Josiane Lima de Gusmão

A situação social do idoso no Brasil: uma breve consideração

ABSTRACT The national and international literature suggest that the process of becoming old in an issue of great interest for researchers,statisticians, and epidemiologists. The literature shows that the population of elderly worldwide is increasing rapidly. Particularly incountries in development, this population has been increasing significantly but the resources and support systems necessary to attendthis population is not expanding at the same rate. Therefore, concerns regarding this population profile have led to many seriousdiscussions and studies to provide data to those in political position to create adequate programs and policies to attend to the specificneeds of the elderly population without isolating them from society. Thus, the goal of this paper is to discuss the social situation of theelderly in Brazil taken into consideration demographic, epidemiologic, and psychosocial. Emphasis is placed on retirement, the importanceof the family, and on the interpersonal relationships.The national and international literature suggest that the process of becoming old in an issue of great interest for researchers, statisticians, and epidemiologists. The literature shows that the population of elderly worldwide is increasing rapidly. Particularly in countries in development, this population has been increasing significantly but the resources and support systems necessary to attend this population is not expanding at the same rate. Therefore, concerns regarding this population profile have led to many serious discussions and studies to provide data to those in political position to create adequate programs and policies to attend to the specific needs of the elderly population without isolating them from society. Thus, the goal of this paper is to discuss the social situation of the elderly in Brazil taken into consideration demographic, epidemiologic, and psychosocial. Emphasis is placed on retirement, the importance of the family, and on the interpersonal relationships.

Sympathetic nerve activity is decreased during device-guided slow breathing.

It is known that slow breathing (<10 breaths min–1) reduces blood pressure (BP), but the mechanisms involved in this phenomenon are not completely clear. The aim of this study was to evaluate the acute responses of the muscle sympathetic nerve activity, BP and heart rate (HR), using device-guided slow breathing (breathe with interactive music (BIM)) or calm music. In all, 27 treated mild hypertensives were enrolled. Muscle sympathetic nerve activity, BP and HR were measured for 5 min before the use of the device (n=14) or while subjects listened to calm music (n=13), it was measured again for 15 min while in use and finally, 5 min after the interventions. BIM device reduced respiratory rate from 16±3 beats per minute (b.p.m) to 5.5±1.8 b.p.m (P<0.05), calm music did not affect this variable. Both interventions reduced systolic (−6 and −4 mm Hg for both) and diastolic BPs (−4 mm Hg and −3 mm Hg, respectively) and did not affect the HR (−1 and −2  b.p.m respectively). Only the BIM device reduced the sympathetic nerve activity of the sample (−8 bursts min–1). In conclusion, both device-guided slow breathing and listening to calm music have decreased BP but only the device-guided slow breathing was able to reduce the peripheral sympathetic nerve activity.

Profile of hypertensive patients: biosocial characteristics, knowledge, and treatment compliance

OBJECTIVE: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. METHODS: The data were collected by interviewing hypertensive outpatients. RESULTS: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. CONCLUSION: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.Objective: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. Methods: The data were collected by interviewing hypertensive outpatients. Results: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. Conclusion: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.

Health-related quality of life and blood pressure control in hypertensive patients with and without complications.

INTRODUCTION: The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL) OBJECTIVE: This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications. MATERIALS AND METHODS: Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 ± 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher’s Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into “with complications” (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and “without complications” (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics. RESULTS: In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143±18/84±11 and 144±21/93±11 mm Hg for patients with and without complications, respectively) relative to phase 1 (128±17/75±13 and 128±15/83±11mmHg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the “with complications” group and from 78% to 50% in the “without complications” group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher’s Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher’s Questionnaire showed no differences in these scores. CONCLUSION: Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL.

Perfil de um grupo de hipertensos: aspectos biossociais, conhecimentos e adesão ao tratamento

OBJECTIVE: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. METHODS: The data were collected by interviewing hypertensive outpatients. RESULTS: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. CONCLUSION: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.Objective: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. Methods: The data were collected by interviewing hypertensive outpatients. Results: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. Conclusion: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.

Os médicos brasileiros seguem as diretrizes brasileiras de hipertensão

OBJECTIVE To evaluate whether procedures adopted by Brazilian physicians in the diagnosis and treatment of hypertension are in compliance with those advocated by the IV Brazilian Hypertension Guidelines. METHOD Survey carried out by means of telephone interviews with Brazilian physicians. The survey featured application of a questionnaire aimed to assess receipt of and compliance with the guidelines, and to evaluate various aspects regarding the treatment of hypertensive patients. RESULTS 68.3% of the respondents had received the guidelines and answered the questionnaire in full. The total sample consisted of 483 physicians--47% cardiologists, 31.7% internists, and 21.3% nephrologists. The survey showed high compliance with certain guideline topics such as more than one measurement at different times for the diagnosis of hypertension (94%), and providing guidance regarding lifestyle changes as a therapeutic strategy. As to arterial pressure levels used for diagnosis and therapeutic target, compliance with guideline recommendations lacks uniformity. The survey showed a clear preference for pressure levels lower than those recommended, especially in patients with comorbidities. Attempts to assess cardiovascular risk also proved to be low. Only 64.7% of the respondents reported that they seek to determine the presence of diabetes mellitus, and 56.4% check for dyslipidemia. The majority (59.3%) mentioned diuretics as the preferred drug class for initial drug treatment of hypertension. CONCLUSION We concluded that there is only partial compliance with Brazilian Hypertension Guidelines and that certain factors should be taken into consideration when drawing up future guidelines, such as: improved distribution; standardization of values for diagnosis and therapeutic target; more extensive coverage of ways for physicians to approach hypertensive patients to better evaluate their overall cardiovascular risk.

Instrumento de Avaliação da Qualidade de Vida para Hipertensos de Bulpitt e Fletcher

This study translated and validated Bulpitt and Fletchers Specific Questionnaire for Quality of Life Assessment of hypertensive patients. The translation and the back-translation were performed by four English teachers, and the final version was submitted to a board of referees. Questions with a Content Validity Index lower than 80% were modified and re-evaluated. The questionnaire was applied in 110 hypertensive outpatients (52 ± 8 years old, 65 % female, blood pressure 128 ± 17/75 ± 13 mmHg), which also answered the SF-36, and also in 20 normotensive people, whose characteristics were similar to those of the hypertensive subjects. The domains of SF-36 and Bulpitt and Fletchers instrument correlated to each other (p < 0.05), except for the social aspects (r=0.07, p= 0.04) and the general state of health (r=0.04, p= 0.61). Hypertensive patients showed more positive responses to the symptoms (40%) than the normotensives (15%). The instrument was validated and is now ready to be used in our midst.Este estudo realizou a traducao para o portugues e a validacao do questionario especifico para avaliacao da qualidade de vida em hipertensos de Bulpitt e Fletcher. A traducao e o back-translation foram realizados por 4 professores de ingles e a versao final submetida a um corpo de juizes. Questoes com Indice de Validade de Conteudo menor que 80% foram modificadas e reavaliadas. O questionario foi aplicado em 110 hipertensos ambulatoriais (52 ± 8 anos, 65% mulheres, pressao arterial 128±17/ 75±13 mmHg), que tambem responderam ao SF-36, e em 20 normotensos, com caracteristicas semelhantes as dos hipertensos. Os dominios do SF-36 e do instrumento de Bulpitt e Fletcher se correlacionaram (p<0,05), exceto em relacao a aspectos sociais (r=0,07, p=0,44) e a estado geral de saude (r=0,04, p=0,61). Os hipertensos apresentaram mais respostas positivas a sintomas (40%) do que os normotensos (15%). O instrumento foi validado e esta apto para ser usado em nosso meio.

Low-dose estrogen therapy does not change postexercise hypotension, sympathetic nerve activity reduction, and vasodilation in healthy postmenopausal women

The aim of this study was to determine whether estrogen therapy enhances postexercise muscle sympathetic nerve activity (MSNA) decrease and vasodilation, resulting in a greater postexercise hypotension. Eighteen postmenopausal women received oral estrogen therapy (ET; n=9, 1 mg/day) or placebo (n=9) for 6 mo. They then participated in one 45-min exercise session (cycle ergometer at 50% of oxygen uptake peak) and one 45-min control session (seated rest) in random order. Blood pressure (BP, oscillometry), heart rate (HR), MSNA (microneurography), forearm blood flow (FBF, plethysmography), and forearm vascular resistance (FVR) were measured 60 min later. FVR was calculated. Data were analyzed using a two-way ANOVA. Although postexercise physiological responses were unaltered, HR was significantly lower in the ET group than in the placebo group (59+/-2 vs. 71+/-2 beats/min, P<0.01). In both groups, exercise produced significant decreases in systolic BP (145+/-3 vs. 154+/-3 mmHg, P=0.01), diastolic BP (71+/-3 vs. 75+/-2 mmHg, P=0.04), mean BP (89+/-2 vs. 93+/-2 mmHg, P=0.02), MSNA (29+/-2 vs. 35+/-1 bursts/min, P<0.01), and FVR (33+/-4 vs. 55+/-10 units, P=0.01), whereas it increased FBF (2.7+/-0.4 vs. 1.6+/-0.2 ml x min(-1) x 100 ml(-1), P=0.02) and did not change HR (64+/-2 vs. 65+/-2 beats/min, P=0.3). Although ET did not change postexercise BP, HR, MSNA, FBF, or FVR responses, it reduced absolute HR values at baseline and after exercise.

The social situation of elderly in Brazil: a brief consideration

ABSTRACT The national and international literature suggest that the process of becoming old in an issue of great interest for researchers,statisticians, and epidemiologists. The literature shows that the population of elderly worldwide is increasing rapidly. Particularly incountries in development, this population has been increasing significantly but the resources and support systems necessary to attendthis population is not expanding at the same rate. Therefore, concerns regarding this population profile have led to many seriousdiscussions and studies to provide data to those in political position to create adequate programs and policies to attend to the specificneeds of the elderly population without isolating them from society. Thus, the goal of this paper is to discuss the social situation of theelderly in Brazil taken into consideration demographic, epidemiologic, and psychosocial. Emphasis is placed on retirement, the importanceof the family, and on the interpersonal relationships.The national and international literature suggest that the process of becoming old in an issue of great interest for researchers, statisticians, and epidemiologists. The literature shows that the population of elderly worldwide is increasing rapidly. Particularly in countries in development, this population has been increasing significantly but the resources and support systems necessary to attend this population is not expanding at the same rate. Therefore, concerns regarding this population profile have led to many serious discussions and studies to provide data to those in political position to create adequate programs and policies to attend to the specific needs of the elderly population without isolating them from society. Thus, the goal of this paper is to discuss the social situation of the elderly in Brazil taken into consideration demographic, epidemiologic, and psychosocial. Emphasis is placed on retirement, the importance of the family, and on the interpersonal relationships.

Variáveis biopsicossociais e atitudes frente ao tratamento influenciam a hipertensão complicada

BACKGROUND Complicated hypertension can be influenced by the characteristics of hypertensive patients. OBJECTIVE To associate the condition of complicated hypertension with biosocial variables such as attitudes and beliefs about the disease and treatment and subjective well-being. METHODS We studied 251 uncomplicated hypertensive patients (SBP > 140 mmHg and/or 90 < DBP < 110 mmHg for patients under no treatment and DBP <110mmHg for patients under treatment without target organ damage and other diseases) and 260 complicated hypertensive patients (DBP > 110 mmHg with or without treatment, with target organ damage or other diseases). RESULTS Complicated hypertensive patients were significantly different from uncomplicated ones (p <0.05) in relation to: 1 - Prevalence of men, not white (53.0%), higher body mass index (29.5 ± 4.6 vs 28.5 ± 4.0 kg/m²), over 10 years of disease (54.0%), completion of previous treatment (53.0%) and reports of sadness about life as a whole (74.0%) 2 - Complicated hypertensive patients never bring the drugs when they travel (59.0%), nor do they buy them before running out the drugs (71.0%) and rarely follow eating guidelines (69.0%) 3 - Uncomplicated hypertensive patients showed no more migraines, joint pain and, among women, menopausal status and hormone replacement therapy, and 4 - Of those who had pressure control (< 140/90 mmHg), 61.9% were uncomplicated hypertensive patients; and 5 - Complicated hypertensive patients were not aware that treatment can prevent kidney problems and they thought that young people do not have high blood pressure. CONCLUSION Complicated hypertensive patients showed more negative structural and psychosocial characteristics, more negative attitudes towards treatment and are unaware of the disease.