954 resultados para Cardiovascular Diseases, prevention
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ABSTRACT OBJECTIVE To determine the distribution of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in Brazilian adolescents, as well as the prevalence of altered levels of such parameters. METHODS Data from the Study of Cardiovascular Risks in Adolescents (ERICA) were used. This is a country-wide, school-based cross-sectional study that evaluated 12 to 17-year old adolescents living in cities with over 100,000 inhabitants. The average and distribution of plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were evaluated. Dyslipidemia was determined by levels of total cholesterol ≥ 170 mg/dl, LDL cholesterol ≥ 130 mg/dl, HDL cholesterol < 45 mg/dL, or triglycerides ≥ 130 mg/dl. The data were analyzed by gender, age, and regions in Brazil. RESULTS We evaluated 38,069 adolescents – 59.9% of females, and 54.2% between 15 and 17 years. The average values found were: total cholesterol = 148.1 mg/dl (95%CI 147.1-149.1), HDL cholesterol = 47.3 mg/dl (95%CI 46.7-47.9), LDL cholesterol = 85.3 mg/dl (95%CI 84.5-86.1), and triglycerides = 77.8 mg/dl (95%CI 76.5-79.2). The female adolescents had higher average levels of total cholesterol, LDL cholesterol, and HDL cholesterol, without differences in the levels of triglycerides. We did not observe any significant differences between the average values among 12 to 14 and 15- to 17-year old adolescents. The most prevalent lipid alterations were low HDL cholesterol (46.8% [95%CI 44.8-48.9]), hypercholesterolemia (20.1% [95%CI 19.0-21.3]), and hypertriglyceridemia (7.8% [95%CI 7.1-8.6]). High LDL cholesterol was found in 3.5% (95%CI 3.2-4.0) of the adolescents. Prevalence of low HDL cholesterol was higher in Brazil’s North and Northeast regions. CONCLUSIONS A significant proportion of Brazilian adolescents has alterations in their plasma lipids. The high prevalence of low HDL cholesterol and hypertriglyceridemia, especially in Brazil’s North and Northeast regions, must be analyzed in future studies, to support the creation of strategies for efficient interventions.
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RESUMO - Os gastos com a sade, em Portugal, como nos pases da Unio Europeia e da OCDE, tm crescido a um ritmo superior ao do crescimento econmico, assumindo uma importncia crescente face ao PIB. Entre estes factores surge a velocidade da introduo da inovao e dos desenvolvimentos tecnolgicos dos domnios do diagnstico e da teraputica. Uma das mais difceis e importantes questes para as polticas de sade a relao entre a sade e os gastos com a prestao de cuidados de sade. Estudos recentes sugerem que os cuidados de sade ocupam um papel importante na melhoria da sade da populao, e que os recentes avanos tecnolgicos so custo-efectivos aceites na generalidade por cada ano de vida ganho. Este trabalho visa estudar a influncia que o financiamento e o estatuto jurdico hospitalar tm na introduo e adopo de novas tecnologias em sade. Para isso, alm da reviso bibliogrfica, foi realizada uma anlise a uma base de dados, cujos elementos se cingem a pacientes com doenas cardiovasculares atendidos num dos hospitais do Servio Nacional de Sade, entre 2000 e 2006. --- ------------------------------------ABSTRACT - Health expenditures in Portugal, as in EU countries and in the OECD, have developed at a higher rate than economic growth, assuming an increasing importance to the GDP. Among these factors appears the speed of the introduction of innovation and technological development in diagnosis and therapy areas. One of the most difficult and most important questions for health policy is the relationship of health to health care spending. Studies now suggest that medical care has played an important role in improving the health of the population, and recent technical advances are cost-effective at generally accepted values of an added year of life. This work aims to study the influence that the prospective payment and the hospitals legal status have in introduction and adoption of new technologies in health. For this, besides the literature review, an analysis was made to a database, whose elements are confined to patients with cardiovascular disease treated in the hospitals of t
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Backgroud: O International Panel on Climate Change prev que o aumento da temperatura mdia global, at ao ano de 2100, varie entre 1,4 e 5,8C desconhecendo-se a evoluo da adaptao da populao a esta subida da temperatura. Em Portugal morre-se mais no Inverno que no Vero. Mas existem evidncias de repercusses na mortalidade atribuveis ao calor extremo. Este estudo procura conhecer os grupos etrios e/ou populacionais que parecem revelar vulnerabilidade acrescida exposio a temperaturas extremas e identificar indicadores de sade apropriados para revelar esses mesmos efeitos. Mtodos: Foram analisados dados de internamentos hospitalar e mortalidade por doenas cardiovasculares, respiratrias, renais, efeitos directos do frio e do calor, na populao com 75 e mais anos de idade, nos distritos de Beja, Bragana e Faro, nos meses de Janeiro e Junho. Para os dados de morbilidade o perodo de anlise foi 2002 a 2005 e para os de mortalidade de 2002 a 2004. Os dados meteorolgicos analisados corresponderam aos valores da temperatura mxima e percentis da temperatura mxima, nos meses de Janeiro (P10) e Junho (P90). Os excessos de internamentos hospitalares, definidos como os dias em que ocorreram internamentos acima do valor da mdia mais 2 desvio padro, foram relacionados com a distribuio das temperaturas extremas (frias abaixo do P10, quentes acima do P90.Os dias com bitos acima do valor da mdia foram relacionados com a distribuio das temperaturas extremas (frias abaixo do P10, quentes acima do P90). Os indicadores propostos foram baseados em Odds Ratios e intervalos de confiana que sugeriam as estimativas mais precisas. Resultados: O grupo que revelou maior vulnerabilidade s temperaturas extremas foi o grupo dos 75 e mais anos, com doenas cardiovasculares quando exposto a temperaturas extremas, nos 3 distritos observados.O n de dias de excesso de bitos por doenas cardiovasculares relacionados com temperaturas extremas foi o mais elevado comparado com as restantes causas de morte. O grupo etrio dos 75 e mais anos com de doenas respiratrias tambm vulnervel, s temperaturas extremas frias, nos 3 distritos. Verificaram-se dias de excessos de internamentos hospitalares e bitos por esta causa de morte, relacionados com a exposio s temperaturas extremas frias. Em Junho, no se verificou excesso de mortalidade associado exposio a temperaturas extremas por esta causa, em qualquer dos distritos analisados. Apenas se verificou a associao entre os dias de ocorrncia de internamentos hospitalares por doenas renais e o calor extremo, em Bragana. Concluses: Foram encontradas associaes estatsticas significativas entre dias de excesso de ocorrncia de internamentos hospitalares ou bitos por causa e exposio a temperaturas extremas frias e quentes possibilitando a identificao de um conjunto de indicadores de sade ambiental apropriados para monitorizar a evoluo dos padres de morbilidade, mortalidade e susceptibilidade das populaes ao longo do tempo.-------------------- Backgroud: International Panel on Climate Change estimates that the rise of mean global temperature varies between 1,4 e 5,8C until 2100, with unknowing evolution adaptation of populations. In Portugal we die more in Winter than in Summer time. But there are several evidences of mortality attributable to extreme eat. The proposal of this study is to know the age and/or populations groups that reveal more vulnerability to exposure to extreme temperature and identifying proper health indicators to reveal those effects. Methods: Data from hospital admissions and mortality caused by cardiovascular, respiratory, renal diseases and direct effects from direct exposure to extreme cold and heat, in population with 75 and more years, in Beja, Bragana and Faro districts, during January and June, were analysed. Analysis period for morbidity data was from 2002 to 2005 and form mortality was 2002 to 2004. Meteorological data analysed were maximum temperature and percentile of maximum temperature, from January (P10) and June (P90. Relationship between excess of hospital admission, defined as the days that occurred hospital admissions above mean value more 2 standards desviation and distribution of extreme temperatures were established (cold under P10 and heat above P90. Proposal indicators were based on Odds Ratios and confidence intervals, suggesting the most precises estimatives. Results: The most vulnerable group to extreme temperature were people with 75 or more years older with cardiovascular diseases, observed in the 3 districts. Number of days caused by excess cardiovascular mortality and extreme temperature were the most number of days between the other causes. The group with 75 or more years old with respiratory diseases is vulnerable too, especially to cold extreme temperature, in all the 3 districts. There were excess of days of hospital admissions and days with deaths, for this cause relating to extreme cold temperature. In June, does not funded excess of mortality associated to extreme temperature by this cause in any district of the in observation. Just was found relationship between days of hospital admissions caused by renal diseases in Bragana in days with extreme heat. Conclusions: Were found statistically significant associations between days of excess of hospital admissions or deaths and exposure to extreme cold and heat temperatures giving the possibility of identifying a core of environmental indicators proper to monitoring patterns and trends evolutions on morbidity, mortality and susceptibly of populations for a long time.
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RESUMO - Um dos grandes desafios actuais enfrentados pela Sade Pblica diz respeito ao fardo representado pelas doenas crnicas no transmissveis enquanto co-responsveis pela maioria das mortes que ocorrem no mundo, pela significativa e progressiva reduo da qualidade de vida e aumento das incapacidades dos indivduos afectados e por uma fasquia bastante elevada das despesas em sade. Entretanto, a complexa dinmica gentica, biolgica, psicolgica, afectiva, scio-cultural e ambiental que envolve o comportamento humano, to amplamente relacionado com algumas destas doenas doenas cardiovasculares, alguns tipos de cancro, obesidade, hipertenso, diabetes e doenas osteo-articulares impe o desafio constante da busca de novas e efectivas intervenes em promoo da sade que influenciem positivamente os estilos de vida dos indivduos, dos grupos e das comunidades. Sendo o sentido de coerncia um trao da personalidade do indivduo desenvolvido sob a influncia directa ou indirecta dos mesmo factores acima referidos, o estabelecimento de uma relao entre este constructo e os comportamentos humanos pode revelar-se promissor para a elaborao de novas intervenes em promoo da sade. Por sua vez, a gravidez, talvez por influncia da ligao materno-fetal, pode representar um ponto de viragem na vida da mulher no que respeita ao sentido de coerncia e aos comportamentos de sade e um bom comeo na vida do beb que ir nascer sob a influncia dos mesmos. Com a finalidade de contribuir para a construo de intervenes efectivas em promoo da sade, atravs da descoberta de provveis potencialidades salutognicas dos constructos referidos sentido de coerncia e ligao materno-fetal , foi desenvolvido um estudo quantitativo, observacional que teve por objectivos: ampliar o conhecimento sobre as mudanas do sentido de coerncia no decorrer da vida, especificamente durante a gravidez; ampliar o conhecimento acerca das relaes de alguns factores de natureza scio-demogrfica, psico-afectiva e obsttrica com o sentido de coerncia das mulheres grvidas e com a ligao materno-fetal; e identificar possveis relaes entre o sentido de coerncia, a ligao materno-fetal e o estilo de vida das mulheres grvidas, este ltimo representado pelos hbitos alimentares, consumo de cafena, consumo de lcool, hbitos tabgicos, prtica regular de actividade fsica e ganho de peso durante a gravidez. O presente relatrio descreve a concepo e os resultados deste estudo, que envolveu a uma amostra de 61 mulheres grvidas que estavam a ser acompanhadas nos servios de sade materna dos Centros de Sade de Carnaxide extenso Linda-a-Velha e de Oeiras, no Distrito de Lisboa, Portugal, entre os meses de Fevereiro e Julho de 2005. Os resultados demonstram que, para a amostra de 61 mulheres grvidas que responderam ao inqurito por questionrio de auto-resposta, foram encontradas associaes estatisticamente significativas entre o sentido de coerncia e a escolaridade e entre o sentido de coerncia e a percepo do prprio estado de sade. Alm disso, foi encontrada alguma evidncia das associaes entre o sentido de coerncia e a faixa etria, estado civil e rendimento mensal familiar e foi observada alguma tendncia para que as mulheres grvidas com nveis de sentido de coerncia mais elevados consumissem menos lcool do que as mulheres grvidas com nveis de sentido de coerncia inferiores. Entretanto, as demais associaes testadas no foram confirmadas. Relativamente ligao materno-fetal, foram encontradas, para a amostra de 41 mulheres grvidas que participaram do segundo momento de colheita de dados do estudo, entre a 20 e a 24 semanas de gravidez, associaes estatisticamente significativas com a escolaridade e o nvel de rendimento familiar das mulheres grvidas, no tendo sido confirmadas as demais associaes testadas. Embora no tenham sido estatisticamente evidenciadas as relaes entre o sentido de coerncia e a ligao materno-fetal e entre estes e os comportamentos de sade, o carcter preliminar destes resultados, devido subjectividade do processo de seleco no probabilstico da amostra estudada e reduzida dimenso desta amostra, e a escassez de estudos descritos na literatura fazem com que seja prudente a realizao de estudos de follow-up, com amostras de maiores dimenses, aleatrias e representativas da populao, para que sejam estabelecidas quaisquer concluses acerca destas questes.-----------------------------ABSTRACT - One of the greatest challenges faced by Public Health in nowadays is the burden represented by chronic diseases as co-responsible for the majority of deaths that occurs in the world, for the meaningful and progressive reduction of quality of life and increase of disabilities in affected individuals and for an important part of health expenses. However, the complexity of the genetic, biological, psychological, emotional, social, cultural and environmental dynamics that involves human behaviours related to some of these diseases cardiovascular diseases, some kind of cancers, obesity, hypertension, diabetes and joint and bone diseases poses the continuous challenge of searching for new and effective interventions of health promotion that positively influence individuals, groups and community lifestyles. Due to the fact that sense of coherence is an individual personality trace directly or indirectly influenced by the same factors listed above, the discovery of a relationship between this construct and human behaviours might be promising to the creation of new health promotion interventions. On the other hand, pregnancy may represent a turn point to the mothers life and a good start in the babys life in relation to sense of coherence and health behaviours and It might occur because of the influence of maternal-fetal attachment. With the purpose of contributing with the creation of effective health promotion interventions through the discovery of probable salutogenic potentials in the referred constructs sense of coherence and maternal-fetal attachment , it was developed a quantitative observational study with the following objectives: to increase knowledge about changes in sense of coherence throughout life, specifically during pregnancy; to increase knowledge about the relationship between sense of coherence and maternal-fetal attachment and some social, demographical, psychological, emotional and obstetric factors of pregnant women; to identify probable relationships between sense of coherence, maternal-fetal attachment and pregnant womens lifestyles, represented by diet habits, caffeine consumption, alcohol consumption, smoking habits, physical activity habits and weigh gain during pregnancy. This report describes the structure and the findings of this study involving a sample of 61 pregnant women who had been followed by health professionals in the mother health services of Carnaxide (Linda-a-Velha unity) and Oeiras Health Centres, in Lisbon, Portugal, between February and July of 2005. The results show that, for the 61 pregnant women who filled the self-reported questionnaire, it was found a statistically significant association between sense of coherence and education level. It was also found some evidence of the associations between sense of coherence and age, marital status and mensal household income and a trend toward pregnant women with higher levels of sense of coherence to drink less alcoholic beverages than pregnant women with lower levels of sense of coherence. However, the others associations tested were not confirmed. Regarding maternal-fetal attachment, it was found, for the sample of 41 women who participated in the second moment of data collection, between the 20th and the 24th week of pregnancy, statistically significant associations with education level and mensal household income. The others associations tested were not confirmed. Although the associations between sense of coherence and maternal-fetal attachment and between these constructs and health behaviours were not confirmed, all findings presented here are considered preliminary because of small dimension of sample and non-probabilistic criteria used for sample selection. Whats more, there are almost no studies described in the literature which could confirm or contradict these findings. Therefore, it is better to be careful and develop follow-up studies, with bigger and representative of population samples, before draw any conclusions about these theme.
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Em frica e no Sul da Arbia, a oncocercose est essencialmente associada ao complexo Simulium damnosum (Ovazza, 1967). A propagao da doena resulta essencialmente do tipo de actividade humana, e das alteraes do ambiente, especalmente a desflorestao macia, transformando o habitat florestal em habitat de savana (Hocking, 1953, Dadzie, 1980, Amazigo, 1991, Amazigo, 2002 a, WHO, 1995 b). 2- Morfologia 2.1 - O ovo O ovo, tm uma forma triangular, com os vrtices arredondados, medindo de 0,1 a 0,5 mm de comprimento. A casca lisa, no apresentando qualquer adaptao especial e o revestimento viscoso. So de cor branca aquando da oviposio, escurecendo com a embriognese, aparecendo ento com cores rosadas, amareladas e acinzentadas. 2.2 - A larva A larva dos simuldeos, apresenta um formato mais ou menos cilndrico, com duas dilataes, uma no trax, ligeira e outra mais acentuada na parte terminal do abdmen. Pode atingir o comprimento de um centmetro, e uma colorao muito variada, dependendo do tipo de alimentos ingeridos, e apresentar-se de colorao totalmente escura, a esbranquiada. O corpo da larva formado por trs partes distintas a cabea, o trax e o abdmen. A cabea: A cabea de uma larva de simuldeo, observao dorsal, apresenta-se pigmentada, podendo com essa pigmentao expressar-se de duas formas, ou com manchas escuras em fundo claro (modelo positivo), ou manchas claras em fundo escuro (modelo negativo), e um par de finas antenas. observao ventral destacam-se dois caracteres de grande valor sistemtico a fenda psgenal e o hipostoma.
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Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno do grau de Mestre em Biotecnologia
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RESUMO: Introduo: As doenas cardiovasculares (DCV) so a principal causa de morbilidade, e mortalidade prematura em Portugal e na Europa. A sua causa multifactorial e a maior parte dos casos resultam de factores de risco modificveis. O clculo do RCVG, pretende ser uma estimativa da probabilidade de desenvolver DCV. Este estudo pretende identificar e caracterizar indivduos em risco de desenvolver doena isqumica coronria e respectivos factores de risco modificveis, no Concelho de Faro e determinar a sua prevalncia e calcular SCORE global de risco cardiovascular Material e mtodos: Estudo, observacional transversal, que incluiu um total de 601 individuos, com idades entre os 40-64 anos de idade, residentes no concelho de Faro, inscritos no Centro de Sade de Faro e que consistiu da avaliao da prevalncia dos factores de risco modificveis da doena isqumica coronria pela utilizao de instrumentos especficos. Resultados e discusso: Foram includos 601 individuos de ambos os gneros. Trata-se de uma populao potencialmente menos literada e num contexto social, cultural, familiar e profissional que, eventualmente, condicionar o estilo de vida e opes em sade. 55,9% dos indivduos tem HTA; 42,4 % dos indivduos tem valor de colesterol total elevado, compatvel com dislipidemia (cut off de 200mg/dl); 50,9 % (cut off 190 mg/dl); 8,7% tem valores de glicemia compatveis com diabetes; 19,8 so fumadores; 72,7% apresenta excesso de peso/obesidade; 37,6% dos indivduos tem baixo nvel de actividade fsica; 20,1% dos indivduos apresenta evidncia de stress, ansiedade ou depresso, pela avaliao utilizando a EADS. Parece existir evidncia de maior proporo de factores de risco entre os homens e uma proporo significativa de indivduos com importantes factores de risco modificveis em simultneo. Mais de metade dos indivduos tem 3 ou mais factores de risco em simultneo, com o excesso de peso/obesidade, hipertenso e dislipidemia a serem os com mais comummente associados. 9,7% dos indivduos tem risco entre 5-9% e apenas 29,3% tem SCORE inferior a 1%. Concluses: A elevada prevalncia dos factores de risco modificveis e a elevada proporo de indivduos identificados com esses factores, e com risco moderado e alto de DCV, parece justificar uma ateno redobrada a esse nvel e um planeamento dos cuidados de sade ajustados e especficos para esta realidade.----------------------- ABSTRACT: Introduction: Cardiovascular diseases are the leading cause of morbidity and premature mortality in Portugal and in Europe. The cause is multifactorial and in most cases results from modifiable risk factors. The global cardiovascular risk calculation is intended as an estimate of the likelihood of developing cardiovascular disease. This study aims to identify and characterize individuals at risk of developing ischemic heart disease and their modifiable risk factors in Faro, and determine its prevalence as well as to calculate global cardiovascular risk SCORE. Methodology: This was a cross sectional observational study, which included a total of 601 individuals, aged 40-64 years of age living in Faro, and enrolled atthe Health Centre of Faro. The prevalence of modifiable risk factors of disease ischemic heart was assessed once, after letter invitation, by the use of the following instruments (acrescentar os instrumentos). Data was analysed with (incluir testes estatisticos utilizados) Results and Discussion: We included 601 subjects of both genders. This is a potentially less literate population with a social, cultural and family contextwhich, may eventually constrain lifestyle and health choices. Almost sixty percent (55.9%) of the individuals have hypertension, 42,4% have high total cholesterol value, compatible with dyslipidemia, 8,7 % had blood glucose values compatible with diabetes, 19,8% are smokers, 72,7% are overweight or obese, 37,6% of individuals have low levels of physical activity, 20,1% of individual show evidence of stress, anxiety or depression, as assessed by using the DASS. There seems to be evidence of a greater proportion of risk factors among men and a significant proportion of individuals with major modifiable risk factores simultaneously. More than half of the studied individuals have three or more risk factors simultaneously, being excess weight / obesity, hypertension and dyslipidemia, the most commonly associated. Almost ten percent (9,7%) of the individuals have a risk between 5-9% and only 29,3% has a SCORE less than 1%. Conclusion: The high prevalence of modifiable risk factors and the high proportion of individuals identified with these factors, and with moderate and high risk of CVD, appear to justify further attention at this level and planning of health care interventions specifically adjusted to this reality.
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Increased levels of plasma oxLDL, which is the oxidized fraction of Low Density Lipoprotein (LDL), are associated with atherosclerosis, an inflammatory disease, and the subsequent development of severe cardiovascular diseases that are today a major cause of death in modern countries. It is therefore important to find a reliable and fast assay to determine oxLDL in serum. A new immunosensor employing three monoclonal antibodies (mAbs) against oxLDL is proposed in this work as a quick and effective way to monitor oxLDL. The oxLDL was first employed to produce anti-oxLDL monoclonal antibodies by hybridoma cells that were previously obtained. The immunosensor was set-up by selfassembling cysteamine (Cyst) on a gold (Au) layer (4 mm diameter) of a disposable screen-printed electrode. Three mAbs were allowed to react with N-hydroxysuccinimide (NHS) and ethyl(dimethylaminopropyl)carbodiimide (EDAC), and subsequently incubated in the Au/Cys. Albumin from bovine serum (BSA) was immobilized further to ensure that other molecules apart from oxLDL could not bind to the electrode surface. All steps were followed by various characterization techniques such as electrochemical impedance spectroscopy (EIS) and square wave voltammetry (SWV). The analytical operation of the immunosensor was obtained by incubating the sensing layer of the device in oxLDL for 15 minutes, prior to EIS and SWV. This was done by using standard oxLDL solutions prepared in foetal calf serum, in order to simulate patient's plasma with circulating oxLDL. A sensitive response was observed from 0.5 to 18.0 mg mL 1 . The device was successfully applied to determine the oxLDL fraction in real serum, without prior dilution or necessary chemical treatment. The use of multiple monoclonal antibodies on a biosensing platform seemed to be a successful approach to produce a specific response towards a complex multi-analyte target, correlating well with the level of oxLDL within atherosclerosis disease, in a simple, fast and cheap way.
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Myoglobin (Mb) is among the cardiac biomarkers playing a major role in urgent diagnosis of cardiovascular diseases. Its monitoring in point-of-care is therefore fundamental. Pursuing this goal, a novel biomimetic ionophore for the potentiometric transduction of Mb is presented. It was synthesized by surface molecular imprinting (SMI) with the purpose of developing highly efficient sensor layers for near-stereochemical recognition of Mb. The template (Mb) was imprinted on a silane surface that was covalently attached to silica beads by means of self-assembled monolayers. First the silica was modified with an external layer of aldehyde groups. Then, Mb was attached by reaction with its amine groups (on the external surface) and subsequent formation of imine bonds. The vacant places surrounding Mb were filled by polymerization of the silane monomers 3-aminopropyltrimethoxysilane (APTMS) and propyltrimethoxysilane (PTMS). Finally, the template was removed by imine cleavage after treatment with oxalic acid. The results materials were finely dispersed in plasticized PVC selective membranes and used as ionophores in potentiometric transduction. The best analytical features were found in HEPES buffer of pH 4. Under this condition, the limits of detection were of 1.3 106 mol/L for a linear response after 8.0 107 mol/L with an anionic slope of 65.9 mV/decade. The imprinting effect was tested by preparing non-imprinted (NI) particles and employing these materials as ionophores. The resulting membranes showed no ability to detect Mb. Good selectivity was observed towards creatinine, sacarose, fructose, galactose, sodium glutamate, and alanine. The analytical application was conducted successfully and showed accurate and precise results.
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Background: Brain natriuretic peptide is a predictor of mortality in multiple cardiovascular diseases but its value in patients with chronic kidney disease is still a matter of debate. Patients and methods: We studied 48 haemodialysis patients with mean age 70.013.9 years,62.5% female, 43.8% diabetics, with a mean haemodialysis time of 38.129.3 months. To evaluate the role of brain natriuretic peptide as a prognostic factor in this population we performed a two-session evaluation of pre- and postmid-week haemodialysis plasma brain natriuretic peptide concentrations and correlated them with hospitalisation and overall and cardiovascular mortality over a two-year period. Results: There were no significant variations in pre and post-haemodialysis plasma brain natriuretic peptide concentrations. Pre- and post-haemodialysis brain natriuretic peptide concentrations were significantly greater in patients who died from all causes(p=0.034 and p=0.001, respectively) and from cardiovascular causes (p=0.043 and p=0.001, respectively). Patients who were hospitalised in the two-year study period also presented greater pre- and posthaemodialysis brain natriuretic peptide concentrations(p=0.03 and p=0.036, respectively). Patients with mean brain natriuretic peptide concentrations 390 pg/mL showed a significantly lower survival at the end of the two-year study period. Conclusion: Brain natriuretic peptide was a good predictor of morbidity and mortality (overall and cardiovascular) in our population.
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BACKGROUND & AIMS: Patients who underwent endoscopic gastrostomy (PEG) present protein-energy malnutrition, but little is known about Trace Elements (TE), Zinc (Zn), Copper (Cu), Selenium (Se), Iron (Fe), Chromium (Cr). Our aim was the evaluation of serum TE in patients who underwent PEG and its relationship with serum proteins, BMI and nature of underlying disorder. METHODS: A prospective observational study was performed collecting: patient's age, gender, underlying disorder, NRS-2002, BMI, serum albumin, transferrin and TE concentration. We used ferrozine colorimetric method for Fe; Inductively Coupled Plasma-Atomic Emission Spectroscopy for Zn/Cu; Furnace Atomic Absorption Spectroscopy for Se/Cr. The patients were divided into head and neck cancer (HNC) and neurological dysphagia (ND). RESULTS: 146 patients (89 males), 21-95 years: HNC-56; ND-90. Low BMI in 78. Low values mostly for Zn (n = 122) and Fe (n = 69), but less for Se (n = 31), Cu (n = 16), Cr (n = 7); low albumin in 77, low transferrin in 94 and 66 with both proteins low. Significant differences between the groups of underlying disease only for Zn (t140.326 = -2,642, p < 0.01) and a correlation between proteins and TE respectively albumin and Zn (r = 0.197, p = 0.025), and albumin and Fe (r = 0.415, p = 0.000). CONCLUSIONS: When gastrostomy was performed, patients display low serum TE namely Zn, but also Fe, less striking regarding others TE. It was related with prolonged fasting, whatever the underlying disease. Low proteins were associated with low TE. Teams taking care of PEG-patients should use Zn supplementation and include other TE evaluation as part of the nutritional assessment of PEG candidates.
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RESUMO - A valorizao econmica de intervenes preventivas pode contribuir para melhorar a afetao de recursos em sade. A hipertenso, primeira causa de morte em Portugal, um grave problema de sade Pblica e o principal fator de risco para a ocorrncia de Acidente Vascular Cerebral (AVC). O presente estudo um primeiro ensaio para quantificar a disposio para pagar (DPP) da sociedade por uma interveno de promoo da adeso teraputica em hipertensos no controlados. Foi aplicado um questionrio presencial a uma amostra de convenincia (n=93), numa perspetiva ex post, sendo o questionrio constitudo por dois formatos de questes e dois cenrios de diferentes redues de presso arterial sistlica (cenrio 1 corresponde reduo de 10 mmHg e cenrio 2 reduo de 20 mmHg). O risco de AVC a 10 anos foi adaptado idade e ao sexo de cada participante. Relativamente ao cenrio 1, a DPP mdia foi de 25,87 e 33,93, dependendo do formato da questo (resposta aberta ou bidding game, respetivamente). Na questo de resposta aberta, 78,3% dos participantes estavam dispostos para pagar pela interveno, no bidding game 75,6% dos participantes referiram estar dispostos para pagar pelo menos 10. No cenrio 2, a DPP mdia foi de 26,81 e 34,79, dependendo se o formato da questo era do tipo resposta aberta ou bidding game, respetivamente. Na questo de resposta aberta, 84,3% dos participantes estavam dispostos para pagar pela interveno, no bidding game 76,1% dos participantes referiram estar dispostos para pagar pelo menos 10. Ao contrrio do bidding game, nas questes de resposta aberta verificou-se 25,8% e 24,7% de respostas no sei, para o cenrio 1 e cenrio 2 respetivamente, diretamente relacionada com a baixa escolaridade dos participantes (p=0,004). Tambm se verificou uma maior tendncia para respostas s questes de bidding game com valores mais elevados, comparativamente s questes de resposta aberta. Identificaram-se duas variveis explicativas para os valores DPP: o rendimento e a ocupao principal. A sensibilidade dos respondentes magnitude dos ganhos em sade foi verificada internamente em cada questionrio (os participantes referiram DPP mais elevadas no cenrio 2 relativamente ao cenrio 1), no entanto, os participantes que beneficiariam mais da interveno no demonstraram DPP superiores aos restantes. Para confirmar os efeitos identificados neste estudo e extrapol-los para a populao portuguesa necessrio realizar um estudo representativo de populao portuguesa.
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RESUMO- Introduo: A obesidade e a Sndrome Metablica (SM) so atualmente um importante problema de sade pblica, com prevalncias crescentes, que se acompanham tambm por aumento da prevalncia de Diabetes Mellitus (DM).Estudos prvios demonstram associao destas entidades com o aumento de risco de eventos cardiovasculares, em particular a DM. A SM tem sido uma entidade muito debatida nos ltimos anos, com aparecimento de diversas definies, contribuindo para resultados dspares no que diz respeito influncia da SM nas doenas cardiovasculares. Tambm tm sido descritas variaes tnicas e regionais. Para alm de alguns estudos epidemiolgicos na populao geral, a informao relativamente sua influncia na presena de doena cardiovascular desconhecida em Portugal, em particular em populaes com suspeita de doena coronria. Objetivos - Esclarecimento de questes relacionadas com a prevalncia de SM e a sua influncia na evoluo de doena ateroclertica arterial por avaliao de uma populao com suspeita de doena coronria. Populao e Mtodos - Estudo observacional, transversal, com incluso prospetiva de indivduos admitidos letivamente para realizao de angiografia coronria por suspeita de doena coronria, tendo sido tambm efetuadas anlises laboratoriais e ecografia carotidea para avaliao da espessura intima-mdia carotidea (EIMc) e da presena de placas carotdeas. Efetuou-se avaliao dos parmetros demogrficos, antropomtricos, determinao do perfil lipdico, glicmia e insulinmia. Os exames angiogrficos foram analisados por anlise quantitativa semi-automtica. Foram excludos indivduos com antecedentes conhecidos de doena cardaca. Resultados - Incluram-se 300 doentes, com idade mdia de 64 9 anos, 59% do gnero masculino. A prevalncia de SM de acordo com a definio da AHA/NHLBI foi 48,4% (ajustada para idade e gnero da populao portuguesa) e a prevalncia de DM foi 14,8% (ajustada). A concordncia global das trs definies mais recentes de SM foi de apenas 43%. A prevalncia de SM aumenta com a idade e tambm mais elevada no gnero feminino. O componente mais frequente foi a hipertenso arterial, seguido pela obesidade abdominal, a elevao da glicmia e por fim as alteraes dos triglicridos e do colesterol HDL. Por outro lado, a presena de doena coronria significativa (leses 50%) ocorreu em apenas 51,3% dos doentes, sendo ainda mais baixa no gnero feminino. Demonstrou-se tambm uma baixa capacidade preditiva para doena coronria dos testes no invasivos clssicos, em particular no gnero feminino. A prevalncia de doena coronria significativa foi idntica nos indivduos com SM comparativamente com indivduos sem alteraes metablicas (46,3% vs. 48,2%, respectivamente), sendo mais elevado nos diabticos (65,2%). Os fatores predizentes independentes de doena coronria significativa foram a idade, o gnero masculino, a elevao da glicmia e dos triglicridos. Pelo contrrio, o ndice de Massa Corporal (IMC) mostrou uma associao protetora relativamente presena de doena coronria. A SM no fator predizente de doena coronria. Relativamente s dimenses dos vasos coronrios, o IMC correlaciona-se positivamente e a glicmia / DM correlacionam-se negativamente. A EIMc aumenta com o aumento da idade e no gnero masculino. A EIMc foi intermdia nos doentes com SM (0,88 0,31 mm) comparativamente com os doentes diabticos (0,97 0,34 mm) e os indivduos Normais (0,85 0,34 mm). Os fatores predizentes independentes de EIMc foram a idade, o gnero masculino, o colesterol HDL e a insulinmia. A EIMc permite predizer com uma acuidade moderada a presena de doena coronria significativa (AUC 0,638), em particular no gnero feminino, sendo um fator predizente independente de presena de doena coronria (OR 2,35, IC 95% 1,04-5,33. p=0,04). Apesar de no se correlacionar com o nmero de vasos coronrios com doena, correlacionou-se com a gravidade da doena (pelo score de Gensini). A insulinmia e o ndice HOMA aumentam diretamente com a idade e com o IMC, sendo contudo sobreponveis em ambos os gneros. Os fatores predizentes de ndice HOMA (resistncia insulina) foram o IMC, bem como os restantes componentes de SM, estando o ndice HOMA relacionado com a presena de SM e o nmero dos seus componentes presentes. O limiar para resistncia insulina foi de 2,66 e para SM foi 2,41. Ao contrrio das restantes definies de SM, a definio da AHA/NHLBI no predizente da presena de DM no gnero masculino. A associao da resistncia insulina com doena coronria foi limiar (OR 1,13, IC 95% 1,00-1,28, p=0,045). Concluses - Numa populao com suspeita de doena coronria, a prevalncia de SM muito elevada (superior a 50%), sendo a prevalncia de DM de 23%. Tambm a obesidade e o excesso de peso foram extremamente prevalentes nesta populao. A concordncia entre definies de SM baixa. A hipertenso arterial e a obesidade abdominal so os componentes mais frequentes de SM, sendo menos prevalentes as alteraes lipdicas. Pelo contrrio, a presena de doena coronria significativa foi muito baixa, em particular nas mulheres. A SM no se associou presena de doena coronria significativa, estando esta mais dependente das alteraes do metabolismo glicdico e dos triglicridos, bem como de outros fatores de risco no modificveis, nomeadamente a idade e o gnero. A EIMc da cartida comum e a presena de placas carotdeas mais elevada nos indivduos diabticos, estando tambm ligeiramente aumentada nos doentes com SM, sendo os fatores predizentes de EIMc apenas a idade, o gnero, a hiperinsulinmia bem como os nveis baixos de colesterol HDL. A utilizao da avaliao da EIMc na estratificao de risco pr-angiografia coronria, poder ser til no gnero feminino. A hiperinsulinmia e o ndice HOMA (ndice de resistncia insulina), esto relacionados com o IMC e consequentemente com a presena de obesidade, embora tambm se correlacione de forma independente com os outros componentes de SM. A resistncia insulina associou-se presena de SM. Relativamente capacidade preditiva da coexistncia com DM, verificou-se associao com a definio da NCEP-ATP III e da IDF, contudo, a definio da AHA/NHLBI s foi predizente de DMnas mulheres. -------------ABSTRACT - Introduction: Obesity and Metabolic Syndrome (MS) are a major public health problem, with increasing prevalence, that follows the increase in diabetes prevalence. Previous studies showed an association of both entities with increased cardiovascular risk, particularly diabetes. MS has been debated in the last few years, with several definitions and different results when analysed the influence of MS on cardiovascular diseases. There are also some regional and ethnical variations. Beyond general population epidemiological studies, information about the influence on cardiovascular disease in Portugal is unknown, particularly in patients with suspected coronary disease. Objectives- To clarify several questions regarding the prevalence of MS and the influence in arterial atherosclerotic disease by evaluation of a population with suspected coronary artery disease. Population and Methods- Observational, cross-sectional study with prospective inclusion of individuals admitted electively for coronary angiography with suspicion of coronary artery disease. All individuals also performed laboratorial evaluation and carotid ultrasound to evaluate carotid intima-media thickness (cIMT) and carotid plaques. We also evaluated demographic, anthropometric parameters, lipid profile, blood glucose and blood insulin. Angiographic data was obtained by semi-automated quantitation. Individuals with previously known cardiac history were excluded from the study. Results- We included 300 individuals with a mean age of 64 9 years, 59% males. MS prevalence according to AHA/NHLBI definition was 48.4% (adjusted for age and gender of the Portuguese population) and the adjusted prevalence of diabetes was 14.8%. Global agreement between the more recent three definitions of MS was only 43%. MS prevalence increases with age and is also higher in women. The most frequent components were hypertension and abdominal obesity, followed by elevated glucose and triglicerides and low HDL-cholesterol. Significant coronary artery disease (stenosis 50%) was present in only 51.3% of patients, being lower in females. Non-invasive tests also had a low predictive capacity, particularly in females. The prevalence of significant coronary disease was identical in patients with MS compared with normal metabolism individuals (46.3% vs. 48.2%, respectively), being higher in diabetics (65.2%). Independent predictive factors for coronary disease were age, male gender, high blood glucose and triglycerides. On the contrary, Body Mass Index (BMI) was a protective factor for coronary disease. MS wasnt a predictor of coronary disease. BMI showed a positive correlation with coronary vessel diameter and glucose /diabetes had a negative correlation. CIMT increased with age and was higher in males. CIMT was intermediate in patients with MS (0.88 0.31 mm) when compared to diabetic patients (0.97 0.34 mm) and Normal individuals (0.85 0.34 mm). Independent predictors for cIMT were age, male gender, HDL-cholesterol and insulin. CIMT had a moderate predictive accuracy for coronary disease (AUC 0,638), particularly in females and is an independent predictor of the presence of significant coronary disease (OR 2.35, 95% CI 1.04-5.33. p=0.04). Although it did not correlate with the number of diseased coronary arteries, it correlated with coronary disease severity by the Gensini score. Insulin and HOMA index increase directly with age and BMI, but were identical in both genders. Predictive factors for HOMA index (insulin resistance) were BMI as well as the other MS components. HOMA index is related to MS and the number of its components. The cut-off for insulin resistance was 2.66 and for MS 2.41. Unlike other MS definitions, AHA/NHLBI definition is not a predictor of diabetes in males. There was a borderline association between insulin resistance and coronary disease (OR 1.13, 95% CI 1.00-1.28, p=0.045). Conclusions - In a population of patients with suspected coronary disease, MS prevalence is extremely high (above 50%) with a diabetes prevalence of 23%. Also obesity and overweight are very prevalent in this population. Global agreement between MS definitions is however low. Hypertension and abdominal obesity are the most frequent components, with a lower prevalence of lipid abnormalities. Coronary disease prevalence was low, particularly in women. MS wasnt associated with coronary disease. Coronary disease was related to glucose and triglycerides, as well as with other non-modifiable factors such as age and gender. CIMT and carotid plaques are increased in diabetic patients, and also slightly elevated in patients with MS, but cIMT independent predictors were age, male gender, insulin and HDLcholesterol. CIMT can be useful in risk stratification before coronary angiography particularly in women. Elevated insulin and HOMA index (an insulin resistance index) are related with BMI and consequently with obesity, and it was also correlated with other MS components. Insulin resistance was associated with MS. The presence of diabetes was associated with the presence of MS by NCEP-ATP III and IDF definitions; however, AHA/NHLBI definition was only predictive of diabetes in females.
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Dissertao para obteno do Grau de Doutor em Qumica Sustentvel
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The association between depression and cardiovascular disease is well documented. Nevertheless, the process through which they are linked remains unknown, as does the direction of this relationship. Studies have suggested both that depression is a risk factor for heart disease and that heart disease is a risk factor for depression. A number of studies have established that a relationship exists between depression and inflammation, with alterations in the levels of inflammatory markers (IL-1, IL-6, TNF-alpha and others). Depressive symptoms have also been identified in many diseases characterized by inflammatory processes e.g. rheumatoid arthritis, bronchial asthma, diabetes, tuberculosis and cardiovascular diseases. In this brief viewpoint, we explain and propose how to use Chagas disease, a disorder characterized by inflammatory processes and leading to cardiovascular and autonomic problems, as a model for studying the directionality of the relationship between heart disease and depression.
