The burden of physical inactivity for the public health care system in Brazil

OBJECTIVE: To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). METHODS: The hospitalization costs were accessed via a database of the Ministry of Health – Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel – Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. RESULTS: In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. CONCLUSION: This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies

Viabilidade do Implante de Eletrodo Ventricular Esquerdo na Terapia de Ressincronização Cardíaca Guiada por Gated SPECT e Remodelamento Ventricular

Resumo Fundamento A terapia de ressincronização cardíaca (TRC) pode beneficiar pacientes com insuficiência cardíaca (IC) avançada. O índice de excentricidade anormal por gated SPECT está relacionado a alterações estruturais e funcionais do ventrículo esquerdo (VE). Objetivo O objetivo do presente estudo foi avaliar a viabilidade do implante de eletrodos do VE guiado por análise de fase e sua relação com o remodelamento ventricular. Métodos Dezoito pacientes com indicação de TRC foram submetidos à cintilografia miocárdica para orientar o implante, avaliando-se os parâmetros de excentricidade e forma ventricular. P < 0,05 foi adotado como significância estatística. Resultados Na linha de base do estudo, a maioria dos pacientes foi classificada como NYHA 3 (n = 12). Após a TRC, 11 dos 18 pacientes foram reclassificados para um menor grau de limitação funcional. Além disso, a qualidade de vida dos pacientes melhorou após a TRC. Foram observadas reduções significativas na duração do QRS, intervalo PR, índice de forma diastólica final, índice de forma sistólica final, volume sistólico e massa miocárdica pós-TRC. O eletrodo do VE da TRC foi posicionado concordante, adjacente e discordante em 11 (61,1%), 5 (27,8%) e 2 (11,1%) pacientes, respectivamente. A excentricidade sistólica e diastólica final demonstrou remodelamento reverso após a TRC. Conclusões O implante de eletrodo do VE em TRC guiado por cintilografia gated SPECT é viável. A colocação do eletrodo concordante ou adjacente ao último segmento a se contrair foi um determinante do remodelamento reverso

Respostas hemodinâmicas durante exercício muscular inspiratório em jovens saudáveis

The literature on hemodynamic responses during inspiratory muscle exercise (IME) lacks a consensus. To evaluate and compare hemodynamic responses during an IME session with and without resistive load, 15 sedentary men were subjected to two randomized IME sessions: one with 40% of maximal inspiratory pressure (IME 40%) and another without a resistive load (Sham), both of which were performed for two minutes over eight sets with oneminute intervals. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), total peripheral resistance (TPR), stroke volume (SV), cardiac output (CO), and heart rate (HR) were measured by infrared digital photoplethysmography during five basal minutes and during the IME sessions. One-way ANOVA analysis of variance and the Student’s t test for paired data were used to analyze hemodynamic response and delta values between sessions, respectively. Effect size was evaluated by Cohen’s D. A 5% significance level was adopted. SBP responses (sham: ∆−1±2 vs. 40%: ∆−4±2mmHg, p=0.27), DBP (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0.60) and MBP (sham: ∆2±1 vs. 40%: ∆0±2mmHg, p=0.28) were similar between sessions. HR increases were higher in the 40% IME session than in the sham session (sham: ∆9±2 vs. 40%: ∆3±2bpm, p=0.001). SV only decreased during the sham session but responses were similar between sessions (sham: ∆−2±2 vs. IME 40%: ∆−6±2ml, p=0.13). Both sessions did not change SBP, DBP, MBP, CO, and TPR, but we observed a greater increase in HR in the IME 40% session. Only the Sham session decreased SV.A literatura carece de um consenso sobre respostas hemodinâmicas durante o exercício muscular  inspiratório (EMI). Este estudo buscou avaliar e comparar as respostas hemodinâmicas durante uma sessão de EMI com e sem carga resistiva. Para tanto, 15 homens sedentários foram submetidos a duas sessõesrandomizadas de EMI: 40% da pressão inspiratória máxima (EMI 40%) e sem carga resistiva (sham), realizadas por dois minutos em oito séries e com intervalos de um minuto. A pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), resistência periférica total (RPT), volume sistólico (VS), débito cardíaco (DC) e frequência cardíaca (FC) foram medidos por fotopletismografia  infravermelha digital por cinco minutos basais e durante as sessões de EMI. Anova de um fator e o teste t de Student para dados pareados foram usados para analisar a resposta hemodinâmica e os valores delta entre as sessões, respectivamente. O tamanho do efeito foi avaliado pelo d de Cohen. Adotou-se nível de significância de 5%. As respostas de PAS (sham: ∆−1±2 vs. 40%: ∆−4±2mmHg, p=0,27), PAD (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0,60) e PAM (sham: ∆2±1 vs. 40%:∆0±2mmHg, p=0,28) foram semelhantes entre as sessões. Os aumentos da FC foram maiores na sessão de EMI 40% do que nas sessões sham (sham: ∆9±2 vs. 40%: ∆3±2bpm, p=0,001). O VS diminuiu exclusivamente durante a sessão sham mas a resposta foi semelhante entre as sessões (sham: ∆−2±2 vs. EMI 40%: ∆−6±2ml, p=0,13). Ambas as sessões não causaram alteração nas variáveis PAS, PAD, PAM, DC e RPT, mas notamos um aumento maior da FC na sessão EMI 40%. Apenas a sessão sham reduziu o VS.No hay consenso en la literatura sobre las respuestas hemodinámicas durante el ejercicio muscular inspiratorio (EMI).El objetivo de este estudio fue evaluar y comparar las respuestas hemodinámicas durante una sesión de EMI con y sin carga resistiva. Para ello, quince hombres sedentarios recibieron dos sesiones aleatorias de EMI: el 40% de la presión inspiratoria máxima (EMI40%) y sin carga resistiva (sham), realizadas durante dos minutos, ocho sesiones y a intervalos de un minuto. La presión arterialsistólica (PAS), la presión arterial diastólica (PAD), la presión arterial media (PAM), la resistencia periférica total (RPT), el volumensistólico (VS), el gasto cardíaco (GC) y la frecuencia cardíaca (FC) se midieron mediante fotopletismografía infrarroja digital durantecinco minutos al inicio y durante las sesiones de EMI. Se utilizaron ANOVA unidireccional y la prueba t de Student a datos emparejadospara analizar la respuesta hemodinámica y los valores delta entre las sesiones. El tamaño del efecto se evaluó por el d de Cohen. Elnivel de significancia adoptado fue de 5%. Las respuestas de PAS (sham: Δ−1±2 vs. 40%: ∆−4±2mmHg, p=0,27), PAD (sham: ∆2±1 vs.40%: ∆1±2mmHg, p=0,60) y PAM (sham: ∆2±1 vs. 40%: ∆0±2mmHg,p=0,28) fueron similares entre las sesiones. El incremento de la FC fue mayor en la sesión de EMI 40% comparada con la sesión sham (sham: Δ9±2 vs. 40%: ∆3±2bpm, p=0,001). El VS tuvo una disminución exclusiva durante la sesión sham, pero la respuestafue similar entre las sesiones (sham: Δ−2±2 vs. EMI 40%: ∆−6±2ml, p=0,13). Ambas sesiones no tuvieron cambios en las variables PAS, PAD, PAM, DC y RPT, pero se observó un mayor incremento de la FC en la sesión EMI 40%. Solamente en la sesión sham hubo una reducción del V

Cardiac autonomic modulation in healthy subjects with a family history of chronic kidney disease

INTRODUCTION: The positive family history of chronic kidney disease (FH+) is a risk factor for the appearance and development of this disease. Thus, it is important to assess traits that may be related to familial predisposition to chronic kidney disease. OBJECTIVE: To evaluate the autonomic modulation by heart rate variability in individuals with FH+. METHODS: We studied 9 health subjects with FH+ and 22 health subjects with negative family history for chronic kidney disease (FH-) matched for age (27 ± 6 vs. 26 ± 4 anos; p = 0.39, respectively). Heart rate was measured continuously by the Polar S810i® for 10 minutes of rest in the supine position. The heart rate variability was evaluated by the time domain, mean of NN intervals (MNN), standard deviation of the NN intervals (SDNN), root mean squared differences of successive NN intervals (RMSSD) and percentage of NN intervals with a difference of duration greater than 50 ms (pNN50) and the fields of low frequency (LF), high frequency (HF) and ratio low/ high (LF/HF). Laboratory biochemical tests were performed after fasting for 12 hours. Results are expressed as mean ± standard deviation, adopting as significant p < 0.05. RESULTS: The groups FH+ and FH-were similar in serum creatinine (p = 0.98), estimated glomerular filtration rate (p = 0.49) and heart rate (p = 0.68). The groups FH+ and FH- showed no significant differences in relation to indices of heart rate variability MNN; SDNN; RMSSD; pNN50; Total power; LF; HF and LF/HF ration, respectively. CONCLUSION: These findings suggest that the cardiac autonomic modulation is preserved in health subjects with HF+.INTRODUÇÃO: O histórico familiar positivo para a doença renal crônica (HF+) é um fator de risco para o surgimento e desenvolvimento dessa doença. Desta forma, é importante avaliar traços que possam estar correlacionados à predisposição familiar para a doença renal crônica. OBJETIVO: Avaliar a modulação autonômica, pela variabilidade da frequência cardíaca, de indivíduos com HF+. MÉTODOS: Foram avaliados nove indivíduos saudáveis com HF+ e 22 indivíduos saudáveis com histórico familiar negativo para doença renal crônica (Grupo HF-), pareados por idade (27 ± 6 vs. 26 ± 4 anos; p = 0,39, respectivamente). A frequência cardíaca foi medida continuamente pelo cardiofrequencímetro Polar S810i® durante 10 minutos de repouso na posição supina. A Variabilidade da Frequência Cardíaca (VFC) foi avaliada pelos índices do domínio do tempo, média dos intervalos RR (MNN), desvio padrão dos intervalos RR (SDNN), raiz média quadrática das diferenças de intervalos RR sucessivos (RMSSD) e percentual de intervalos RR com diferença de duração maior que 50 ms (pNN50), e pelos domínios de baixa frequência (BF), alta frequência (AF) e razão baixa/alta (BF/AF). Os exames laboratoriais foram realizados após jejum de 12 horas. Os resultados são expressos como média ± desvio padrão, adotando como significativo p < 0,05. RESULTADOS: Os grupos HF+ e HFforam semelhantes em relação à estimativa da taxa de filtração glomerular (p = 0,49) e frequência cardíaca (p = 0,68). Os grupos HF+ e HF- não apresentaram diferenças significativas em relação aos índices da variabilidade da frequência cardíaca MNN; SDNN, RMSSD, pNN50, Potência total; BF; AF u.n e razão BF/AF. CONCLUSÃO: A modulação autonômica cardíaca está preservada em indivíduos saudáveis com HF+

Hemodynamic responses during inspiratory muscle exercise in healthy young adults

ABSTRACT The literature on hemodynamic responses during inspiratory muscle exercise (IME) lacks a consensus. To evaluate and compare hemodynamic responses during an IME session with and without resistive load, 15 sedentary men were subjected to two randomized IME sessions: one with 40% of maximal inspiratory pressure (IME 40%) and another without a resistive load (Sham), both of which were performed for two minutes over eight sessions with one-minute intervals. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), total peripheral resistance (TPR), stroke volume (SV), cardiac output (CO), and heart rate (HR) were measured by infrared digital photoplethysmography during five basal minutes and during the IME sessions. One-way analysis of variance and the Student’s t test for paired data were used to analyze hemodynamic response and delta values between sessions. Effect size was evaluated by Cohen’s D. A 5% significance level was adopted. SBP responses (sham: ∆−1±2 vs. 40%: ∆−4±2mmHg, p=0.27), DBP (sham: ∆2±1 vs. 40%: ∆1±2mmHg, p=0.60) and MBP (sham: ∆2±1 vs. 40%: ∆0±2mmHg, p=0.28) were similar between sessions. HR increases were higher in the 40% IME session than in the sham session (sham: ∆9±2 vs. 40%: ∆3±2bpm, p=0.001). SV only decreased during the sham session but responses were similar between sessions (sham: ∆−2±2 vs. IME 40%: ∆−6±2ml, p=0.13). Both sessions did not change SBP, DBP, MBP, CO, and TPR, but we observed a greater increase in HR in the IME 40% session. Only the Sham session decreased SV

Influência da hereditariedade para hipertensão arterial na hipotensão pós-exercício

Verificar o comportamento cardiovascular de homens normotensos com histórico familiar positivo para hipertensão arterial proveniente da mãe e de homens normotensos com histórico familiar proveniente do pai após uma sessão de exercício aeróbio. Foram selecionados 35 homens adultos divididos nos grupos: HF+mãe (somente mãe com hipertensão arterial, n=14) e HF+pai (somente pai com hipertensão arterial, n=21). Os participantes foram submetidos ao exercício aeróbio, em cicloergômetro (Kikos®), por 50 minutos, em intensidade de 50 a 70% da frequência cardíaca de reserva (sessão exercício) e a uma sessão controle. As variáveis pressão arterial média (FinometerPro®) e fluxo sanguíneo do antebraço (Pletismografia de Oclusão Venosa-Hokanson®) foram registradas continuamente durante 10 minutos pré e 30 minutos pós cada sessão. A resistência vascular do antebraço foi calculada pela divisão da pressão arterial média pelo fluxo sanguíneo do antebraço. Foi considerado p≤0,05 como diferença significativa. No grupo HF+mãe a pressão arterial média e a resistência vascular do antebraço não modificaram significativamente no momento pós em relação ao momento pré-exercício. Diferentemente, no grupo HF+pai a pressão arterial média e resistência vascular do antebraço reduziram significativamente na recuperação do exercício. Na sessão controle essas variáveis aumentaram significativamente no pós em relação ao pré, em ambos os grupos. O exercício físico não provocou modificações no sistema cardiovascular de homens normotensos, com histórico familiar positivo para hipertensão proveniente da mãe. Enquanto aqueles com histórico familiar positivo para hipertensão proveniente do pai apresentaram hipotensão pós-exercício, comportamento parcialmente justificado pela diminuição da resistência vascular do antebraço.To verify the cardiovascular response of normotensive men with positive family history of arterial hypertension from the mother and of normotensive men with positive family history of arterial hypertension from the father after an aerobic exercise session. Were selected 35 adult men divided into groups: HF+mother (only mother with arterial hypertension, n = 14) and HF+father (only father with arterial hypertension, n = 21). The participants underwent aerobic exercise, on a cycle ergometer (Kikos®), for 50 minutes, at intensity of 50 to 70% of the reserve heart rate (exercise session) and a control session. The variables mean arterial pressure (FinometerPro®) and forearm blood flow (Venous Occlusion Plethysmography-Hokanson®) were continuously recorded for 10 minutes before and 30 minutes after each session. The forearm vascular resistance was calculated by dividing the mean arterial pressure by the forearm blood flow. Was considered significant p≤0.05. In the HF+mother group, mean arterial pressure and forearm vascular resistance did not change significantly in the post-moment compared to the pre-exercise moment. In contrast, in the HF+father group, mean arterial pressure and forearm vascular resistance significantly reduced in recovery from exercise. In the control session, these variables increased significantly in the post compared to the pre, in both groups. Physical exercise did not cause changes in the cardiovascular system of normotensive men, with a positive family history of hypertension from the mother. While those with a positive family history of hypertension from their father presented post-exercise hypotension, behavior partially justified by the decrease in vascular resistance in the forearm

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia