Risk of heart failure in ambulatory resistant hypertension: a meta-analysis of observational studies.

The impact of ambulatory resistant hypertension (ARH) on the occurrence of heart failure (HF) is not yet completely known. We performed for the first time a meta-analysis, by using published data or available data from published databases, on the risk of HF in ARH. Patients with ARH (24-h BP ≥ 130/80 mmHg during treatment with ≥3 drugs) were compared with those with controlled hypertension (CH, clinic BP < 140/90 mmHg and 24-h BP < 130/80 mmHg regardless of the number of drugs used), white coat uncontrolled resistant hypertension (WCURH, clinic BP ≥ 140/90 mmHg and 24-h BP < 130/80 mmHg in treated patients) and ambulatory nonresistant hypertension (ANRH, 24-h BP ≥ 130/80 mmHg during therapy with ≤2 drugs). We identified six studies/databases including 21,365 patients who experienced 692 HF events. When ARH was compared with CH, WCURH, or ANRH, the overall adjusted hazard ratio for HF was 2.32 (95% confidence interval (CI) 1.45-3.72), 1.72 (95% CI 1.36-2.17), and 2.11 (95% CI 1.40-3.17), respectively, (all P < 0.001). For some comparisons a moderate heterogeneity was found. Though we did not find variables that could explain the heterogeneity, sensitivity analyses demonstrated that none of the studies had a significant influential effect on the overall estimate. When we evaluated the potential presence of publication bias and small-study effect and adjusted for missing studies identified by Duval and Tweedie's method the estimates were slightly lower but remained significant. This meta-analysis shows that treated hypertensive patients with ARH are at approximately twice the risk of developing HF than other ambulatory BP phenotypes.

Impact of caregivers' education regarding respiratory infections on the health status of day-care children: a randomized trial.

BACKGROUND: Acute respiratory infections are the most common illness in childhood, and caregivers often make an excessive use of medication and medical consultations. It is vital to design and implement educational interventions in order to minimize the burden of the disease. OBJECTIVE: This study aimed to evaluate the impact of a health education session (HES) about respiratory infections on the indicators of individual health and health care utilization of day-care children. METHODS: Randomized controlled trial in 10 day-care centres in Porto, including caregivers (parents or legal tutors) of children under 3 years of age. Children's caregivers were randomly distributed into an Intervention Group (IG), who attended a HES, and a Comparison Group (CG). Children's indicators of individual health and health care utilization were evaluated in both groups, during the month after HES. RESULTS: Children whose caregivers attended to the HES had fewer lower respiratory tract infections (IG = 5.8%; CG = 19.0%; P = 0.050) and fewer acute otitis media (IG = 9.5%; CG = 27.0%; P = 0.030), as well as fewer medical consultations (IG = 38.5% versus CG = 61.9%; P = 0.015) and less antibiotic consumption (IG = 11.5% versus CG = 29.5%; P = 0.022). They were also less absent from day care (IG = 21 days versus CG = 59 days; P = 0.037) and their caregivers were less absent from work (IG = 15 days versus CG = 44 days; P = 0.046). Caregivers who attended HES made more use of nasal irrigation (IG = 79.6% versus CG = 53.3%; P = 0.011). CONCLUSIONS: The HES about respiratory infections has positively influenced the indicators of individual health and health care utilization of children attending day-care centres in Porto.

Risk factors for respiratory infections among children attending day care centres.

BACKGROUND: Upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI) and acute otitis media (AOM) are common in children attending day care centres. OBJECTIVES: This study aimed to characterize the risk factors of URTI, LRTI and AOM in children attending day care. METHODS: A cross-sectional study was conducted in children aged up to 3 years (n = 152) of six day care centres in Porto. Logistic regression was used on independent variables: mother-related, household-related, child-related and day care-related risk factors as predictors of the dependent variables: URTI, LRTI and AOM. RESULTS: The risk of URTI increased as the number of children decreased [odds ratio (OR) = 0.620, 95% CI = 0.411-0.935], as the area per child decreased (OR = 0.434, 95% CI = 0.206-0.914) and as the disinfection of WC/diapers-change increased (OR = 2.56, 95% CI = 1.089-6.017). There was a higher risk of URTI if nasal aspirators (OR = 6.763, 95% CI = 1.022-44.753), rather than physiologic serum (OR = 5.296, 95% CI = 1.097-25.559), were used at day care centres. The risk of LRTI increased as the household size decreased (OR = 0.213, 95% CI = 0.048-0.937) and it was higher if the child had no siblings (OR = 7.831, 95% CI = 1.065-57.578). The risk of LRTI was higher if the child was not exclusively breastfed (OR = 24.612, 95% CI = 1.108-546.530) and the risk increased as the duration of exclusive breastfeeding decreased (OR = 0.396, 95% CI = 0.170-0.920). The risk of AOM increased as the birth body mass index (OR = 2.247, 95% CI = 1.011-4.992) and weight (OR = 1.607, 95% CI = 1.014-2.545) increased and if nasal aspirators were used (OR = 6.763, 95% CI = 1.022-44.753). CONCLUSION: URTI were related with day care centres' risk factors, LRTI were associated with mother-related and household-related risk factors and AOM was connected with child-related risk factors.

Central arterial pulse waveform acquisition with a portable pen-like optical fiber sensor.

OBJECTIVE: Pulse waveform features related to cardiovascular pathologies and arterial stiffness have been extensively studied, and optical fiber sensors have been studied with an aim to simplify the pulse waveform acquisition in the carotid artery. In this paper, a novel optical fiber sensor to record pulse waveform in the carotid artery has been proposed. METHODS: The pulse waveform optical fiber sensor design, based on fiber Bragg gratings, is presented. The probe was characterized, and its response to controlled waveforms was studied. Finally, tests were performed on human subjects. RESULTS: The developed sensor has a displacement sensitivity of 21.2 pm/µm, with ability to detect the carotid pulse wave in the neck surface, with a resolution of 1.3 mmHg. CONCLUSION: This study revealed a new technological approach for acquisition of the central pulse waveform.