Marilia Estevam Cornélio

Sodium Intake Is Associated with Carotid Artery Structure Alterations and Plasma Matrix Metalloproteinase-9 Upregulation in Hypertensive Adults

The mechanisms by which dietary sodium modulates cardiovascular risk are not fully understood. This study investigated whether sodium intake is related to carotid structure and hemodynamics and to plasma matrix metalloproteinase (MMP) activity in hypertensive adults. One hundred thirty-four participants were cross-sectionally evaluated by clinical history, anthropometry, carotid ultrasound, and analysis of hemodynamic, inflammatory, and metabolic variables. Daily sodium intake (DSI) was estimated by 24-h recall, discretionary sodium, and a FFQ. In 42 patients, plasma MMP-2 and MMP-9 activities were also analyzed. The mean DSI was 5.52 ± 0.29 g/d. Univariate analysis showed that DSI correlated with common carotid artery systolic and diastolic diameter (r = 0.36 and 0.34; both P < 0.001), peak and mean circumferential tension (r = 0.44 and 0.39; both P < 0.001), Youngs Elastic Modulus (r = 0.40; P < 0.001), intima-media thickness (r = 0.19; P < 0.05), and internal carotid artery resistive index (r = 0.20; P < 0.05). Multivariate analyses revealed that only artery diameter, circumferential wall tension, and Youngs Elastic Modulus were independently associated with DSI. Conversely, plasma MMP-9 activity was associated with DSI (r = 0.53; P < 0.001) as well as with common carotid systolic diameter (r = 0.33; P < 0.05) and Youngs Elastic Modulus (r = 0.38; P < 0.01). In conclusion, sodium intake is associated with carotid alterations in hypertensive adults independently of systemic hemodynamic variables. The present findings also suggest that increased MMP-9 activity might play a role in sodium-induced vascular remodeling.

Development and reliability of an instrument to measure psychosocial determinants of salt consumption among hypertensive patients

This study aimed to present the content validity and reliability analyses of an instrument to study the determinant factors of salt consumption among hypertensive subjects, based on an extension of the Theory of Planned Behavior. Content validity was assessed by 3 experts and a pre-test was carried out with 5 subjects. The final tool, comprising 3 different behaviors related to salt consumption and corresponding psychosocial variables, was applied to 32 subjects for internal consistency and temporal stability (15-day interval) analysis. Cronbachs alpha coefficients > 0.70 and significant intra-class correlation coefficients were observed for most variables, indicating the temporal stability of the measured concepts. The developed instrument exhibited evidence of both content validity and reliability.This study aimed to present the content validity and reliability analyses of an instrument to study the determinant factors of salt consumption among hypertensive subjects, based on an extension of the Theory of Planned Behavior. Content validity was assessed by 3 experts and a pre-test was carried out with 5 subjects. The final tool, comprising 3 different behaviors related to salt consumption and corresponding psychosocial variables, was applied to 32 subjects for internal consistency and temporal stability (15-day interval) analysis. Cronbachs alpha coefficients >; 0.70 and significant intra-class correlation coefficients were observed for most variables, indicating the temporal stability of the measured concepts. The developed instrument exhibited evidence of both content validity and reliability.

A randomized controlled trial of the effectiveness of planning strategies in the adherence to medication for coronary artery disease.

AIM To examine the effect of action and coping planning strategies in the adherence to medication among outpatients with coronary artery disease. BACKGROUND Action and coping planning strategies are based on implementation intention, which requires self-regulation by the individual, to prioritize intentionally planned responses over learned or habitual ones, from daily routines to stressful situations. DESIGN Randomized controlled trial. METHODS Participants (n = 115) were randomized into intervention (use of action and coping planning strategies, n = 59) or control (usual care, n = 56) groups. The study was conducted between June 2010-May 2011 in two in-person visits: baseline and 2-month follow-up. Participants in the intervention group received telephone reinforcement between baseline and 2-month follow-up. Adherence to medication for cardioprotection and symptoms relief was evaluated by proportion of adherence, global measure of adherence evaluation and Morisky Self-Reported Measure of Medication Adherence Scale at both baseline and 2-month follow-up. FINDINGS When using the measure of global measure of adherence, participants in the intervention group reported adherence to therapy more often than controls (odds ratio = 5.3), but no statistically significant change was observed in the other two outcome measures. CONCLUSION This study has shown that individuals who use action and coping planning report higher adherence to drug treatment, when measured by the global adherence evaluation. Further studies with longer follow-ups are needed to assess if the effect of planning strategies has long-term duration.

Relationship Between Beliefs Regarding a Low Salt Diet in Chronic Renal Failure Patients on Dialysis

OBJECTIVE The aim of this study was to investigate the relationship between beliefs regarding a low salt diet and the nutritional behavior of sodium consumption as well their relation with sociodemographic and clinical variables among chronic renal failure (CRF) patients on dialysis. DESIGN AND METHODS This cross-sectional study enrolled a sample of 117 patients who answered the Brazilian version of the Beliefs about Dietary Compliance Scale (BDCS), the sodium frequency food questionnaire, and the use of discretionary salt/day. RESULTS The average of total salt consumption was 10.6 g/day (±6.3) and it was positively correlated with the interdialytic weight gain (r = 0.20 P = .032) and negatively correlated with the education level (r = -0.19 P = .044). The Benefits beliefs were discriminatory of the higher and lower salt consumers, and proportionally related to monthly income (r = 0.22 P = .017). The Barriers beliefs were positively correlated only to time on dialysis (r = 0.25 P = .008). Subjects with lower schooling and those of older age tended to consume more discretionary salt (r = -0.27, P = .005; r = 0.23, P = .016, respectively); however, they reported a lower consumption of foods with high salt content (r = 0.25 P = .006; r = -0.27 P = .004). CONCLUSIONS Educational interventions aimed at reducing salt consumption for this group must include interventions targeted at different behaviors related to overall salt consumption, the specificities of age, and level of schooling of the patients.

Behavioural determinants of salt consumption among hypertensive individuals

BACKGROUND High salt consumption among populations remains a challenge for health professionals dealing with prevention and control of hypertension. The present study aimed to identify the psychosocial predictors of salt consumption among hypertensive individuals, based on an extended version of the Theory of Planned Behaviour (TPB). Three salt consumption behaviours were studied: Behaviour 1- using <4 g of salt per day during cooking; Behaviour 2- avoiding adding salt/table salt use to the prepared foods; and Behaviour 3- avoiding the consumption of foods with high salt content. METHODS At baseline (n = 108), TPB and additional variables (self-efficacy, habit, past behaviour, hedonic determinant, self-perceived diet quality) were measured. At 2-month follow-up (n = 95), the three behaviours were assessed. Behaviour and intention were sequentially regressed on the study variables, using polytomous logistic regression and hierarchical linear regression with rank transformation, respectively. RESULTS Behaviour 1 was predicted by intention [odds ratio (OR) = 6.23; 95% confidence interval (CI) = 1.81-21.52], whereas self-efficacy and habit predicted intention. Behaviour 2 exhibited high score mean and low variation and was predicted by self-perceived diet quality (OR = 2.56; 95% CI = 1.03-6.36). Behaviour 3 was predicted by the hedonic determinant (OR = 1.42; 95% CI = 1.01-1.98). CONCLUSIONS The results indicate that salt-related behaviours are explained by a variety of determinants. Among these determinants, special consideration should be given to motivational and hedonic aspects.

Development of an instrument to measure psychosocial determinants of physical activity behavior among coronary heart disease patients

The aim of this study was to report the development and the analysis of content validity and reliability of the Psychosocial Determinants of Physical Activity among Coronary Heart Disease Patients Questionnaire, based on an extension of the Theory of Planned Behavior. In the content validity step, three experts evaluated the instrument which was, afterwards, pre-tested with five subjects in order to obtain a conceptually appropriate and easily understood instrument. Fifty-one patients participated in the evaluation of internal consistency of the reviewed instrument. Cronbachs alpha coefficients above 0.75 were observed for the constructs: Intention, Attitude, Subjective Norm, Self-efficacy and Habit. The new instrument demonstrated acceptable evidence of content validity and reliability.Este estudio tuvo como objetivo presentar el desarrollo, el analisis de contenido y de confiabilidad del Cuestionario para la identificacion de los factores psicosociales determinantes del comportamiento de actividad fisica en pacientes afectados de coronariopatias, basado en la extension de la Teoria del Comportamiento Planificado. Se sometio la validez del contenido del instrumento a la evaluacion por parte de tres jueces y pre test con cinco sujetos, hasta mostrarse conceptualmente adecuado y comprensible para los sujetos entrevistados. Fue aplicado en 51 sujetos para la evaluacion preliminar de consistencia interna, a traves de la determinacion del coeficiente Alfa de Cronbach. Fueron observados coeficientes Alfa de Cronbach >0,75 para los constructos Intencion, Actitud, Norma Subjetiva, Autoeficacia y Habito. El instrumento desarrollado evidencio la validez de su contenido, asi como su confiabilidad.

Upper Arm Circumference Is an Independent Predictor of Left Ventricular Concentric Hypertrophy in Hypertensive Women

Upper arm circumference (UAC) measurement is necessary for the proper sizing of cuffs and is recommended for accurate blood pressure (BP) assessment. The aim of this report is to identify and quantify the relationships between UAC and the usual anthropometric measurements of body fat distribution and cardiac structure in hypertensive subjects. We evaluated 339 patients (202 women and 137 men) by medical history, physical examination, anthropometry, metabolic and inflammatory parameters, and echocardiography. Partial correlation analyses adjusted for age and body mass index revealed that anthropometric variables were significantly associated with echocardiographic parameters exclusively in women. In this regard, UAC correlated with interventricular septum thickness, posterior wall thickness, and relative wall thickness ≥0.45, while waist circumference was related to left cardiac chamber diameter. Multivariate analyses including age, body mass index, systolic BP, homeostasis model assessment index, and use of antihypertensive medications demonstrated that UAC was an independent predictor of left ventricular wall thickness and concentric hypertrophy in women. Further linear regression analyses revealed that waist circumference was an independent predictor of left ventricular end-diastolic and left atrial diameters in this gender. Overall, these findings suggest that UAC determination might serve not only as a routine approach preceding BP evaluation but also as a simple and feasible predictor of adverse LV remodeling in hypertensive women.

Desenvolvimento de instrumento para medida dos fatores psicossociais determinantes do comportamento de atividade física em coronariopatas

The aim of this study was to report the development and the analysis of content validity and reliability of the Psychosocial Determinants of Physical Activity among Coronary Heart Disease Patients Questionnaire, based on an extension of the Theory of Planned Behavior. In the content validity step, three experts evaluated the instrument which was, afterwards, pre-tested with five subjects in order to obtain a conceptually appropriate and easily understood instrument. Fifty-one patients participated in the evaluation of internal consistency of the reviewed instrument. Cronbachs alpha coefficients above 0.75 were observed for the constructs: Intention, Attitude, Subjective Norm, Self-efficacy and Habit. The new instrument demonstrated acceptable evidence of content validity and reliability.Este estudio tuvo como objetivo presentar el desarrollo, el analisis de contenido y de confiabilidad del Cuestionario para la identificacion de los factores psicosociales determinantes del comportamiento de actividad fisica en pacientes afectados de coronariopatias, basado en la extension de la Teoria del Comportamiento Planificado. Se sometio la validez del contenido del instrumento a la evaluacion por parte de tres jueces y pre test con cinco sujetos, hasta mostrarse conceptualmente adecuado y comprensible para los sujetos entrevistados. Fue aplicado en 51 sujetos para la evaluacion preliminar de consistencia interna, a traves de la determinacion del coeficiente Alfa de Cronbach. Fueron observados coeficientes Alfa de Cronbach >0,75 para los constructos Intencion, Actitud, Norma Subjetiva, Autoeficacia y Habito. El instrumento desarrollado evidencio la validez de su contenido, asi como su confiabilidad.

Analysis of action plans and coping plans for reducing salt consumption among women with hypertension

a redução do consumo de sal entre mulheres hipertensas um estudo piloto”, presentada a lo Departamento de Enfermagem, de la Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brasil. Apoyo financiero de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). 2 Estudiantes de Doctorado, Departamento de Enfermagem, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brasil. 3 PhD, Profesor Asociado, Departamento de Enfermagem, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brasil.Este e um estudo transversal, baseado na teoria Implementation Intentions, cujo objetivo foi descrever planos de acao desenvolvidos por mulheres hipertensas (n=49) para adicionar, no maximo, 4g de sal/dia aos alimentos e reduzir o consumo de alimentos salgados, bem como barreiras percebidas e estrategias de enfrentamento para efetivar os planos de acao. Os planos foram categorizados quanto a similaridade e submetidos a analise de frequencia. A maioria dos planos de acao e enfrentamento de obstaculos referiu-se a efetivacao do comportamento para adicionar, no maximo, 4g/sal/dia/pessoa aos alimentos. As estrategias de acao foram voltadas para a quantificacao do sal adicionado, e os principais obstaculos foram relacionados a menor palatabilidade dos alimentos com menos sal. Os planos de enfrentamento apontaram para o preparo, em separado, dos alimentos e uso de temperos naturais em substituicao ao sal. Esses dados podem auxiliar o enfermeiro para direcionar atividades clinicoeducativas, visando a reducao de consumo de sal entre pacientes que preparam sua alimentacao.This cross-sectional study, based in implementation intention theory, describes action plans developed by women with hypertension (n=49) to add no more than 4g of salt per day to food and to reduce consumption of salty foods, as well as describing the barriers perceived and the coping strategies adopted for putting the action plans into practice. The plans were categorized according to similarities and were submitted to frequency analysis. The majority of the action and coping plans had to do with the effectuation of the behavior involving adding up to 4g of salt per day per person to food. The action strategies were aimed at quantifying the salt added, and the main obstacles were related to the reduced palatability of the food made with less salt. The coping plans have to do with preparing foods separately and to using natural seasonings instead of salt. This data can help the nurse to design activities for clinical education, with a view to reducing salt consumption among patients who prepare their own food.

Characterization of salt consumption among hypertensives according to socio-demographic and clinical factors

OBJETIVO: avaliar a relacao entre os comportamentos de consumo de sal e variaveis sociodemograficas e clinicas. METODO: o consumo de sodio foi avaliado segundo os metodos: de autorrelato (visando 3 diferentes comportamentos relacionados ao consumo de sal), recordatorio de 24h, sal per capita, questionario de frequencia alimentar, estimativa de consumo total de sodio e excrecao urinaria de sodio (n=108). RESULTADOS: o consumo elevado de sal, segundo as diferentes medidas de consumo do nutriente foi associado as variaveis: sexo masculino, baixo nivel de escolaridade e de renda mensal, cor branca, inatividade profissional e as variaveis clinicas: indice de massa corporea elevada, niveis tensionais, indicadores de hipertrofia ventricular e numero de medicacoes utilizadas. CONCLUSAO: os dados obtidos mostram uma associacao heterogenea entre os diferentes comportamentos relacionados ao consumo de sal e as variaveis sociodemograficas e clinicas. Esses dados podem ser utilizados para otimizar o direcionamento das atividades educativas, visando a reducao do consumo de sal entre hipertensos.OBJECTIVE To evaluate the relationship between the behaviors of salt consumption and socio-demographic and clinical variables. METHOD Sodium consumption was evaluated using the methods: self-reporting (considering 3 different behaviors related to salt consumption), 24- hr dietary recall, discretionary salt, food frequency questionnaire, estimation of total sodium intake and 24-hr urinary excretion of sodium (n=108). RESULTS Elevated salt intake according to the different measurements of consumption of the nutrient was associated with the variables: male sex, low level of schooling and monthly income, being Caucasian, and being professionally inactive; and with the clinical variables: elevated Body Mass Index, tensional levels, ventricular hypertrophy and the number of medications used. CONCLUSION The data obtained shows a heterogenous association between the different behaviors related to salt consumption and the socio-demographic and clinical variables. This data can be used to optimize the directing of educational activities with a view to reducing salt consumption among hypertensives.