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1.
Arq Bras Cardiol ; 112(5): 649-705, 2019 Jun 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31188969
2.
Arq. bras. cardiol ; 112(5): 649-705, May 2019. gráfico, tabela
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1022925

RESUMO

Development: The Department of Geriatric Cardiology of the Brazilian Society of Cardiology (Departamento de Cardiogeriatria da Sociedade Brasileira da Cardiologia) and the Brazilian Geriatrics and Gerontology Society (Sociedade Brasileira de Geriatria e Gerontologia). (AU)


Assuntos
Humanos , Geriatria
3.
Clin Cardiol ; 41(1): 28-33, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29356017

RESUMO

BACKGROUND: The perception of cardiovascular (CV) risk is essential for adoption of healthy behaviors. However, subjects underestimate their own risk. HYPOTHESIS: Clinical characteristics might be associated with self-underestimation of CV risk. METHODS: This is a retrospective, cross-sectional study of individuals submitted to routine health evaluation between 2006 and 2012, with calculated lifetime risk score (LRS) indicating intermediate or high risk for CV disease (CVD). Self-perception of risk was compared with LRS. Logistic regression analysis was performed to test the association between clinical characteristics and subjective underestimation of CV risk. RESULTS: Data from 5863 subjects (age 49.4 ± 7.1 years; 19.9% female) were collected for analysis. The LRS indicated an intermediate risk for CVD in 45.7% and a high risk in 54.3% of individuals. The self-perception of CV risk was underestimated compared with the LRS in 4918 (83.9%) subjects. In the adjusted logistic regression model, age (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.10-1.47 per 10 years, P = 0.001), smoking (OR: 1.99, 95% CI: 1.40-2.83, P < 0.001), dyslipidemia (OR: 1.21, 95% CI: 1.01-1.46, P = 0.045), physical activity (OR: 1.66, 95% CI: 1.36-2.02, P < 0.001), and use of antihypertensive (OR: 1.49, 95% CI: 1.15-1.92, P = 0.002) and lipid-lowering medications (OR: 2.13, 95% CI: 1.56-2.91, P < 0.001) were associated with higher chance of risk underestimation, whereas higher body mass index (OR: 0.92, 95% CI: 0.90-0.94, P < 0.001), depressive symptoms (OR: 0.46, 95% CI: 0.37-0.57, P < 0.001), and stress (OR: 0.41, 95% CI: 0.33-0.50, P < 0.001) decreased the chance. CONCLUSIONS: Among individuals submitted to routine medical evaluation, aging, smoking, dyslipidemia, physical activity, and use of antihypertensive and lipid-lowering medications were associated with higher chance of CV risk underestimation. Subjects with these characteristics may benefit from a more careful risk orientation.


Assuntos
Doenças Cardiovasculares/psicologia , Técnicas de Apoio para a Decisão , Nível de Saúde , Exame Físico/métodos , Medição de Risco/métodos , Autoimagem , Adulto , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
4.
Clinics (Sao Paulo) ; 72(8): 474-480, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28954006

RESUMO

OBJECTIVE:: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS:: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS:: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS:: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.


Assuntos
Doenças Assintomáticas/epidemiologia , Infarto Encefálico/complicações , Infarto Encefálico/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Fatores Etários , Idoso , Análise de Variância , Infarto Encefálico/fisiopatologia , Brasil/epidemiologia , Disfunção Cognitiva/fisiopatologia , Feminino , Humanos , Testes de Inteligência , Imagem por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Prevalência , Escalas de Graduação Psiquiátrica , Valores de Referência , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos
5.
Arq. bras. cardiol ; 109(2): 103-109, Aug. 2017. tab
Artigo em Inglês | LILACS-Express | ID: biblio-887907

RESUMO

Abstract Background: Depressive symptoms are independently associated with an increased risk of cardiovascular disease (CVD) among individuals with non-diagnosed CVD. The mechanisms underlying this association, however, remain unclear. Inflammation has been indicated as a possible mechanistic link between depression and CVD. Objectives: This study evaluated the association between persistent depressive symptoms and the onset of low-grade inflammation. Methods: From a database of 1,508 young (mean age: 41 years) individuals with no CVD diagnosis who underwent at least two routine health evaluations, 134 had persistent depressive symptoms (Beck Depression Inventory - BDI ≥ 10, BDI+) and 1,374 had negative symptoms at both time points (BDI-). All participants had been submitted to repeated clinical and laboratory evaluations at a regular follow-up with an average of 26 months from baseline. Low-grade inflammation was defined as plasma high-sensitivity C-Reactive Protein (CRP) concentrations > 3 mg/L. The outcome was the incidence of low-grade inflammation evaluated by the time of the second clinical evaluation. Results: The incidence of low-grade inflammation was more frequently observed in the BDI+ group compared to the BDI- group (20.9% vs. 11.4%; p = 0.001). After adjusting for sex, age, waist circumference, body mass index, levels of physical activity, smoking, and prevalence of metabolic syndrome, persistent depressive symptoms remained an independent predictor of low-grade inflammation onset (OR = 1.76; 95% CI: 1.03-3.02; p = 0.04). Conclusions: Persistent depressive symptoms were independently associated with low-grade inflammation onset among healthy individuals.


Resumo Fundamento: Sintomas depressivos estão associados de forma independente ao risco aumentado de doença cardiovascular (DCV) em indivíduos com DCV não diagnosticada. Os mecanismos subjacentes a essa associação, entretanto, não estão claros. Inflamação tem sido indicada como um possível elo mecanicista entre depressão e DCV. Objetivos: Este estudo avaliou a associação entre sintomas depressivos persistentes e o início de inflamação de baixo grau. Métodos: De um banco de dados de 1.508 indivíduos jovens (idade média: 41 anos) sem diagnóstico de DCV submetidos a pelo menos duas avaliações de saúde de rotina, 134 tinham sintomas depressivos persistentes (Inventário de Depressão de Beck - BDI ≥10, BDI+) e 1.374 não apresentavam sintomas em nenhuma das ocasiões (BDI-). Todos os participantes foram submetidos a repetidas avaliações clínicas e laboratoriais em seguimento regular, cuja média foi de 26 meses desde a condição basal. Definiu-se inflamação de baixo grau como concentração plasmática de proteína C reativa (PCR) ultrassensível > 3 mg/L. O desfecho foi a incidência de inflamação de baixo grau por ocasião da segunda avaliação clínica. Resultados: A incidência de inflamação de baixo grau foi maior no grupo BDI+ em comparação ao grupo BDI- (20,9% vs. 11,4%; p = 0,001). Após ajuste para sexo, idade, circunferência abdominal, índice de massa corporal, níveis de atividade física, tabagismo e prevalência de síndrome metabólica, os sintomas depressivos persistentes continuaram sendo um preditor independente de início de inflamação de baixo grau (OR = 1,76; IC 95%: 1,03-3,02; p = 0,04). Conclusões: Sintomas depressivos persistentes foram independentemente associados com início de inflamação de baixo grau em indivíduos saudáveis.

6.
Clinics ; 72(8): 474-480, Aug. 2017. tab
Artigo em Inglês | LILACS | ID: biblio-890719

RESUMO

OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.


Assuntos
Humanos , Masculino , Feminino , Idoso , Doenças Assintomáticas/epidemiologia , Infarto Encefálico/complicações , Infarto Encefálico/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Fatores Etários , Análise de Variância , Infarto Encefálico/fisiopatologia , Brasil/epidemiologia , Disfunção Cognitiva/fisiopatologia , Testes de Inteligência , Imagem por Ressonância Magnética , Testes Neuropsicológicos , Prevalência , Escalas de Graduação Psiquiátrica , Valores de Referência , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos
7.
Arq Bras Cardiol ; : 0, 2017 06 29.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28678924

RESUMO

Background: Depressive symptoms are independently associated with an increased risk of cardiovascular disease (CVD) among individuals with non-diagnosed CVD. The mechanisms underlying this association, however, remain unclear. Inflammation has been indicated as a possible mechanistic link between depression and CVD. Objectives: This study evaluated the association between persistent depressive symptoms and the onset of low-grade inflammation. Methods: From a database of 1,508 young (mean age: 41 years) individuals with no CVD diagnosis who underwent at least two routine health evaluations, 134 had persistent depressive symptoms (Beck Depression Inventory - BDI ≥ 10, BDI+) and 1,374 had negative symptoms at both time points (BDI-). All participants had been submitted to repeated clinical and laboratory evaluations at a regular follow-up with an average of 26 months from baseline. Low-grade inflammation was defined as plasma high-sensitivity C-Reactive Protein (CRP) concentrations > 3 mg/L. The outcome was the incidence of low-grade inflammation evaluated by the time of the second clinical evaluation. Results: The incidence of low-grade inflammation was more frequently observed in the BDI+ group compared to the BDI- group (20.9% vs. 11.4%; p = 0.001). After adjusting for sex, age, waist circumference, body mass index, levels of physical activity, smoking, and prevalence of metabolic syndrome, persistent depressive symptoms remained an independent predictor of low-grade inflammation onset (OR = 1.76; 95% CI: 1.03-3.02; p = 0.04). Conclusions: Persistent depressive symptoms were independently associated with low-grade inflammation onset among healthy individuals.

8.
Front Psychol ; 8: 57, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28184203

RESUMO

Cardiovascular risk (CVR) factors may be associated with poor cognitive functioning in elderlies and impairments in brain structure. Using MRI and voxel-based morphometry (VBM), we assessed regional white matter (WM) volumes in a population-based sample of individuals aged 65-75 years (n = 156), subdivided in three CVR subgroups using the Framingham Risk Score. Cognition was assessed using the Short Cognitive Performance Test. In high-risk subjects, we detected significantly reduced WM volume in the right juxtacortical dorsolateral prefrontal region compared to both low and intermediate CVR subgroups. Findings remained significant after accounting for the presence of the APOEε4 allele. Inhibitory control performance was negatively related to right prefrontal WM volume, proportionally to the degree of CVR. Significantly reduced deep parietal WM was also detected bilaterally in the high CVR subgroup. This is the first large study documenting the topography of CVR-related WM brain volume deficits. The significant association regarding poor response inhibition indicates that prefrontal WM deficits related to CVR are clinically meaningful, since inhibitory control is known to rely on prefrontal integrity.

9.
Int J Cardiol ; 224: 33-36, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-27611915

RESUMO

BACKGROUND: The effect of socioeconomic stressors on the incidence of cardiovascular disease (CVD) is currently open to debate. Using time-series analysis, our study aimed to evaluate the relationship between unemployment rate and hospital admission for acute myocardial infarction (AMI) and stroke in Brazil over a recent 11-year span. METHODS AND RESULTS: Data on monthly hospital admissions for AMI and stroke from March 2002 to December 2013 were extracted from the Brazilian Public Health System Database. The monthly unemployment rate was obtained from the Brazilian Institute for Applied Economic Research, during the same period. The autoregressive integrated moving average (ARIMA) model was used to test the association of temporal series. Statistical significance was set at p<0.05. From March 2002 to December 2013, 778,263 admissions for AMI and 1,581,675 for stroke were recorded. During this time period, the unemployment rate decreased from 12.9% in 2002 to 4.3% in 2013, while admissions due to AMI and stroke increased. However, the adjusted ARIMA model showed a positive association between the unemployment rate and admissions for AMI but not for stroke (estimate coefficient=2.81±0.93; p=0.003 and estimate coefficient=2.40±4.34; p=0.58, respectively). CONCLUSIONS: From 2002 to 2013, hospital admissions for AMI and stroke increased, whereas the unemployment rate decreased. However, the adjusted ARIMA model showed a positive association between unemployment rate and admissions due to AMI but not for stroke. Further studies are warranted to validate our findings and to better explore the mechanisms by which socioeconomic stressors, such as unemployment, might impact on the incidence of CVD.


Assuntos
Análise de Séries Temporais Interrompida/tendências , Infarto do Miocárdio/epidemiologia , Admissão do Paciente/tendências , Acidente Vascular Cerebral/epidemiologia , Desemprego/tendências , Adulto , Idoso , Brasil/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Análise de Séries Temporais Interrompida/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/economia , Fatores Socioeconômicos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/economia
10.
Ann Noninvasive Electrocardiol ; 21(3): 246-55, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26413928

RESUMO

BACKGROUND: Pacemaker with remote monitoring (PRM) may be useful for silent atrial fibrillation (AF) detection. The aims of this study were to evaluate the incidence of silent AF, the role of PRM, and to determine predictors of silent AF occurrence. METHODS: Three hundred elderly patients with permanent pacemaker (PPM) were randomly assigned to the remote group (RG) or control group (CG). All patients received PPM with remote monitoring capabilities. Primary end point was AF occurrence rate and the secondary end points were time to AF detection and number of days with AF. RESULTS: During the average follow-up of 15.7±7.7 months, AF episodes were detected in 21.6% (RG = 24% vs CG = 19.3%, P = 0.36]. There was no difference in the time to detect the first AF episode. However, the median time to detect AF recurrence in the RG was lower than that in the CG (54 days vs 100 days, P = 0.004). The average number of days with AF was 16.0 and 51.2 in the RG and CG, respectively (P = 0.028). Predictors of silent AF were left atrial diameter (odds ratio [OR] 1.2; 95% CI = 1.1-1.3; P < 0.001) and diastolic dysfunction (OR 4.8; 95% CI = 1.6-14.0; P = 0.005). CONCLUSIONS: The incidence of silent AF is high in elderly patients with pacemaker; left atrial diameter and diastolic dysfunction were predictors of its occurrence. AF monitoring by means of pacemaker is a valuable tool for silent AF detection and continuous remote monitoring allows early AF recurrence detection and reduces the number of days with AF.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Monitorização Fisiológica/métodos , Marca-Passo Artificial , Idoso , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva
11.
Einstein (Sao Paulo) ; 13(3): 454-61, 2015 Jul-Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26466065

RESUMO

Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Angina Instável/tratamento farmacológico , Cuidados Críticos , Infarto do Miocárdio/tratamento farmacológico , Síndrome Coronariana Aguda/diagnóstico , Angina Instável/diagnóstico , Anticoagulantes/uso terapêutico , Cineangiografia , Medicina Baseada em Evidências/métodos , Humanos , Infarto do Miocárdio/diagnóstico , Inibidores da Agregação de Plaquetas/uso terapêutico
12.
Einstein (Säo Paulo) ; 13(3): 454-461, July-Sep. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-761960

RESUMO

Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.


A síndrome coronária sem supradesnivelamento do ST geralmente resulta da instabilização de uma placa aterosclerótica, com subsequente ativação plaquetária e de diversos fatores de coagulação. O tratamento visa aliviar a dor isquêmica, limitar o dano miocárdico e diminuir a mortalidade. Diversos agentes antiagregantes e anticoagulantes provaram sua utilidade, e novas drogas passaram a compor o arsenal terapêutico, buscando maior eficácia anti-isquêmica e menores índices de sangramento. Apesar dos avanços, as taxas de mortalidade, infarto e reinternação ainda permanecem elevadas.


Assuntos
Humanos , Síndrome Coronariana Aguda/tratamento farmacológico , Angina Instável/tratamento farmacológico , Cuidados Críticos , Infarto do Miocárdio/tratamento farmacológico , Síndrome Coronariana Aguda/diagnóstico , Angina Instável/diagnóstico , Anticoagulantes/uso terapêutico , Cineangiografia , Medicina Baseada em Evidências/métodos , Infarto do Miocárdio/diagnóstico , Inibidores da Agregação de Plaquetas/uso terapêutico
13.
Arq Bras Cardiol ; 104(6): 443-9, 2015 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26131699

RESUMO

BACKGROUND: The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns "quality of life related to health". Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists. OBJECTIVE: Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life. METHODS: This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State. RESULTS: The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old). 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68). 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014), obesity (p < 0.001), lack of physical activity (p = 0.016), osteoarthritis (p < 0.001), cognitive impairment (p < 0.001), and major depression (p < 0.001). Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36. CONCLUSION: Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression.


Assuntos
Doenças Cardiovasculares/psicologia , Transtorno Depressivo/psicologia , Qualidade de Vida/psicologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Transtorno Depressivo/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Valores de Referência , Índice de Gravidade de Doença
14.
Arq. bras. cardiol ; 104(6): 443-449, 06/2015. tab
Artigo em Inglês | LILACS | ID: lil-750700

RESUMO

Background: The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns “quality of life related to health”. Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists. Objective: Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life. Methods: This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State. Results: The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old). 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68). 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014), obesity (p < 0.001), lack of physical activity (p = 0.016), osteoarthritis (p < 0.001), cognitive impairment (p < 0.001), and major depression (p < 0.001). Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36. Conclusion: Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression. .


Fundamento: Com o envelhecimento, a prevalência de doenças crônico-degenerativas sofreu aumento progressivo. A repercussão dessas doenças sobre a capacidade funcional foi reconhecida. Outro parâmetro de saúde é a “qualidade de vida relacionada à saúde”. Na população idosa, as doenças cardiovasculares destacam-se pelo impacto epidemiológico e clínico. Elas, geralmente, vêm associadas a outras afecções. Esse conjunto de problemas pode comprometer a independência e a qualidade de vida do idoso que busca tratamento cardiológico. Objetivo: Avaliar, em uma população de idosos cardiopatas, quais são os determinantes clínicos mais relevantes de dependência e de qualidade de vida. Métodos: O grupo foi selecionado aleatória e consecutivamente, sendo aplicados quatro questionários: HAQ, SF-36, PRIME‑MD e Mini Exame do Estado Mental. Resultados: Incluiu-se 1020 idosos, 63,3% mulheres. O grupo tinha em média 75,56 ± 6,62 anos. 61,4% mostrou-se independente ou com dependência leve. O escore de qualidade de vida foi elevado (HAQ: 88,66 ± 2,68). 87,8% dos pacientes apresentou escore total do SF-36 ≥ 66. À análise multivariada, a associação entre os diagnósticos e graus elevados de dependência foi significante apenas para acidente vascular cerebral prévio (p = 0,014), obesidade (p < 0,001), sedentarismo (p = 0,016), osteoartrite (p < 0,001), déficit cognitivo (p < 0,001), e depressão maior (p < 0,001). Ao analisarmos a qualidade de vida, a depressão maior e a depressão por doença física associou-se significativamente com todos os domínios do SF-36. Conclusão: Em uma população de idosos cardiopatas, os determinantes clínicos mais relevantes de prejuízos para dependência e qualidade de vida foram as comorbidades não cardiovasculares, particularmente a depressão. .


Assuntos
Humanos , Hepatócitos/patologia , Regeneração Hepática , Falência Hepática Aguda/metabolismo , Apoptose , /fisiologia , Proteína Ligante Fas/fisiologia , Hepatócitos/metabolismo , Falência Hepática Aguda/terapia , Necrose , Receptores do Fator de Necrose Tumoral/metabolismo , Transdução de Sinais , Ligante Indutor de Apoptose Relacionado a TNF/fisiologia , Fator de Necrose Tumoral alfa/metabolismo
17.
Eur J Prev Cardiol ; 22(8): 1076-82, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25038080

RESUMO

BACKGROUND: Poor adherence to medical treatment represents a major health problem. A subject's misperception of his own cardiovascular risk has been indicated as a key driver for low compliance with preventive measures. This study analysed the relationship between objectively calculated short- and long-term cardiovascular risk and its subjective perception. DESIGN: Cross-sectional study in asymptomatic Brazilian subjects. METHODS: Individuals (N = 6544, mean age 49.1 ± 7 years, 22.2% female) who underwent a routine mandatory health evaluation were studied. A questionnaire in which each individual rated his own cardiovascular risk as low, intermediate or high according to his own perception was used. The 10-year and lifetime cardiovascular risk were calculated respectively using the Framingham risk (FRS) and Lifetime risk (LRS) scores. Individuals were classified as hypo-perceivers (i.e. perceived risk lower than estimated risk), normo-perceivers (i.e. perceived risk coincident with estimated risk) and hyper-perceivers (i.e. perceived risk higher than estimated risk). RESULTS: Cardiovascular risk, using the FRS, was low in 77.9% (N = 5071), intermediate in 14.4% (N = 939) and high in 7.7% (N = 499) of subjects. Cardiovascular risk, using the LRS, was low in 7.6% (N = 492), intermediate in 43.1% (N = 2787) and high in 49.3% (N = 3184) of the study population. The prevalence of normo-perceivers was 57.6% using the FRS and only 20.6% using the LRS. Using the LRS, 72.3% of the intermediate and 91.2% of the high-risk subjects were hypo-perceivers. CONCLUSIONS: In a large sample of asymptomatic individuals, there was a gap between calculated and perceived cardiovascular risk. Using a long-term risk score, most of the intermediate- and high-risk subjects were hypo-perceivers.


Assuntos
Doenças Cardiovasculares/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Percepção , Adulto , Doenças Assintomáticas , Brasil/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Comorbidade , Estudos Transversais , Técnicas de Apoio para a Decisão , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Inquéritos e Questionários
19.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 23(2): 28-34, abr.-jun. 2013. tab, graf
Artigo em Português | LILACS | ID: lil-724439

RESUMO

A falta de aderência às orientações e tratamentos dos pacientes com doenças cardiovasculares é extremamente prevalente e se associa a maior morbidade, mortalidade e custos em saúde. Controle pressórico inadequado nos hipertensos, maior mortalidade nos pacientes que realizaram angioplastia e necessidade de reinternação em pacientes com insuficiência cardíaca são algumas das consequências associadas à má aderência. Diversos fatores estão implicados, como complexidade do regime terapêutico, custos, efeitos adversos, falta de acesso ao sistema de saúde, comunicação inadequada, baixos níveis de conhecimento em saúde e presença de depressão ou déficit cognitivo. Não existe padrão ouro para mensurar os níveis de aderência e foram utilizados autorrelatos, contagem de comprimidos, embalagens eletrônicas, renovação de receitas em sistemas fechados de farmácia e níveis séricos de medicação. Para melhora deste cenário, precisamos implementar efetivamente os conhecimentos existentes e desenvolver novas estratégias de intervenção. Diminuição do custo d drogas, simplificação de esquemas posológicos, comunicação adequada e estratégias comportamentais que incorporam o uso de medicações e comportamentos mais saudáveis no dia-a-dia dos pacientes obtiveram sucesso em estudos clínicos.


The lack of adherence to guidelines and treatment of patients with cardiovascular disease in highly prevalente and is associated with increased morbidity, mortality and healthcare costs. Inadequate blood pressure control in hypertensive patients, increased mortality in patients undergoing angioplasty and need for re-hospitalization in patients with heart failure are some of the consequences associated with poor adherence. Several factors are implicated as therapeutic regimen complexity, cost, adverse effects, lack of access to health care, inadequate communication, low levels of knowledge about health and presence of depression or cognitive impairment. There is no gold standard for measuring levels of adherence. Therefore self-reports, pill counts, electronic packaging, prescription refills in closed pharmacy system and sérum levels of medications were used for measuring levels of adherence. To improve this scenario, we need to effectively implemente existing knowledge and developed new strategies for intervention. Decreased drug cost, simplified dosing regimens, proper communication and behavioral strategies that incorporated the use of medications and healthy behaviors in the daily lives of patients were successful in clinical trials.


Assuntos
Humanos , Adesão à Medicação/psicologia , Doenças Cardiovasculares/etiologia , Alfabetização em Saúde , Anti-Hipertensivos/uso terapêutico , Hipertensão/complicações , Inquéritos e Questionários , Fatores de Risco
20.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 23(2): 40-45, abr.-jun. 2013.
Artigo em Português | LILACS | ID: lil-724441

RESUMO

Vivemos um momento de transição radical na área da saúde. Com novos modelos de saúde, a atenção é entregue por equipes, avaliada pelos resultados e adquirida como pacotes. Nesta nova configuração, mídias digitais e sociais tornam-se uma fonte cada vez mais importante de valor. As pessoa estão sendo capacitadas a participar mais ativamente de sua própria saúde, fornecendo novas ferramentas para gerenciar as condições crônicas e aliviar a carga sobre os sobrecarregados sistemas de saúde. A saúde é prestada, tradicionalmente, em três espaços: domicílios, clínicas e hospitais. As mídias digitais criaram o quarto espaço, o espaço digital, que inclui: canal digital para saúde, inovação digital e iniciativas digitais de impacto social. No canal digital para saúde, os profissionais de saúde estão implantando mídia digital e social no sistema de saúde tradicional para, por exemplo, consulta de acompanhamento por e-mail e acesso on-line para os resultados de laboratório. Na área de inovação digital para consumidores, mídia digital e social oferecem maneiras novas e melhores para pacientes e cuidadores gerirem doença e saúde e compartilharem experiências com comunidade on-line. Nas iniciativas digitais de impacto social, as organizações dos setores público e privado usam inovações digitais para facilitar comunicações interativas, a fim de prevenir a doença e promover a saúde. Concluindo, o uso das estratégias digitais na área da saúde está cada vez mais presente e, certamente, contribui e contribuirá para a melhoria da prática clínica, porém, ainda se sugere a necessidade de novos estudos bem planejados e de qualidade sobre este novo método.


We are living a moment of a radical transition in the health area. Health care is proportioned by a team, evaluated by results and acquired like packets. In this new way of health care the digital and social media become na important source of value. People are being capable of taking part actively of their own health, providing tools to manage chronic conditions in order to relieve "overburdened" health system. The health traditionally contains three spaces: homes, ambulatories and hospitals. The digital media created the fourth space, the digital space that includes: digital channel for health, digital innovation and digital initiatives of social impact. In the digital channel for health, the health professional are implanting digital and social media in the traditional health system to make the follow up of patients by e-mail, or to have online access of laboratory results. In the digital innovation for consumers social and digital media provide new and better ways for patients and caregivers to manage disease and health and share experiences with online community. In the digital initiatives of social impact, the private and public organizations to prevent disease and promote health. Concluding, the use of digital strategies in the health area is more and more presente and certainly contributes and will contribute to improve clinical practice, however we suggest the need of well-planned new studies for the use of this strategy.


Assuntos
Humanos , Doenças Cardiovasculares/prevenção & controle , Mídias Sociais , Promoção da Saúde/métodos , Difusão de Inovações , Inovação , Internet , Pessoal de Saúde/tendências , Telemedicina
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