Exercise as a tool for hypertension and resistant hypertension management: current insights

Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension. Aerobic exercise, dynamic resistance exercise, and concurrent training - the combination of dynamic resistance and aerobic exercise training in the same exercise session or on separate days - has been demonstrated to reduce blood pressure and help in the management of hypertension. The present review draws attention to the importance of exercise training in the management of blood pressure in both hypertension and resistant hypertension individuals.This work is financed by FEDER funds through the Operational Competitiveness Factors Program – COMPETE and by National Funds through FCT – Foundation for Science and Technology within the project “P2020-PTDC/DTPDES/1725/2014.” iBiMED is a research unit supported by the Portuguese Foundation for Science and Technology (FCT) (Ref: UID/BIM/04501/2013) and POCI-01–0145-FEDER-007628 funds. CIDESD is a research unit supported by FCT (UID/DTP/04045/2013) and by the European Regional Development Fund, through COMPETE 2020 (POCI-01–0145-FEDER-006969). Susana Lopes received a PhD grant from the Foundation for Science and Technology (SFRH/BD/129454/2017).publishe

Health records as the basis of clinical coding: is the quality adequate?: a qualitative study of medical coders' perceptions

Background: Health records are the basis of clinical coding. In Portugal, relevant diagnoses and procedures are abstracted and categorised using an internationally accepted classification system and the resulting codes, together with the administrative data, are then grouped into diagnosis-related groups (DRGs). Hospital reimbursement is partially calculated from the DRGs. Moreover, the administrative database generated with these data is widely used in research and epidemiology, among other purposes. Objective: To explore the perceptions of medical coders (medical doctors) regarding possible problems with health records that may affect the quality of coded data. Method: A qualitative design using four focus groups sessions with 10 medical coders was undertaken between October and November 2017. The convenience sample was obtained from four public hospitals in Portugal. Questions related to problems with the coding process were developed from the literature and authors' expertise. The focus groups sessions were taped, transcribed and analysed to elicit themes. Results: There are several problems, identified by the focus groups, in health records that influence the coded data: the lack of or unclear documented information; the variability in diagnosis description; "copy & paste"; and the lack of solutions to solve these problems

A clinical-pathological and survival study of oral squamous cell carcinomas from a population of the north of Portugal

Objectives: Our aim was to analyze the clinical, pathological, and outcome characteristics of oral squamous cell carcinomas (OSCC) from a population of the north of Portugal. Material and Methods: We conducted a descriptive study of 128 OSCC diagnosed between the years of 2000 and 2010 in the Centro Hospitalar do Porto. Through of the review of the clinical records we studied several clinical, pathological, and outcome variables. The overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier method and log-rank test. Cox regression method was used for multivariate analysis. Results: Of 128 patients with OSCC, 83 (64.8%) were male and 45 (35.2%) were female, (mean age of 62.13±15.57 years). The most affected location was the tongue (n=52; 40.6%). The most common cause of reference was a nonhealing ulcer (n=35; 28.9%) followed by oral pain (n=27; 22.3%). Sixty (60.6%) patients were tobacco consumers and 55 (57.3%) alcohol consumers. The cumulative 3-years OS rate was 58.6% and DFS was 55.4%. In multivariable analysis for OS, we found an adverse independent prognostic value for advanced tumour size (p<0.001) and for the presence of perineural permeation (p=0.012). For DFS, advanced stage tumours presented adverse independent prognostic value (p<0.001). Conclusions: OSCC occurred most frequently in males, in older patients, and in patients with tobacco and/or alcohol habits. TNM and tumour stage additionally to the perineural permeation were the most important prognostic factors for the survival of these patients, contributing to identify high-risk subgroups and to guide therapy

Tamanho de amostra para características de espigas de milho híbrido simples, duplo e triplo

Using adequate sample size in experimental units improves the efficiency of the research. In the agricultural year of 2004/2005, an experiment was conducted in Santa Maria, Rio Grande do Sul State, Brazil, with the objective of estimating sample size for the following traits: ear length, ear and cob diameter, ear weight, weight of grains per ear, cob weight and the weight of 100 grains, number of grain rows per ear, number of grains per ear and length of grains for two single hybrids (P30F33 and P Flex), two three-way hybrids (AG8021 and DG501) and two double hybrids (AG2060 and DKB701) of maize. For a 5% (D5) precision, the weight traits (dehusked ear weight, weight of grains per ear, cob weight and weight of 100 grains) can be sampled with 21 ears; the size traits (ear length, ear diameter, cob diameter and grain length) with eight ears; and the number traits (number of grain and rows) with 13 ears. Sample size varies as a function of ear trait and the type of hybrid i.e. single, three-way or double. Genetic variability among ears does not correspond to the increasing genetic variability i.e. single, three-way and double for the sample size of traits per ear.O uso dos tamanhos de amostras adequados nas unidades experimentais melhora a eficiência da pesquisa. Foi conduzido um experimento no ano agrícola 2004/2005 em Santa Maria, Rio Grande do Sul, com o objetivo de estimar o tamanho de amostra para o comprimento de espiga, o diâmetro de espiga e de sabugo, o peso da espiga, dos grãos por espiga, do sabugo e de 100 grãos, o número de fileiras de grãos por espiga, o número de grãos por espiga e o comprimento dos grãos de dois híbridos simples (P30F33 e P Flex), dois híbridos triplos (AG8021 e DG501) e dois híbridos duplos (AG2060 e DKB701) de milho. Para uma precisão de 5% (D5), características de peso (peso de espiga despalhada, de grãos, de sabugo e de 100 grãos) podem ser amostradas com 21 espigas, características de tamanho (comprimento de espiga e de grão, diâmetro de espiga e de sabugo) com oito espigas, e dados de contagem (número de grãos e de fileiras) com 13 espigas. O tamanho de amostra é variável em função da característica da espiga e do tipo de híbrido: simples, triplo ou duplo. A variabilidade genética existente entre os híbridos de milho, na forma crescente: simples, triplo e duplo, não reflete na mesma ordem no tamanho de amostra de caracteres da espiga

Brazilian Chronic Dialysis Survey 2013 - Trend analysis between 2011 and 2013

Introduction: National chronic dialysis data have had impact in the treatment planning. Objective: To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2013 and compare with 2011-12. Methods: A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis units. Results: Three hundred thirty four (51%) of the dialysis units in the country answered the questionnaire. In July 2013, the total estimated number of patients on dialysis was 100,397. The estimated prevalence and incidence rates of chronic maintenance dialysis were 449 (range: 284 in the North region and 622 in the South) and 170 patients per million population, respectively. The estimated number of new patients starting dialysis in 2013 was 34,161. The annual gross mortality rate was 17.9%. For prevalent patients, 31.4% were aged 65 years or older, 90.8% were on hemodialysis and 9.2% on peritoneal dialysis, 31,351 (31.2%) were on a waiting list of renal transplant, 30% were diabetics, 17% had PTH levels > 600 pg/ml and 23% hemoglobin 600 pg/ml e 23% hemoglobina < 10 g/dl. Cateter venoso era usado como acesso em 15,4% dos pacientes em hemodiálise. Conclusão: O número absoluto de pacientes em diálise tem aumentado 3% ao ano nos últimos 3 anos. As taxas de prevalência e incidência de pacientes em diálise ficaram estáveis, e a taxa de mortalidade tendeu a diminuir em relação a 2012. Houve tendência a melhor controle da anemia e dos níveis de PTH.Universidade Federal de São Paulo (UNIFESP)Universidade Federal da BahiaUniversidade Federal do Rio Grande do SulUniversidade Federal FluminenseFaculdade de Medicina do ABCUNIFESPSciEL

2010 report of the Brazilian dialysis census

INTRODUCTION: National chronic dialysis data are fundamental for treatment planning. OBJECTIVE: To report data of the annual survey of the Brazilian Society of Nephrology about patients with chronic renal failure who were on dialysis in 1 July, 2010. METHODS: A national survey based on data from the country's dialysis centers. Data collection was performed by using a questionnaire filled out online by the dialysis centers. RESULTS: 340 (53.3%) centers answered the questionnaire. National data were estimated for the overall dialysis population. In July 2010, the estimated total number of patients on dialysis was 92,091. The estimated prevalence and incidence rates of end-stage chronic kidney disease patients on maintenance dialysis were 483 and 100/million population, respectively. The estimated number of patients starting a dialysis program in 2010 was 18,972. The annual crude mortality rate was 17.9%. Of those on maintenance dialysis, 30.7% were aged 65 years or older, 90.6% were on hemodialysis and 9.4% on peritoneal dialysis, 35,639 (38.7%) were on a kidney transplant waiting list, 28% were diabetics, 34.5% had serum phosphorus levels > 5.5 mg/dL, and 38.5% had hemoglobin levels 5,5 mg/dL e 38,5%, hemoglobina < 11 g/dL. O cateter venoso era usado como acesso vascular em 13,6% dos pacientes em hemodiálise. CONCLUSÕES: A prevalência de pacientes em diálise tem apresentado aumento progressivo. Os dados dos indicadores da qualidade diálise de manutenção melhoraram em relação a 2009 e destacam a importância do censo anual para o planejamento da assistência dialítica.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUniversidade Federal da Bahia Faculdade de Medicina da Bahia Departamento de MedicinaUniversidade Federal do Rio Grande Faculdade de Medicina Departamento de Medicina InternaUniversidade Federal Fluminense Faculdade de Medicina Departamento de Medicina ClínicaFaculdade de Medicina do ABC Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Caraterização geomorfológica dos inselbergs do setor Malema-Ribáuè da Província de Nampula (Moçambique)

This study aims to understand the relationship between the geological and morphological characteristics of the inselbergs located in the Ribáuè-Malema sector of Nampula (Mozambique). The detailed characterization of this particular type of landscape will contribute to develop further studies focused in geoheritage and environmental conservation topics. The study area comprises part of the Malema, Ribáué and Lalaua districts. The studied inselbergs were characterized according to their lithological and morphological attributes, using the information provided by the geological maps and by digital terrain models made in ArcGIS 10.8.2. In the classified resistant landforms, the predominant lithologies are granites, gneisses and migmatites

Chronic Dialysis in Brazil - Report of the Brazilian Dialysis Census, 2011

INTRODUCTION: National data on maintenance dialysis are important for treatment planning. AIM: To describe the results of the dialysis census of the Brazilian Society of Nephrology for 2011 and observed trends from 2000 to 2011. METHODS: A survey was conducted using questionnaire filled online by the dialysis units, with July as reference month for estimates. From a total of 645 units, 353 (54.9%) responded to the survey. RESULTS: The estimated number of patients on dialysis in Brazil was 91,314 in 2011 (42,629 in 2010; 92,091 in 2011). For approximately 85% of the patients the treatment was provided by the Brazilian Unified Health Care System. The estimated prevalence and incidence rates in 2011 were 475 and 149 maintenance dialysis patients per million population, respectively. For prevalent patients, 90.6% were on hemodialysis, 31.5% 65 years of age or older, 28% diabetic and 35.5% (n=32,454) on waiting list for transplantation in 2011. The estimated number of patients starting dialysis in 2011 was 28,680 (18,972 in 2010) and annual mortality rate 19.9% (17.9% in 2010). CONCLUSIONS: The data indicate pronounced increase in the dialysis population across the years in Brazil with a trend for stabilization in the last two years. The reason for the increase in incidence and mortality in 2011 deserves investigation. A large number of patients were on waiting list for renal transplantation. By providing a picture of the situation and trends on maintenance dialysis treatment in Brazil the census is useful to guide resources allocation and interventions to improve treatment quality.INTRODUÇÃO: Dados nacionais sobre diálise crônica são fundamentais para o planejamento do tratamento. OBJETIVO: Descrever resultados do censo de diálise da Sociedade Brasileira de Nefrologia referentes a 2011 e tendências observadas de 2000 a 2011. MÉTODOS: Levantamento utilizando questionário preenchido on-line pelas unidades de diálise do Brasil usando julho de 2011 como referência para estimativas. Do total de 643 unidades com programa dialítico crônico, 353 (54,9%) responderam. RESULTADOS: O número estimado de pacientes em diálise no Brasil em 2011 foi 91.314 (42.629 em 2000, 92.091 em 2010). Para aproximadamente 85% dos pacientes, o tratamento foi pago com recursos do SUS. As estimativas de prevalência e incidência para 2011 foram de 475 e 149 pacientes em diálise por milhão da população, respectivamente. Entre prevalentes, 90,6% estavam em hemodiálise, 31,5% tinham idade > 65 anos, 28% eram diabéticos, e 35,5% (n=32.454) estavam em fila de espera para transplante. Para 2011, o número estimado de pacientes iniciando diálise foi 28.680 (18.972 em 2010) e a taxa anual de mortalidade 19,9% (17,9% para 2010). CONCLUSÕES: Os dados indicam aumento pronunciado da população em diálise no Brasil ao longo dos anos, com tendência a estabilização nos dois últimos anos. As razões para aumento da incidência e mortalidade em 2011 merecem investigação. É grande o número estimado de pacientes em fila de espera para transplante renal. O censo fornece um quadro da situação e tendências da diálise no Brasil, sendo, portanto, útil para orientar alocação de recursos e intervenções que melhorarem a qualidade do tratamento.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUniversidade Federal da Bahia Faculdade de Medicina da Bahia Departamento de MedicinaUniversidade Federal do Rio Grande do Sul Faculdade de Medicina Departamento de Medicina InternaUniversidade Federal Fluminense Faculdade de Medicina Departamento de Medicina InternaHospital São João de DeusFaculdade de Medicina do ABC Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Multisource and temporal variability in Portuguese hospital administrative datasets: Data quality implications

[EN] Background: Unexpected variability across healthcare datasets may indicate data quality issues and thereby affect the credibility of these data for reutilization. No gold-standard reference dataset or methods for variability assessment are usually available for these datasets. In this study, we aim to describe the process of discovering data quality implications by applying a set of methods for assessing variability between sources and over time in a large hospital database. Methods: We described and applied a set of multisource and temporal variability assessment methods in a large Portuguese hospitalization database, in which variation in condition-specific hospitalization ratios derived from clinically coded data were assessed between hospitals (sources) and over time. We identified condition-specific admissions using the Clinical Classification Software (CCS), developed by the Agency of Health Care Research and Quality. A Statistical Process Control (SPC) approach based on funnel plots of condition-specific standardized hospitalization ratios (SHR) was used to assess multisource variability, whereas temporal heat maps and Information-Geometric Temporal (IGT) plots were used to assess temporal variability by displaying temporal abrupt changes in data distributions. Results were presented for the 15 most common inpatient conditions (CCS) in Portugal. Main findings: Funnel plot assessment allowed the detection of several outlying hospitals whose SHRs were much lower or higher than expected. Adjusting SHR for hospital characteristics, beyond age and sex, considerably affected the degree of multisource variability for most diseases. Overall, probability distributions changed over time for most diseases, although heterogeneously. Abrupt temporal changes in data distributions for acute myocardial infarction and congestive heart failure coincided with the periods comprising the transition to the International Classification of Diseases, 10th revision, Clinical Modification, whereas changes in the DiagnosisRelated Groups software seem to have driven changes in data distributions for both acute myocardial infarction and liveborn admissions. The analysis of heat maps also allowed the detection of several discontinuities at hospital level over time, in some cases also coinciding with the aforementioned factors. Conclusions: This paper described the successful application of a set of reproducible, generalizable and systematic methods for variability assessment, including visualization tools that can be useful for detecting abnormal patterns in healthcare data, also addressing some limitations of common approaches. The presented method for multisource variability assessment is based on SPC, which is an advantage considering the lack of gold standard for such process. Properly controlling for hospital characteristics and differences in case-mix for estimating SHR is critical for isolating data quality-related variability among data sources. The use of IGT plots provides an advantage over common methods for temporal variability assessment due its suitability for multitype and multimodal data, which are common characteristics of healthcare data. The novelty of this work is the use of a set of methods to discover new data quality insights in healthcare data.The authors would like to thank the Central Authority for Health Services, I.P. (ACSS) for providing access to the data. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was financed by FEDER-Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020-Operacional Programme for Competitiveness and Internationalisation (POCI) and by Portuguese funds through FCT- Fundacao para a Ciencia e a Tecnologia in the framework of the project POCI-01-0145-FEDER-030766 ("1st.IndiQare-Quality indicators in primary health care: validation and implementation of quality indicators as an assessment and comparison tool") . In addition, we would like to thank to projects GEMA (SBPLY/17/180501/000293) -Generation and Evaluation of Models for Data Quality, and ADAGIO (SBPLY/21/180501/000061) - Alarcos Data Governance framework and systems generation, both funded by the Department of Education, Culture and Sports of the JCCM and FEDER; and to AETHER-UCLM: A smart data holistic approach for context -aware data analytics focused on Quality and Security project (Ministerio de Ciencia e Innovacion, PID2020- 112540RB-C42) . CSS thanks the Universitat Politecnica de Valencia contract no. UPV-SUB.2-1302 and FONDO SUPERA COVID-19 by CRUE- Santander Bank grant "Severity Subgroup Discovery and Classification on COVID-19 Real World Data through Machine Learning and Data Quality assessment (SUBCOVERWD-19) ."Souza, J.; Caballero, I.; Vasco Santos, J.; Lobo, M.; Pinto, A.; Viana, J.; Sáez Silvestre, C.... (2022). Multisource and temporal variability in Portuguese hospital administrative datasets: Data quality implications. Journal of Biomedical Informatics. 136:1-11. https://doi.org/10.1016/j.jbi.2022.10424211113