Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

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

A relevância do código de pontuação da ginástica artística na iniciação esportiva : um olhar pedagógico

tica Artística (GA) é uma modalidade esportiva que vem ganhando mais adeptos nas últimas duas décadas, porém, tanto pais como professores preocupam-se com o desenvolvimento das crianças (motor, psicológico, cognitivo, etc), dado a inserção precoce ao ambiente competitivo, processo comum nessa modalidade. Um dos motivos dessa preocupação está relacionado à alta demanda técnica dos elementos, norteados pelo Código de Pontuação da GA, que tem sido exigido pelos técnicos em suas aulas. Nesse contexto, esta pesquisa teve como objetivo verificar de que maneira o CP pode interferir na iniciação de crianças à modalidade, e como é possível solucionar os problemas causados pela especialização precoce das mesmas. A pesquisa do tipo descritivo Thomas e Nelson (2002) utilizou como técnica o questionário, aplicado a 21 técnicos de Ginástica Artística que atuam em clubes e associações da cidade de São Paulo, e as respostas foram interpretadas pela Análise de Conteúdo de Bardin (2011). A partir das análises foi possível identificar que a grande maioria dos técnicos utiliza o regulamento oficial da modalidade como parâmetro para as aulas de iniciação esportiva, por este ser um norte para que a criança tenha sucesso nos campeonatos e festivais. A pesquisa pôde causar uma reflexão aos técnicos acerca da especialização precoce, e também possibilitou que os mesmos trouxessem à tona soluções interessantes para a problemática, como: a diminuição da faixa etária por categoria, e alteração nas exigências presentes no Código de Pontuação

Expression of costimulatory molecules in antigen-activated peritoneal macrophages treated with either ovalbumin or palmitoyl-ova conjugates

One of the mechanisms by which adjuvants are believed to promote T-cell activation and prevent induction of oral tolerance is by up-regulating the expression of co-stimulatory molecules on antigen presenting cells. Mice treated orally with palmitoyl-ovalbumin conjugates become immunized, while those treated with native ovalbumin (Ova) become tolerant. Cells from the peritoneal cavity of B6D2F1 mice were cultured in the presence of 0.01, or 0.1 mg/100ml of either Ova, or palmitoyl-Ova and tested for the presence of cell markers. PE-conjugated anti-mouse CD80, CD86, and CD11b antibodies as well as biotin-PE were used to stain the antigen-activated peritoneal cells. A significant increase in the expression of CD86 and CD80 was observed following in vitro stimulation with palmitoyl-Ova; additionally, both Ova and palmitoyl-Ova induced the basal expression of CD11b. These findings could be related with the strong T-cell proliferative response induced by palmitoyl-Ova

Ethanol affects the absorption and tissue distribution of orally administered antigens in mice

The aim of this work was to evaluate the effects of ethanol on the adsorption and tissue distribution of orally administered antigens in mice. Results showed that ethanol reduced the level of anti-ovalbumin IgA antibodies in intestinal fluid for the mice treated orally with a palmitoyl-ovalbumin conjugate. Ethanol was administered intragastrically to mice at 5 g/kg body weight for 14 days (chronic treatment), or 10 g/kg body weight every 7th day up to 14 days (acute treatment). Thereafter, 99m technetium-labeled antigens were administered and lymphoid tissues were collected. Ethanol interfered with the transport of ovalbumin to the liver. Moreover, the transport of palmitoyl-ovalbumin to mesenteric lymph nodes was reduced 6 h after the antigen administration. In conclusion, there was a relationship between the suppression of ethanol-mediated specific local IgA responses and the decreased transport of palmitoyl-ovalbumin to mesenteric lymph nodes

Punção da fístula arteriovenosa com a técnica em casa de botão com agulha romba

INTRODUÇÃO: A canulação da fístula arteriovenosa (FAV) pode ser realizada pelas técnicas de punção por área, rotatória ou em casa de botão (CB); entretanto, a técnica ideal ainda não foi estabelecida. OBJETIVO: Avaliar as dificuldades e complicações na introdução da técnica de punção em CB em FAV construída com veia nativa. MÉTODOS: 16 pacientes com idade de 57±14 anos, em hemodiálise há 63±38 meses foram submetidos à punção em CB. Na fase de formação do túnel (T), as punções foram feitas com agulha cortante (AC) e na fase de manutenção com agulha romba (AR). Nas duas fases, os pacientes foram avaliados para a intensidade da dor em uma escala de 0 a 10. RESULTADOS: O nº de sessões de HD para formação do T foi de 9,5 ± 1,5 e o número de sessões na fase de manutenção foi de 29,7 ± 0,8. Nas 152 HD para formação do T não ocorreram complicações significativas. Durante 475 HD com AR as complicações foram: resistência na punção (7,6%), punção com AC por opção do puncionador (5,7%), troca de AR para AC durante a punção (4,2%) e sangramento local durante a HD (0,8%). Um paciente necessitou antibioticoterapia. A mediana do índice de dor foi 4 na fase de formação do T e 2 na fase de manutenção. Os valores de Kt/V pré- e pós-alteração na técnica de punção não foram diferentes (1,48 ± 0,27 e 1,45 ± 0,23). CONCLUSÃO: A implantação da punção em CB com AR é tecnicamente fácil, apresenta poucas complicações, reduz a dor e não induz variação na dose de diálise

Dermatophytosis caused by Trichophyton raubitschekii. Report of the first case in São Paulo, Brazil Dermatofitose por Trichophyton raubitschekii. Registro do primeiro caso em São Paulo, Brasil

The authors report the first case of dermatophytosis caused by Trichophyton raubitschekii in a patient from the State of São Paulo with Tinea corporis lesions localized on the buttocks. Culture on Sabouraud-agar with cycloheximide permitted the isolation and identification of the fungus, and the diagnosis was confirmed by Dr. Lynne Sigler, University of Alberta, Canada. Systemic treatment with fluconazole, 150 mg/week for 4 weeks, in combination with topical treatment with isoconazole initially yielded favorable results, with recurrence of the lesions after the medication was discontinued. This is the fifth case of this dermatophytosis published in the Brazilian medical literature.<br>Os Autores registram o primeiro caso de dermatofitose por Trichophyton raubitschekii em paciente do Estado de São Paulo, com lesões de Tinea corporis localizada nas nádegas. O cultivo em ágar-Sabouraud com cicloheximida permitiu o isolamento e identificação do fungo, cujo diagnóstico foi confirmado pela Drª Lynne Sigler, da Universidade de Alberta, Canadá. O tratamento sistêmico com fluconazol, 150mg/semana por 4 semanas, associado ao tratamento tópico com isoconazol ofereceu inicialmente resultados favoráveis, com recidiva das lesões, após suspensão do medicamento. Trata-se do quinto caso publicado na literatura médica nacional