Avaliação da qualidade de vida de pacientes com obesidade grave submetidos à cirurgia bariátrica em um sistema público de saúde

Objectives: To assess QoL of obese patients in the Brazilian public healthcare system, before and after bariatric surgery, and to determine the appropriateness of the Moorehead-Ardelt Questionnaire II (M-A-QoLQII) compared with the Short-Form Health Survey (SF-36). Subjects and methods: Forty-one severe obese patients in a waiting-list, and 84 patients who underwent bariatric surgery were included. Correlations were tested and reliability determined by the Cronbach's coefficient. Results: BMI differed between the pre- and post-surgery groups (52.3 +/- 8.3 kg/m(2) vs. 32.5 +/- 6.4 kg/m(2), p &lt; 0.001). The latter showed better scores in the SF-36 domains than in the pre-surgery. SF-36 and M-A-QoLQII categories were correlated (r = 0.53, 0.49 and 0.47, for vitality, mental health, and general health domains, p &lt; 0.001). In the logistic regression, age, previous BMI, and loss of excess weight were associated with functional capacity. Conclusions:The outcomes of bariatric surgery obtained in a Brazilian public healthcare center were successful. M-A-QoLII represents a useful tool to assess surgery outcomes, including QoL. Arq Bras Endocrinol Metab. 2012;56(1):33-8Objetivos: Avaliar a qualidade de vida de pacientes obesos do sistema público de saúde brasileiro antes e após cirurgia bariátrica e a adequação do questionário Moorehead-Ardelt II (M--A-QoLQII) em relação ao SF-36. Sujeitos e métodos: Quarenta e um pacientes obesos graves em lista de espera e 84 submetidos à cirurgia bariátrica foram incluídos. Correlações foram testadas e confiabilidade determinada pelo coeficiente de Cronbach. Resultados: O IMC diferiu entre os grupos pré- e pós-cirurgia (52,3 ± 8,3 kg/m2 vs. 32,5 ± 6,4 kg/m2 , p < 0,001). O último apresentou melhores escores nos domínios do SF-36 que o pré-cirurgia. As categorias do SF-36 e M-A-QoLQII se correlacionaram (r = 0,53; 0,49; 0,47 para vitalidade, saúde mental e saúde geral, p 0,001). Na regressão logística, idade, IMC prévio e excesso de peso perdido associaram-se independentemente à capacidade funcional. Conclusões: Resultados da cirurgia bariátrica em centro de saúde público brasileiro foram promissores. O M-A-QoLQII representa ferramenta útil para avaliar seus resultados, inclusive a QV. Arq Bras Endocrinol Metab. 2012;56(1):33-

Original Article Efficacy of Lifestyle Change Psychological Intervention in Coronary Risk Reduction

Summary Objective: To evaluate the efficacy of a program of lifestyle change through psychological intervention, combined with pharmacological therapy, for coronary risk reduction in uncontrolled hypertensive patients with overweight and dyslipidemia over 11 months of follow-up. Method

Cross-sectional Study on Blood Pressure Control in the Department of Nephrology of the Escola Paulista de Medicina - UNIFESP

OBJECTIVE - To assess hypertension control rates in a specialized university-affiliated medical department, the influence of sex, diabetes, and obesity on that control, and the strategies for the treatment of hypertension. METHODS - We carried out a cross-sectional study with 1,210 patients followed up for at least 6 months. Information was gathered from medical and nursing records and comprised the following data: sex, age, weight, height, abdominal and hip circumferences, blood pressure, and class and number of the antihypertensive drugs prescribed. To assess obesity, we used body mass index and waist/hip ratio. Blood pressure was considered under control when its levels were below 140/90 mmHg. RESULTS - The study consisted of 73% females and 27% males. Most females (31.7%) were 50 to 59 years of age, and most males (28.3%) were 60 to 69 years. The blood pressure control rate found was 20.9% for the 1,210 patients and 23.4% for the hypertensive diabetic patients (n=290). Despite the low control rates found, 70% of the patients used 1 or 2 antihypertensive medications. A high prevalence of obesity (38%) was observed, and females had a greater abdominal obesity index than males did (90% vs 82%, p<0.05). Patients with a greater body mass index had less control of blood pressure. CONCLUSION - The percentage of hypertensive patients with controlled blood pressure levels was low and was associated with a high prevalence of obesity. These data indicate the need for reviewing the strategies of global treatment for hypertension

Eficácia de uma intervenção psicológica no estilo de vida para redução do risco coronariano Efficacy of lifestyle change psychological intervention in coronary risk reduction

OBJETIVO: Avaliar a eficácia de um programa destinado a promover mudanças no estilo de vida por meio de intervenção psicológica associado à terapia farmacológica para redução do risco coronariano em pacientes com hipertensão não-controlada, sobrepeso e dislipidemia acompanhados durante 11 meses. MÉTODOS: Estudo controlado e aleatório com 74 pacientes distribuídos para três programas de tratamento distintos. Um grupo (TC) recebeu exclusivamente tratamento farmacológico convencional. O grupo de orientação (GO) recebeu tratamento farmacológico e participou de um programa de orientação para controle dos fatores de risco cardiovascular. O terceiro grupo (IPEV) recebeu tratamento farmacológico e participou de um programa de intervenção psicológica breve destinado a reduzir o nível de estresse e mudar o comportamento alimentar. A principal medida de avaliação foi o índice de risco de Framingham. RESULTADOS: Os pacientes do grupo TC obtiveram uma redução média de 18% (p = 0,001) no risco coronariano; os pacientes do grupo GO apresentaram um aumento de risco de 0,8% (NS); e os pacientes do grupo IPEV obtiveram uma redução média de 27% no índice de risco de Framingham (p = 0,001). CONCLUSÃO: O tratamento farmacológico aliado a um programa de intervenção psicológica destinado a reduzir o nível de estresse e mudar o comportamento alimentar resultou em benefícios adicionais na redução de risco coronariano.<br>OBJECTIVE: To evaluate the efficacy of a program of lifestyle change through psychological intervention, combined with pharmacological therapy, for coronary risk reduction in uncontrolled hypertensive patients with overweight and dyslipidemia over 11 months of follow-up. METHODS: A randomized controlled trial with 74 patients assigned to three different treatment programs. One group (CT) only received conventional pharmacological treatment. Another group (OG) received pharmacological treatment and participated in a guidance program to control cardiovascular risk factors. A third group (LSPI) received pharmacological treatment and participated in a brief psychological intervention program for reduction of estresse levels and changing of eating behavior. The main measure was the Framingham risk index. RESULTS: CT patients presented an average reduction of 18% (p = 0.001) in coronary risk; OG patients elevated the risk by 0.8% (NS) and the LSPI group showed an average reduction of 27% on the Framingham risk index (p = 0.001). CONCLUSION: Pharmacological treatment combined with psychological intervention for reduction of estresse level and changing of eating behavior resulted in additional benefits in coronary risk reduction

Reprodutibilidade da medida ambulatorial da pressão arterial em pacientes hipertensos com diabete melito tipo 2 Reproducibility of ambulatory blood pressure monitoring in hypertensive patients with type 2 diabetes mellitus

OBJETIVO: Avaliar a reprodutibilidade e o efeito placebo sobre a monitorização ambulatorial da pressão arterial (MAPA) (SpaceLabs-90207). MÉTODOS: Mensurou-se a PA no consultório e por meio de duas MAPA, realizadas em um intervalo de 1 a 10 meses (média de 4,9 meses), de 26 pacientes com diabetes tipo 2 e hipertensão. Onze pacientes (G1) realizaram as duas MAPA sem medicação anti-hipertensiva por 15 dias, enquanto o G2 (N = 15) fez a segunda MAPA em uso de placebo pelo mesmo período. RESULTADOS: Ao avaliarmos os coeficientes de variação (CV) da PA sistólica na vigília (PASV), PA diastólica na vigília (PADV), PA sistólica nas 24h (PAS24h) e PA diastólica nas 24h (PAD24h), encontramos valores de 4,6%, 3,9%, 5,0% e 4,0% no G1 e 4,3%, 5,1%, 3,7% e 5,1% no G2, respectivamente. Quanto ao CV da PA sistólica e diastólica durante o sono (PASS e PADS), encontramos 7,7% e 8,2% para G1, e 5,6% e 6,3% para G2, respectivamente. O CV da freqüência cardíaca na vigília e durante o sono foram: G1 = 5,9% e 9,0%, G2 = 6,9% e 5,8%, respectivamente. Analisando o total dos pacientes, todas as variáveis mostraram fortes correlações entre a primeira e a segunda MAPA (PASV, r=0,76; P<0,001; PADV, r=0,65; p<0,001; PAS24h, r=0,77; p<0,001; PAD24h, r=0,70; p<0,001; PASS, r=0,62; p<0,001; PADS, r=0,52; p<0,01). Ocorreram também correlações entre a PA sistólica e a diastólica de consultório e a PAS24h e PAD24h (r=0,65; p<0,001; r=0,57; p<0,01). CONCLUSÃO: A média dos níveis pressóricos avaliados pela MAPA apresentou boa reprodutibilidade e esses não foram afetados pelo efeito placebo.<br>OBJECTIVE: To evaluate the reproducibility of ambulatory blood pressure monitoring (ABPM) (SpaceLabs-90207) and placebo effect on ABPM. METHODS: Blood pressure was measured in the office and over two ABPM periods with an interval from one to ten months (mean 4.9 months), in 26 patients with type 2 diabetes mellitus and hypertension. Eleven patients (G1) had two ABPMs without taking antihypertensive drugs for 15 days, whereas G2 (N=15) had the second ABPM after administration of a placebo for 15 days. RESULTS: In the evaluation of the coefficient of variation (CV) of diurnal (awake) systolic BP (DSBP), of diurnal (awake) diastolic BP (DDBP), of 24-hour systolic BP (24hSBP) and of 24-hour diastolic BP (24hDBP), the values found were 4.6%, 3.9%, 5.0%, 4.0% for G1 and 4.3%, 5.1%, 3.7%, 5.1% for G2 respectively. We also determined the CV of nocturnal (sleep) systolic and diastolic BP (NSBP and NDBP) for G1 (7.7%; 8.2%) and G2 (5.6%; 6.3%). Heart rate CV during alertness and sleep were: G1=5.9% and 9.0%; G2=6.9% and 5.8% respectively. When the total number of 'patients was analyzed, all variables showed a strong correlation between the first and second ABPM measurements (DSBP, r = 0.76; P < 0.001; DDBP, r = 0.65; p < 0.001; 24hSBP, r = 0.77; p < 0.001; 24hDBP, r = 0.70; p < 0.001; NSBP, r = 0.62; p < 0.001; NDBP, r = 0.52; p < 0.01). Office systolic and diastolic BP and 24hSBP and 24hDBP also showed correlation (r = 0.65; p < 0.001; r = 0.57; p < 0.01). CONCLUSION: Mean of pressure levels measured by ABPM presented good reproducibility and were not affected by placebo

Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

PURPOSE - To evaluate diastolic dysfunction (DD) in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS - Four hundred sixty essential hypertensive patients (HT) underwent Doppler echocardiography to obtain E/A wave ratio (E/A), atrial deceleration time (ADT), and isovolumetric relaxation time (IRT). All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy) and to age (<40; 40 - 60; >60 years). One hundred six normotensives (NT) persons were also evaluated. RESULTS - A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38±0.03 vs HT - 1.27±0.02, p<0.01), was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR). Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01). CONCLUSION - DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients