Helena França Correia dos Reis

Maior Letalidade e Morbidade por Infarto Agudo do Miocárdio em Hospital Público, em Feira de Santana - Bahia

FUNDAMENTO: Fatores relacionados ao nivel socio-economico, a qualidade e a gestao assistencial podem influenciar na letalidade e morbidade por infarto agudo do miocardio (IAM). OBJETIVO: Comparar letalidade e morbidade por IAM entre hospital publico e privado. METODOS: Estudo observacional, com grupos de comparacao. Avaliacao clinica na admissao e registro de dados diagnosticos, terapeuticos e evolutivos ate a alta ou o obito. Comparacao das caracteristicas clinicas por analise univariada seguida de analise bivariada, avaliando a associacao de preditores com obito e morbidade (Killip >I), SPSS, versao 13,0. RESULTADOS: Avaliados 150 pacientes, 63 (42,0%) privados e 87 (58,0%) publicos, com 63,1% e 62,1% de homens e idades de 61,1±13,8 e 60,0±11,6 anos, respectivamente. A letalidade por IAM foi de 19,5% nos publicos vs 4,8% nos privados (p=0,001) e a morbidade (Killip classe >1) de 34,3% nos publicos vs 15,0% nos privados (p=0,012). Houve diferenca significativa nos publicos devido a menor renda familiar e escolaridade (70,1% com um a dois salarios vs 19,0%, p 1 hora: 76,9% vs 48,6%; p=0,003) e maior tempo para ser medicado (THM>15 minutos: 47,1% vs 8,0%, p<0,001), UTI para 8% vs 94% nos privados e trombolise para 20,6% vs 54,0%, respectivamente (p<0,001). CONCLUSAO: Letalidade e morbidade maior no paciente publico, que se apresentou mais grave, mais tardiamente e recebeu tratamento de menor qualidade.BACKGROUND Factors related to socioeconomic status and health care quality and management may influence mortality and morbidity rates due to acute myocardial infarction (AMI). OBJECTIVE To compare mortality and morbidity in patients with AMI hospitalized in public and private hospitals. METHODS An observational study, with comparison groups. Clinical evaluation on admission, and recording of diagnostic, therapeutic and evolution data until discharge or death. Comparison of clinical characteristics by univariate analysis followed by bivariate analysis, evaluating the combination of predictors with death and morbidity (Killip> I), SPSS, version 13.0. RESULTS 150 patients were evaluated, 63 (42.0%) of private hospitals and 87 (58.0%) of public hospitals, with 63.1% and 62.1% of males, aged 61.1 +/- 13.8 and 60.0 +/- 11.6 years, respectively. The mortality from AMI was 19.5% in public hospitals vs 4.8% in private hospitals (p = 0.001), and morbidity (Killip class> I) was 34.3% in public hospitals vs 15.0% in private hospitals (p = 0.012). There was a significant difference between public and private patients, due to lower family income and education (70.1% with one to two salaries vs 19.0%, p <0.001, and 49.4% of illiterates vs 6.3%, p <0.001, respectively ); late arrival at the hospital (HAT> 1 hour: 76.9% vs 48.6%, p = 0.003); and a longer period of time before being medicated (AMT > 15 minutes: 47.1% vs 8.0%; p <0.001); ICU for 8% of the patients in public hospitals vs 94% in private hospitals; and thrombolysis for 20.6% vs 54.0%, respectively (p <0.001). CONCLUSION Mortality and morbidity were greater among public patients, which presented more serious conditions, arrived later at the hospital and received lower quality treatment.

Increased mortality and morbidity due to acute myocardial infarction in a public hospital, in Feira de Santana, Bahia

FUNDAMENTO: Fatores relacionados ao nivel socio-economico, a qualidade e a gestao assistencial podem influenciar na letalidade e morbidade por infarto agudo do miocardio (IAM). OBJETIVO: Comparar letalidade e morbidade por IAM entre hospital publico e privado. METODOS: Estudo observacional, com grupos de comparacao. Avaliacao clinica na admissao e registro de dados diagnosticos, terapeuticos e evolutivos ate a alta ou o obito. Comparacao das caracteristicas clinicas por analise univariada seguida de analise bivariada, avaliando a associacao de preditores com obito e morbidade (Killip >I), SPSS, versao 13,0. RESULTADOS: Avaliados 150 pacientes, 63 (42,0%) privados e 87 (58,0%) publicos, com 63,1% e 62,1% de homens e idades de 61,1±13,8 e 60,0±11,6 anos, respectivamente. A letalidade por IAM foi de 19,5% nos publicos vs 4,8% nos privados (p=0,001) e a morbidade (Killip classe >1) de 34,3% nos publicos vs 15,0% nos privados (p=0,012). Houve diferenca significativa nos publicos devido a menor renda familiar e escolaridade (70,1% com um a dois salarios vs 19,0%, p 1 hora: 76,9% vs 48,6%; p=0,003) e maior tempo para ser medicado (THM>15 minutos: 47,1% vs 8,0%, p<0,001), UTI para 8% vs 94% nos privados e trombolise para 20,6% vs 54,0%, respectivamente (p<0,001). CONCLUSAO: Letalidade e morbidade maior no paciente publico, que se apresentou mais grave, mais tardiamente e recebeu tratamento de menor qualidade.BACKGROUND Factors related to socioeconomic status and health care quality and management may influence mortality and morbidity rates due to acute myocardial infarction (AMI). OBJECTIVE To compare mortality and morbidity in patients with AMI hospitalized in public and private hospitals. METHODS An observational study, with comparison groups. Clinical evaluation on admission, and recording of diagnostic, therapeutic and evolution data until discharge or death. Comparison of clinical characteristics by univariate analysis followed by bivariate analysis, evaluating the combination of predictors with death and morbidity (Killip> I), SPSS, version 13.0. RESULTS 150 patients were evaluated, 63 (42.0%) of private hospitals and 87 (58.0%) of public hospitals, with 63.1% and 62.1% of males, aged 61.1 +/- 13.8 and 60.0 +/- 11.6 years, respectively. The mortality from AMI was 19.5% in public hospitals vs 4.8% in private hospitals (p = 0.001), and morbidity (Killip class> I) was 34.3% in public hospitals vs 15.0% in private hospitals (p = 0.012). There was a significant difference between public and private patients, due to lower family income and education (70.1% with one to two salaries vs 19.0%, p <0.001, and 49.4% of illiterates vs 6.3%, p <0.001, respectively ); late arrival at the hospital (HAT> 1 hour: 76.9% vs 48.6%, p = 0.003); and a longer period of time before being medicated (AMT > 15 minutes: 47.1% vs 8.0%; p <0.001); ICU for 8% of the patients in public hospitals vs 94% in private hospitals; and thrombolysis for 20.6% vs 54.0%, respectively (p <0.001). CONCLUSION Mortality and morbidity were greater among public patients, which presented more serious conditions, arrived later at the hospital and received lower quality treatment.

Prevalence and variables associated with physical inactivity in individuals with high and low socioeconomic status

BACKGROUND: Studies that considered only the leisure physical activity found that the physical inactivity is higher among lower-income individuals. There is a possibility that this association shows modifications, when considering transportation, work and domestic activities. OBJECTIVE: To determine whether there is a difference between the prevalence of physical inactivity between individuals of high and low socioeconomic levels. METHODS: The sample consisted of individuals of both sexes, aged 18 or older, from two groups of different socioeconomic levels. The low socioeconomic level (LSEL) group consisted of the parents of students from a public school. The high socioeconomic level (HSEL) group consisted of the parents of students from a private College. The International Physical Activity Questionnaire (IPAQ) was used to determine the level of physical activity. RESULTS: A total of 91 individuals were evaluated in the LSEL group and 59 in the HSEL group. In the LSEL group, 42.9% (39) of the individuals were classified as insufficiently active, compared to 57.6% (34) of individuals in the HSEL group. Taking as a parameter of physical inactivity the time of weekly physical activity < 150 minutes, there was a decrease in the classification of inactivity in both groups, although with the maintenance of higher inactivity among individuals of HSEL (49.2% vs 28.6%; p= 0.01). CONCLUSION: The individuals of HSEL are more sedentary than the individuals of LSEL.BACKGROUND Studies that considered only the leisure physical activity found that the physical inactivity is higher among lower-income individuals. There is a possibility that this association shows modifications, when considering transportation, work and domestic activities. OBJECTIVE To determine whether there is a difference between the prevalence of physical inactivity between individuals of high and low socioeconomic levels. METHODS The sample consisted of individuals of both sexes, aged 18 or older, from two groups of different socioeconomic levels. The low socioeconomic level (LSEL) group consisted of the parents of students from a public school. The high socioeconomic level (HSEL) group consisted of the parents of students from a private College. The International Physical Activity Questionnaire (IPAQ) was used to determine the level of physical activity. RESULTS A total of 91 individuals were evaluated in the LSEL group and 59 in the HSEL group. In the LSEL group, 42.9% (39) of the individuals were classified as insufficiently active, compared to 57.6% (34) of individuals in the HSEL group. Taking as a parameter of physical inactivity the time of weekly physical activity < 150 minutes, there was a decrease in the classification of inactivity in both groups, although with the maintenance of higher inactivity among individuals of HSEL (49.2% vs 28.6%; p= 0.01). CONCLUSION The individuals of HSEL are more sedentary than the individuals of LSEL.

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.

Prevalência e variáveis associadas à inatividade física em indivíduos de alto e baixo nível socioeconômico

BACKGROUND: Studies that considered only the leisure physical activity found that the physical inactivity is higher among lower-income individuals. There is a possibility that this association shows modifications, when considering transportation, work and domestic activities. OBJECTIVE: To determine whether there is a difference between the prevalence of physical inactivity between individuals of high and low socioeconomic levels. METHODS: The sample consisted of individuals of both sexes, aged 18 or older, from two groups of different socioeconomic levels. The low socioeconomic level (LSEL) group consisted of the parents of students from a public school. The high socioeconomic level (HSEL) group consisted of the parents of students from a private College. The International Physical Activity Questionnaire (IPAQ) was used to determine the level of physical activity. RESULTS: A total of 91 individuals were evaluated in the LSEL group and 59 in the HSEL group. In the LSEL group, 42.9% (39) of the individuals were classified as insufficiently active, compared to 57.6% (34) of individuals in the HSEL group. Taking as a parameter of physical inactivity the time of weekly physical activity < 150 minutes, there was a decrease in the classification of inactivity in both groups, although with the maintenance of higher inactivity among individuals of HSEL (49.2% vs 28.6%; p= 0.01). CONCLUSION: The individuals of HSEL are more sedentary than the individuals of LSEL.BACKGROUND Studies that considered only the leisure physical activity found that the physical inactivity is higher among lower-income individuals. There is a possibility that this association shows modifications, when considering transportation, work and domestic activities. OBJECTIVE To determine whether there is a difference between the prevalence of physical inactivity between individuals of high and low socioeconomic levels. METHODS The sample consisted of individuals of both sexes, aged 18 or older, from two groups of different socioeconomic levels. The low socioeconomic level (LSEL) group consisted of the parents of students from a public school. The high socioeconomic level (HSEL) group consisted of the parents of students from a private College. The International Physical Activity Questionnaire (IPAQ) was used to determine the level of physical activity. RESULTS A total of 91 individuals were evaluated in the LSEL group and 59 in the HSEL group. In the LSEL group, 42.9% (39) of the individuals were classified as insufficiently active, compared to 57.6% (34) of individuals in the HSEL group. Taking as a parameter of physical inactivity the time of weekly physical activity < 150 minutes, there was a decrease in the classification of inactivity in both groups, although with the maintenance of higher inactivity among individuals of HSEL (49.2% vs 28.6%; p= 0.01). CONCLUSION The individuals of HSEL are more sedentary than the individuals of LSEL.

Prevalencia y variables asociadas a la inactividad física en individuos de alto y bajo nivel socioeconómico

BACKGROUND: Studies that considered only the leisure physical activity found that the physical inactivity is higher among lower-income individuals. There is a possibility that this association shows modifications, when considering transportation, work and domestic activities. OBJECTIVE: To determine whether there is a difference between the prevalence of physical inactivity between individuals of high and low socioeconomic levels. METHODS: The sample consisted of individuals of both sexes, aged 18 or older, from two groups of different socioeconomic levels. The low socioeconomic level (LSEL) group consisted of the parents of students from a public school. The high socioeconomic level (HSEL) group consisted of the parents of students from a private College. The International Physical Activity Questionnaire (IPAQ) was used to determine the level of physical activity. RESULTS: A total of 91 individuals were evaluated in the LSEL group and 59 in the HSEL group. In the LSEL group, 42.9% (39) of the individuals were classified as insufficiently active, compared to 57.6% (34) of individuals in the HSEL group. Taking as a parameter of physical inactivity the time of weekly physical activity < 150 minutes, there was a decrease in the classification of inactivity in both groups, although with the maintenance of higher inactivity among individuals of HSEL (49.2% vs 28.6%; p= 0.01). CONCLUSION: The individuals of HSEL are more sedentary than the individuals of LSEL.BACKGROUND Studies that considered only the leisure physical activity found that the physical inactivity is higher among lower-income individuals. There is a possibility that this association shows modifications, when considering transportation, work and domestic activities. OBJECTIVE To determine whether there is a difference between the prevalence of physical inactivity between individuals of high and low socioeconomic levels. METHODS The sample consisted of individuals of both sexes, aged 18 or older, from two groups of different socioeconomic levels. The low socioeconomic level (LSEL) group consisted of the parents of students from a public school. The high socioeconomic level (HSEL) group consisted of the parents of students from a private College. The International Physical Activity Questionnaire (IPAQ) was used to determine the level of physical activity. RESULTS A total of 91 individuals were evaluated in the LSEL group and 59 in the HSEL group. In the LSEL group, 42.9% (39) of the individuals were classified as insufficiently active, compared to 57.6% (34) of individuals in the HSEL group. Taking as a parameter of physical inactivity the time of weekly physical activity < 150 minutes, there was a decrease in the classification of inactivity in both groups, although with the maintenance of higher inactivity among individuals of HSEL (49.2% vs 28.6%; p= 0.01). CONCLUSION The individuals of HSEL are more sedentary than the individuals of LSEL.

Comparação e efeitos de dois diferentes tempos de oclusão da via aérea durante a mensuração da pressão inspiratória máxima em pacientes neurológicos na unidade de terapia intensiva de pacientes adultos

OBJECTIVE: To verify if the maximal inspiratory pressure values with 40 seconds occlusion time are greater than with the 20 seconds occlusion time, and the impacts on the following patients physiological variables: respiratory rate, pulse oxygen saturation, heart rate and blood pressure, before and after the measurements. METHODS: This was a transversal prospective randomized study. Fifty-one patients underwent maximal inspiratory pressure measurement, measured by one single investigator. The manometer was calibrated before each measurement, and then connected to the adapter and this to the unidirectional valve inspiratory branch for 20 or 40 seconds. RESULTS: The values with 40 seconds occlusion (57.6 ± 23.4 cmH2O) were significantly higher than the measurements taken with 20 seconds occlusion (40.5 ± 23.4 cmH2O; p=0.0001). The variables changes between the before and after measurement respiratory and hemodynamic parameters monitoring showed: heart rate variation for the 20 seconds occlusion 5.13 ± 8.56 beats per minute and after 40 seconds occlusion 7.94 ± 12.05 beats per minute (p = 0.053), versus baseline. The mean blood pressure change for 20 seconds occlusion was 9.29 ± 13.35 mmHg and for 40 seconds occlusion 15.52 ± 2.91 mmHg (p=0.021). The oxygen saturation change for 20 seconds occlusion was 1.66 ± 12.66%, and for 40 seconds 4.21 ± 5.53% (p=0.0001). The respiratory rate change for 20 seconds occlusion was 6.68 ± 12.66 movements per minute and for 40 seconds 6.94 ± 6.01 (p=0.883). CONCLUSION: The measurement of maximal inspiratory pressure using a longer occlusion (40 seconds) produced higher values, without triggering clinically significant stress according to the selected variables.

Mayor letalidad y morbilidad por infarto agudo de miocardio en hospital público, en Feira de Santana - Bahía

FUNDAMENTO: Fatores relacionados ao nivel socio-economico, a qualidade e a gestao assistencial podem influenciar na letalidade e morbidade por infarto agudo do miocardio (IAM). OBJETIVO: Comparar letalidade e morbidade por IAM entre hospital publico e privado. METODOS: Estudo observacional, com grupos de comparacao. Avaliacao clinica na admissao e registro de dados diagnosticos, terapeuticos e evolutivos ate a alta ou o obito. Comparacao das caracteristicas clinicas por analise univariada seguida de analise bivariada, avaliando a associacao de preditores com obito e morbidade (Killip >I), SPSS, versao 13,0. RESULTADOS: Avaliados 150 pacientes, 63 (42,0%) privados e 87 (58,0%) publicos, com 63,1% e 62,1% de homens e idades de 61,1±13,8 e 60,0±11,6 anos, respectivamente. A letalidade por IAM foi de 19,5% nos publicos vs 4,8% nos privados (p=0,001) e a morbidade (Killip classe >1) de 34,3% nos publicos vs 15,0% nos privados (p=0,012). Houve diferenca significativa nos publicos devido a menor renda familiar e escolaridade (70,1% com um a dois salarios vs 19,0%, p 1 hora: 76,9% vs 48,6%; p=0,003) e maior tempo para ser medicado (THM>15 minutos: 47,1% vs 8,0%, p<0,001), UTI para 8% vs 94% nos privados e trombolise para 20,6% vs 54,0%, respectivamente (p<0,001). CONCLUSAO: Letalidade e morbidade maior no paciente publico, que se apresentou mais grave, mais tardiamente e recebeu tratamento de menor qualidade.BACKGROUND Factors related to socioeconomic status and health care quality and management may influence mortality and morbidity rates due to acute myocardial infarction (AMI). OBJECTIVE To compare mortality and morbidity in patients with AMI hospitalized in public and private hospitals. METHODS An observational study, with comparison groups. Clinical evaluation on admission, and recording of diagnostic, therapeutic and evolution data until discharge or death. Comparison of clinical characteristics by univariate analysis followed by bivariate analysis, evaluating the combination of predictors with death and morbidity (Killip> I), SPSS, version 13.0. RESULTS 150 patients were evaluated, 63 (42.0%) of private hospitals and 87 (58.0%) of public hospitals, with 63.1% and 62.1% of males, aged 61.1 +/- 13.8 and 60.0 +/- 11.6 years, respectively. The mortality from AMI was 19.5% in public hospitals vs 4.8% in private hospitals (p = 0.001), and morbidity (Killip class> I) was 34.3% in public hospitals vs 15.0% in private hospitals (p = 0.012). There was a significant difference between public and private patients, due to lower family income and education (70.1% with one to two salaries vs 19.0%, p <0.001, and 49.4% of illiterates vs 6.3%, p <0.001, respectively ); late arrival at the hospital (HAT> 1 hour: 76.9% vs 48.6%, p = 0.003); and a longer period of time before being medicated (AMT > 15 minutes: 47.1% vs 8.0%; p <0.001); ICU for 8% of the patients in public hospitals vs 94% in private hospitals; and thrombolysis for 20.6% vs 54.0%, respectively (p <0.001). CONCLUSION Mortality and morbidity were greater among public patients, which presented more serious conditions, arrived later at the hospital and received lower quality treatment.