Hypertension from the patient's perspective: contributions to the care offered by health professionals and self-care - a qualitative study

ABSTRACT BACKGROUND: Hypertension is the most common disease in primary care settings. Only 30% of cases were adequately controlled. OBJECTIVES: To analyze the knowledge and understanding of patients with hypertension regarding the factors that facilitate and limit adherence to treatment and, based on the results, build specific guidelines on hypertension self-care and control. DESIGN AND SETTING: This qualitative study was conducted in a primary healthcare setting. METHODS: Patients with hypertension who were followed at a primary healthcare unit were interviewed through focus groups, and a qualitative interpretation of their statements according to Bardin's content analysis was performed. RESULTS: Three focus groups were formed (21 participants), from whose analysis emerged 74 core ideas related to the concept of hypertension, causes of increase in blood pressure, clinical consequences of hypertension, and possible patients' contributions to help control blood pressure, arising from eating habits, psychosocial conditions, and lifestyle. Patients tend to accept the concept of "high blood pressure" as an inherent condition of the disease in their lives. Eating habits are strongly related to life history and self-perception of health. The association between high blood pressure and nervousness or stress appears to be strong. CONCLUSION: The experience of having "pressure problem" is unique for each person. It is necessary to optimize listening, recognizing that, for the patient to understand what hypertension is and its management, there must be understanding and convergence of proposals, adjustments, and changes in a positive and personalized way. As a result of this study, we implemented educational actions in primary healthcare units.

Hypertension from the patient's perspective: contributions to the care offered by health professionals and self-care - a qualitative study.

BACKGROUND: Hypertension is the most common disease in primary care settings. Only 30% of cases were adequately controlled. OBJECTIVES: To analyze the knowledge and understanding of patients with hypertension regarding the factors that facilitate and limit adherence to treatment and, based on the results, build specific guidelines on hypertension self-care and control. DESIGN AND SETTING: This qualitative study was conducted in a primary healthcare setting. METHODS: Patients with hypertension who were followed at a primary healthcare unit were interviewed through focus groups, and a qualitative interpretation of their statements according to Bardin's content analysis was performed. RESULTS: Three focus groups were formed (21 participants), from whose analysis emerged 74 core ideas related to the concept of hypertension, causes of increase in blood pressure, clinical consequences of hypertension, and possible patients' contributions to help control blood pressure, arising from eating habits, psychosocial conditions, and lifestyle. Patients tend to accept the concept of "high blood pressure" as an inherent condition of the disease in their lives. Eating habits are strongly related to life history and self-perception of health. The association between high blood pressure and nervousness or stress appears to be strong. CONCLUSION: The experience of having "pressure problem" is unique for each person. It is necessary to optimize listening, recognizing that, for the patient to understand what hypertension is and its management, there must be understanding and convergence of proposals, adjustments, and changes in a positive and personalized way. As a result of this study, we implemented educational actions in primary healthcare units.

Sensor Fusion with NARX Neural Network to Predict the Mass Flow in a Sugarcane Harvester.

Measuring the mass flow of sugarcane in real-time is essential for harvester automation and crop monitoring. Data integration from multiple sensors should be an alternative to receive more reliable, accurate, and valuable predictions than data delivered by a single sensor. In this sense, the objective was to evaluate if the fusion of different sensors installed in a sugarcane harvester improves the mass flow prediction accuracy. A harvester was experimentally instrumented, and neural network models integrated sensor data along the harvester to perform the self-calibration of these sensors and estimate the mass flow. Nonlinear autoregressive networks with exogenous input (NARX) and multiple linear regression (MLR) models were compared to predict the mass flow. The prediction with the NARX showed a significant superiority over MLR. MLR decreases the estimated mass flow variability in the harvester. NARX with multi-sensor data has an RMSE of 0.3 kg s-1, representing a MAPE of 0.7%. The fusion of sensor signals improves prediction accuracy, with higher performance than studies with approaches that used a single sensor. The mass flow approach with multiple sensors is a potential approach to replace conventional yield monitors. The system generates accurate data with high sample density within sugarcane rows.

Algorithms for clinical assessment of the cervical spine in patients with severe trauma: a mixed-method analyzis / Algoritmos de avaliação clínica da coluna cervical em pacientes com traumatismo grave: uma análise mista / Algoritmos de evaluación clínica de la columna cervical en pacientes con traumatismo grave: un análisis mixto

ABSTRACT Objective: Cervical trauma is an important cause of morbidity and mortality, affecting 2% of patients admitted to emergency units. Therefore, this study aims to compare the use of two clinical cervical spine evaluation algorithms, the Canadian C-Spine Rule (CCR) and the National Emergency X-radiography Utilization Study (NEXUS). Methods: A descriptive study of the use of the two algorithms by medical residents in the initial assessment of severely traumatized patients admitted to the regional emergency unit was conducted. The evaluation of the indication for imaging tests and the positive predictive value of the algorithms were the parameters analyzed. Finally, the residents answered a questionnaire evaluating the applicability, degree of confidence and advantages of both flowcharts. Results: There was no significant difference between the number of indications for imaging or their predictive values. In the analysis of the questionnaires, the CCR proved to be more reliable and the NEXUS more applicable, and the positive and negative points of applying each of them were highlighted. Conclusion: It is concluded that the two methods are similar in detecting injuries and optimizing the use of imaging exams, being equally indicated to evaluate cervical trauma. However, the technical specifics of each must be taken into account when deciding which to use. Level of evidence IV; Descriptive Study.

RESUMO Objetivo: O trauma cervical é uma importante causa de morbidade e mortalidade, com acometimento de 2% dos pacientes admitidos nas unidades de emergência. Assim sendo, a pesquisa visa comparar a utilização de dois algoritmos clínicos de avaliação da coluna cervical: Canadian C-Spine Rule (CCR) e National Emergency X-radiography Utilization Study (NEXUS). Métodos: Foi realizado um estudo descritivo da utilização dos dois algoritmos por médicos residentes na avaliação inicial de pacientes traumatizados graves admitidos na unidade de emergência regional. A avaliação da indicação de exames de imagem e do valor preditivo positivo dos algoritmos foram os parâmetros analisados. Por fim, os residentes responderam a um questionário de avaliação da aplicabilidade, grau de confiança e vantagens de ambos os fluxogramas. Resultados: Não houve diferença significativa entre os números de indicação para imagem nem dos valores preditivos. Na análise do questionário, o CCR mostrou-se mais confiável e o NEXUS foi mais aplicável, sendo destacados os pontos positivos e negativos da aplicação de cada um deles. Conclusões: Conclui-se que houve semelhança na detecção de lesões e otimização da utilização de exames de imagem entre os dois métodos, sendo igualmente indicados para avaliação de traumatismo cervical, contudo cada um tem especificidades técnicas que devem ser levadas em conta no momento da escolha. Nível de evidência IV; Estudo descritivo.

RESUMEN Objetivo: El trauma cervical es una importante causa de morbilidad y mortalidad, con acometimiento de 2% de los pacientes admitidos en las unidades de emergencia. Siendo así, la investigación tiene como objetivo comparar el uso de dos algoritmos clínicos de evaluación de la columna cervical: Canadian C-Spine Rule (CCR) y National Emergency X-radiography Utilization Study (NEXUS). Métodos: Fue realizado un estudio descriptivo del uso de los dos algoritmos por médicos residentes en la evaluación inicial de los pacientes traumatizados graves admitidos en la unidad de emergencia regional. La evaluación de la indicación de exámenes de imagen y del valor predictivo positivo de los algoritmos fueron los parámetros analizados. Finalmente, los residentes respondieron un cuestionario de evaluación de la aplicabilidad, grado de confianza y ventajas de ambos diagramas de flujo. Resultados: No hubo diferencia significativa entre los números de indicación para imagen ni de los valores predictivos. En el análisis del cuestionario, el CCR se mostró más confiable y el NEXUS fue más aplicable, siendo destacados los puntos positivos y negativos de la aplicación de cada uno de ellos. Conclusiones: Se concluye que hubo semejanza en la detección de lesiones y optimización del uso de exámenes de imagen entre los dos métodos, siendo igualmente indicados para la evaluación de traumatismo cervical, aunque cada uno tiene especificidades técnicas que deben ser llevadas en cuenta en el momento de elegir. Nivel de evidencia IV; Estudio descriptivo.

Evaluation of Minimum Preparation Sampling Strategies for Sugarcane Quality Prediction by vis-NIR Spectroscopy.

Proximal sensing for assessing sugarcane quality information during harvest can be affected by various factors, including the type of sample preparation. The objective of this study was to determine the best sugarcane sample type and analyze the spectral response for the prediction of quality parameters of sugarcane from visible and near-infrared (vis-NIR) spectroscopy. The sampling and spectral data acquisition were performed during the analysis of samples by conventional methods in a sugar mill laboratory. Samples of billets were collected and four modes of scanning and sample preparation were evaluated: outer-surface ('skin') (SS), cross-sectional scanning (CSS), defibrated cane (DF), and raw juice (RJ) to analyze the parameters soluble solids content (Brix), saccharose (Pol), fibre, pol of cane and total recoverable sugars (TRS). Predictive models based on Partial Least Square Regression (PLSR) were built with the vis-NIR spectral measurements. There was no significant difference (p-value > 0.05) between the accuracy SS and CSS samples compared to DF and RJ samples for all prediction models. However, DF samples presented the best predictive performance values for the main sugarcane quality parameters, and required only minimal sample preparation. The results contribute to advancing the development of on-board quality monitoring in sugarcane, indicating better sampling strategies.

Importance of Vertices in Complex Networks Applied to Texture Analysis.

Texture analysis has attracted increasing attention in computer vision due to its power in describing images and the physical properties of objects. Among the methods for texture analysis, complex network (CN)-based ones have emerged to model images because of their flexibility. In image modeling, each pixel is mapped to a vertex of the CN and two vertices are connected if they are spatially close in the image. Then measurements are extracted from the CN to characterize its topology and therefore characterize the image content. Despite the promising results, the accuracy of these methods depends on the suitability of the measurement for the application. In texture analysis, simple measurements have been used, such as those based on vertex degree and shortest paths. Motivated by these issues, this paper proposes a new method for texture analysis based on the CN and a new measurement that calculates the importance of each vertex within its neighborhood. For calculating the importance of vertices, we extend the pagerank to CN in order to correlate the vertex importance with its degree and show that this new measurement extracts texture properties. Experimental results on well-known datasets and in the recognition of soybean diseases using leaf texture show the effectiveness of the proposed method for texture recognition.

Simplifying Sample Preparation for Soil Fertility Analysis by X-ray Fluorescence Spectrometry.

Portable X-ray fluorescence (pXRF) sensors allow one to collect digital data in a practical and environmentally friendly way, as a complementary method to traditional laboratory analyses. This work aimed to assess the performance of a pXRF sensor to predict exchangeable nutrients in soil samples by using two contrasting strategies of sample preparation: pressed pellets and loose powder (<2 mm). Pellets were prepared using soil and a cellulose binder at 10% w w-1 followed by grinding for 20 min. Sample homogeneity was probed by X-ray fluorescence microanalysis. Exchangeable nutrients were assessed by pXRF furnished with a Rh X-ray tube and silicon drift detector. The calibration models were obtained using 58 soil samples and leave-one-out cross-validation. The predictive capabilities of the models were appropriate for both exchangeable K (ex-K) and Ca (ex-Ca) determinations with R2 ≥ 0.76 and RPIQ > 2.5. Although XRF analysis of pressed pellets allowed a slight gain in performance over loose powder samples for the prediction of ex-K and ex-Ca, satisfactory performances were also obtained with loose powders, which require minimal sample preparation. The prediction models with local samples showed promising results and encourage more detailed investigations for the application of pXRF in tropical soils.

Effects of high glucose concentrations on the endothelial function of the renal microcirculation of rabbits.

OBJECTIVE: To assess the acute effects of high glucose concentrations on vascular reactivity in the isolated non diabetic rabbit kidney. METHODS: Rabbits were anaesthetized for isolation of the kidneys. Renal arteries and veins were cannulated for perfusion with Krebs-Henselleit solution and measurement of perfusion pressure. After 3 hours of perfusion with glucose 5,5 mM (control ) and 15 mM, the circulation was submitted to sub maximal precontraction (80% of maximal response) trough continuous infusion of noradrenaline 10 mM. Vascular reactivity was then assessed trough dose-responses curves with endothelium-dependent (acetylcholine) and independent (sodium nitroprusside) vasodilators. The influence of hyperosmolarity was analyzed with perfusion with mannitol 15mM. RESULTS: A significant reduction in the endothelium-dependent vasodilation in glucose 15mM group was observed compared to that in control, but there was no difference in endothelium-independent vasodilation. After perfusion with mannitol 15 mM, a less expressive reduction in endothelium-dependent vasodilation was observed, only reaching significance in regard to the greatest dose of acetylcholine. CONCLUSION: High levels of glucose similar to those found in diabetic patients in the postprandial period can cause significant acute changes in renal vascular reactivity rabbits. In diabetic patients these effects may also occur and contribute to diabetes vascular disease.

Efeitos de altas concentrações de glicose na função endotelial da microcirculação renal de coelhos / Effects of high glucose concentrations on the endothelial function of the renal microcirculation of rabbits

OBJECTIVE: To assess the acute effects of high glucose concentrations on vascular reactivity in the isolated non diabetic rabbit kidney. METHODS: Rabbits were anaesthetized for isolation of the kidneys. Renal arteries and veins were cannulated for perfusion with Krebs-Henselleit solution and measurement of perfusion pressure. After 3 hours of perfusion with glucose 5,5 mM (control ) and 15 mM, the circulation was submitted to sub maximal precontraction (80 percent of maximal response) trough continuous infusion of noradrenaline 10 mM. Vascular reactivity was then assessed trough dose-responses curves with endothelium-dependent (acetylcholine) and independent (sodium nitroprusside) vasodilators. The influence of hyperosmolarity was analyzed with perfusion with mannitol 15mM. RESULTS: A significant reduction in the endothelium-dependent vasodilation in glucose 15mM group was observed compared to that in control, but there was no difference in endothelium-independent vasodilation. After perfusion with mannitol 15 mM, a less expressive reduction in endothelium-dependent vasodilation was observed, only reaching significance in regard to the greatest dose of acetylcholine. CONCLUSION: High levels of glucose similar to those found in diabetic patients in the postprandial period can cause significant acute changes in renal vascular reactivity rabbits. In diabetic patients these effects may also occur and contribute to diabetes vascular disease