Hipertensos: que diferenças entre controlados e não controlados

Introdução: A Hipertensão Arterial (HTA) é uma patologia muito frequente, com elevada morbilidade e mortalidade e custos terapêuticos farmacológicos importantes. Em Portugal estima-se uma prevalência de HTA de 42,62%. A abordagem farmacológica inicial por diuréticos, a cronoterapia e o impacto negativo de alguns medicamentos no controlo têm fundamentação científica. Objetivos: Determinar a prevalência e comparar diferenças entre pacientes hipertensos controlados e não controlados. Metodologia: Estudo observacional, analítico, em Junho de 2013, na população de três ficheiros clínicos de médicos de uma Unidade de Saúde Familiar no concelho de Coimbra, com HTA diagnosticada e registada pela codificação ICPC-2 (com ou sem complicações) a 13 de Maio de 2013. Amostra aleatória com reposição, calculada para um intervalo de confiança de 95% e margem de erro de 6% em cada um dos ficheiros, após listagem por ordem ascendente do número nacional de utente, assumindo uma frequência de controlo de 50%. Dados colhidos pelos autores, por consulta de todos os processos aleatorizados, no programa específico de HTA e no ambiente de prescrição do Sistema de Apoio ao Médico, após parecer positivo da Comissão de Ética da Administração Regional de Saúde do Centro. Controlo de HTA para os casos de três últimos registos <140/90 mmHg. Resultados: População de n=972 (prevalência da HTA de 20,2%). Amostra de n=201 indivíduos, sendo 104 homens (51,7%) e 86 com menos de 65 anos (42,8%) (p=0,127 entre sexo e grupo etário). Para n=130 (64,7%) da amostra há controlo da HTA. A lesão em órgão alvo é significativamente mais frequente nos pacientes com HTA controlada (33,1% vs 19,7%, p=0,031). Quando há toma de pelo menos 1 medicamento anti-hipertensor à noite há maior frequência de controlo (56,9% vs 29,6%, p<0,001). A simultaneidade de prescrição de anti-inflamatórios não esteroides (AINE) é mais frequente nos pacientes com HTA não controlada (11,3% vs 3,8%, p=0,043). Discussão: Verifica-se o maior controlo da HTA em comparação com outros estudos em Portugal. Identificaram-se como factores significativamente mais frequentes no controlo da HTA, o acidente cardiovascular prévio, a toma de pelo menos um anti-hipertensor à noite e a ausência de prescrição simultânea de AINE. Os dados estão de acordo com as evidências disponíveis e também sugerem que o facto de ter complicações poderá ser fator motivador de maior atenção por parte da pessoa e/ou maior investimento pela equipa de saúde

Health horizons: Future trends and technologies from the European Medicines Agency’s horizon scanning collaborations

In medicines development, the progress in science and technology is accelerating. Awareness of these developments and their associated challenges and opportunities is essential for medicines regulators and others to translate them into benefits for society. In this context, the European Medicines Agency uses horizon scanning to shine a light on early signals of relevant innovation and technological trends with impact on medicinal products. This article provides the results of systematic horizon scanning exercises conducted by the Agency, in collaboration with the World Health Organization (WHO) and the European Commission’s Joint Research Centre’s (DG JRC). These collaborative exercises aim to inform policy-makers of new trends and increase preparedness in responding to them. A subset of 25 technological trends, divided into three clusters were selected and reviewed from the perspective of medicines regulators. For each of these trends, the expected impact and challenges for their adoption are discussed, along with recommendations for developers, regulators and policy makers

Evolução natural da acuidade auditiva e equilíbrio: uma revisão analítica: Natural Evolution of auditory acuity and balance: an analytical review

O presente estudo constrói uma análise crítica sobre o desenvolvimento da acuidade auditiva e os seus efeitos ao longo do processo evolutivo humano. Desse modo, foi realizada uma pesquisa exploratória com o intuito de formular uma síntese de informações sobre o eixo temático, apoiando-se na busca das literaturas. Para tanto, utilizou-se do método de pesquisa bibliográfica sistemática, tendo o auxílio da ferramenta de busca das bases de dados: U. S. National Library of Medicine (PubMed), Scielo e Google acadêmico, dispondo-se do uso de revisões sistemáticas, artigos públicos completos e na língua portuguesa. Assim, o objetivo da obra se concentra na descrição, análise e reflexão sobre a importância de se ter a percepção auditiva ao longo da história das espécies, mais especificamente dos seres humanos. No ato da pesquisa, foi notório a escassez de artigos que abordam a evolução da audição e sua relação à aspectos primordiais no homem como no equilíbrio e postura. Por fim, mediante a observação do conteúdo investigado, o estudo indicou que o desenvolvimento das especificidades dos sentidos, em especial do ouvido, possibilitou a edificação do meio cívico contemporâneo, devido à sua capacidade em proporcionar o avanço do senso de orientação e de consciência em nível individual e grupal

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Trends in lung cancer mortality in Brazil from the 1980s into the early 21st century: age-period-cohort analysis

The aim of this study was to describe the pattern of trends in lung cancer mortality in Brazil and identify the effects of the factors age, period and cohort (APC) on mortality rates. A time series study was conducted using secondary population-based data. Lung cancer mortality rates by sex were calculated for the period 1980 to 2007. APC models were adjusted to identify the influence of age, period and cohort effects on rates. Lung cancer mortality rates are significantly higher among men. Specific rates for men over the age of 64 and for women of all ages are increasing. There was a greater increase of adjusted rates among women. With respect to the age effect, mortality risk increases with age starting with the earliest age groups. With regard to the cohort effect, there is a lesser risk of mortality among men born after 1950 and an increasing risk across all cohorts among women. The results regarding younger generations indicate that present trends are likely to continue. The cohort effect among women suggests an increasing trend in mortality rates, whereas a decrease in rates among men under the age of 65 suggests that this trend will continue. These trends reflect tobacco control measures adopted since 1986

Health horizons:Future trends and technologies from the European Medicines Agency's horizon scanning collaborations

In medicines development, the progress in science and technology is accelerating. Awareness of these developments and their associated challenges and opportunities is essential for medicines regulators and others to translate them into benefits for society. In this context, the European Medicines Agency uses horizon scanning to shine a light on early signals of relevant innovation and technological trends with impact on medicinal products. This article provides the results of systematic horizon scanning exercises conducted by the Agency, in collaboration with the World Health Organization (WHO) and the European Commission's Joint Research Centre's (DG JRC). These collaborative exercises aim to inform policy-makers of new trends and increase preparedness in responding to them. A subset of 25 technological trends, divided into three clusters were selected and reviewed from the perspective of medicines regulators. For each of these trends, the expected impact and challenges for their adoption are discussed, along with recommendations for developers, regulators and policy makers

Factors associated with disease-specific survival of patients with non-small cell lung cancer

ABSTRACT Objective: Lung cancer is a global public health problem and is associated with high mortality. Lung cancer could be largely avoided by reducing the prevalence of smoking. The objective of this study was to analyze the effects of social, behavioral, and clinical factors on the survival time of patients with non-small cell lung cancer treated at Cancer Hospital I of the José Alencar Gomes da Silva National Cancer Institute, located in the city of Rio de Janeiro, Brazil, between 2000 and 2003. Methods: This was a retrospective hospital cohort study involving 1,194 patients. The 60-month disease-specific survival probabilities were calculated with the Kaplan-Meier method for three stage groups. The importance of the studied factors was assessed with a hierarchical theoretical model after adjustment by Cox multiple regression. Results: The estimated 60-month specific-disease lethality rate was 86.0%. The 60-month disease-specific survival probability ranged from 25.0% (stages I/II) to 2.5% (stage IV). The performance status, the intention to treat, and the initial treatment modality were the major prognostic factors identified in the study population. Conclusions: In this cohort of patients, the disease-specific survival probabilities were extremely low. We identified no factors that could be modified after the diagnosis in order to improve survival. Primary prevention, such as reducing the prevalence of smoking, is still the best method to reduce the number of people who will suffer the consequences of lung cancer