Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort.

BACKGROUND: Few studies have evaluated the association between delivery by cesarean section (CS) and asthma, allergic rhinitis and chronic rhinitis and whether this association is different in children with and without a family history of asthma. This study aims to investigate whether children born by CS have a higher chance to develop asthma, allergic rhinitis and chronic rhinitis and to evaluate the influence of parental history of asthma on these associations. METHODS: This is a cross-sectional study of 672 children nested in a birth cohort evaluated at 6-years of age. Asthma and chronic/allergic rhinitis were identified by means of the mother's responses to the ISAAC questionnaire. The association between CS, asthma, chronic rhinitis and allergic rhinitis was evaluated by multivariable logistic regression. The evidence of effect modification of parental history of asthma on the association CS and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders. RESULTS: Asthma was not associated with birth by CS irrespective of parental history of asthma (odds ratio (OR) 1.03; 95 % CI 0.61-1.74). Chronic rhinitis and allergic rhinitis were both significantly associated with birth by CS but only in the subgroup of children with by parental history of asthma (OR 1.56; 95 % CI 1.04-2.34) and (OR 1.60; 95 % CI 1.01-2.55) respectively, after adjustment for confounders. The parental history of asthma was a effect modifier in the association between CS, chronic rhinitis and allergic rhinitis (p for effect modification = 0.10 and 0.02, respectively). CONCLUSION: CS increases the risk of chronic rhinitis and allergic rhinitis in children at 6 years of age with parental history of asthma. Health professionals must be alerted with regard to the increased risk of allergic rhinitis and made aware this is another reason to avoid unnecessary CS.

High-dose daptomycin therapy for left-sided infective endocarditis: a prospective study from the international collaboration on endocarditis.

The use of daptomycin in Gram-positive left-sided infective endocarditis (IE) has significantly increased. The purpose of this study was to assess the influence of high-dose daptomycin on the outcome of left-sided IE due to Gram-positive pathogens. This was a prospective cohort study based on 1,112 cases from the International Collaboration on Endocarditis (ICE)-Plus database and the ICE-Daptomycin Substudy database from 2008 to 2010. Among patients with left-sided IE due to Staphylococcus aureus, coagulase-negative staphylococci, and Enterococcus faecalis, we compared those treated with daptomycin (cohort A) to those treated with standard-of-care (SOC) antibiotics (cohort B). The primary outcome was in-hospital mortality. Time to clearance of bacteremia, 6-month mortality, and adverse events (AEs) ascribable to daptomycin were also assessed. There were 29 and 149 patients included in cohort A and cohort B, respectively. Baseline comorbidities did not differ between the two cohorts, except for a significantly higher prevalence of diabetes and previous episodes of IE among patients treated with daptomycin. The median daptomycin dose was 9.2 mg/kg of body weight/day. Two-thirds of the patients treated with daptomycin had failed a previous antibiotic regimen. In-hospital and 6-month mortalities were similar in the two cohorts. In cohort A, median time to clearance of methicillin-resistant S. aureus (MRSA) bacteremia was 1.0 day, irrespective of daptomycin dose, representing a significantly faster bacteremia clearance compared to SOC (1.0 versus 5.0 days; P < 0.01). Regimens with higher daptomycin doses were not associated with increased incidence of AEs. In conclusion, higher-dose daptomycin may be an effective and safe alternative to SOC in the treatment of left-sided IE due to common Gram-positive pathogens.

[(Lack of) control of clinical and anthropometrical parameters in individuals with coronary artery disease]. / (Des)controle de parâmetros clínicos e antropométricos em indivíduos com doença arterial coronária.

This cross-sectional study evaluated the clinical and anthropometrical parameters of 100 individuals with coronary artery disease, who were assisted at preventive cardiology outpatient clinic at a public hospital in Salvador/BA. Data collection was performed through interviews and both clinical and laboratory evaluations. The results were analyzed as averages and percentages. Most participants were black men, aged <60 years, married, low education level and small income, unemployed and diagnosed with myocardial infarction. Most reported having arterial hypertension, dyslipidemia, a sedentary lifestyle, and had quit smoking and drinking. All women and 82% of the men had an increased abdominal circumference, 19% had causal blood glucose>200 mg/dl, 36% was overweight, 28% were obese, 65% were in soma stage of hypertension, 65% had low HDL-C and 43% had high total cholesterol. It was observed that individuals with high cardiovascular risk and deficient socioeconomic conditions show a lack of control of several cardiovascular risk factors, thus demanding effective health care practices to control the illness.

Comparison of the energy and metabolic nutritional profile of women with central obesity of socioeconomic classes A/B vs C/D/E.

INTRODUCTION: Objective: to describe the characteristics of food consumption and energy intake of women with central obesity of socioeconomic classes A/B vs C/D/E. Methodology: a cross-sectional study in which a structured questionnaire was answered containing data on socioeconomics and physical activities. Weight and waist circumference (WC) were measured and the 24-hour recall was assessed (24hR) in relation to food consumption. Biochemical exams were analyzed. The dietary analysis was performed on the Nutwin software and statistical analysis on the SPSS 23.0. Results: there were 89 women assessed in each group and no significant differences were observed in relation to age, with averages of 51.2 ± 12.2 years vs 49 ± 14.4 years for classes C/D/E vs A/B, respectively. A sedentary lifestyle was predominant for class C/D/E 82 (92.13%) vs 22 (24.71%) (p < 0.001).Significant differences were observed between the groups for variables of hypertriglyceridemia (p < 0.001), predominant in the C/D/E socioeconomic group, and HDL-C (p < 0.001), predominant in the A/B socioeconomic group. Total energy consumption of women from class C/D/E vs A/B presented mean values of 1,528.72 kcal (1,128.8-1,697.3) vs 2,267.48 kcal (1,670.3-2,625.84), respectively. Significant differences were observed in the consumption of fiber between groups C/D/E vs A/B (p < 0.001), with less consumption in class C/D/E. With reference to income and schooling levels, we observed heterogeneity in the results and emphasize the marked contrast between low and high income that could influence the choice of food, contributing in the lower income to monotonous diets, less energy consumption and, furthermore, low quality in the ingested food. Conclusion: in this study, all of the women presented metabolic profiles in different manners among the groups and, also, women of class C/D/E, who presented insufficient fiber consumption, directly contributing to this condition of obesity, also presented worse lipid (total cholesterol and triglycerides) and glycemic profiles.

INTRODUCCIÓN: Objetivo: describir las características del consumo alimentario e ingestión energética de mujeres con obesidad central de clase socioeconómica A/B vs C/D/E. Metodología: estudio transversal en el que respondieron a un cuestionario estructurado que contenía datos socioeconómicos y actividad física. Se evaluaron el peso, circunferencia de la cintura (CC), y se hizo un recordatorio de 24 horas (R24h) en relación al consumo alimentario y los exámenes bioquímicos. Los análisis dietéticos se realizaron en el software Nutwin y los análisis estadísticos en el SPSS 23.0. Resultados: se valoraron 89 mujeres en cada grupo y no se observó diferencia significativa para la edad, con una media de 51,2 ± 12,2 años frente a 49 ± 14,4 años clase C/D/E vs A/B, respectivamente. El sedentarismo fue predominante en la clase C/D/E 82 (92,13%) vs 22 (24,71%), (p < 0,001). Se observaron diferencias significativas entre los grupos para las variables de hipertrigliceridemia (p < 0,001), predominantes en el grupo de clase socioeconómico C/D/E y HDL-C (p < 0,001), predominante en el grupo de clase socioeconómico A/B. El consumo energético total de las mujeres de clase C/D/E vs A / B, presentó medianas de 1528,72 kcal (1128,8-1697,3) frente a 2267,48 kcal (1670,3-2625,84), respectivamente. Se observó una diferencia significativa del consumo de fibra entre los grupos C/D/E vs A/B (p < 0,001), siendo el consumo menor en la clase C / D / E. En lo que se refiere a la renta y escolaridad, observamos la heterogeneidad de los resultados y destacamos el marcado contraste entre la baja y elevada renta lo que podría influir en la elección de los alimentos, contribuyendo en la menor renta para la monotonía alimentaria, menor consumo energético y, además, baja calidad de los alimentos ingeridos. Conclusión: en este estudio, todas las mujeres presentaron perfiles metabólicos de maneras distintas entre los grupos. Las mujeres de la clase C/D/E presentaron consumo insuficiente de fibra, lo que ciertamente contribuyó al cuadro de obesidad encontrado y paralelamente presentan peor perfil lipídico (colesterol total y triglicéridos) y glucémico.

Effect of nursing telemonitoring on the knowledge of obese women: clinical trial.

OBJECTIVE: To assess the effectiveness of remote monitoring in the knowledge of overweight women. METHOD: Randomized clinical trial with 101 women, randomly assigned to the control group (CG=50) and to the intervention group (IG=51). The IG received educational intervention over the telephone, during three months and routine follow-up in the service, while the CG only received conventional follow-up. The knowledge was assessed by a specific questionnaire. Data were analyzed by the Robust Linear Regression Model, adopting a statistical significance of 5%. RESULTS: In the intragroup assessment, an increase in the correct answers with a statistically significant difference was observed only for the IG in the domains: "Concept and causes of overweight," "Complications of overweight" and "Eating habits." In the intergroup comparison, an increase in the average knowledge was verified in the same domains for the IG (p≤0.005). CONCLUSION: nursing telemonitoring contributed positively to the improvement of women's knowledge.

A palm oil-rich diet may reduce serum lipids in healthy young individuals.

OBJECTIVE: The literature on palm oil as a cholesterol-raising oil is conflicting, requiring further studies. This study tested the influence of a palm oil-rich diet on plasma lipids of healthy young individuals. METHODS: Thirty-four medical students, 18-26 y old, with a total cholesterol level <200 mg/dL, high-density lipoprotein cholesterol (HDL-C) level >40 mg/dL, low-density lipoprotein cholesterol (LDL-C) level <130 mg/dL, triacylglycerol level <150 mg/dL, glycemic level <100 mg/dL, blood pressure <140/90 mmHg, and a body mass index of 18 to <25 kg/m(2) were studied. Once a day for 2 wk, the students ingested 10 mL of previously boiled crude palm oil after lunch or dinner, as preferred. Palm oil was consumed in the same way and quantity that it is consumed in one serving of a very popular typical Brazilian seafood dish. Total cholesterol, LDL-C, HDL-C, very LDL-C, non-HDL-C, and triacylglycerol were measured at baseline, after the palm oil-enriched diet, and after the washout period. RESULTS: A decrease in all lipid fractions was observed, with a mild, statistically significant decrease in concentrations of very LDL-C (19.41 +/- 4.21 versus 17.18 +/- 4.0 mg/dL, P = 0.002) and triacylglycerol (97.07 +/- 21.08 versus 85.91 +/- 20.02 mg/dL, P = 0.002). Males (61.9%) also showed a mildly significant increase in LDL-C, whereas females showed a mildly significant decrease in all lipid fractions, except for HDL-C. CONCLUSION: This study shows that boiled crude palm oil may have a mild, triacylglycerol-reducing effect in young, healthy individuals and may also show a mild LDL-C-increasing effect in males.

Clinical and functional profile of patients with the Painful Shoulder Syndrome (PSS).

BACKGROUND: The Painful Shoulder Syndrome (PSS) is characterized by varying degrees of pain and functional limitation. The aim of this study is to describe the clinical and functional profile of these patients. MATERIAL AND METHODS: 136 patients undergoing clinical treatment for PSS were evaluated by a questionnaire regarding the following variables: sex, age, occupation, affected shoulder and its dominance, image diagnosis, pain location, intensity and characteristics, physical activity involving the shoulder, preferential position of upper limbs during occupational activity, limitation of movements during activities o daily living, and job absenteeism. RESULTS: 74.3% of the patients were women (p<0.001), and 54.4% were at or below the mean age of 50+/-12.5 years. The right shoulder was affected most frequently (58.8%) and dominant (91.9%). Rotator cuff tear was the most frequent shoulder pathology (75.4%). Treatment was sought more commonly in the chronic stage of pain (61.0%). Pain, moderate in intensity, predominated in males (54.3%) and severe pain was more frequent in females (47.5%), restricted to the shoulder in 44.1% and worsening at night (50%). The upper limbs were used more frequently below shoulder level during usual daily activities (68.4%), and limitation of movements was present mainly in women (63.4%, p=0.017). CONCLUSION: Rotator cuff tear is the most frequent cause of PSS. PSS produces pain and functional limitation, especially in women.

Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment).

The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434.

[Control of arterial hypertension in a family care unit]. / Controle da hipertensão arterial em uma unidade de saúde da família.

OBJECTIVE: To assess the impact of the implementation of the Family Health Care Program for arterial hypertension management in a primary care unit. METHODS: There were studied 135 patients with confirmed diagnosis of arterial hypertension (45 patients from each primary care team) who received treatment between December 2003 and December 2004 and were followed up until July 2005 in the city Salvador, Northeastern Brazil. Blood pressure measures were compared at baseline and at the end of the follow-up period, and their association with cardiovascular risk factors and variables such as gender, age, body mass index, number of medical visits, number of antihypertensive drugs taken by patients, education level and family income were evaluated. Data were described as means and standard deviations, absolute and percentual values and the Wilcoxon, Kruskal-Walis and Chi-square tests were performed. RESULTS: Mean blood pressures at baseline and at the end of the follow-up were 155.9+/-24.1/95.3+/-13.9 mmHg and 137.2+/-16.1/86.7+/-8.7 mmHg (p<0.01), respectively. At starting treatment, 28.9% hypertense patients had well-controlled blood pressure levels (<140/90 mmHg) compared to 57% at the end of the follow-up period (p<0.01). The mean number of medical visits was 10.1+/-3.9, with 91.8% compliance. Two antihypertensive drugs were used by 50.4% and one drug by 35.6% of the patients. The prevalences of associated risk factors assessed at entering the program were overweight/obesity (71.9%), dyslipidemia (58.5%) and diabetes/impaired fasting glucose (43.7%). The results of the different care teams were comparable. CONCLUSIONS: The implementation of the Family Health Care Program has provided a better management of arterial hypertension but the associated risk factors have remained at higher levels than those recommended and thus needing better management.

Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort.

OBJECTIVE: To verify whether the occurrence of acute viral bronchiolitis in the first year of life constitutes a risk factor for asthma at age 6 considering a parental history of asthma. METHODS: Cross-sectional study in a cohort of live births. A standardized questionnaire of the International Study of Asthma and Allergies in Childhood was applied to the mothers to identify asthma in children at the age of 6 years. Acute viral bronchiolitis diagnosis was performed by maternal report of a medical diagnosis and/or presence of symptoms of coryza accompanied by cough, tachypnea, and dyspnea when participants were 3, 6, 9, and 12 months. Socioeconomic, environmental data, parental history of asthma, and data related to pregnancy were collected in the first 72h of life of the newborn and in prospective home visits by trained interviewers. The association between acute viral bronchiolitis and asthma was evaluated by logistic regression analysis and potential modifier effect of parental history was verified by introducing an interaction term into the adjusted logistic regression model. RESULTS: Prevalence of acute viral bronchiolitis in the first year of life was 68.6% (461). The occurrence of acute viral bronchiolitis was a risk factor for asthma at 6 years of age in children with parental history of asthma OR: 2.66, 95% CI (1.10-6.40), modifier effect p=0.002. Parental history of asthma OR: 2.07, 95% CI (1.29-3.30) and male gender OR: 1.69, 95% CI, (1.06-2.69) were other identified risk factors for asthma. CONCLUSION: Acute viral bronchiolitis in the first year of life is a risk factor for asthma in children with parental history of asthma.

Lipid profile correlates with glycemic control in young patients with type 1 diabetes mellitus.

Data on dyslipidemia in type 1 diabetes is scarce. The authors aimed to evaluate the lipid profile in patients with type 1 diabetes and its correlation to glycemic control. Ninety-four subjects (53.2% males), aged 15.4+/-4.7 (3.6-21.9 years), with disease duration of 5.0+/-3.6 years (0.3-17 years) were evaluated for heart rate, blood pressure, height, and weight. Laboratory data included total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs), glycemia, glycosylated hemoglobin (HbA1c), creatinine, thyroid-stimulating hormone, antithyroid antibodies, and 24-hour microalbuminuria. Correlations were performed by the Spearman rank correlation test, and the significance level was <0.05. Mean values were TC, 168.6+/-46.6 mg/d; HDL, 43.1+/-15.3 mg/dL; LDL, 110.9+/-40.6 mg/dL; TGs, 78.3+/-48.6 mg/dL; glycemia, 204.6+/-116.7 mg/dL; and HbA1c, 11.2%+/-2.9%. High TC (43.9% vs. 10.7%; p<0.002) and LDL (51.5% vs. 10.7%; p<0.01) were more prevalent in patients 19 years and younger (n=66). HbA1c correlated with TC (r=0.30; p=0.004), LDL (r=0.28; p=0.008), TG (r=0.31; p=0.003), and TG/HDL ratio (r=0.25; p=0.01). Duration of diabetes correlated with LDL (r=0.21; p=0.04) and insulin daily doses with TG (r=0.23; p=0.04) and body mass index expressed as z scores (r=-0.28; p=0.007). There was a high prevalence of hypercholesterolemia (54.6%) in these diabetic patients, and lipid fraction levels were correlated with HbA1c. Good management of diabetes seems to be of paramount importance in controlling dyslipidemia.

Endothelial Effect of Statin Therapy at a High Dose Versus Low Dose Associated with Ezetimibe.

BACKGROUND: The effect of statins on the endothelial function in humans remains under discussion. Particularly, it is still unclear if the improvement in endothelial function is due to a reduction in LDL-cholesterol or to an arterial pleiotropic effect. OBJECTIVE: To test the hypothesis that modulation of the endothelial function promoted by statins is primarily mediated by the degree of reduction in LDL-cholesterol, independent of the dose of statin administered. METHODS: Randomized clinical trial with two groups of lipid-lowering treatment (16 patients/each) and one placebo group (14 patients). The two active groups were designed to promote a similar degree of reduction in LDL-cholesterol: the first used statin at a high dose (80 mg, simvastatin 80 group) and the second used statin at a low dose (10 mg) associated with ezetimibe (10 mg, simvastatin 10/ezetimibe group) to optimize the hypolipidemic effect. The endothelial function was assessed by flow-mediated vasodilation (FMV) before and 8 weeks after treatment. RESULTS: The decrease in LDL-cholesterol was similar between the groups simvastatin 80 and simvastatin 10/ezetimibe (27% ± 31% and 30% ± 29%, respectively, p = 0.75). The simvastatin 80 group presented an increase in FMV from 8.4% ± 4.3% at baseline to 11% ± 4.2% after 8 weeks (p = 0.02). Similarly, the group simvastatin 10/ezetimibe showed improvement in FMV from 7.3% ± 3.9% to 12% ± 4.4% (p = 0.001). The placebo group showed no variation in LDL-cholesterol level or endothelial function. CONCLUSION: The improvement in endothelial function with statin seems to depend more on a reduction in LDL-cholesterol levels, independent of the dose of statin administered, than on pleiotropic mechanisms.

Prevalence of cardiovascular risk factors in selected samples of schoolchildren--socioeconomic influence.

Few data are available regarding the prevalence of cardiovascular risk factors in schoolchildren in Brazil. Weight, height, body mass index, blood pressure, and serum cholesterol were determined in 366 students, from 6-12 years of age, 209 (57.1%) from a private school and 157 (41.9%) from a public school, 187 (51.1%) female, aged 8.4+/-1.7 years. Prevalence of the risk of being overweight was 14.8%, being overweight/obese 13.1%, and presenting with elevated cholesterol (>/=170 mg/dL) was 28.1%, particularly at the private school: 21.5% vs. 5.7% for the risk of being overweight (p<0.001), 17.2% vs. 7.6% for being overweight/obese (p<0.01), 41.8% vs. 10.2% for cholesterol >/=170 mg/dL (p<0.001), and 14.8% vs. 1.3% for cholesterol >/=200 mg/dL (p<0.001), respectively. The results showed a high prevalence of risk factors among these school children, especially among private students.

Assessment of risk factors in coronary patients being followed by cardiologists: control of risk factors in coronary patients.

Control of risk factors for coronary heart disease secondary prevention is still very unsatisfactory. This study assessed 104 patients referred by cardiologists to discover how carefully National Cholesterol Education Program II recommendations were being followed. Average age of the cohort was 60.9+/-10.8 years, and 67.3% were men. A total of 57(54.8%) experienced a previous myocardial infarction and 83 (80.3%) a revascularization procedure. They saw their doctors 4.4+/-2.9 times a year and had blood tests 2.8+/-1.7 times a year. Blood pressure was >/=140/90 mm Hg in 57.8%, body mass index >/=25 kg/m2 in 62.5%, and the weight-to-hip ratio >/=0.95 in 42.9% of men, and >/=0.85 in 47.0% of women. Total, low-density lipoprotein, and high-density lipoprotein cholesterol and triglyceride values were 222.9+/-47.3 mg/dL, 144.9 mg/dL, 44.8+/-11.5 mg/dL, and 176+/-119.41 mg/dL, respectively. Low-density lipoprotein cholesterol was <100 mg/dL in 8.1%, and <130 mg/dL in 47.1%; the total cholesterol/high-density lipoprotein cholesterol ratio was 5.1+/-1.5 (>/=5 in 51%). In these patients, the control of major risk factors like high blood pressure, overweight, and high low-density lipoprotein cholesterol was poor.

[Environmental factors associated with the decision time for seeking care in myocardial infarction]. / Fatores ambientais associados ao tempo de decisão para procura de atendimento no infarto do miocárdio.

The purpose was to estimate the decision time (DT) for searching for attendance for men and women suffering from acute myocardial infarction (AMI); and to analyze the influence of surrounding variables in the DT. Transversal study, involving one hundred patients interviewed in hospitals of Salvador-BA, Brazil. For data analysis, it was used the chi-squared or Fisher's exact test, and the Robust Linear Regression Model. AMI at the home predominated, with family members and patients receiving mistaken actions. A high DT was observed both, for women (0.9h) and men (1.4h). Those at home during the initial symptoms had higher DT, compared to those at work; and lower in relation to those in public spaces (p=0.047). Statistically significant interaction occurred among gender and the fact of living with company; and among gender and having a companion and children, for the outcome of the DT. Nursing care focused on the specificity of surrounding factors and gender can optimize early attendance.

Comparison of the energy and metabolic nutritional profile of women with central obesity of socioeconomic classes A/B vs C/D/E / Comparación del perfil nutricional energético y metabólico de las mujeres con obesidad central de las clases socioeconómicas A/B versus C/D/E

Objective: to describe the characteristics of food consumption and energy intake of women with central obesity of socioeconomic classes A/B vs C/D/E. Methodology: a cross-sectional study in which a structured questionnaire was answered containing data on socioeconomics and physical activities. Weight and waist circumference (WC) were measured and the 24-hour recall was assessed (24hR) in relation to food consumption. Biochemical exams were analyzed. The dietary analysis was performed on the Nutwin software and statistical analysis on the SPSS 23.0. Results: there were 89 women assessed in each group and no significant differences were observed in relation to age, with averages of 51.2 ± 12.2 years vs 49 ± 14.4 years for classes C/D/E vs A/B, respectively. A sedentary lifestyle was predominant for class C/D/E 82 (92.13%) vs 22 (24.71%) (p < 0.001).Significant differences were observed between the groups for variables of hypertriglyceridemia (p < 0.001), predominant in the C/D/E socioeconomic group, and HDL-C (p < 0.001), predominant in the A/B socioeconomic group. Total energy consumption of women from class C/D/E vs A/B presented mean values of 1,528.72 kcal (1,128.8-1,697.3) vs 2,267.48 kcal (1,670.3-2,625.84), respectively. Significant differences were observed in the consumption of fiber between groups C/D/E vs A/B (p < 0.001), with less consumption in class C/D/E. With reference to income and schooling levels, we observed heterogeneity in the results and emphasize the marked contrast between low and high income that could influence the choice of food, contributing in the lower income to monotonous diets, less energy consumption and, furthermore, low quality in the ingested food. Conclusion: in this study, all of the women presented metabolic profiles in different manners among the groups and, also, women of class C/D/E, who presented insufficient fiber consumption, directly contributing to this condition of obesity, also presented worse lipid (total cholesterol and triglycerides) and glycemic profiles

Objetivo: describir las características del consumo alimentario e ingestión energética de mujeres con obesidad central de clase socioeconómica A/B vs C/D/E. Metodología: estudio transversal en el que respondieron a un cuestionario estructurado que contenía datos socioeconómicos y actividad física. Se evaluaron el peso, circunferencia de la cintura (CC) y se hizo un recordatorio de 24 horas (R24h) en relación al consumo alimentario y los exámenes bioquímicos. Los análisis dietéticos se realizaron en el software Nutwin y los análisis estadísticos en el SPSS 23.0. Resultados: se valoraron 89 mujeres en cada grupo y no se observó diferencia significativa para la edad, con una media de 51,2 ± 12,2 años frente a 49 ± 14,4 años clase C/D/E vs A/B, respectivamente. El sedentarismo fue predominante en la clase C/D/E 82 (92,13%) vs 22 (24,71%), (p < 0,001). Se observaron diferencias significativas entre los grupos para las variables de hipertrigliceridemia (p < 0,001), predominantes en el grupo de clase socioeconómico C/D/E y HDL-C (p < 0,001), predominante en el grupo de clase socioeconómico A/B. El consumo energético total de las mujeres de clase C/D/E vs A / B, presentó medianas de 1528,72 kcal (1128,8-1697,3) frente a 2267,48 kcal (1670,3-2625,84), respectivamente. Se observó una diferencia significativa del consumo de fibra entre los grupos C/D/E vs A/B (p < 0,001), siendo el consumo menor en la clase C / D / E. En lo que se refiere a la renta y escolaridad, observamos la heterogeneidad de los resultados y destacamos el marcado contraste entre la baja y elevada renta lo que podría influir en la elección de los alimentos, contribuyendo en la menor renta para la monotonía alimentaria, menor consumo energético y, además, baja calidad de los alimentos ingeridos. Conclusión: en este estudio, todas las mujeres presentaron perfiles metabólicos de maneras distintas entre los grupos. Las mujeres de la clase C/D/E, presentaron consumo insuficiente de fibra, lo que ciertamente contribuyó al cuadro de obesidad encontrado y paralelamente presentan peor perfil lipídico (colesterol total y triglicéridos) y glucémico

Effect of nursing telemonitoring on the knowledge of obese women: clinical trial / Resultado del telemonitoreo de enfermería en el conocimiento de mujeres obesas: un ensayo clínico / Efeito do telemonitoramento de enfermagem no conhecimento de mulheres obesas: ensaio clínico

ABSTRACT Objective: To assess the effectiveness of remote monitoring in the knowledge of overweight women. Method: Randomized clinical trial with 101 women, randomly assigned to the control group (CG=50) and to the intervention group (IG=51). The IG received educational intervention over the telephone, during three months and routine follow-up in the service, while the CG only received conventional follow-up. The knowledge was assessed by a specific questionnaire. Data were analyzed by the Robust Linear Regression Model, adopting a statistical significance of 5%. Results: In the intragroup assessment, an increase in the correct answers with a statistically significant difference was observed only for the IG in the domains: "Concept and causes of overweight," "Complications of overweight" and "Eating habits." In the intergroup comparison, an increase in the average knowledge was verified in the same domains for the IG (p≤0.005). Conclusion: nursing telemonitoring contributed positively to the improvement of women's knowledge.

RESUMEN Objetivo: Evaluar la eficacia del monitoreo a distancia de enfermería en la mejora del conocimiento de mujeres con sobrepeso. Método: Ensayo clínico aleatorizado, realizado con 101 mujeres, asignadas aleatoriamente en grupo control (GC =50) y en grupo de intervención (GI =51). El GI recibió intervención educativa por teléfono, durante tres meses, y seguimiento de rutina en el servicio, mientras que el GC recibió solo el seguimiento convencional. Se evaluó el conocimiento mediante un cuestionario específico. Los datos se analizaron utilizando el Modelo de Regresión Linear Robusto, adoptando la significancia estadística del 5%. Resultados: En la evaluación intragrupal, hubo un aumento en los aciertos con una diferencia estadísticamente significante solo para el GI en los dominios: "Concepto y causas del sobrepeso", "Complicaciones del sobrepeso" y "Hábitos alimenticios". En la comparación intergrupal, se verificó que el GI aumentó la media del conocimiento en los mismos dominios (p≤0,005). Conclusión: el telemonitoreo de enfermería contribuyó positivamente a la mejora del conocimiento de las mujeres.

RESUMO Objetivo: Avaliar a efetividade do monitoramento remoto de enfermagem na melhora do conhecimento de mulheres com excesso de peso. Método: Ensaio clínico randomizado, com 101 mulheres, alocadas aleatoriamente no grupo controle (GC = 50) e no grupo intervenção (GI = 51). O GI recebeu intervenção educativa por telefone durante três meses e acompanhamento de rotina no serviço, e o GC, apenas acompanhamento convencional. O conhecimento foi avaliado por questionário específico. Os dados foram analisados pelo Modelo de Regressão Linear Robusto, adotando-se significância estatística de 5%. Resultados: Na avaliação intragrupo houve aumento de acertos com diferença estatisticamente significante apenas para o GI nos domínios: "Conceito e causas do excesso de peso", "Complicações do excesso de peso" e "Hábitos alimentares". Na comparação intergrupos, verificou-se para o GI aumento na média do conhecimento nos mesmos domínios (p ≤ 0,005). Conclusão: o telemonitoramento de enfermagem contribuiu positivamente para a melhora do conhecimento das mulheres.

Quality of life of patients after an acute coronary event: hospital discharge.

BACKGROUND: The acute coronary syndrome (ACS) has a high morbi-mortality rate, including physical deficiencies and functional limitations with impact on quality of life. Cardiovascular rehabilitation 1 (CVR1) should begin as early as possible, to enable improvement in functional capacity and quality of life. Previous studies have shown association of cardiovascular diseases with quality of life, in which depression and anxiety are the domains most altered. The aim of the study is to verify the impact of an acute coronary event on quality of life at the moment of hospital discharge. METHODOLOGY: This was a cross-sectional study, with ACS patients hospitalized in ICU of a private hospital in the city of Salvador, Brazil, submitted to CVR1. The quality of life questionnaire Euroqol-5D was applied on discharge from hospital. Patients included in the study were those with ACV, who had medical permission to walk, had not been submitted to acute surgical treatment, were time and space oriented, and over the age of 18 years. Patients excluded from the study were those with cognitive, orthopedic and neurological problems, who used orthesis on a lower limb, and were in any condition of risk at the time of beginning with CVR1. Data were collected by a previously trained ICU team. RESULTS: Data were collected of 63 patients who revealed compromise in the domains of pain/feeling ill (20.63%) and anxiety/depression (38.09%). Statistical significance was observed in the association between sex and pain/feeling ill (P < 0.01), sex and anxiety/depression (P < 0.01), diabetes and mobility (P < 0.01), hereditary factors and anxiety/depression (p < 0.01), BMI and pain/feeling ill (P < 0.01). CONCLUSION: In this sample of patients, on discharge from hospital after ACS, the pain/feeling ill and anxiety/depression domains were shown to be compromised.

Association between birth weight and cardiovascular risk factors in adolescents.

BACKGROUND: Birth weight (BW) is a medium- and long-term risk determinant of cardiovascular risk factors. OBJECTIVE: To assess the association between BW and cardiovascular risk factors in adolescents of the city of Salvador, Bahia state. METHODS: Cross-sectional study with comparison of BW groups. Sample comprising 250 adolescents classified according to the BMI as follows: high-normal (> 50th percentile and < 85th percentile); overweight (> 85th percentile and < 95th percentile); and obesity (> 95th percentile). The risk variables compared were as follows: waist circumference (WC); arterial blood pressure; lipid profile; glycemia; serum insulin; HOMA-IR; and metabolic syndrome. The BW was informed by parents and classified as follows: low (BW < 2,500g); normal (BW > 2,500g and < 4,000g); and high (BW > 4,000g). RESULTS: One hundred and fifty-three (61.2%) girls, age 13.74 ± 2.03 years, normal BW 80.8%, low BW 8.0%, and high BW 11.2%. The high BW group as compared with the normal BW group showed a higher frequency of obesity (42.9%, p=0.005), elevated SBP and DBP (42.9%, p=0.000 and 35.7%, p=0.007, respectively), and metabolic syndrome (46.4%, p=0.002). High BW adolescents as compared with normal BW adolescents had a prevalence ratio for high SBP 3.3 (95% CI: 1.7-6.4) and obesity 2.6 (95% CI: 1.3-5.2). The WC of high BW adolescents was 83.3 ± 10.1 (p=0.038). The lipid profile showed no statistically significant differences. CONCLUSION: Our findings suggest that obesity, elevated SBP and DBP, and metabolic syndrome during adolescence might be associated with high BW.

Sociodemographic and clinical factors associated with the decision time for seeking care in acute myocardial infarction.

OBJECTIVE: this study aimed to analyze the interaction of gender in the association between decision time for seeking healthcare services and the sociodemographic and clinical variables. METHOD: this exploratory, cross-sectional study was performed with 100 individuals interviewed in hospitals in Salvador, Bahia. The chi-square test or Fisher's exact test and the robust linear regression model were used in the analysis. A statistical significance of 5% was adopted. RESULTS: men and women presented long decision times. The decision time was less for smokers and those with constant and/or severe pain. There was an interaction between gender and smoking and between gender and pain radiating to the neck or jaw for the decision time outcome. CONCLUSION: decision times were long and were influenced by clinical and gender variables. The study provides support for nursing care practices focused on the specificity of these factors and of the genders aiming to reduce the decision time.