Prevalência de insuficiência cardíaca e associação com saúde autorreferida no Brasil: Pesquisa Nacional de Saúde - 2013

A insuficiência cardíaca (IC) é um desafio na saúde mundial. A saúde autorreferida (SAR) é preditora de morbimortalidade e é categorizada em saúde autorreferida boa (SAR B) e precária (SAR P). Objetivo: Estimar a prevalência da IC e associação com a SAR no Brasil. Métodos: Este estudo utilizou dados da Pesquisa Nacional de Saúde (PNS) em 2013, com dados válidos para 59.655 adultos (≥ 18 anos). A prevalência de IC relacionou-se às características sociodemográficas, percepção do estado de saúde (SAR, percepções de saúde física e mental), diagnóstico de depressão e prática de exercício físico. Utilizou-se a regressão de Poisson com variância robusta. Resultados: O diagnóstico de IC foi referido por 1,1% dos entrevistados. Observou-se que ter o diagnóstico médico de IC aumenta em quatro vezes a chance de ter pior percepção de saúde (OR = 4,17; IC95% 3,65–4,76), contudo essa medida reduz para menos da metade, quando ajustado por faixa etária e percepção da saúde física (OR = 1,78; IC95% 1,52–2,08). Conclusão: A prevalência de IC representou 1,7 milhões de indivíduos com essa enfermidade na população brasileira. A estreita associação entre IC e SAR precária evidenciou aumento de 78% de chance do indivíduo que tenha IC relatar SAR precária.Heart failure (HF) is a global health challenge. Self-rated health (SRH) is a predictor of morbidity and mortality and to analysis is categorized into good self-rated health (SRH G) and poor (SRH P). Objective: To estimate the prevalence of HF and association with SRH in Brazil. Methods: This study that used data from the National Health Survey (NHS) held in 2013, with valid data to 59,655 adults (≥ 18 years). The prevalence of HF related to sociodemographics, health perception (SRH, perceptions of physical and mental health), diagnosis of depression and exercising. Poisson regression with robust variance was used. Results: The diagnosis of HF was referenced by 1.1% of respondents. It was observed that having the medical diagnosis of HF increases by four times the chance of having worse perception of health (OR = 4.17; 95% CI 3.65-4.76), however this measure reduces to less than half, when adjusted for age and perception of physical health (OR = 1.78; 95% CI 1.52-2.08). Conclusion: The prevalence of HF represented 1.7 million individuals with this disease in the brazilian population. The close association between HF and SRH precarious showed increased 78% chance of the individual who have HF report SRH precarious

Correlation between sleep and quality of life in patients with heart failure

Heart failure (HF) is a serious and growing public health problem on the world. Among its many features there are low quality of life (QOL) and excessive daytime sleepiness (EDS) due to sleep disorders which impairs its quality. It was identified the EDS and sleep quality in patients with HF and their SDE was correlated to their QOL. Among the 52 subjects of the study, 23 patients completed the study (13M), with average age of 60.5 years, functional class (FC) II and III, ejection fraction ≤45%. Subjects were evaluated for their quality of sleep, EDS and QOL. Questionnaires were applied in the form of interview by using the SF−36 for QOL, Pittsburgh Sleep Quality Index Questionnaire for quality of sleep and Epworth Sleepiness Scale for SDE. A total of 60.86% of the sample showed poor sleep quality. Correlating QOL to EDS, significant results were obtained in the pain (p=0.04 and r=−43), vitality (p=0.05 and r=−0.40) and social functioning (p=0.003 and r=-0.59). The sample has a poor sleep quality, with presence of SDE negatively correlated with QOL in aspects of vitality, pain and social functioning.A insuficiência cardíaca (IC) é um problema grave e crescente de saúde pública no cenário mundial. Dentre suas várias características, estão a baixa qualidade de vida (QV) e sonolência diurna excessiva (SDE) em virtude dos distúrbios do sono, que prejudicam sua qualidade. Identificou-se a SDE e a qualidade do sono (QS) em pacientes com IC e, correlacionou-se a SDE à QV desses pacientes. Dos 52 indivíduos incluídos no estudo, 23 pacientes o concluíram (13 H), com idade média de 60,5 anos, classe funcional (CF) II e III, com fração de ejeção ≤ 45%. Aplicou-se o 36-item Short-Form Health Survey (SF-36) para QV, Questionário de Pittsburgh para QS, e Escala de Sonolência de Epworth para SDE. Ao final, 60,86% da amostra apresentaram QS ruim. Ao correlacionar-se QV com o grau de SDE, obtiveram-se resultados significativos para dor (p=0,04 e r=-0,43), vitalidade - VT (p=0,05 e r=-0,40) e aspectos sociais -AS (p=0,003 e r=-0,59). A amostra estudada apresenta QS ruim, com SDE estando presente e se correlacionando de forma negativa com QV em seus aspectos de dor, VT e AS.La insuficiencia cardíaca (IC) es un problema mundialmente grave y creciente en la salud pública. La mala calidad de vida (QV) y la somnolencia excesiva (SDE), debida a los trastornos del sueño, son las principales características que perjudican su calidad. Se identificó la SDE y la calidad del sueño (QS) en pacientes con IC y se los correlacionó con estos pacientes. De los 52 sujetos participantes, concluyeron el estudio 23 pacientes (13 H), con un promedio de edad de 60,5 años, la clase funcional (CF) II y III y fracción de eyección del ≤ 45%. Se aplicó 36-item Short-Form Health Survey (SF-36) a la QV, el cuestionario de Pittsburgh para la QS y la Escala de Somnolencia de Epworth para la SDE. Los resultados mostraron que en el 60,86% de la muestra no se obtuvo una buena QS y al correlacionarse la QV con el grado SDE los resultados fueron significativos al dolor (p=0,04 y r=-0,43), a la vitalidad - VT (p=0,05 y r=-0,40) y a los aspectos sociales - AS (p=0,003 y r=-0,59). En la muestra estudiada se mostró una mala QS, además estaba presente la SDE correlacionándola negativamente con la QV en los aspectos dolor, VT y AS

Sistemas de saúde e percepção de barreiras para admissão e aderência em programas de reabilitação cardíaca: estudo comparativo

Além da elevada prevalência de doenças cardiovasculares (DCV), iniquidades regionais no acesso aos serviços de saúde e subutilização de programas de reabilitação cardíaca (PRC) ainda são marcantes no cenário brasileiro. Objetivo: Esse estudo visou descrever e comparar barreiras para uso de PRC em usuários de diferentes sistemas de saúde e níveis de atendimento em um estado brasileiro. Métodos: Participantes de PRC e pacientes elegíveis de enfermarias e ambulatórios foram pareados pelos sistemas de saúde que utilizavam e responderam a Escala de Barreiras para Reabilitação Cardíaca (EBRC). Os testes U de Mann-Withney e Kruskal Wallis foram usados para comparar barreiras entre os sistemas de saúde e entre níveis de atendimento, respectivamente. Resultados: Cento e quarenta (87%) pacientes participaram do estudo. A média total dos itens da escala foi 1,98±0,48 e diferiu apenas entre participantes de PRC e pacientes internados (p<0,05). Algumas barreiras de acesso, necessidades percebidas e comorbidades/estado funcional foram maiores no sistema público do que no privado (p<0,05). A falta de conhecimento sobre PRC (3.75±1.66) e a falta de referência médica (2.32±1.53) destacaram-se no domínio necessidades percebidas, que teve o maior escore médio da amostra (2.31±0.71). Conclusões: Barreiras de acesso e necessidades percebidas foram maiores para usuários de serviços públicos. Viagens e trabalho foram barreiras maiores para participantes de PRC, enquanto para pacientes internados e ambulatoriais as maiores barreiras foram necessidades percebidas. Logo, a disseminação de PRC e estratégias para referência de elegíveis devem ser estimuladas em ambos os sistemas de saúde e níveis de atendimento.In addition to the high prevalence of cardiovascular disease (CVD), regional iniquities in access to health services and underutilization of cardiac rehabilitation programs (CRP) are still significant in the Brazilian scenario. Objective:This study aimed to describe and compare barriers to the use of CRP in users of different health systems and levels of care in a Brazilian state. Methods: CRP participants and eligible inpatients and outpatients were matched by the health systems they used and responded to the Cardiac Rehabilitation Barriers Scale (CRBS). Mann-Whitney U and Kruskal Wallis tests were used to compare barriers in health systems and levels of care, respectively. Results: One hundred and forty (87%) adults with heart disease participated in the study. The total mean score of barriers on the scale was 1.98 ± 0.48 and only differed between CRP participants and inpatients (p<0.05). Some access barriers, perceived needs and comorbidities/functional status were higher in the public services than in the private services (p <0.05). Lack of knowledge about CRP (3.75 ± 1.66) and lack of medical referral (2.32 ± 1.53) were the major barriers in the perceived needs domain, which had the highest average score in the sample (2.31 ± 0.71). Conclusions: Access barriers and perceived needs were greater among users of public services. Travel and work were greater barriers for CRP participants, while for inpatients and outpatients the largest were perceived needs. Therefore, the dissemination of CRP and implementation of strategies for eligible referral should be encouraged in both health systems and levels of care

Peripheral and respiratory muscle strength in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a pulmonary pathology associated with numerous systemic manifestations, among them musculoskeletal dysfunction. The aim of the study was to evaluate and compare respiratory and peripheral muscle strength in patients with COPD and healthy individuals. This is a cross-sectional, analytical and observational study, in which 18 individuals were evaluated, nine of them with COPD and nine healthy. Femoral quadriceps neuromuscular performance (assessed by means of isokinetic dynamometry), handgrip strength (manual dynamometer) and maximum respiratory pressure (manovacuometry) were evaluated. Data were expressed by mean and standard deviation, analyzed in the SPSS 20.0 statistical package. Significance level of 5% and confidence interval of 95% for all measures were considered. Individuals with COPD had lower quadriceps femoral neuromuscular performance and lower respiratory pressures than healthy subjects; however, there was a statistically significant difference only for muscle power and MIP (p <0.05). Handgrip strength was higher in individuals with COPD (p <0.05). individuals with COPD have neuromuscular changes in peripheral and respiratory muscles that may possibly cause reduced functional performance

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Efficacy of home-based inspiratory muscle training in patients post-covid-19: Protocol for a randomized clinical trial.

IntroductionCurrent evidence suggests the emergence of a novel syndrome (long COVID syndrome) due to sequels and persistent COVID-19 symptoms. Respiratory muscle training improves respiratory muscle strength, exercise capacity, diaphragm thickness, and dyspnea, especially in patients with decreased respiratory muscle strength. This study aims to evaluate the effectiveness of a protocol for home-based inspiratory muscle training to improve respiratory muscle strength, dyspnea, and quality of life of patients post-COVID-19.Methods and analysesThis randomized, controlled, double-blind clinical trial will be conducted at the Instituto de Medicina Tropical of Universidade Federal do Rio Grande do Norte (Brazil). Sample size will be determined using maximal inspiratory pressure after a pilot study with five patients per group (total of 10 patients). Patients included in the study will be evaluated in three moments: pre-training (initial), post-training (three weeks), and retention (24 weeks). The sample will be randomized in two groups: active (IMT using 30% of IMT and load increase of 10% of initial IMT every week. Patients will perform 30 repetitions, twice a day (morning and afternoon), for seven consecutive days, and six weeks) and SHAM (IMT without load). The following measurements will be assessed: anthropometry, respiratory muscle strength, pulmonary volume and capacity, dyspnea, perception of effort and lower limb fatigue, handgrip strength, functional capacity, anxiety, depression, and functional status. After initial evaluation, all patients will receive a POWERbreathe® (POWERbreathe®, HaB Ltd, Southam, UK) device to perform the training. Normality will be verified using Shapiro-Wilk or Kolmogorov-Smirnov, according to the number of patients included. Variables presenting nonparametric distribution will be compared using Wilcoxon (intragroup analysis) and Mann-Whitney test (intergroup analysis), whereas repeated measures two-way ANOVA will be performed in case of parametric distribution. Dunn's post hoc test will be used to identify significant differences in the two-way ANOVA test.Primary outcomesRespiratory muscle strength, dyspnea, and quality of life of post-COVID-19 patients.Second outcomesPulmonary function, dyspnea, exercise tolerance, handgrip strength, anxiety, depression, and functional status.Trial registrationTrial register number NCT05077241

Heart rate recovery after physical exertion tests in elderly hypertensive patients undergoing resistance training

Introduction: Heart rate recovery after exercise is a valuable variable, associated with prognosis and it has been used as an indicator of cardiorespiratory fitness, especially in patients with heart disease, as hypertensive patients. Objective: This study aimed to analyze the response of heart rate recovery in elderly hypertensive patients undergoing a resistance training program. Methods: Sample was composed for 10 elderly women with a mean age of 70.7 ± 7.4 years. Exercise test and six-minute walk test were developed and we checked heart rate recovery in the 1st and 2nd minute post tests, before and after resistance training. Results: There was an increase in mean heart rate recovery in the analyzed minutes in both tests, but only in the 1st minute after six minutes walk test we found a significant increase (p = 0.02). Conclusion: The results suggest the efficacy of resistance training to improve cardiorespiratory fitness of elderly hypertensive patients

Força muscular respiratória em idosas hipertensas fisicamente ativas e sedentárias

Introduction: Aging is related to the increased incidence of hypertension, as well as the decrease in respiratory muscle strength. Objectives: To compare respiratory muscle strength between physically active and sedentary hypertensive elderly women. Methods: The sample consisted of 53 elderly women, hypertensive, which were classified into two groups using the International Physical Activity Questionnaire level (IPAQ): sedentary group – G1 (n=31) and active group –G2 (n=22). Each volunteer developed maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). The results were compared between groups adopting as significant at p <0.05. Results: The values for MIP/MEP were higher (p=0.04 and p=0.01, respectively) in G2 (57.09±14.04 cmH2O / 83.13±18.43 cmH2O) when compared to G1 (49.83±9.08 cm H2O / 71.41±14.26 cmH2O). Conclusion: Physically active hypertensive elderly women had higher maximal respiratory pressures values than those found in sedentary hypertensive elderly women