial included 59 women with mild to moderate CVI. They were randomized to a control group (n = 23; 54.08 ± 9.04 years) and KT group (n = 36; 55.87 ± 9.97 years). Near-infrared spectroscopy was positioned in the medial gastrocnemius muscle for assessment of resting tissue perfusion 48 h after the first day of evaluation and after placement of the Kinesio Taping® tape. The evaluation also consisted of performing movements of the plethysmography examination. To verify the comparisons of pre- and post-Kinesio Taping® data, the variation delta was used for analysis. Mann-Whitney U test was performed an an alpha of 5% was considered statistically significant. RESULTS: There wasn't a significant difference between groups regarding the peripheral tissue perfusion evaluation variables Peripheral Oxygen Saturation Difference - DELTA_SPO2: (KT Group 3.21 (0.84-3.62); Control 2.21 (1.59-4.83), p = 0.219) and Difference in deoxygenate hemoglobin values - DELTA_HHB (units) KT Group -0.62 (-2.14-0.67); Control Group -0.07 (-2.15-2.62) p = 0.238). Despite the lack of statistical significance, the KT group had a 785.7% greater drop in HHB values than the control group. CONCLUSIONS: Acute use of Kinesio Taping® in women with CVI did not significantly alter tissue perfusion of calf muscles. However, it was possible to observe percentage differences in venous retention to be considered from a clinical point of view.
Subject(s)
Athletic Tape , Muscle, Skeletal , Venous Insufficiency , Humans , Female , Middle Aged , Venous Insufficiency/therapy , Double-Blind Method , Muscle, Skeletal/physiology , Adult , Plethysmography/methods , Chronic Disease , Spectroscopy, Near-Infrared/methods , Aged , Oxygen/metabolismABSTRACT
OBJECTIVE: To analyze the association between chronic health conditions and severe acute respiratory syndrome in pregnant women. METHOD: Retrospective, exploratory study conducted with 1,152 pregnant women from all 27 states of Brazil who sought hospital treatment and were diagnosed with severe acute respiratory syndrome between 2020 and 2022. Public data from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) of the Brazilian Ministry of Health were used. Nonparametric tests were performed in data interpretation. RESULTS: The mortality rate of pregnant women due to severe acute respiratory syndrome in Brazil was 7%. Severe acute respiratory syndrome was statistically associated with the previous presence of diabetes (p = 0.023), neurological disease (p = 0.001), and drug use (p = 0.001). The epidemiological investigation of respiratory syndrome cases took longer in Black pregnant women (p = 0.012), unvaccinated women (p < 0.001) and women living in the north and south of the country (p = 0.011). CONCLUSION: Severe acute respiratory syndrome was more common in pregnant women with diabetes, neurological disease and drug users. However, these conditions did not lead to an increase in the number of deaths.
Subject(s)
Severe Acute Respiratory Syndrome , Humans , Female , Pregnancy , Retrospective Studies , Adult , Brazil/epidemiology , Chronic Disease/epidemiology , Young Adult , Severe Acute Respiratory Syndrome/epidemiology , Nervous System Diseases/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications/epidemiology , AdolescentABSTRACT
OBJECTIVE: To analyze the prevalence and associated factors with chronic diseases among women of reproductive age in primary health care. METHOD: Cross-sectional study conducted with 397 women of reproductive age living in northern Paraná, Brazil. Data were collected from July 2019 to September 2020. The Women's Clinical Record was used to collect sociodemographic data, risk behaviors, diagnosis of chronic diseases and medication use. Chi-Square test was performed for association analysis, and Logistic Regression estimating Odds Ratio and 95% confidence intervals. RESULTS: The prevalence of chronic diseases among women of reproductive age was 38.53% and the associated factors were: age group from 31 to 40 years old (OR=3.67; p=0.001) and from 41 to 49 years (OR =9.7; p=0.001), incomplete high school education (OR= 2.7; p=0.001), obesity (OR= 2.25; p=0.001) and smoking (OR=2.23; p=0.001). CONCLUSION: Age at the end of the reproductive phase, obesity and smoking were associated with the presence of chronic diseases. Knowledge of these factors can assist in screening, monitoring and health education actions provided to women of childbearing age.