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Resumo Introdução A doença cerebrovascular (DCBV) é a segunda principal causa de morte no mundo e no Brasil. Objetivo Avaliar as tendências da mortalidade por DCBV em duas cidades brasileiras (Maceió e Florianópolis) com diferenças socioeconômicas extremas, entre 1981 e 2015, estimando os efeitos idade, período e coorte. Método Estudo de séries temporais da mortalidade por DCBV em indivíduos com ≥ 40 anos, empregando a ferramenta Web tool. Resultados A mortalidade por DCBV diminuiu com o tempo, aumentou com a idade e foi menor para gerações mais novas. O efeito foi igual para ambos os sexos. Houve diminuição da mortalidade nas duas cidades, mas a diferença foi grande e a mortalidade continua alta em Maceió. Com base na amplitude dos efeitos estimados, foi possível verificar que o efeito de coorte foi o termo mais significativo para explicar a variabilidade temporal das taxas de mortalidade por DCBV no período. Conclusão A comparação da tendência temporal nas duas cidades mostrou a importância da melhora das condições de vida, do acesso a serviços de saúde para prevenção e controle dos fatores de risco, assim como assistência hospitalar aos casos para diminuirmos a mortalidade por DCBV em todo o território nacional. Abstract Background Cerebrovascular disease (CBVD) is the second leading cause of death in the world and Brazil. Objective To evaluate trends in mortality from CBVD in two Brazilian cities (Maceió and Florianópolis) with extreme socioeconomic differences, between 1981 and 2016, estimating the age, cohort effect. Method Study of CBVD mortality time series in individuals aged ≥40 years, using the Age, Period, Cohort (APC) analysis and the Web tool. Results CBVD mortality decreased with time, increased with age and was lower for younger generations. The effect was the same for both sexes. There was a decrease in mortality in both cities, but the difference was large, and mortality remains high in Maceió. Based on the amplitude of the estimated effects, it was possible to verify that the cohort effect was the most significant term to explain the temporal variability of mortality rates due to CVD in the period. Conclusion The comparison of the time trend in the two cities showed the importance of improving living conditions, access to health services for the prevention and control of risk factors, as well as hospital care for cases to reduce mortality from CVD nationwide.

Resumo Fundamento: A mortalidade por doenças cardiovasculares (DCV) vem mostrando tendência à estabilização em alguns países, incluindo o Brasil e o estado do Rio de Janeiro, após décadas de queda. Não encontramos análises detalhadas dessa tendência para o estado do Rio de Janeiro. Objetivo: Analisar as tendências da mortalidade prematura e tardia por doenças do aparelho circulatório (DAC), doença isquêmica do coração (DIC) e doença cerebrovascular (DCBV) por sexo nas regiões de saúde do estado do Rio de Janeiro e capital (1996-2016). Métodos: Dados de óbitos e população foram obtidos no DATASUS/MS. Taxas foram compensadas por códigos mal definidos, corrigidos pelos códigos cardiovasculares mal definidos e ajustadas por sexo e idade pelo método direto. O Joinpoint Trend Analysis Software foi empregado para calcular a variação percentual anual (APC) e variação percentual anual média (AAPC). Foram consideradas para o estudo APC e AAPC significativamente diferentes de zero, calculadas por um teste de student com significância de 5%. Resultados: A mortalidade por DIC estabilizou ou até aumentou em pelo menos 50% das localidades analisadas (EAPC ≥0). Nas regiões Norte e Noroeste, nenhuma mudança foi observada. Para DCBV, apenas uma região apresentou estabilidade na mortalidade (EAPC próximo a 0). Para as outras regiões, a taxa continuou a diminuir (APC

Background: Hypertension is responsible for a substantial number of deaths due to cardiovascular disease and stroke. A crucial step toward its control is the identification of modifiable predictors of hypertension. Objectives: To estimate the relationship between salt intake, serum uric acid and incident hypertension in a primary care setting. Methods: Retrospective cohort of the CAMELIA study in which a non-randomized sample of 1098 participants who were ≥ 20 year-old was recruited from a primary care program. Originally, the sample consisted of hypertensive, diabetic and non-diabetic/non-hypertensive subjects. For the analysis, 258 participants with blood pressure (BP) lower than 140/90 mm Hg not using antihypertensive drugs and without diabetes mellitus were included. Five years after the first visit, their medical records were reviewed. Patients were divided into two groups according to BP in the first visit: normal BP group (systolic BP ≤ 120 mm Hg and diastolic BP ≤ 80 mm Hg) and high-normal BP group (systolic BP 121-139 mm Hg and/or diastolic BP 81-89 mm Hg). Results: In multivariate analysis, high-normal BP, hyperuricemia and salt intake ≥ 6 g/day predicted incident hypertension. In participants of thenormal BP group, high salt intake conferred the highest risk. In the high-normal BP group, smoking and serum uric acid were found to be the most important ones. Conclusion: In a healthy, multiethnic, and normotensive population from an urban primary care program, high-normal BP, hyperuricemia and high salt intake were found to be predictors of incident hypertension. Resumen: Antecedentes: La hipertensión es responsable de un gran número de muertes debido a cardiopatías e ictus. Un paso esencial para su control es la identificación de factores modificables predictivos de la hipertensión. Objetivos: Calcular la relación entre ingesta de sal, ácido úrico sérico e hipertensión incidental en un centro de atención primaria. Métodos: Cohorte retrospectiva del estudio CAMELIA, en el que se incluyó una muestra no aleatorizada de 1.098 participantes con edades ≥ 20 años, obtenida de un programa de atención primaria. Originalmente, la muestra incluía sujetos hipertensos, diabéticos y no diabéticos/no hipertensos. Para el análisis, se estudiaron 258 participantes con presión arterial (PA) inferior a 140/90 mm Hg, sin prescripción de fármacos antihipertensivos, y no diabéticos. Transcurridos cinco años de la primera visita, se revisaron sus historias médicas. Se dividió a los pacientes en dos grupos, con arreglo a su PA en la primera visita: grupo con PA normal (PA sistólica ≤ 120 mm Hg y PA diastólica ≤ 80 mm Hg), y grupo con PA alta-normal BP (PA sistólica 121-139 mm Hg y/o PA diastólica 81-89 mm Hg). Resultados: En el análisis multivariante, la PA alta-normal, hiperuricemia e ingesta de sal ≥ 6 g/día predijeron la hipertensión incidental. En los participantes del grupo de PA normal, la ingesta elevada de sal confirió el mayor riesgo. En el grupo de PA alta-normal, el tabaquismo y el ácido úrico sérico fueron los factores más importantes. Conclusión: En una población sana, multiétnica y normotensa, procedente de un programa de atención primaria urbana la PA alta-normal, hiperuricemia e ingesta elevada de sal constituyeron los factores predictivos de la hipertensión incidental.

Resumo Fundamento: A classificação da insuficiência cardíaca (IC) por fenótipos possui grande relevância na prática clínica. Objetivo: O estudo visou analisar a prevalência, as características clínicas e os desfechos entre os fenótipos de IC no contexto da atenção primária. Métodos: Trata-se de uma análise de um estudo de coorte que incluiu 560 indivíduos, com idade ≥ 45 anos, que foram selecionados aleatoriamente em um programa de atenção primária. Todos os participantes foram submetidos a avaliações clínicas, dosagem do peptídeo natriurético tipo B (BNP), eletrocardiograma e ecocardiografia em um único dia. A IC com fração de ejeção do ventrículo esquerdo (FEVE) < 40% foi classificado como IC com fração de ejeção reduzida (ICFEr), FEVE de 40% a 49% como IC com fração de ejeção intermediária (ICFEi) e FEVE ≥ 50% como IC com fração de ejeção preservada (ICFEp). Após 5 anos, os pacientes foram reavaliados quanto à ocorrência do desfecho composto de óbito por qualquer causa ou internação por doença cardiovascular. Resultados: Dos 560 pacientes incluídos, 51 pacientes tinham IC (9,1%), 11 dos quais tinham ICFEr (21,6%), 10 tinham ICFEi (19,6%) e 30 tinham ICFEp (58,8%). A ICFEi foi semelhante à ICFEp nos níveis de BNP (p < 0,001), índice de massa do ventrículo esquerdo (p = 0,037) e índice de volume do átrio esquerdo (p < 0,001). O fenótipo de ICFEi foi semelhante ao de ICFEr em relação à doença arterial coronariana (p = 0,009). Após 5 anos, os pacientes com ICFEi apresentaram melhor prognóstico quando comparados aos pacientes com ICFEp e ICFEr (p < 0,001). Conclusão: A prevalência de ICFEI foi semelhante ao observado em estudos anteriores. A ICFEI apresentou características semelhantes a ICFEP neste estudo. Nossos dados mostram que a ICFEi teve melhor prognóstico em comparação com os outros dois fenótipos. Abstract Background: The classification of heart failure (HF) by phenotypes has a great relevance in clinical practice. Objective: The study aimed to analyze the prevalence, clinical characteristics, and outcomes between HF phenotypes in the primary care setting. Methods: This is an analysis of a cohort study including 560 individuals, aged ≥ 45 years, who were randomly selected in a primary care program. All participants underwent clinical evaluations, b-type natriuretic peptide (BNP) measurements, electrocardiogram, and echocardiography in a single day. HF with left ventricular ejection fraction (LVEF) < 40% was classified as HF with reduced ejection fraction (HFrEF), LVEF 40% to 49% as HF with mid-range ejection fraction (HFmrEF) and LVEF ≥ 50% as HF with preserved ejection fraction (HFpEF). After 5 years, the patients were reassessed as to the occurrence of the composite outcome of death from any cause or hospitalization for cardiovascular disease. Results: Of the 560 patients included, 51 patients had HF (9.1%), 11 of whom had HFrEF (21.6%), 10 had HFmrEF (19.6%) and 30 had HFpEF (58.8%). HFmrEF was similar to HFpEF in BNP levels (p < 0.001), left ventricular mass index (p = 0.037), and left atrial volume index (p < 0.001). The HFmrEF phenotype was similar to HFrEF regarding coronary artery disease (p = 0.009). After 5 years, patients with HFmrEF had a better prognosis when compared to patients with HFpEF and HFrEF (p < 0.001). Conclusion: The prevalence of ICFEI was similar to that observed in previous studies. ICFEI presented characteristics similar to ICFEP in this study. Our data show that ICFEi had a better prognosis compared to the other two phenotypes.

Objetivo: descrever e analisar o processo da seleção dos diagnósticos de enfermagem prioritários para o cuidado enfermagem aos indivíduos nos diferentes estágios de insuficiência cardíaca, na atenção primária. Método: trata-se de um recorte de pesquisa, constituído por fase metodológica, com a aplicação da técnica Delphi junto a especialistas referente a 176 diagnósticos de enfermagem segundo a Taxonomia NANDA-I no período de dezembro de 2012 a julho de 2013.Resultados: 144 diagnósticos foram identificados como não prioritários e 32 foram selecionados como diagnósticos de enfermagem prioritários, agregados neste estudo como: “sinal de gravidade”; “conhecimento/atitude/prática”; “sintoma”; e “risco”. Conclusão: o mapa gerado por esse esforço fez-se útil para orientar a busca da prevalência de cada diagnóstico e sobretudo para propor intervenções em saúde na atenção primária direcionadas às necessidades dos indivíduos saudáveis, com diagnóstico clínico de insuficiência cardíaca ou com risco para o seu desenvolvimento.

Background: Primary care physicians have difficulty dealing with patients who have HF with preserved LVEF(HFpEF). The prognosis of HFpEF is poor, and difficult to predict on primary care. Objective: The aim of the study is to apply the H2FPEF score to primary care patients and verify its power to assess the risk of death or hospitalization due to cardiovascular disease. Methods: This longitudinal study included 402 individuals, with signs or symptoms of HF, aged≥45 years and, underwent an evaluation which included clinical examination, BNP and echocardiogram. The diagnosis of HFpEF was confirmed by the criteria of the European Society of Cardiology. After five years, the patients were reassessed as to the occurrence of the composite outcome, death from any cause or hospitalization for cardiovascular disease. H2FPEF used six variables: body mass index, medications for hypertension, age, pulmonary artery systolic pressure, atrial fibrillation and E/e' ratio ranged from 0 to 9 points. The level of statistical significance was p

Background Population aging is still an important worldwide phenomenon. Elderly people suffer from multiple chronic diseases that require the use of several drugs, and this demographic scenario fosters the increased prescription of multiple drugs, or Polypharmacy (PP) and Potentially Inappropriate Medication (PIM). Objective This study aimed to identify the prevalence rates and associated factors of PP and PIM in Brazilian older adults. Method The prevalence of PIM use and PP was estimated in a sample of 222 patients enrolled in the Family Health Program in Niterói, Brazil. Logistic regression models were used to analyze the data. Age and sex were kept in the models as potential confounding factors. Results PP and PIM use presented prevalence rates of 23.9 and 24.8%, respectively. PP was associated with body mass index, coronary heart disease, diabetes mellitus, and a number of comorbidities, whereas PIM use was associated with PP. Conclusion The prevalence rates of PP and PIM use found were lower than those reported in previous studies. This could be a result of differences in availability of drugs or prescribing habits. Multiple chronic diseases were associated with PP. These results suggest that more care should be taken in prescribing for the elderly population. Resumo Introdução O envelhecimento populacional é um fenômeno mundial. Os idosos apresentam mais comorbidades e usam vários medicamentos, cenário que aumenta a prescrição de polifarmácia (PF) e o uso de medicamentos potencialmente inapropriados (MPIs). Objetivo O objetivo do estudo foi identificar a prevalência e os fatores associados à PF e aos MPIs em idosos brasileiros. Método Foi utilizada uma amostra de 222 idosos inscritos no Programa Médico de Família em Niterói, Brasil (Estudo Digitalis). Foi estimada a prevalência de PF e MPIs. Foram usados modelos de regressão logística. Idade e sexo foram mantidos nos modelos como possíveis fatores de confusão. Resultados A prevalência de PF foi de 23,9% e de MPIs 24,8%. A PF foi associada com índice de massa corpórea, doença coronariana, diabetes mellitus e número de comorbidades; já MPIs foram associados com PF. Conclusão A prevalência de PF e MPIs, embora elevada, foi menor do que a evidenciada em outros estudos. Isso pode ser reflexo das diferenças na disponibilidade das medicações e nos hábitos de prescrição. A PF foi associada à presença de múltiplas comorbidades, visto que sempre é necessário o uso de várias drogas para a manutenção terapêutica. Os resultados deste estudo demonstram que ainda é preciso maior cuidado na prescrição de pacientes idosos.

Introduction: Population aging is associated with increased prevalence of cardiovascular diseases that have a significant impact on overall morbidity and mortality. Insulin resistance (IR) and visceral obesity are risk factors for vascular damage and cardiometabolic diseases. Aims: Estimating the correlation between lipid accumulation product (LAP) and IR in elderly individuals and comparing them to traditional anthropometric indices. Methods: Cross-sectional study comprising 411 individuals >60 years, who were treated in a primary care service. Body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC), arm circumference (AC), sagittal abdominal diameter (SAD) and waist-hip ratio (WHR) were recorded. IR was estimated based on HOMA-IR (homeostasis model assessment IR index). LAPa index was calculated as [WC-65]×[triglyceride (TG)] in men, and as [WC-58]×[TG] in women, whereas LAPb was calculated by using the minimum WC values recorded for the current sample, i.e., 61.5 cm for women and 71.5 cm for men. Results: There was correlation among LAPa (0.506), LAPb (0.515) and HOMA-IR. LAP was better correlated to HOMA-IR and showed higher area under the curve than BMI, NC, WHR and SAD. Based on the receiver operating characteristic curve analysis, LAPb≥47.40 and LAPa≥52.5 were the best cut-off values used to identify individuals with IR presenting 68.8% and 68.2% sensitivity, and 68.6% and 68.6% specificity, respectively. Conclusion: LAP may be a useful and simple clinical marker to assess cardiometabolic risk factors in the elderly population treated at a primary care service. Resumo: Introdução: O envelhecimento da população associa-se ao aumento da prevalência de doenças cardiovasculares, com um impacto significativo na morbimortalidade geral. Resistência à insulina (RI) e obesidade visceral são fatores de risco para lesão vascular e doença cardiometabólica. Objetivo: Estimar a correlação entre produto de acumulação de lípidos (LAP) e IR em indivíduos idosos e compará-los com os índices antropométricos tradicionais. Métodos: Este estudo transversal incluiu 411 indivíduos acima de 60 anos, atendidos na atenção primária. Foram registradas índice de massa corporal (IMC), circunferência do pescoço (CP), circunferência da cintura (CC), circunferência do quadril (CQ), circunferência do braço (CA), diâmetro abdominal sagital (DAS) e relação cintura-quadril (RCQ). A RI foi estimada pelo HOMA-IR (índice de avaliação do modelo de homeostase). O índice de PALa foi calculado como [WC-65] × [TG] em homens, e [WC-58] × [TG] em mulheres e PALb foi calculada usando o valor mínimo da CC sendo 61,5 cm para mulheres e 71,5 cm para homens. Resultados: Houve correlação entre LAPa (0,506), LAPb (0,515) e HOMA-IR. O LAP foi melhor correlacionado com o HOMA-IR e mostrou maior área sob a curva do que o IMC, NC, WHR e SAD. Com base na análise da curva característica operacional do receptor, LAPb ≥47.40 e LAPa ≥52.5 foram os melhores valores de corte utilizados para identificar indivíduos com IR apresentando 68,8% e 68,2% de sensibilidade, e 68,6% e 68,6% de especificidade, respectivamente. Conclusão: O LAP pode ser um marcador clínico útil e simples para avaliar os factores de risco cardiometabólico na população idosa tratada num serviço de cuidados primários.

Resumo: Introdução: A dispneia é o sintoma mais comummente reportado por pacientes com insuficiência cardíaca, doenças pulmonares, obesos e idosos. Recentemente, a dispneia na anteflexão do tórax − flexopneia − foi descrita entre os pacientes com insuficiência cardíaca. Objetivo: Estimar a associação da dispneia aos esforços, ortopneia, dispneia paroxística noturna e flexopneia com as doenças crônicas não transmissíveis e, especialmente, com a insuficiência cardíaca e seus fenótipos na atenção primária. Métodos: Estudo transversal que incluiu 633 indivíduos de 45‐99 anos, sorteados entre os cadastrados no programa Médico de Família de Niterói, Brasil. Os participantes foram submetidos a questionário estruturado, avaliação clínica, exames laboratoriais, eletrocardiograma e ecocardiograma, em único dia. Resultados: A dispneia paroxística noturna e a flexopneia apresentaram associação com a insuficiência cardíaca antes do ajuste (ORb = 2,42; IC 95% = 1,10‐5,29 e ORb = 2,59; IC 95% = 1,52‐4,44, respectivamente). Nos modelos múltiplos, a doença pulmonar obstrutiva crônica, angina pectoris e o infarto do miocárdio não mostraram associação com a flexopneia. Conclusão: A flexopneia foi a única que não se associou com as doenças respiratórias e as doenças coronarianas. Mesmo após o controle pela depressão e índice de massa corporal, manteve associação com a insuficiência cardíaca e com a insuficiência cardíaca com fração de ejeção preservada, mostrando‐se como um sintoma promissor para diferenciar a insuficiência cardíaca dos outros dois grupos de doença. Abstract: Introduction: Dyspnea is the symptom most commonly reported by patients with heart failure (HF) and/or pulmonary disease, the obese and the elderly. Recently ‘bendopnea’ (shortness of breath when bending forward) has been described in patients with HF. Objective: To determine the association of exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea and bendopnea with chronic disease, especially heart failure, and their phenotypes in primary care. Methods: This cross‐sectional study included 633 individuals aged between 45 and 99 years enrolled in a primary care program in Niteroi, Brazil. Participants underwent clinical assessment and laboratory tests and completed a questionnaire, all on the same day. Results: Paroxysmal nocturnal dyspnea and bendopnea were associated with HF (unadjusted OR 2.42, 95% CI 1.10‐5.29 and OR 2.59, 95% CI 1.52‐4.44, respectively). In multivariate models, chronic obstructive pulmonary disease, coronary heart disease and myocardial infarction were not associated with bendopnea. Conclusions: Bendopnea was the only type of dyspnea not linked to respiratory disease or coronary heart disease. Even after adjusting for depression and body mass index, the association remained with HF with or without preserved ejection fraction, and bendopnea thus appears to be a promising symptom to differentiate HF from the other two disease groups. Palavras‐chave: Insuficiência cardíaca, Cuidados de saúde primários, Dispneia, Dispneia paroxística noturna, Flexopneia, Keywords: Heart failure, Primary care, Dyspnea, Paroxysmal nocturnal dyspnea, Bendopnea

Background: Dyspnea is the most common symptom in heart failure. In the elderly, it is common in chronic obstructive pulmonary disease and depression. Objective: To estimate the prevalence of dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea and its association with chronic diseases in primary care. Methods: A cross-sectional study, part of the Digitalis Study, including 633 individuals, between 45 to 99 years old, registered in a primary care program in Niteroi, Brazil. All participants underwent clinical evaluations, blood and urine collection, and responded to a questionnaire in a single day. Self-reports were used for the diagnosis of diseases. Results: Of the 633 individuals, 30% had dyspnea. In the crude analysis, chronic obstructive pulmonary disease showed the strongest associations with the three types of dyspnea, followed by depression and heart failure. Chronic obstructive pulmonary disease alone did not present any cases of paroxysmal nocturnal dyspnea, and heart failure alone showed a very strong relationship with this type of dyspnea. Conclusions: The different behavior of the associations of the types of dyspnea with major chronic diseases in patients in primary care can help in the better characterization of patients with heart failure. Resumen: Introducción: La disnea es el síntoma más común en la insuficiencia cardíaca. En los ancianos es común en la enfermedad pulmonar obstructiva crónica y la depresión. Objetivo: Estimar la prevalencia de disnea de esfuerzo, ortopnea y disnea paroxística nocturna y su asociación con enfermedades crónicas en la atención primaria. Métodos: Estudio transversal, parte del estudio Digitalis, que incluyó a 633 individuos, entre 45 y 99 años de edad, registrados en un programa de atención primaria en Niterói, Brasil. Todos los participantes se sometieron a evaluaciones clínicas, recolección de sangre y orina, y respondieron a un cuestionario en un solo día. Se usaron autorrelatos para el diagnóstico de las enfermedades. Resultados: De los 633 individuos, el 30% presentó disnea. En el análisis crudo la enfermedad pulmonar obstructiva crónica mostró las asociaciones más fuertes con los tres tipos de disnea, seguidos por la depresión y la insuficiencia cardíaca. La enfermedad pulmonar obstructiva crónica, evaluada de forma aislada, no presentó ningún caso de disnea paroxística nocturna, y la insuficiencia cardíaca por sí sola mostró una relación muy fuerte con este tipo de disnea. Conclusiones: El comportamiento diferente de las asociaciones de los tipos de disnea con las principales enfermedades crónicas en pacientes en atención primaria puede ayudar a una mejor caracterización de los pacientes con insuficiencia cardíaca. Keywords: Dyspnea, Heart Failure, Depression, Chronic obstructive pulmonary disease, Paroxysmal nocturnal dyspnea, Palabras clave: Disnea, Insuficiencia cardíaca, Depresión, Enfermedad pulmonar obstructiva crónica, Disnea paroxística nocturna

The objective of this study was to identify the factors associated with the impairment of quality of life (QoL) in community-dwelling individuals with LUTS. A randomized sample of the population registered in the Family Health Program - Niterói aged 45 years or over was selected. Information about demographic, socioeconomic and lifestyle factors, co-morbidities and nocturia was collected. The NANDA-I taxonomy was used to identify the other LUTS, and QoL evaluation was performed in accordance with the SF-36 Short Form questionnaire (SF36-SF). For the SF36-SF domains (outcome) associated with LUTS, multiple logistic models were tested including the urinary symptoms and the sociodemographic and associated clinical variables. Stress urinary incontinence was associated with white skin, female gender, obesity, smoking, alcohol intake, depression and low scores in all evaluated domains of QoL. Nocturia was associated with advanced age, low schooling level, higher BMI, hypertension, diabetes, health insurance and the lowest scores in all evaluated domains of Qol, except for the Role Emotional. According to multivariate analysis, stress incontinence and depression are associated with the highest risks of low scores in General Health, Physical Functioning and Vitality domains, while nocturia and obesity showed association with the highest risks of low scores in Physical Functioning, Bodily-Pain and Vitality domains.

Objetivos: observar a implementação de protocolos canadenses aos pacientes com insuficiência cardíaca, assim como identificar junto às enfermeiras, aspectos de educação em saúde. Método: pesquisa exploratória no período de agosto a dezembro de 2013, onde a coleta de dados deu-se por observação durante a Shadow Experience, e por entrevista de enfermeiras canadenses. Para análise dos dados, utilizou-se a estatística descritiva. Resultados: 28 pacientes foram observados na estratégia Shadow Experience em diferentes níveis de atendimento, e 13 enfermeiras entrevistadas. Em Educação em Saúde, o contato interpessoal foi a estratégia mais utilizada (69,23%), o tratamento foi a ação prioritária (76,92%), seguida da prevenção (30,77%). Há desafios com relação aos hábitos de vida prejudiciais, e para o autocuidado considerado pouco eficaz(38,46%). Conclusão: A interação interpessoal, a qual envolveu profissionais e indivíduos canadenses em diferentes níveis de atendimento, contribuiu para identificar em sua implementação, ações básicas e desafios para insuficiência cardíaca.Descritores: enfermagem; insuficiência cardíaca; atenção primária; intercâmbio educacional internacional.

Obesity impacts the quality of life (HRQL). Studies about the effects of a possible interaction between gender and body mass are rare. The objective of the present paper is to estimate the biological interaction between gender and obesity on HRQL. This was a cross-sectional study based on data from CAMELIA study with population assisted by the Family Doctor Program of Niteroi visited between June 2006 and December 2007. HRQL was assessed by the SF-36. The exposure categories were: obese women, non-obese women, obese men and non-obese men, the reference category. Obese women showed higher percentages of low overall, physical and mental quality of life with the largest associations in the physical component. The excess risk due to interaction was statistically significant in physical dimension: RERI = 1.97 (0.40-3.52) and RERIa = 1,97 (0.40-1.7). Among the Brazilian population aged 20–64 years, obesity was independently associated with low HRQL. This association differed by gender, being significant for women. The possibility of the combined effect takes greater importance in the context of increasing incidence of obesity globally. Healthcare professionals in primary care settings should pay attention to gender differences in the impact of obesity on HRQL.

Introdução: a preocupação quanto à capacidade de atendimento em saúde, principalmente hospitalar, aumenta com o recrudescimento da epidemia do Covid-19. Objetivo: analisar dados do SIVEP-Gripe de 18 municípios da região metropolitana do Rio de Janeiro, de pacientes internados por SRAG em hospitais públicos e privados. Métodos: é um estudo epidemiológico ecológico e de coorte histórica com o município e o paciente como unidades de análise, no período de março a novembro de 2020. Foram estimadas as razões de chances para sinais e sintomas, fatores de risco, se hospital público ou privado, internação em UTI e óbitos. Empregou-se o teste do qui-quadrado de Pearson (p90% dos seus residentes. Pelo menos 25% dos hospitais, públicos e privados, internaram somente um paciente levando à dificuldade de aprendizado. Os hospitais públicos apresentaram maior chance de terem internado pacientes mais velhos, de cor de pele preta ou parda, com dispneia, desconforto respiratório e baixa saturação de oxigênio, doença hepática e imunossupressão, condições de maior risco para resultados negativos. A chance de um paciente ter passado por uma UTI em um hospital público foi cerca da metade do hospital privado e a de morte foi cerca do triplo. Conclusão: os municípios estudados, exceto Niterói, não estão preparados para dar suporte a seus residentes na pandemia de Covid-19. Verificou-se discrepância no atendimento dos hospitais públicos e privados, assim como falhas na atenção básica levando a um maior risco de resultados desfavoráveis e um elevado número de óbitos nas unidades hospitalares públicas.

Introdução: a insuficiência cardíaca é um grave problema de saúde pública com elevada morbimortalidade, com estimativa de 23 milhões ao redor do mundo. Objetivo: estimar a prevalência de diagnósticos de enfermagem prioritários nos indivíduos com fatores de risco para insuficiência cardíaca na atenção primária. Metodologia: trata-se de análise secundária de uma amostra de 603 indivíduos do Estudo Digitalis, para os quais foi selecionado pelo método delphi, 25(vinte e cinco) diagnósticos de enfermagem prioritários. Resultados: dos 603 participantes, identificou-se 437 hipertensos, 380 diabéticos, 180 obesos e 52 com doença arterial coronariana, e ainda predominância feminina e faixa etária de 45 a 69 anos. E ainda a associação significativa com variáveis sociodemográficas, hábitos de vida e fatores de risco deu-se com onze diagnósticos. Conclusão: a identificação destes diagnósticos de enfermagem associados principalmente aos fatores de risco trouxe a perspectiva do planejamento de ações em saúde aos indivíduos com fatores de risco para o desenvolvimento da insuficiência cardíaca na atenção primária.

O Estado do Rio de Janeiro tem a maior proporção de municípios com piores índices de vulnerabilidade ao Covid-19 (IVC) do sul e sudeste. Objetivo: descrever os padrões de ocorrência da pandemia do COVID-19 nos 18 municípios da Região Metropolitana do Rio do Janeiro, considerando a vulnerabilidade ao vírus. Resultados: Os gráficos mostram tendência à estabilização da epidemia, a exceção de São Gonçalo que apresenta tendência crescente e Itaguaí, decrescente. Houve uma associação moderada, positiva e significativa entre os indicadores de vulnerabilidade sugerindo que as maiores incidências ocorreram em municípios menos vulneráveis, em municípios com menores proporção de população preta e parda e com maior número de ubs/habitante, e essas correlações não diminuíram nos último dois meses. Conclusão: A COVID-19 se disseminou de forma desigual. Municípios menos vulneráveis apresentaram mais casos e apenas um município da região apresentou tendência à redução de casos. A importância da divulgação de informações sobre o funcionamento das UBS e as políticas de atendimento e monitoramento de sintomáticos, além da testagem dos contatos ficou clara para permitir um adequado acompanhamento dos padrões de disseminação da doença visando contribuir para a orientação das atividades de controle dirigidas ao enfrentamento da epidemia.

Background: The study is based on the fact that left atrial (LA) volume measurement is a marker of the presence of diastolic dysfunction and that Vitamin D deficiency may be associated with ventricular remodeling, worsening of left ventricular (LV) diastolic and systolic function, and activation of the renin-angiotensin-aldosterone system. Objective: To evaluate whether LAV changes are related to vitamin D deficiency. Method: A cross-sectional, population-based, unicentric study in which 640 patients over 45 years of age enrolled in the Niteroi’s [...]

Vitamin D is considered a steroid hormone with a broad spectrum of action in the human body. Its action arises from the binding of its active metabolite (1α,25-dihydroxyvitamin D) to its receptor (VDR), which is present throughout the body, including vascular smooth muscle cells and cardiomyocytes. Initially, vitamin D deficiency was related only to changes in the musculoskeletal system, but in recent years, researchers have demonstrated its relationship with several pathologies related to other systems, such as cardiovascular diseases. The objective of this study is to review vitamin D’s pathophysiology, describe its relationship with cardiovascular diseases based on the most recent publications, and highlight the results of vitamin supplementation in the prevention of such pathologies.

Background: Obstructive sleep apnea (OSA) is a chronic progressive disorder with high mortality and morbidity rate, associated with cardiovascular diseases (CVD), especially heart failure (HF). The pathophysiological changes related to OSA can directly affect the diastolic function of the left ventricle. Objectives: To assess the association of the risk of OSA, evaluated by the Berlin Questionnaire (BQ), and echocardiographic (ECHO) parameters related to diastolic dysfunction in individuals without HF assisted in primary care. Methods: A cross-sectional study that included 354 individuals (51% women) aged 45 years or older. All individuals selected were submitted to an evaluation that included the following procedures: consultation, filling out the BQ, clinical examination, laboratory examination and transthoracic Doppler echocardiography (TDE). Continuous data are presented as medians and interquartile intervals, and categoric variables in absolute and relative frequencies. The variables associated with risk of OSA and at the 0.05 level integrated the gamma regression models with a log link function. A value of p < 0.05 was considered an indicator of statistical significance. Exclusion criteria were presence of HF, to fill out the BQ and patients with hypertension and obesity not classified as high risk for OSA by other criteria. All individuals were evaluated on a single day with the following procedures: medical appointment, BQ, laboratory tests and ECHO. Results: Of the 354 individuals assessed, 63% were classified as having high risk for OSA. The patients with high risk for OSA present significantly abnormal diastolic function parameters. High risk for OSA confirmed positive and statistically significant association, after adjustments, with indicators of diastolic function, such as indexed left atrium volume LAV-i (p = 0.02); E’/A’ (p < 0.01), A (p = 0.02), E/A (p < 0.01). Conclusion: Our data show that patients at high risk for OSA present worsened diastolic function parameters measured by TDE. Resumo Fundamento: A apneia obstrutiva do sono (AOS) é um transtorno crônico, progressivo, com alta morbimortalidade e associado às doenças cardiovasculares (DCV), entre elas a insuficiência cardíaca (IC). As alterações fisiopatológicas relacionadas com a AOS podem impactar diretamente a função diastólica do ventrículo esquerdo. Objetivo: Estimar a associação entre risco de AOS, avaliada pelo Questionário de Berlim (QB), e parâmetros do ecocardiograma, relacionados com a função diastólica, em indivíduos sem IC na atenção primária. Métodos: Estudo transversal que incluiu 354 indivíduos (51% mulheres) com idade igual ou superior a 45 anos. Todos os indivíduos selecionados foram submetidos a uma avaliação que constou dos seguintes procedimentos: consulta, preenchimento do QB e exame clínico, realização de exames laboratoriais e ecocardiograma Doppler transtorácico (EDT). Os dados contínuos são apresentados em medianas e intervalos interquartílicos e os categóricos em frequências absolutas e relativas. As variáveis que apresentaram associação ao risco de AOS em nível de 0,05 integraram os modelos de regressão gama com função de ligação log link. Análise bruta: Um valor de p < 0,05 foi considerado como indicador de significância estatística. Resultados: Dos 354 indivíduos analisados, 63% foram classificados como tendo alto risco para AOS. Os pacientes com alto risco para AOS apresentam alterações significativas dos parâmetros que avaliam a função diastólica. Alto risco para AOS confirmou sua associação positiva e estatisticamente significativa, após ajuste, a indicadores de disfunção diastólica - VAE-i (p = 0,02); E’/A’ (p < 0,01); A (p = 0,02); E/A (p < 0,01). Conclusão: Nossos dados mostram que pacientes com alto risco de AOS apresentam piora dos parâmetros de função diastólica medidos pelo EDT.

Background Blood pressure variability (BPV) has been shown to predict cardiovascular events. Within-visit BPV is the simplest and easiest measure of BPV, but previous studies have shown conflicts as to whether within-visit BPV correlates with target organ damage. We aimed to evaluate whether within-visit BPV correlates with B-type natriuretic peptide (BNP) in a general population. Hypothesis Within-visit BPV correlates with BNP in a general population. Methods This was a cross-sectional study that included 633 individuals, randomly selected, age 45 to 99 years, registered in the primary care program from an urban medium-sized town. Patients were scheduled for a single-day visit that consisted of clinical evaluation and laboratory tests. Three blood pressure (BP) readings, 1 minute apart, were done, and within-visit BPV was determined as the coefficient of variation (CV) of the 3 BP measures. Our main outcome was to correlate BNP and within-visit BPV. A multivariable model was estimated using a generalized linear model to evaluate the independent effects of different variables on BNP levels. Results The median age was 57 years. Median BNP was 16 pg/mL, and the median systolic and diastolic BP-CV were, respectively, 3.9% and 3.5%. There was a weak but positive correlation between BNP and both systolic BP-CV and diastolic BP-CV (r = 0.107 and P = 0.007 and r = 0.092 and P = 0.019, respectively). In multiple regression equation, systolic BP, diastolic BP-CV, body mass index, and estimated glomerular filtration rate were associated with BNP. Conclusions In the present study, there was a positive, albeit weak, correlation between within-visit BPV and BNP. In addition, diastolic BPV was associated with BNP even after adjustment for multiple confounders.

Serum creatinine (sCr) is usually higher among black people in the United States due to increased muscle mass, justifying the addition of race adjustment in creatinine-based formulas to estimate glomerular filtration rate (eGFR). We aimed to assess if sCr levels are different in low-income communities in Brazil according to their race. A total of 1,303 participants were enrolled (58% females, 50±14 years-old, 33% self-defined as white, 41% as mixed race, and 26% as black). No significant differences in sCr were found between racial groups and no influence of race on sCr was seen in the linear regression analysis. The eGFR, calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula with no race adjustment, was no different between whites, mixed race and blacks. However, using such adjustment, eGFR for mixed race and black individuals was significantly higher than for whites (p < 0.001). In conclusion, no significant differences in sCr levels were found between racial groups, raising doubts as to whether race adjustment in eGFR formula should be used in that population.

Introduction: Urinary incontinence (UI) is prevalent in women, and the frequency of its clinical subtypes varies according to the population studied and the choice of diagnostic criteria. The aim of this study was to evaluate the distribution of the most common subtypes – stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) – and their correlation with demographic, clinical and reproductive factors of patients seen at the university hospital of Universidade Federal do Rio de Janeiro. Methods: This cross-sectional study was conducted in a referral service of a tertiary care center. A retrospective analysis of records of 770 women referred to the urogynecologic outpatient clinic was performed. The clinical diagnosis of UI subtype was established in accordance with international standardization. Women presenting with SUI and MUI were compared in terms of age, reproductive history, comorbidities, medications used and gynecological surgeries. The effect of independent variables was assessed through multiple regression analyses. Results: The frequency of the clinical diagnosis of MUI and SUI was, respectively, 54.6% and 31.8%. Factors associated with MUI when compared with SUI were diabetes mellitus (odds ratio, OR = 1.75; 95% confidence interval, 95% CI = 1.08; 2.85) and perineoplasty (OR = 1.79; 95% CI = 1.18; 2.72). Age showed a borderline significance (p = 0.05). Conclusion: The distribution of UI subtypes was different from the distribution found in populational studies, which shows the specific aspects of women referred for specialized care. MUI was the most common subtype and was associated with previous vaginal surgery and diabetes mellitus when compared with SUI. Keywords: Urinary incontinence; Urge; urinary incontinence; stress; women’s health; epidemiology

The objective of the present study was to characterize the potential drug interactions (PDI), estimating the factors associated to their occurrence in adults and the elderly assisted by the Programa Médico de Família de Niterói, Rio de Janeiro. This is a sub-study of STUDY DIGITALIS, which included individuals enrolled in the Niteroi Family Medical Program (45-99 years). In this study, 341 individuals with a prescription of two or more drugs were analyzed. The classification of PDI followed MICROMEDEX. There were 113 different interactions. Of the total number of individuals, 63.6% had at least one PDI. The variables with higher probability of PDI were: lower level of schooling; income less than R$800.00; absence of health plan; previous diagnosis of hypertension and diabetes; use of 5 or more medications prescribed. After adjustment, the variables previous diagnosis of hypertension and diabetes and use of 5 or more prescription drugs remained statistically significant. Careful management of primary care treatment with monitoring is important in patients with PDI, especially in patients who are more susceptible.O objetivo do presente estudo foi caracterizar as interações medicamentosas potenciais (IMP) e avaliar os fatores associados à sua ocorrência em adultos e idosos assistidos pelo Programa Médico de Família de Niterói, Rio de Janeiro. Trata-se de um subestudo do ESTUDO DIGITALIS, que incluiu indivíduos cadastrados no Programa Médico de Família de Niterói (45-99 anos). Foram analisados 341 indivíduos com prescrição de dois ou mais medicamentos. A classificação das IMP seguiu o MICROMEDEX®. Houve 113 interações diferentes. Do total de indivíduos, 63,6% apresentaram pelo menos uma IMP. As variáveis com maior chance de IMP foram: menor escolaridade; renda inferior a R$800,00; ausência de plano de saúde; diagnóstico de hipertensão, diabetes, infarto agudo do miocárdio; e uso de 5 ou mais medicamentos prescritos. Após ajuste, as variáveis diagnóstico anterior de hipertensão e diabetes e uso de 5 ou mais medicamentos prescritos permaneceram significativas estatisticamente. É importante uma gestão cautelosa do tratamento na atenção básica com monitoramento das IMP, especialmente em pacientes mais susceptíveis.

This study focused on the correlation between neck circumference and other anthropometric measurements and cardiovascular risk factors and insulin resistance in the elderly in Niterói, Rio de Janeiro State, Brazil. This was a cross-sectional study in 411 patients seen in primary care. Anthropometric measurements including neck circumference, body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) were recorded. Bioelectrical impedance analysis (BIA) estimated the percentage of total body fat (%TBF). Insulin resistance was estimated by HOMA-IR (homeostasis model assessment IR index). The data were analyzed by the Mann-Whitney test and the correlation between numerical variables by Spearman’s test. Receiver operating characteristic (ROC) was used to assess the anthropometric measurements’ predictive capacity to diagnosis insulin resistance. Neck circumference was positively correlated with WC, BMI, WHR, %TBF, and HOMA-IR in both sexes. In women, neck circumference showed higher AUC (area under the curve) for insulin resistance. In men, WC showed higher AUC, followed by BMI and neck circumference. The current study in Southeast Brazil suggests that neck circumference can predict insulin resistance, an important marker of cardiovascular risk in the elderly population treated in primary care. Resumo: O presente estudo investigou a correlação da circunferência do pescoço (CP) e outras medidas antropométricas com os fatores de risco cardiovasculares e resistência insulínica (RI) em idosos de Niterói, Rio de Janeiro, Brasil. Foi realizado estudo transversal com 411 pacientes na atenção primária de saúde. Medidas antropométricas como CP, índice de massa corporal (IMC), circunferência da cintura (CC) e razão cintura-quadril (RCQ) foram aferidas. A bioimpedância elétrica (BIA) estimou o percentual da gordura corporal total (%GC). A resistência à insulina foi estimada pelo HOMA-IR (homeostasis model assessment IR index). Os dados foram analisados utilizando o teste de Mann-Whitney e a correlação entre as variáveis numéricas pelo teste de Spearman. A curva ROC (receiver operating characteristic) foi utilizada para avaliar a capacidade preditiva das medidas antropométricas no diagnóstico de RI. A CP foi positivamente correlacionada com a CC, o IMC, RCQ, %TBF e com o HOMA-IR em ambos os sexos. Nas mulheres, a CP apresentou a maior AUC (área sob a curva) para RI. Nos homens, a CC apresentou a maior AUC, seguido pelo IMC e CP. O presente estudo realizado no Sudeste do Brasil sugere que a CP pode predizer a RI, importante marcador de risco cardiovascular, na população idosa atendida na atenção primária de saúde. Resumen: El presente estudio investigó la correlación de la circunferencia del cuello (CP) y otras medidas antropométricas con los factores de riesgo cardiovasculares y resistencia a la insulina (RI) en ancianos de Niterói, Río de Janeiro, Brasil. Fue realizado estudio transversal con 411 pacientes en la atención primaria de salud. Medidas antropométricas como CP, índice de masa corporal (IMC), circunferencia de la cintura (CC) y razón cintura-cadera (RCC) fueron tomadas con precisión. La bioimpedancia eléctrica (BIA) estimó el porcentaje de la grasa corporal total (%GC). La resistencia a la insulina se estimó por el HOMA-IR (homeostasis model assessment IR index). Los datos se analizaron utilizando el test de Mann-Whitney y la correlación entre las variables numéricas por el test de Spearman. La curva ROC (receiver operating characteristic) fue utilizada para evaluar la capacidad predictiva de las medidas antropométricas en el diagnóstico de RI. La CP fue positivamente correlacionada con la CC, el IMC, RCC, %TBF y con el HOMA-IR en ambos sexos. En las mujeres, la CP presentó la mayor AUC (área bajo la curva) para RI. En los hombres, la CC presentó la mayor AUC, seguido por el IMC y CP. El presente estudio realizado en el sudeste de Brasil sugiere que la CP puede predecir la RI, importante marcador de riesgo cardiovascular, en la población anciana atendida en la atención primaria de salud.

Background: Heart failure (HF) is a major public health issue with implications on health-related quality of life (HRQL). Objective: To compare HRQL, estimated by the Short-Form Health Survey (SF-36), in patients with and without HF in the community. Methods: Cross-sectional study including 633 consecutive individuals aged 45 years or older, registered in primary care. The subjects were selected from a random sample representative of the population studied. They were divided into two groups: group I, HF patients (n = 59); and group II, patients without HF (n = 574). The HF group was divided into HF with preserved ejection fraction (HFpEF - n = 35) and HF with reduced ejection fraction (HFrEF - n = 24). Results: Patients without HF had a mean SF-36 score significantly greater than those with HF (499.8 ± 139.1 vs 445.4 ± 123.8; p = 0.008). Functional capacity - ability and difficulty to perform common activities of everyday life - was significantly worse (p < 0.0001) in patients with HF independently of sex and age. There was no difference between HFpEF and HFrEF. Conclusion: Patients with HF had low quality of life regardless of the syndrome presentation (HFpEF or HFrEF phenotype). Quality of life evaluation in primary care could help identify patients who would benefit from a proactive care program with more emphasis on multidisciplinary and social support. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0) Resumo Fundamento: A insuficiência cardíaca (IC) é um importante problema de saúde pública, com implicações na qualidade de vida relacionada à saúde (QVRS). Objetivo: Comparar a QVRS, estimada através do Questionário SF-36 (Short-Form Health Survey), em pacientes com e sem IC na comunidade. Métodos: Estudo transversal incluindo 633 indivíduos consecutivos com idade igual ou superior a 45 anos, registrados na atenção primária e selecionados de uma amostra aleatória representativa da população estudada. Foram divididos em dois grupos: grupo I, pacientes com IC (n = 59); e grupo II, pacientes sem IC (n = 574). O grupo I foi dividido em pacientes com IC com fração de ejeção preservada (ICFEP - n = 35) e pacientes com IC com fração de ejeção reduzida (ICFER - n = 24). Resultados: Pacientes sem IC tiveram um escore médio do SF-36 significativamente maior do que aqueles com IC (499,8 ± 139,1 vs 445,4 ± 123,8; p = 0,008). A capacidade funcional - habilidade e dificuldade para realizar atividades comuns da vida diária - foi significativamente pior (p < 0,0001) nos pacientes com IC independentemente de sexo e idade. Não houve diferença entre ICFEP e ICFER. Conclusão: Pacientes com IC mostraram baixa qualidade de vida a despeito da apresentação da síndrome (fenótipo ICFEP ou ICFER). A avaliação da qualidade de vida na atenção primária poderia auxiliar a identificar pacientes que se beneficiariam de um programa de atenção à saúde pró-ativo com maior ênfase em suporte multidisciplinar e social. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Background Systemic sclerosis (SSc) is an uncommon autoimmune multisystem disease associated with reduced life expectancy compared with the general population.1 In order to prolong survival of this patient population, clear information on the most important death-related conditions is undoubtedly necessary. No mortality data in SSc, however, are available from Latin America, as well as few large series studies have looked at the mortality profile in SSc. Objectives We aimed to describe the causes of death in SSc occurred in the state of Rio de Janeiro, Brazil, from 2006–2015, and also to compare the data gathered with the general population mortality. Methods All death certificates issued in the state of Rio de Janeiro, Brazil, from 2006–2015 were screened for the code attributed to SSc according to the tenth revision of the International Classification of Diseases (ICD-10), either as an underlying (UD) cause of death (also referred to as basic cause of death) or a non-underlying (non-UD) cause. In addition to compiling the causes of death in both settings, we calculated the non-adjusted as well as the age bracket-adjusted (age at death Results Of 1.294.491 fatalities recorded over the study period, ICD-10 code for SSc was listed on 374 (0.02%) death certificates, being a basic cause of death on 223 occasions and a non-UD cause on 151 occasions. The overall mean (SD) age at death in SSc was 58.7 (15.6) years, with men (n=56) having an earlier mean age at death than women (n=318) [53.5 vs 59.6 years, respectively; p=0.004]. For SSc as a basic cause of death, the main non-UD causes were respiratory system diseases (61.4%), in particular pneumonia, followed by septicemia (37.6%), diseases of the circulatory system (34.9%), and renal failure (9.4%). There were no significant differences between the genders for each cause of death. The mean age at death was significantly lower among men vs women for diseases of the respiratory system, respiratory failure, certain infectious and parasitic diseases, and septicemia. For SSc as a non-UD cause of death, the major conditions leading to death were circulatory system diseases (39%), in particular pulmonary arterial hypertension (PAH; 13.2%), followed by certain infections and parasitic diseases (11.9%), malignant neoplasms (10.5%) and diseases of the digestive system (9.9%). Compared with the overall population, patients with SSc had an excess of death (odds ratio [OR] >1) due to PAH (OR 138.94), septicemia (OR 1.92), gastrointestinal hemorrhage (OR 2.40), other systemic connective tissue diseases (OR 24.78) and pulmonary fibrosis (OR 11.05), as well as due to heart failure (OR 6.40) for deaths occurred before age 50. Conclusions We have shown large data on the mortality profile of patients with SSc, the first from Latin America. Of note, infections and cardiorespiratory diseases had a strong impact on mortality, as evidenced by previous publications.1 Taking all into account, these data support an increased vigilance for infections, as well as the need to implement effective measures to control modifiable cardiovascular risk factors, including screening for PAH. References Rubio-Rivas M, et al. Semin Arthritis Rheum 2014; 44:208–219. Disclosure of Interest None declared

Background: Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF), its diagnosis being a challenge to the outpatient clinic practice. Objective: To describe and compare two strategies derived from algorithms of the European Society of Cardiology Diastology Guidelines for the diagnosis of HFPEF. Methods: Cross-sectional study with 166 consecutive ambulatory patients (67.9±11.7 years; 72% of women). The strategies to confirm HFPEF were established according to the European Society of Cardiology Diastology Guidelines criteria. In strategy 1 (S1), tissue Doppler echocardiography (TDE) and electrocardiography (ECG) were used; in strategy 2 (S2), B-type natriuretic peptide (BNP) measurement was included. Results: In S1, patients were divided into groups based on the E/E'ratio as follows: GI, E/E'> 15 (n = 16; 9%); GII, E/E'8 to 15 (n = 79; 48%); and GIII, E/E'< 8 (n = 71; 43%). HFPEF was confirmed in GI and excluded in GIII. In GII, TDE [left atrial volume index (LAVI) ≥ 40 mL/m2; left ventricular mass index LVMI) > 122 for women and > 149 g/m2 for men] and ECG (atrial fibrillation) parameters were assessed, confirming HFPEF in 33 more patients, adding up to 49 (29%). In S2, patients were divided into three groups based on BNP levels. GI (BNP > 200 pg/mL) consisted of 12 patients, HFPEF being confirmed in all of them. GII (BNP ranging from 100 to 200 pg/mL) consisted of 20 patients with LAVI > 29 mL/m2, or LVMI ≥ 96 g/m2 for women or ≥ 116 g/m2 for men, or E/E'≥ 8 or atrial fibrillation on ECG, and the diagnosis of HFPEF was confirmed in 15. GIII (BNP < 100 pg/mL) consisted of 134 patients, 26 of whom had the diagnosis of HFPEF confirmed when GII parameters were used. Measuring BNP levels in S2 identified 4 more patients (8%) with HFPEF as compared with those identified in S1. Conclusion: The association of BNP measurement and TDE data is better than the isolated use of those parameters. BNP can be useful in identifying patients whose diagnosis of HF had been previously excluded based only on TDE findings.

Resumo: Insuficiência cardíaca com fração de ejeção preservada (ICFEP) é uma síndrome de alta prevalência e difícil diagnóstico no ambulatório. O doseamento de peptídeo natriurético tipo B (BNP) pode ser útil no diagnóstico de ICFEP, porém com valor de corte diferente daquele utilizado na sala de emergência. O objetivo desse estudo foi identificar o ponto de corte do BNP em doentes ambulatórios para diagnóstico de ICFEP. Métodos/resultados: Estudo prospectivo observacional envolvendo 161 doentes ambulatórios (68,1 ± 11,5 anos, 72% mulheres) com suspeita de ICFEP. Doentes foram submetidos a exame clínico, eletrocardiograma, ecocardiograma com Doppler tecidual e doseamento de BNP e classificados de acordo com critérios propostos por Paulus et al. para diagnóstico de ICFEP. ICFEP foi confirmada em 49 doentes que apresentavam valores mais elevados de BNP (144,4 pg/mL mediana 113 pg/mL versus 27,6 pg/mL mediana 16,7 pg/mL p

Introduction: Heart failure with preserved ejection fraction (HFPEF) is a highly prevalent syndrome that is difficult to diagnose in outpatients. The measurement of B-type natriuretic peptide (BNP) may be useful in the diagnosis of HFPEF, but with a different cutoff from that used in the emergency room. The aim of this study was to identify the BNP cutoff for a diagnosis of HFPEF in outpatients. Methods and Results: This prospective, observational study enrolled 161 outpatients (aged 68.1±11.5 years, 72% female) with suspected HFPEF. Patients underwent ECG, tissue Doppler imaging, and plasma BNP measurement, and were classified in accordance with algorithms for the diagnosis of HFPEF. HFPEF was confirmed in 49 patients, who presented higher BNP values (mean 144.4 pg/ml, median 113 pg/ml, vs. mean 27.6 pg/ml, median 16.7 pg/ml, p

Hypertension is the most prevalent risk factor for cardiovascular disease, and its proper control can prevent the high morbidity and mortality associated with this disease.To assess the degree of compliance of antihypertensive prescriptions with the VI Brazilian Guidelines on Hypertension and the blood pressure control rate in primary care.Cross-sectional study conducted between August 2011 and November 2012, including 332 adults ≥ 45 years registered in the Family Doctor Program in Niteroi and selected randomly. The analysis included the prescribed antihypertensive classes, doses, and frequencies, as well as the blood pressure (BP) of the individuals.The rate of prescription compliance was 80%. Diuretics were the most prescribed medications, and dual therapy was the most used treatment. The most common non-compliances were underdosing and underfrequencies. The BP goal in all cases was140/90 mmHg, except for diabetic patients, in whom the goal was set at130/80 mmHg. Control rates according to these goals were 44.9% and 38.6%, respectively. There was no correlation between prescription compliance and BP control.The degree of compliance was considered satisfactory. The achievement of the targets was consistent with national and international studies, suggesting that the family health model is effective in BP management, although it still needs improvement.A hipertensão arterial é o fator de risco mais prevalente para a doença cardiovascular e seu controle adequado pode prevenir a elevada morbi-mortalidade associada a esta doença.Avaliar o grau de conformidade das prescrições de anti-hipertensivos com as VI Diretrizes Brasileiras de Hipertensão e a taxa de controle pressórico na atenção básica.Estudo transversal conduzido entre agosto de 2011 e novembro de 2012, incluindo 332 adultos ≥ 45 anos cadastrados no Programa Médico de Família de Niterói e selecionados aleatoriamente. Foram analisadas as classes de anti-hipertensivos prescritos, suas doses e frequências, bem como a pressão arterial (PA) dos indivíduos.A taxa de conformidade das prescrições foi de 80%. Diuréticos foram as medicações mais prescritas e a terapia dupla foi o tratamento mais utilizado. As não conformidades mais comuns foram subdoses e subfrequências. A meta de PA para todos os casos foi140/90 mmHg, exceto para diabéticos, que foi130/80 mmHg. As taxas de controle de acordo com essas metas foram de 44,9% e 38,6%, respectivamente. Não houve correlação entre conformidade da prescrição e controle pressórico.O grau de conformidade foi considerado satisfatório. O alcance das metas foi compatível com estudos nacionais e internacionais, sugerindo que o modelo de saúde da família é efetivo no manejo da PA, embora ainda necessite aprimoramento. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0).

The consolidation of nephrology as a medical specialty is relatively new and its denomination does not intuitively reflects its true scope.To assess the degree of knowledge from a population sample regarding the term "nephrology".We carried out a cross-sectional study in Niterói, RJ, with adult passerby individuals answering to the question "Do you know what nephrology is?". The variables recorded included: gender, age, skin-color, residence, income, educational level and kidney-disease history in the family. p values0.05 were considered significant.Of the 564 individuals asked, 504 were willing to answer. Of those who refused, 64% were males, 58% caucasians--from whom 85% were aged30 years. The mean age among participants was 39 (22-56) years, 49% were males and 56% caucasians. Twenty-eight percent of the interviewees knew the term "nephrology". Their knowledge came from school (39%) and family (30%). Those who knew about the term "nephrology" were older (42 ± 17 vs. 39 ± 17 years, p0.05), had higher income (R$ 4,522 vs. R$ 2,934, p0.05) and higher education (27% vs. 12% with complete higher education, p0.001). They were predominantly caucasians (64% vs. 53%, p = 0.001), and had a higher rate of renal disease in the family (55% vs. 36%, p0.001). In the multivariate analysis, associations were maintained for age (OR 1.02; 95% CI 1.00 to 1.03, p = 0.004); higher education (OR 10.60, 95% CI, 4.20 to 26.86, p0.001) and kidney disease in the family (OR 2.2, 95% CI, 1.40 to 3.41, p0.001).Only 28% knew the term "nephrology", illustrating the specialty's low penetration. We must strive to popularize this field of medicine aiming at better educating the population concerning the prevention and care of kidney diseases.

Background: The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives: To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods: A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study. Assessment of patients was conducted by conventional echocardiogram using the ultraportable V Scan (GE) device right after the pre-anesthetic clinical evaluation. We assessed the clinical impact of echocardiography results by using a questionnaire addressed to the anesthetist. Results: Mean age of patients was 68.9 ± 7.0 years, 154 were women. The most frequent surgeries were: a) facectomy - cataract - 18; b) inguinal hernia surgery - 18; c) Cholecystectomy - 16. We found 58 normal tests (27.5%), 70 (33.2%) with mild valve reflux, and 83 (39.3%) with relevant abnormality, such as increase in heart chamber size, global and/or segmental contractile dysfunction, significant valve dysfunction or other unspecified. Test results caused delay of surgical procedure for a more detailed cardiac evaluation in 20 (9.5%) patients, and change in anesthetic management in 7 (3.3%). Conclusion: There was a considerable clinical impact with the use of the ultraportable echocardiography, since one out of every ten patients evaluated had their clinical management changed due to the detection of previously unsuspected, significant heart diseases, with the potential for severe complications. Resumo Fundamento: O ecocardiógrafo ultraportátil, com importante mobilidade e facilidade diagnóstica em mãos experientes pode contribuir para a segurança na avaliação pré-operatória em cirurgias não cardíacas. Objetivo: Avaliar os parâmetros de função cardíaca nos pacientes com mais de 60 anos de idade, candidatos a cirurgias não-cardíacas eletivas, classificados como ASA 1 ou ASA 2 na classificação de risco cirúrgico. Métodos: Foram incluídos 211 pacientes direcionados para cirurgias eletivas diversas e sem suspeita prévia de cardiopatia. Os pacientes foram avaliados por técnica ecocardiográfica convencional, usando o aparelho ultraportátil V Scan (GE) logo após a avaliação clínica pré-anestésica. Avaliamos o impacto clínico dos resultados da ecocardiografia por um questionário dirigido ao anestesista. Resultados: A idade média dos pacientes foi 68,9 ± 7,0 anos, 154 do sexo feminino. As cirurgias mais frequentes foram: a) Facectomia-catarata - 18; b) Herniorrafia inguinal - 18; c) Colecistectomia - 16. No total, foram observados 58 exames normais (27,5%), 70 (33,2%) exames que apresentavam leves refluxos valvares e 83 (39,3%) exames com alguma anormalidade relevante, como aumento de câmara cardíaca, disfunção contrátil global e/ou segmentar, disfunção valvar mais significativa ou outra não especificada. Os resultados determinaram que 20 (9,5%) pacientes tivessem seus procedimentos cirúrgicos adiados até avaliação cardiológica mais detalhada e em 7 (3,3%) houve mudança na conduta anestésica. Conclusão: Houve um impacto clínico considerável com o uso da ecocardiografia ultraportátil, pois um em cada dez pacientes avaliados sofreu modificação na conduta clínica, em função da detecção de cardiopatias significativas, não suspeitadas previamente, e com potencial para complicações graves.

Introduction: Cardiovascular disease (CVD) is especially prevalent in patients with chronic kidney disease (CKD). Objective: To evaluate the role of CKD and metabolic syndrome (MS), which is a cluster of risk factors for CVD, as predictors of CVD. Methods: Observational, cross-sectional study with a random sample aged 45 or more years extracted from the population assisted by the primary care program in Niterói city in the state of Rio de Janeiro, Brazil. CKD was diagnosed by the K/DOQI guidelines and MS, by the harmonized criteria. CVD was said to be present if the participant had one or more of the following findings: echocardiographic abnormalities, and history of myocardial infarction, stroke or heart failure. A logistic regression model was developed to analyze risk factors for CVD using CKD as the variable of primary interest. Results: Fifty hundred and eighty-one participants (38.2% male) with a mean age of 59.4 ± 10.2 years were analyzed. The prevalence rate of CKD was 27.9%. In participants without CKD, MS was associated with a slight but statistically significant increase in the risk for CVD (OR = 1.52, p = 0.037); in those with CKD but without MS the risk for CVD was also statistically significant and at a greater magnitude (OR = 2.42, p = 0.003); when both were present the risk for CVD was substantially higher (OR = 5.13, p < 0.001). Conclusion: In this study involving a population assisted by a primary care program, CKD was confirmed as an independent risk factor for CVD. The presence of MS concurrent with CKD substantially amplified the risk for CVD. Resumo Introdução: A doença cardiovascular (DCV) é especialmente prevalente em pacientes com doença renal crônica (DRC). Objetivo: Avaliar o papel da DRC e da síndrome metabólica (SM), que é um conjunto de fatores de risco para DCV, como previsores de DCV. Métodos: Estudo observacional, transversal, com uma amostra representativa da população assistida pelo programa de atenção primária em Niterói, RJ, Brasil, incluindo pacientes com idade igual ou maior do que 45 anos. A DRC foi diagnosticada segundo o K/DOQI e a SM, pelo critério harmonizado. A DCV foi dita estar presente diante de um ou mais dos seguintes achados: anormalidades ecocardiográficas ou história de infarto do miocárdio, acidente vascular cerebral ou insuficiência cardíaca. Um modelo de regressão logística foi desenvolvido para analisar os fatores de risco cardiovasculares usando a DRC como a variável de interesse primário. Resultados: Foram analisados 581 participantes (38,2% homens), com idade média de 59,4 ± 10,2 anos. A taxa de prevalência da DRC foi de 27,9%. Em participantes sem DRC, a SM foi associada com um ligeiro, mas estatisticamente significativo aumento no risco cardiovascular (OR = 1,52, p = 0,04); naqueles com DRC, mas sem SM, o risco para DCV também foi estatisticamente significativo e com maior magnitude (OR = 2,42, p = 0,003); quando ambos estavam presentes, o risco para DCV foi substancialmente mais elevado (OR = 5,13, p < 0,001). Conclusão: Neste estudo, envolvendo uma população assistida por um programa de atenção primária, a DRC foi confirmada como um fator de risco independente para DCV. A presença da SM concomitante com a DRC ampliou substancialmente esse risco.

Background: Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective: To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied. Methods: Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05). Results: Of the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion: BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS. Resumo Fundamento: A síndrome da apneia obstrutiva do sono (SAOS) é uma doença crônica, progressiva, com alta morbimortalidade. Encontra-se subdiagnosticada, principalmente entre mulheres. Objetivo: Estudar a prevalência de alto risco para SAOS globalmente e para as categorias do Questionário de Berlim (QB), e avaliar a confiabilidade do uso do QB na população estudada. Métodos: Estudo observacional, transversal de indivíduos cadastrados no Programa Médico de Família de Niterói, selecionados aleatoriamente, com idade entre 45 e 99 anos, com coleta entre agosto/2011 e dezembro/2012. Variáveis associadas com cada uma das categorias do QB e com o alto risco para SAOS (global) (valor p

Objective: The aim of this study is to estimate the association of shortness of breath (SOB), fatigue and bilateral lower limb edema (LLE) – typical symptoms of HF – with quality of life (QOL) dimensions, measured by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Methods: This cross-sectional study was conducted as part of the CAMELIA study (Cardiometabolic Renal Familial Study), which involved families covered by the Family Doctor Program (FDP) in Niteroi, Rio de Janeiro, Brazil. The study included 455 patients aged 30 and over, assessed by questionnaire, medical consultation, and blood and urine tests. Results: The prevalence of symptoms was: fatigue 56.9%, SOB 22.6% and LLE 16.9%. There were independent and statistically significant associations between SOB and fatigue and all SF-36 dimensions, excepting emotional performance and SOB (p

The Family Medical Program is a health care system in the Rio de Janeiro state. Women’s health services offered by the Family Medical Program include preventive exams and screening, family planning, and prenatal follow-up. Although cervical cancer screening is offered, barriers to care still hinder the full success of the program, and we are attempting to identify these barriers. We undertook a cross-sectional and prospective study involving 351 women who were referred to the Family Medical Program between March 2009 and November 2010. Demographic data were obtained through a structured household questionnaire. The dependent variable was defined as the non-realization of the Pap smear test following the protocol of the Health Ministry. Cervical samples for screening were collected after clinical examination. Women who had undergone Pap smear testing at least once every 3 years comprised 282 of the participants (80.3 %). Most of the women had normal or inflammatory cytology (96.3 %). Illiteracy and the absence of symptomatic episodes of sexually transmitted disease were independent barriers to having cancer screening at regular intervals. Illiterate women were more likely to be older, not to be using any contraceptive method, and on average had more than two children, more than four pregnancies, and more than two abortions. Embarrassment was the greatest barrier to seeking professional care reported by all women, regardless of level of educational attainment. Other important barriers to seeking care and/or screening included time constraints, due to work or childcare. This study indicates that the Family Medical Program effectively provides cervical cancer screening coverage for its eligible population, at the level mandated by the WHO and the Brazilian Health Ministry. Fully 96.3 % of the women in our study had normal or benign inflammation on cytology. Understanding of barriers to care-seeking behavior that limit program adherence is one way to facilitate communication between providers and patients regarding the benefits of cancer screening.

FUNDAMENTO: O modelo fisiopatológico da insuficiência cardíaca com fração de ejeção normal (ICFEN) está centrado na presença de disfunção diastólica, o que ocasiona mudanças estruturais e funcionais no átrio esquerdo (AE). A medida do tamanho do AE pode ser utilizada como um marcador da presença de ICFEN, sendo um indicador da elevação crônica da pressão de enchimento do VE, cuja mensuração é de fácil obtenção. OBJETIVO: Estimar a acurácia da medida do tamanho do AE, utilizando os valores indexados do diâmetro e do volume do AE para o diagnóstico de ICFEN em pacientes ambulatoriais. MÉTODOS: Estudamos 142 pacientes (67,3 ± 11,4 anos, 75% de mulheres) com suspeita de IC, os quais foram divididos em dois grupos: com ICFEN (n = 35) e sem ICFEN (n = 107). RESULTADOS: A função diastólica, avaliada pelo ecodopplercardiograma, mostrou diferença significativa entre os dois grupos em relação aos parâmetros que avaliaram o relaxamento ventricular (E' 6,9 ± 2,0 cm/s vs. 9,3 ± 2,5 cm/s - p < 0,0001) e a pressão de enchimento do VE (relação E/E' 15,2 ± 6,4 vs. 7,6 ± 2,2 - p < 0,0001). O ponto de coorte do volume do AE indexado (VAE-I) de 35 mL/m² foi o que melhor se correlacionou com o diagnóstico de ICFEN, demonstrando sensibilidade de 83%, especificidade de 83% e acurácia de 83%. Já o ponto de coorte do diâmetro ântero-posterior do AE indexado (DAE-I) de 2,4 cm/m² apresentava sensibilidade de 71%, especificidade de 66% e acurácia de 67%. CONCLUSÃO: Para o diagnóstico de ICFEN em pacientes ambulatoriais, o VAE-I é o método mais acurado em comparação ao DAE-I. Na avaliação ecocardiográfica, a medida do tamanho do AE deveria ser substituída pela medida indexada do volume. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0) BACKGROUND: The pathophysiological model of heart failure (HF) with preserved ejection fraction (HFPEF) focuses on the presence of diastolic dysfunction, which causes left atrial (LA) structural and functional changes. The LA size, an indicator of the chronic elevation of the left ventricular (LV) filling pressure, can be used as a marker of the presence of HFPEF, and it is easily obtained. OBJECTIVE: To estimate the accuracy of measuring the LA size by using indexed LA volume and diameter (ILAV and ILAD, respectively) for diagnosing HFPEF in ambulatory patients. METHODS: This study assessed 142 patients (mean age, 67.3 ± 11.4 years; 75% of the female sex) suspected of having HF, divided into two groups: with HFPEF (n = 35) and without HFPEF (n = 107). RESULTS: The diastolic function, assessed by use of Doppler echocardiography, showed a significant difference between the groups regarding the parameters assessing ventricular relaxation (E': 6.9 ± 2.0 cm/s vs. 9.3 ± 2.5 cm/s; p < 0.0001) and LV filling pressure (E/E' ratio: 15.2 ± 6.4 vs. 7.6 ± 2.2; p < 0.0001). The ILAV cutoff point of 35 mL/m2 best correlated with the diagnosis of HFPEF, showing sensitivity, specificity, and accuracy of 83%. The ILAD cutoff point of 2.4 cm/m2 showed sensitivity of 71%, specificity of 66%, and accuracy of 67%. CONCLUSION: For diagnosing HFPEF in ambulatory patients, the ILAV proved to be a more accurate parameter than ILAD. On echocardiographic assessment, ILAV, rather than ILAD, should be routinely measured. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0)

FUNDAMENTO: O modelo fisiopatológico da insuficiência cardíaca com fração de ejeção normal (ICFEN) está centrado na presença de disfunção diastólica, o que ocasiona mudanças estruturais e funcionais no átrio esquerdo (AE). A medida do tamanho do AE pode ser utilizada como um marcador da presença de ICFEN, sendo um indicador da elevação crônica da pressão de enchimento do VE, cuja mensuração é de fácil obtenção. OBJETIVO: Estimar a acurácia da medida do tamanho do AE, utilizando os valores indexados do diâmetro e do volume do AE para o diagnóstico de ICFEN em pacientes ambulatoriais. MÉTODOS: Estudamos 142 pacientes (67,3 ± 11,4 anos, 75% de mulheres) com suspeita de IC, os quais foram divididos em dois grupos: com ICFEN (n = 35) e sem ICFEN (n = 107). RESULTADOS: A função diastólica, avaliada pelo ecodopplercardiograma, mostrou diferença significativa entre os dois grupos em relação aos parâmetros que avaliaram o relaxamento ventricular (E' 6,9 ± 2,0 cm/s vs. 9,3 ± 2,5 cm/s - p < 0,0001) e a pressão de enchimento do VE (relação E/E' 15,2 ± 6,4 vs. 7,6 ± 2,2 - p < 0,0001). O ponto de coorte do volume do AE indexado (VAE-I) de 35 mL/m² foi o que melhor se correlacionou com o diagnóstico de ICFEN, demonstrando sensibilidade de 83%, especificidade de 83% e acurácia de 83%. Já o ponto de coorte do diâmetro ântero-posterior do AE indexado (DAE-I) de 2,4 cm/m² apresentava sensibilidade de 71%, especificidade de 66% e acurácia de 67%. CONCLUSÃO: Para o diagnóstico de ICFEN em pacientes ambulatoriais, o VAE-I é o método mais acurado em comparação ao DAE-I. Na avaliação ecocardiográfica, a medida do tamanho do AE deveria ser substituída pela medida indexada do volume. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0)BACKGROUND: The pathophysiological model of heart failure (HF) with preserved ejection fraction (HFPEF) focuses on the presence of diastolic dysfunction, which causes left atrial (LA) structural and functional changes. The LA size, an indicator of the chronic elevation of the left ventricular (LV) filling pressure, can be used as a marker of the presence of HFPEF, and it is easily obtained. OBJECTIVE: To estimate the accuracy of measuring the LA size by using indexed LA volume and diameter (ILAV and ILAD, respectively) for diagnosing HFPEF in ambulatory patients. METHODS: This study assessed 142 patients (mean age, 67.3 ± 11.4 years; 75% of the female sex) suspected of having HF, divided into two groups: with HFPEF (n = 35) and without HFPEF (n = 107). RESULTS: The diastolic function, assessed by use of Doppler echocardiography, showed a significant difference between the groups regarding the parameters assessing ventricular relaxation (E': 6.9 ± 2.0 cm/s vs. 9.3 ± 2.5 cm/s; p < 0.0001) and LV filling pressure (E/E' ratio: 15.2 ± 6.4 vs. 7.6 ± 2.2; p < 0.0001). The ILAV cutoff point of 35 mL/m2 best correlated with the diagnosis of HFPEF, showing sensitivity, specificity, and accuracy of 83%. The ILAD cutoff point of 2.4 cm/m2 showed sensitivity of 71%, specificity of 66%, and accuracy of 67%. CONCLUSION: For diagnosing HFPEF in ambulatory patients, the ILAV proved to be a more accurate parameter than ILAD. On echocardiographic assessment, ILAV, rather than ILAD, should be routinely measured. (Arq Bras Cardiol. 2011; [online].ahead print, PP.0-0)

FUNDAMENTO: Buscando aprimorar a utilização dos exames de ecocardiografia, foram criados os Critérios de Adequação (CA) (Appropriateness Criteria), pela Sociedade Norte-Americana de Ecocardiografia (ASE) /Colégio Americano de Cardiologia (ACC). OBJETIVO: Comparar o perfil de adequação de solicitação de ecocardiograma transtorácico (ETT) de acordo com os CA, entre Hospital Público Universitário (HU) e Hospital Privado (HP), e verificar quais características se associam com melhor perfil de solicitação de ETT. MÉTODOS: Foram avaliados prospectivamente 779 solicitações consecutivas de ETT no HP (49,8%) e no HU (50,2%). Sendo 55,6% solicitações para mulheres e 44,4%, para homens com 59,1 ± 15,7 anos. As indicações foram classificadas como: apropriadas, inapropriadas ou não classificadas, e a adequação aos CA foi correlacionada com idade, sexo dos pacientes, além do tempo de formado do solicitante. A análise estatística empregou Coeficiente Kappa e teste Qui-quadrado. RESULTADOS: Não houve diferença significativa no perfil de adequação de solicitações apropriadas de ETT nas duas instituições (71% x 75%; p = 0,3). No HP, os fatores associados a maior taxa de exames apropriados foram: sexo feminino (p = 0,001) e idade menor que 60 anos (p < 0,001). No HU, médicos formados entre 5 e 10 anos apresentaram maior taxa de solicitações inadequadas (p = 0,02). As variáveis que foram preditoras independentes de exames apropriados foram, no HP: sexo feminino (p = 0,001) e idade < 60 anos (p = 0,001). CONCLUSÃO: Nesta avaliação, HP e HU apresentaram perfis de adequação de solicitações similares. Sexo feminino, tempo de formado do médico solicitante e a idade do paciente influíram na adequação das solicitações.BACKGROUND: Aiming at improving the use of echocardiography tests, the Appropriateness Criteria (AC) were created by the American Society of Echocardiography (ASE)/American College of Cardiology (ACC). OBJECTIVE: To compare the appropriateness profile of transthoracic echocardiography (TTE) requests in accordance with the AC, between a public University Hospital (UH) and a Private Hospital (PH), and verify which characteristics are associated with a better TTE request profile. METHODS: We prospectively assessed 779 consecutive TTE requests in a PH (49.8%) and a UH (50.2%), with 55.6% of requests for women and 44.4% for men, aged 59.1 ± 15.7 years. The indications were classified as appropriate, inappropriate or non-classified, and adequacy to AC was correlated with age, patient gender, and the time since graduation of the requesting physician. The statistical analysis used Kappa coefficient and chi-square test. RESULTS: There was no significant difference regarding the adequacy profile of appropriate TTE requests in the two institutions (71% vs. 75%, p = 0.3). At PH, the factors associated with higher rates of appropriate tests were: female gender (p = 0.001) and age younger than 60 years (p

OBJETIVO: Avaliar a qualidade de vida de portadores de glaucoma, comparando pacientes do sistema público de saúde com pacientes atendidos no sistema particular, através do Questionário de Função Visual de 25 itens do National Eye Institute (NEI-VFQ). MÉTODOS: Realizou-se um estudo transversal, desenvolvido mediante a aplicação do questionário NEI-VFQ, em 83 pacientes glaucomatosos não consecutivos em diferentes estágios da doença, sendo 51 do Hospital Universitário Antonio Pedro (instituição pública), e 32 pacientes de clínica particular (instituição privada). RESULTADOS: Houve diferença estatística significativa entre os grupos nos subdomínios referentes à "saúde geral", "visão geral", "dor ocular", "atividades para perto", "atividades para longe", "saúde mental" e "atividades de vida diária". Não foi encontrada diferença significativa nos subdomínios referentes a "aspectos sociais", "dependência", "capacidade para dirigir", "visão de cores" e "visão periférica". O escore geral demonstrou diferença estatística significativa entre os grupos, com média de 73,13 para instituição pública e 86,07 para instituição privada. CONCLUSÃO: O impacto do glaucoma na qualidade de vida foi maior nos pacientes de instituição pública, quando comparados com aqueles de instituição privada através do questionário NEI-VFQ. PURPOSE: To evaluate the quality of life of glaucoma patients comparing public health system, and private practice, through the questionnaire National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ). METHODS: A cross-sectional study, developed through the application of NEI-VFQ questionnaire in 83 non-consecutive glaucoma patients at different stages of the disease, and 51 from public health system, and 32 patients from private clinic. RESULTS: Statistically significant difference between groups was demonstrated in subdomains related to the "general health", "general vision", "ocular pain", "near activities", "distance activities", "mental health" and "role difficulties" no significant difference was demonstrated in "social functioning", "dependency", "driving", "color vision" and "peripheral vision". Regarding the overall score given by the questionnaire statistical difference was observed with an average of 73.13 in the public institutions and 86.07 in the private practice. CONCLUSION: The impact on quality of life was higher in patients from the public institution when compared to those of the private practice through the NEI-VFQ questionnaire.

The aim of this study was to determine the prevalence and relationship of human papillomavirus (HPV) genotypes in cervical samples from 140 human immunodeficiency virus (HIV)-seropositive women routinely attending an outpatient public gynecological service in the state of Rio de Janeiro, Brazil. MY09/11 consensus primers were used to detect generic HPV DNA. HPV typification was performed by restriction fragment length polymorphism analysis following polymerase chain reaction amplification. The overall HPV prevalence was 60.0%. The identification of 24 different HPV genotypes including uncommon types was performed. A9 oncogenic genotypes were present in 54.02% of HIV-positive women. Abnormal cervical lesions, the time since HIV diagnosis and the number of sexual partners contributed independently to the high oncogenic HPV prevalence. The oncogenic and non-oncogenic group were similarly affected by risk factors in contrast to negative HPV women. The frequency of multiple infections was 20%; furthermore, all of them presented at least one oncogenic type. The analyzed sample represents an epidemiological source of uncommon infection. Due to high HPV prevalence, more frequent cytological screening and/or liberal colposcopic evaluations should be performed in HIV-positive patients.

INTRODUCTION: The aim of this work was to survey HPV information from a random population of young women from Rio de Janeiro, Brazil. METHODS: This cross-sectional study included cervical samples from 241 female students. To determine human papillomavirus status, polymerase chain reaction amplification was performed. HPV typing was determined by restriction fragment length polymorphism analysis. Demographic data, life style, sexual and gynecological history were obtained through use of a structured questionnaire. RESULTS: The average age of the women was 19.6 years-old (SD=3.4 years). HPV prevalence was 27.4%. Nineteen different HPV genotypes were detected, including 13 high risk types. HPV 16 was the most prevalent type (6.2%), followed by 31 (4.1 %) and 66 (3.7%). Most of the oncogenic types belonged to the A9 species (28/48). The frequency of women infected by at least one oncogenic type was significantly higher than those only infected by low risk types (18.7% versus 7.5%). Cervical changes were detected in 12.5% of the sample and were significantly linked to infection with HPV types of the A9 species. Demographic variables, sexual initiation, or number of sexual partners were not associated with HPV prevalence, variety of HPV genotypes or oncogenic types. CONCLUSIONS: The relative frequency of HPV genotypes other than vaccine types in young females should be taken into account when evaluating vaccination strategies. Due to the high prevalence of HPV infection among the population studied, implementation of sex education in schools, promotion of condom use and an organized screening program to prevent cervical cancer must be encouraged for this age group.

INTRODUCTION: The aim of this work was to survey HPV information from a random population of young women from Rio de Janeiro, Brazil. METHODS: This cross-sectional study included cervical samples from 241 female students. To determine human papillomavirus status, polymerase chain reaction amplification was performed. HPV typing was determined by restriction fragment length polymorphism analysis. Demographic data, life style, sexual and gynecological history were obtained through use of a structured questionnaire. RESULTS: The average age of the women was 19.6 years-old (SD=3.4 years). HPV prevalence was 27.4%. Nineteen different HPV genotypes were detected, including 13 high risk types. HPV 16 was the most prevalent type (6.2%), followed by 31 (4.1 %) and 66 (3.7%). Most of the oncogenic types belonged to the A9 species (28/48). The frequency of women infected by at least one oncogenic type was significantly higher than those only infected by low risk types (18.7% versus 7.5%). Cervical changes were detected in 12.5% of the sample and were significantly linked to infection with HPV types of the A9 species. Demographic variables, sexual initiation, or number of sexual partners were not associated with HPV prevalence, variety of HPV genotypes or oncogenic types. CONCLUSIONS: The relative frequency of HPV genotypes other than vaccine types in young females should be taken into account when evaluating vaccination strategies. Due to the high prevalence of HPV infection among the population studied, implementation of sex education in schools, promotion of condom use and an organized screening program to prevent cervical cancer must be encouraged for this age group.INTRODUÇÃO: O objetivo deste trabalho foi investigar a infecção por HPV em uma população randômica de mulheres jovens no estado do Rio de Janeiro, Brasil. MÉTODOS: Este estudo incluiu amostras cervicais de 241 jovens. A detecção de papilomavírus humanos foi realizada pela reação da cadeia da polimerase e a tipificação deste vírus determinada pelo polimorfismo do comprimento do fragmento de restrição. Dados demográficos, estilo de vida, história sexual e ginecológica foram obtidos através de um questionário. A média de idade das mulheres foi 19,6 anos (SD=3,4). RESULTADOS: A prevalência de HPV foi de 27,4% e 19 diferentes tipos foram detectados, incluindo 13 oncogênicos. O HPV 16 foi o tipo mais prevalente (6,2%), seguido do 31 (4,1%) e do 66 (3,7%). A maioria dos tipos oncogênicos pertencia à espécie A9 (28/48). A frequência de mulheres infectadas por ao menos um tipo oncogênico foi significantemente mais alta do que aquelas infectadas por tipos de baixo risco (18,7% versus 7,5%). Alterações cervicais foram detectadas em 12,5% das jovens e foram positivamente relacionadas a tipos de HPV da espécie A9. Variáveis demográficas, iniciação sexual e número de parceiros sexuais não foram associados com a prevalência de HPV, variedade de genótipos ou tipos oncogênicos. CONCLUSÕES: A frequência razoável de outros genótipos além dos vacinais nestas jovens deve ser considerada para avaliação de estratégias de vacinação. Devido à alta prevalência de HPV na população estudada, a implantação de educação sexual nas escolas, incentivo ao uso de preservativo e exames preventivos devem ser encorajados nesta faixa etária.

We investigated human papillomavirus (HPV) infection in two female populations from diverse socio-economic strata from the state of Rio de Janeiro and we also investigated the possible co-factors related to infection and the progression to cancer. In Group I, the reference group of this study, 10.7% of the patients presented HPV infection, as detected by generic PCR, while in Group II (low socio-demographic conditions) HPV was detected in 31.1% of the samples. HPV16 was the most prevalent virus type found in both Groups I and II (5.3% and 10%, respectively), followed by HPV 18 (1.3% and 4.7%, respectively). Although only a small sample was analysed, we detected differences among the groups regarding the rates of HPV infection, HPV types, age, ethnicity, familial income, schooling, marital status, parity, tobacco smoking and oral contraceptive use. For Group I, the Papanicolaou test was the most powerful independent factor associated with HPV status, followed by an age of under 30 years old, the number of sexual partners and black ethnicity. Our data are in agreement with the co-factors that are typically described for the developed world. For Group II, the Pap test was also the most relevant variable that was analysed, but the history of other sexually transmitted diseases and the use of alcohol were additional factors that were implicated in infection. These findings point out the need for the development of general and specific strategies for HPV screening of all Brazilian women.

The relationship between severe-grade cervical lesions and clusters of human papillomavirus (HPV) genotypes in a taxonomic classification was surveyed in 232 women with previous abnormal cytology. HPV co-infections were clustered according to phylogenetic criteria. Multiple infections were detected in 22.0% of the entire sample. Clade A10 (represented by HPV-6 and HPV-11) appeared more frequently in multiple infections than clade A9, which was represented by five of the most common high-risk types, including HPV-16. Although HPV-16 was the most frequent genotype, it was not more prevalent in multiple infections. Abortion and two or more sexual partners were risk-factors associated with HPV co-infections. Severe cervical dysplasia was associated with co-infections with oncogenic types from different clades, with the association being significant for the high-risk clades A7 and A9.