Ana Luiza Lima Sousa

Diet and medication in the treatment of hyperuricemia in hypertensive patients

OBJECTIVE To evaluate the effects of diet and medication, either isolated or associated, on serum levels of uric acid in patients with hyperuricemia. METHODS We studied patients from the Hypertension Unit of the University of Goias who had hyperuricemia (men > or =8.5 mg/dL and women > or =7.5 mg/dL). We divided the patients into three groups: G1 (low purine diet), G2 (low purine diet + medication), and G3 (medication only). Patients received allopurinol, 150 mg/day titrated up to 300 mg/dL when necessary. Patients were evaluated with regards to their lifestyles (diet, smoking, physical, activity, alcohol consumption), uric acid, blood pressure, use of medication, body mass index, cholesterol, and triglyceride. Follow-up took place in weeks 0 (M1), 6 (M2), 12 (M3) during the intervention and in week 36 (M4) after the study was completed. RESULTS Fifty-five patients participated in the study, 31 women, mean age 54.4+/-10.6 years, body mass index 28.6+/-3.9 kg/m2. A similar reduction (p<0.001) in uric acid levels occurred in the three intervention groups. In week 36 (M4), after 24 weeks without intervention, a tendency toward elevation of uricemia was noted in G2 and G3, and a continuous drop in uricemia was noted in G1. No significant modifications were observed in the other variables analyzed. CONCLUSION Considering the cost x benefit relationship, a diet low in purine should be the 1st therapeutic option for controlling hyperuricemia in patients with similar characteristic to the ones presented in this study.

Hospitalizações por condições cardiovasculares sensíveis à atenção primária em municípios goianos

OBJETIVO: Analisar taxas de hospitalizacao por condicoes cardiovasculares sensiveis a atencao primaria. METODOS: Estudo ecologico com 237 municipios do Estado de Goias, de 2000 a 2008, utilizando dados do Sistema de Informacao Hospitalar e Sistema de Informacao da Atencao Basica. As taxas de hospitalizacao foram calculadas pela proporcao entre o numero de hospitalizacoes por condicoes cardiovasculares e a populacao acima de 40 anos. Foram avaliadas em trienios: A (2000-2002), B (2003-2005) e C (2006-2008), segundo sexo, faixa etaria, porte populacional, pertencimento a regiao metropolitana, macrorregiao de saude, distância da capital, Indice de Condicoes de Vida e Saude e cobertura de Estrategia Saude da Familia. A cobertura populacional potencial da Saude da Familia foi calculada conforme diretrizes do Ministerio da Saude. A variabilidade das taxas foi avaliada segundo teste t e ANOVA. RESULTADOS: Ocorreram 253.254 internacoes (17,2% do total) por condicoes cardiovasculares sensiveis a atencao primaria. As taxas de hospitalizacao diminuiram entre os trienios: A (213,5, dp = 104,6), B (199,7, dp = 96,3) e C (150,2, dp = 76,1), com diferenca entre os periodos A-C e B-C (p < 0,001). Porte populacional municipal nao influenciou o comportamento das taxas. Municipios proximos a capital e aqueles da regiao metropolitana apresentaram maiores taxas (p < 0,001). Em todos os percentis do Indice de Condicoes de Vida e Saude, houve reducao das taxas (p < 0,001), exceto no percentil 1. Reducao foi tambem observada em todas as macrorregioes, exceto na regiao nordeste do estado. A reducao das taxas ocorreu independentemente da cobertura da Saude da Familia. CONCLUSOES: As taxas de hospitalizacao por condicoes cardiovasculares sensiveis a atencao primaria diminuiram nesses municipios, independentemente da cobertura da Saude da Familia.OBJECTIVE To analyze rates of hospitalization due to primary care-sensitive cardiovascular conditions. METHODS This ecological study on 237 municipalities in the state of Goiás, Central-West Brazil, between 2000 and 2008, used data from the Hospital Information System and the Primary Care Information System. The hospitalization rates were calculated as the ratio between the number of hospitalizations due to cardiovascular conditions and the population over the age of 40 years. The data were evaluated over the three-year periods A (2000-2002), B (2003-2005) and C (2006-2008), according to sex, age group, population size, whether the individual belonged to the metropolitan region, healthcare macroregion, distance from the state capital, living conditions index and coverage within the Family Health Strategy. The potential population coverage of the Family Health Strategy was calculated in accordance with Ministry of Health guidelines. The variability of the rates was evaluated using the t test and ANOVA. RESULTS A total of 253,254 hospitalizations (17.2%) occurred due to primary care-sensitive cardiovascular conditions. The hospitalization rates diminished between the three-year periods: A (213.5, SD = 104.6), B (199.7, SD = 96.3) and C (150.2, SD = 76.1), with differences from A to C and from B to C (p < 0.001). Municipal population size did not influence the behavior of the rates. Municipalities near the state capital and those in the metropolitan area presented higher rates (p < 0.001). At all percentiles of the Life and Health Conditions Index, there were decreases in the rates (p < 0.001), except at percentile 1. Decreases were also observed in all the macroregions except for the northeastern region of the state. The reduction in rates was independent of the Family Health Strategy coverage. CONCLUSION The rates of hospitalization due to primary care-sensitive cardiovascular conditions decreased in these municipalities, independent of the Family Health Strategy coverage.

The effect of educational intervention on the disease knowledge of diabetes mellitus patients

La prevencion de diabetes y sus complicaciones es un desafio para el equipo de salud. El objetivo de esta investigacion fue evaluar el efecto de accion educativa sobre el conocimiento de la enfermedad en pacientes portadores de diabetes tipo 2. Fue realizado ensayo clinico aleatorizado con 62 pacientes registrados en servicio de referencia en tratamiento de la hipertension arterial en 2010. Los datos fueron obtenidos a traves de un cuestionario aplicado a los grupos Intervencion (GI) y Control (GC), al inicio y al final del estudio. El GI participo de actividades educativas grupales, utilizando la metodologia problematizadora. Los resultados muestran un aumento significativo del conocimiento sobre la diabetes en pacientes del GI, en todas las cuestiones (p<0,05). En el GC, algunas alteraciones observadas, fueron mucho menores cuando comparadas al GI. Se concluye que fue posible elevar los conocimientos sobre la enfermedad por medio de realizacion de actividades educativas. Numero del Registro clinico, Identificador primario: RBR-58n26hDescriptores: Enfermeria en Salud Comunitaria; Educacion en Salud; Diabetes Mellitus; Autocuidado.Rev. Latino-Am. EnfermagemThe prevention of diabetes and its complications is a challenge for the healthcare team. The aim of this study was to evaluate the effect of educational action on the disease knowledge of patients with type 2 diabetes. A randomized clinical trial was conducted with 62 patients registered in a service of reference in the treatment of hypertension in 2010. Data were collected through a questionnaire applied to the Intervention (IG) and Control (CG) groups at the beginning and at the end of the study. The IG participated in group educational activities, using problematization methodology. The results showed a significant increase in knowledge about diabetes in the patients of the IG, in all the topics (p<0.05). In the CG, some changes were observed in knowledge, however, these were fewer when compared with the IG. In conclusion, it was possible to increase disease knowledge through the performance of educational activities. Clinical trial identifier: RBR-58n26h.

Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

Background Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Objective Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Methods Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. Results We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Conclusion Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

Parental stress in mothers of children and adolescents with cerebral palsy

Objectives to evaluate parental stress of mothers of children and adolescents with cerebral palsy; to verify whether parental stress undergoes variations according to the level of motor compromise, the childs phase of life, and sociodemographic variables. Method a cross-sectional, descriptive study, with 223 mothers of children and adolescents with cerebral palsy. Results 45.3% of the mothers presented high levels of stress; there were differences in stress between mothers of children with mild and severe motor impairment; mothers of older children were more stressed than mothers of younger children and of adolescents; paid work and leisure activities reduced the stress. Conclusion mothers of children and adolescents with cerebral palsy, whose children present mild to severe motor impairment are vulnerable to parental stress. Paid work and leisure activities were the factors that contributed most to reducing the stress.OBJETIVOS: evaluar el estres familiar de madres de ninos y adolescentes con paralisis cerebral; verificar si el estres familiar sufre variaciones dependientes del nivel de compromiso motor, de las fases de la vida en que los hijos se encuentran y de las variables sociodemograficas. METODO: estudio transversal y descriptivo con 223 madres de ninos y adolescentes con paralisis cerebral. RESULTADOS: 45,3% de las madres presentaron altos niveles de estres; existen diferencias en el estres entre las madres de hijos con leve y grave comprometimiento motor; las madres de ninos mayores estaban mas estresadas que las madres de ninos menores y de adolescentes; el trabajo remunerado y el tiempo libre redujeron el estres. CONCLUSION: las madres de ninos y adolescentes con paralisis cerebral, cuyos hijos presentan compromiso motor, de leve a grave, son vulnerables al estres familiar. El trabajo remunerado y las actividades de tiempo libre fueron los factores que mas contribuyeron para reducir el estres

Comparação e correlação entre automedida, medida casual e monitorização ambulatorial da pressão arterial

BACKGROUND Casual blood pressure (BP) measurement by healthcare professionals is subject to great variability and new methods are necessary to overcome this limitation. OBJECTIVE To compare and assess the correlation between the BP levels obtained by self-measured BP (SMBP), casual BP measurement and ambulatory blood pressure monitoring (ABPM). METHODS We assessed hypertensive individuals submitted to the three methods of BP measurement at an interval < 30 days; the BP means were used for comparison and correlation. The following devices were used: OMRON 705 CP (casual measurement), OMRON HEM 714 (SMBP) and SPACELABS 9002 (ABPM). RESULTS A total of 32 patients were assessed, of which 50.09% were females, with a mean age of 59.7 (± 11.2), BMI mean of 26.04 (± 3.3) kg/m(2). Mean systolic (SBP) and diastolic blood pressure (DBP) for SMBP were 134 (± 15.71) mmHg and 79.32 (± 12.38) mmHg. The casual measurement means of SBP and DBP were, respectively, 140.84 (± 16.15) mmHg and 85 (± 9.68) mmHg. The mean values of ABPM during the wakefulness period were 130.47 (± 13.26) mmHg and 79.84 (± 9.82) mmHg for SBP and DBP, respectively. At the comparative analysis, the SMBP had similar results to those obtained at ABPM (p > 0.05) and different from the casual measurement (p < 0.05). At the analysis of correlation, SMBP values were higher than the casual measurements, considering ABPM as the reference standard in BP measurements. CONCLUSION SMBP showed a better correlation with ABPM than the casual measurement and was also better correlated with the latter, especially regarding the DBP and should be considered as a low-cost alternative for the follow-up of the hypertensive patient.

Automedida da pressão arterial para o controle das cifras tensionais e para a adesão ao tratamento

BACKGROUND: The measurement of blood pressure (BP) by the patient himself without strict protocols, adequate training, and validated equipment at their own household is defined as self measured blood pressure (SMBP). OBJECTIVE: To evaluate the interference of the SMBP in treatment adherence and blood pressure control. METHODS: The study included 57 patients, 38 in the study group (SG) and 19 in the control group (CG). These patients were followed for 12 months and assessed at randomization (V1) as well as in the sixth (V2) and the twelfth month (V3). Compare the mean blood pressure by casual measurement, by SMBP and by ambulatory monitoring of blood pressure (AMBP), laboratory tests and the answers to the questionnaire on lifestyle. The instruments used were: OMRON HEM 714, for SMBP; OMRON 705 CP, for the casual measurement, and Monitor SPACELABS 9002 for the AMBP. RESULTS: The average age was 62.05 ± 10.78 in the SG and 55.42 ± 11.87 in the CG (p = 0.03). The values of systolic blood pressure (SBP) by casual measurement in the SG and CG were: 140.01 ± 16.73 mmHg and 141.79 ± 23.21 mmHg in V1 (p = 0.72), 135.49 ± 12.73 mmHg and 145.69 ± 19.31 mmHg in V2 (p = 0.02), 131.64 ± 19.28 mmHg and 134.88 ± 23.21 mmHg at V3 (p = 0.59). The values of diastolic blood pressure (DBP) were: 84.13 ± 10.71 mmHg and 86.29 ± 10.35 mmHg in V1 (p = 0.47), 81.69 ± 10.88 mmHg and 89.61 V2 ± 11.58 mmHg (p = 0.02), 80.31 ± 11.83 mmHg and 86 ± 13.38 mmHg in V3 (p = 0.12). CONCLUSION: Patients in the SG had adherence to non-pharmacological treatment similar to the CG, but they had greater adherence to drug treatment and used fewer antihypertensive drugs. There was no difference between groups when comparing the metabolic profile and renal function. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0)

Comparison and correlation between self-measured blood pressure, casual blood pressure measurement and ambulatory blood pressure monitoring

BACKGROUND Casual blood pressure (BP) measurement by healthcare professionals is subject to great variability and new methods are necessary to overcome this limitation. OBJECTIVE To compare and assess the correlation between the BP levels obtained by self-measured BP (SMBP), casual BP measurement and ambulatory blood pressure monitoring (ABPM). METHODS We assessed hypertensive individuals submitted to the three methods of BP measurement at an interval < 30 days; the BP means were used for comparison and correlation. The following devices were used: OMRON 705 CP (casual measurement), OMRON HEM 714 (SMBP) and SPACELABS 9002 (ABPM). RESULTS A total of 32 patients were assessed, of which 50.09% were females, with a mean age of 59.7 (± 11.2), BMI mean of 26.04 (± 3.3) kg/m(2). Mean systolic (SBP) and diastolic blood pressure (DBP) for SMBP were 134 (± 15.71) mmHg and 79.32 (± 12.38) mmHg. The casual measurement means of SBP and DBP were, respectively, 140.84 (± 16.15) mmHg and 85 (± 9.68) mmHg. The mean values of ABPM during the wakefulness period were 130.47 (± 13.26) mmHg and 79.84 (± 9.82) mmHg for SBP and DBP, respectively. At the comparative analysis, the SMBP had similar results to those obtained at ABPM (p > 0.05) and different from the casual measurement (p < 0.05). At the analysis of correlation, SMBP values were higher than the casual measurements, considering ABPM as the reference standard in BP measurements. CONCLUSION SMBP showed a better correlation with ABPM than the casual measurement and was also better correlated with the latter, especially regarding the DBP and should be considered as a low-cost alternative for the follow-up of the hypertensive patient.

Comparison of Cardiovascular Risk Factors in Different Areas of Health Care Over a 20-Year Period

Background Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs. Objectives To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years. Methods All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05. Results The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase in dyslipidemia (p < 0.05). Conclusion In general, there was an unfavorable progression of CVRFs in the population under study, despite it having adequate specialized knowledge about these risk factors.

Efectos de intervención educativa sobre el conocimiento de la enfermedad en pacientes con diabetes mellitus

La prevencion de diabetes y sus complicaciones es un desafio para el equipo de salud. El objetivo de esta investigacion fue evaluar el efecto de accion educativa sobre el conocimiento de la enfermedad en pacientes portadores de diabetes tipo 2. Fue realizado ensayo clinico aleatorizado con 62 pacientes registrados en servicio de referencia en tratamiento de la hipertension arterial en 2010. Los datos fueron obtenidos a traves de un cuestionario aplicado a los grupos Intervencion (GI) y Control (GC), al inicio y al final del estudio. El GI participo de actividades educativas grupales, utilizando la metodologia problematizadora. Los resultados muestran un aumento significativo del conocimiento sobre la diabetes en pacientes del GI, en todas las cuestiones (p<0,05). En el GC, algunas alteraciones observadas, fueron mucho menores cuando comparadas al GI. Se concluye que fue posible elevar los conocimientos sobre la enfermedad por medio de realizacion de actividades educativas. Numero del Registro clinico, Identificador primario: RBR-58n26hDescriptores: Enfermeria en Salud Comunitaria; Educacion en Salud; Diabetes Mellitus; Autocuidado.Rev. Latino-Am. EnfermagemThe prevention of diabetes and its complications is a challenge for the healthcare team. The aim of this study was to evaluate the effect of educational action on the disease knowledge of patients with type 2 diabetes. A randomized clinical trial was conducted with 62 patients registered in a service of reference in the treatment of hypertension in 2010. Data were collected through a questionnaire applied to the Intervention (IG) and Control (CG) groups at the beginning and at the end of the study. The IG participated in group educational activities, using problematization methodology. The results showed a significant increase in knowledge about diabetes in the patients of the IG, in all the topics (p<0.05). In the CG, some changes were observed in knowledge, however, these were fewer when compared with the IG. In conclusion, it was possible to increase disease knowledge through the performance of educational activities. Clinical trial identifier: RBR-58n26h.