RESUMO
Aims: We adopted a modeling approach to predict the likely future prevalence of type 2 diabetes, taking into account demographic changes and trends in obesity and smoking in Brazil. We then used the model to estimate the likely future impact of different policy scenarios, such as policies to reduce obesity. Methods: The IMPACT TYPE 2 DIABETES model uses a Markov approach to integrate population, obesity, and smoking trends to estimate future type 2 diabetes prevalence. We developed a model for the Brazilian population from 2006 to 2036. Data on the Brazilian population in relation to sex and age were collected from the Brazilian Institute of Geography and Statistics, and data on the prevalence of type 2 diabetes, obesity, and smoking were collected from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL). Results: The observed prevalence of type 2 diabetes among Brazilians aged over 25 years was 10.8% (5.2-14.3%) in 2006, increasing to 13.7% (6.9-18.4%) in 2020. Between 2006 and 2020, the observed prevalence in men increased from 11.0 to 19.1% and women from 10.6 to 21.3%. The model forecasts a dramatic rise in prevalence by 2036 (27.0% overall, 17.1% in men and 35.9% in women). However, if obesity prevalence declines by 1% per year from 2020 to 2036 (Scenario 1), the prevalence of diabetes decreases from 26.3 to 23.7, which represents approximately a 10.0% drop in 16 years. If obesity declined by 5% per year in 16 years as an optimistic target (Scenario 2), the prevalence of diabetes decreased from 26.3 to 21.2, representing a 19.4% drop in diabetes prevalence. Conclusion: The model predicts an increase in the prevalence of type 2 diabetes in Brazil. Even with ambitious targets to reduce obesity prevalence, type 2 diabetes in Brazil will continue to have a large impact on Brazilian public health.
Assuntos
Diabetes Mellitus Tipo 2 , Obesidade , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Brasil/epidemiologia , Masculino , Feminino , Prevalência , Adulto , Pessoa de Meia-Idade , Obesidade/epidemiologia , Idoso , Fumar/epidemiologia , Previsões , Cadeias de Markov , Fatores de RiscoRESUMO
OBJECTIVE: Estimate reductions in cardiovascular mortality achievable through improvement in nutrient intakes according to processing level (NOVA classification), that is, reducing consumption of culinary ingredients (G2), processed (G3) and ultra-processed foods (G4) while encouraging consumption of unprocessed and minimally processed foods (G1). DESIGN: Modelling study. SETTING: General adult population of Brazil. PARTICIPANTS: Men and women aged 25 or more years (34 003) investigated in the Household Budget Survey 2017-2018, in the consumption data module. MAIN OUTCOME MEASURES: We used the IMPACT Food Policy Model to estimate the reduction in deaths from cardiovascular diseases (CVD) up to 2048 in five scenarios with reductions in saturated fat, trans fat, salt and added sugar intakes resulting from changes in NOVA groups. (1) The optimistic scenario modelised an increase in the energy intake provided by G1 and a reduction in the energy intake from G2, G3 and G4, return to previous levels. (2) The minimal scenario modelised a 3.7% increase in the energy intake from G1, and a reduction in the energy intake from G4 to the 2008-2009 level. (3) The modest scenario only modelised a 25.0% reduction of the energy intake from G2 and G3. (4) The intermediary scenario modelised the minimal scenario plus a 25.0% reduction in the energy intake from G2. (5) Finally, the advanced scenario modelised the minimal scenario plus a 25.0% reduction in the energy intake from G2 and G3. RESULTS: Proposed changes in the optimistic scenario could prevent or delay 52.8% CVD-related deaths by 2048. Changes modelled in the minimal, modest, intermediary and advanced scenarios may result in a 10.1%, 28.4%, 31.4% and 38.6% reduction in 2048 CVD mortality, respectively. CONCLUSIONS: Substantial health gains can be achieved by improving the diet, through plausible modifications aimed at the level of processing as a tool for Brazilian food policies.
Assuntos
Doenças Cardiovasculares , Adulto , Brasil/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Dieta , Ingestão de Energia , Fast Foods , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Excessive sodium consumption is one of the leading dietary risk factors for non-communicable diseases, including cardiovascular disease (CVD), mediated by high blood pressure. Brazil has implemented voluntary sodium reduction targets with food industries since 2011. This study aimed to analyse the potential health and economic impact of these sodium reduction targets in Brazil from 2013 to 2032. METHODS: We developed a microsimulation of a close-to-reality synthetic population (IMPACTNCD-BR) to evaluate the potential health benefits of setting voluntary upper limits for sodium content as part of the Brazilian government strategy. The model estimates CVD deaths and cases prevented or postponed, and disease treatment costs. Model inputs were informed by the 2013 National Health Survey, the 2008-2009 Household Budget Survey, and high-quality meta-analyses, assuming that all individuals were exposed to the policy proportionally to their sodium intake from processed food. Costs included costs of the National Health System on CVD treatment and informal care costs. The primary outcome measures of the model are cardiovascular disease cases and deaths prevented or postponed over 20 years (2013-2032), stratified by age and sex. RESULTS: The study found that the application of the Brazilian voluntary sodium targets for packaged foods between 2013 and 2032 could prevent or postpone approximately 110,000 CVD cases (95% uncertainty intervals (UI): 28,000 to 260,000) among men and 70,000 cases among women (95% UI: 16,000 to 170,000), and also prevent or postpone approximately 2600 CVD deaths (95% UI: - 1000 to 11,000), 55% in men. The policy could also produce a net cost saving of approximately US$ 220 million (95% UI: US$ 54 to 520 million) in medical costs to the Brazilian National Health System for the treatment of CHD and stroke and save approximately US$ 71 million (95% UI: US$ 17 to170 million) in informal costs. CONCLUSION: Brazilian voluntary sodium targets could generate substantial health and economic impacts. The reduction in sodium intake that was likely achieved from the voluntary targets indicates that sodium reduction in Brazil must go further and faster to achieve the national and World Health Organization goals for sodium intake.
Assuntos
Doenças Cardiovasculares , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Fast Foods , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , SódioRESUMO
OBJECTIVE: To analyse the mortality rate trend due to coronary heart disease (CHD) and stroke in the adult population in Brazil. METHODS: From 2000 to 2018, a time trend study with joinpoint regression was conducted among Brazilian men and women aged 35 years and over. Age-adjusted and age, sex specific CHD and stroke trend rate mortality were measured. RESULTS: Crude mortality rates from CHD decreased in both sexes and in all age groups, except for males over 85 years old with an increase of 1.78%. The most accentuated declining occurred for age range 35 to 44 years for both men (52.1%) and women (53.2%) due to stroke and in men (33%) due to CHD, and among women (32%) aged 65 to 74 years due to CHD. Age-adjusted mortality rates for CHD and stroke decreased in both sexes, in the period from 2000 to 2018. The average annual rate for CHD went from 97.09 during 2000-2008 to 78.75 during 2016-2018, whereas the highest percentage of change was observed during 2008 to 2013 (APC -2.5%; 95% CI). The average annual rate for stroke decreased from 104.96 to 69.93, between 2000-2008 and 2016-2018, and the highest percentage of change occurred during the periods from 2008 to 2013 and 2016 to 2018 (APC 4.7%; 95% CI). CONCLUSION: The downward trend CHD and stroke mortality rates is continuing. Policy intervention directed to strengthen care provision and improve population diets and lifestyles might explain the continued progress, but there is no room for complacency.
Assuntos
Doença das Coronárias/mortalidade , Acidente Vascular Cerebral/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doença das Coronárias/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Caracteres Sexuais , Acidente Vascular Cerebral/epidemiologiaRESUMO
BACKGROUND: Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors. METHODS: We performed a retrospective analysis using the previously validated IMPACT model to explain observed changes in CHD mortality in Mexican adults. The model integrates nationwide data at two-time points (2000 and 2012) to quantify the effects on CHD mortality attributable to changes in risk factors and therapeutic trends. RESULTS: From 2000 to 2012, CHD mortality rates increased by 33.8% in men and by 22.8% in women. The IMPACT model explained 71% of the CHD mortality increase. Most of the mortality increases could be attributed to increases in population risk factors, such as diabetes (43%), physical inactivity (28%) and total cholesterol (24%). Improvements in medical and surgical treatments together prevented or postponed 40.3% of deaths; 10% was attributable to improvements in secondary prevention treatments following MI, while 5.3% to community heart failure treatments. CONCLUSIONS: CHD mortality in Mexico is increasing due to adverse trends in major risk factors and suboptimal use of CHD treatments. Population-level interventions to reduce CHD risk factors are urgently needed, along with increased access and equitable distribution of therapies.
Assuntos
Doença das Coronárias/mortalidade , Mortalidade/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , IncertezaRESUMO
Cardiovascular diseases are the number one cause of death globally, but their optimal prevention remains a challenge. A high-risk approach can only have a limited effect at a population level, while population-based strategies can improve and extend the coverage of a high-risk approach. However, one main problem for promoting cardiovascular diseases prevention public policies is the difficulty to foresee population health benefits of a single policy. Computer simulation models can assist with this problem, due to their ability to estimate intervention effects over different periods, and by scaling up the evidence to a broader, more diverse population. Their applicability to countries with different social, political and economic contexts can assist in the design of public policies. There are several models that assess health and economics scenarios, but regardless which model is chosen, when adequately used, they can provide reasonable estimations of health policies' impact. There is a growing consensus amongst the public health communities about the powerful role of population-level policies. They are more effective, cost saving and more equitable when compared with individual-level interventions. Policy makers and the public health community need to make further progress in changing the focus of prevention, from individuals to populations.
Las enfermedades cardiovasculares son la principal causa de muerte en el mundo, pero su prevención óptima sigue siendo un desafío. El enfoque prioritario a escala individual en pacientes de alto riesgo solo puede tener un efecto limitado a nivel colectivo, mientras que las estrategias de alcance poblacional pueden mejorar y ampliar la cobertura de estos enfoques de alto riesgo. Sin embargo, uno de los principales problemas para promover políticas públicas de prevención de enfermedades cardiovasculares es la dificultad para prever los beneficios que una política única puede tener en salud. Los modelos de simulación por computadora pueden ayudar con este problema, dada su capacidad para estimar los efectos de una intervención en diferentes períodos, ampliando la evidencia a una población más extensa y diversa. Adicionalmente, su aplicabilidad a países con diferentes contextos sociales, políticos y económicos puede asistir en el diseño de políticas públicas. Existen varios modelos que evalúan escenarios tanto de salud como de economía, pero independientemente de qué modelo se elija, usados adecuadamente pueden proporcionar estimaciones razonables del impacto de las políticas de salud. Existe un consenso creciente en el ámbito de la salud pública sobre el importante rol de las políticas poblacionales. Son más efectivas, económicas, y equitativas en comparación con las intervenciones a nivel individual. En la formulación de políticas públicas en general, y de salud pública en particular, se debe avanzar en cambiar el enfoque de la prevención desde las personas a las comunidades.
Assuntos
Política Pública , Simulação por Computador , HumanosRESUMO
Prisoners in most countries have a higher prevalence of HCV than the general population, but their access to treatment is very limited. Our aim was to evaluate a pilot programme using the ECHO model to enhance linkage to care in patients with HCV in 3 Argentinean prisons between October 2018 and January 2020. All inmates were invited to participate, and data were collected through a personal interview. We then estimated HCV prevalence with dried blood spot and performed a logistic regression analysis to identify risk behaviours associated with HCV infection. Finally, HCV management was assessed and monitored through ECHO. Overall, 1141 inmates agreed to participate, representing 39.7% of the total prison population. Anti-HCV prevalence was estimated at 1.58% (CI 0.93; 2.48), being significantly higher in women 2.98% (CI 1.4;5.6) than in men 1.07% (CI 0.5; 2.0); P = .03. Patients with anti-HCV were significantly older than those who tested negative, 42.3 years (CI 37.6;47.1) vs 30.1 years (CI 30.6;31.2), P < .001, respectively. Multiple logistic regression analysis, identified age OR 1.07 (CI 1.03;1.12, P = .001), history of sexually transmitted disease OR 3.08 (CI 0.97;9.82, P = .057) and intravenous drug use OR 12.6 (CI 3.31;48.53, P < .001) as risk factors associated with anti-HCV. Treatment was initiated in all the patients with specialist physician support utilizing ECHO model. In conclusion, our pilot study reported a low prevalence of anti-HCV in the studied population. Incarceration provides an ideal opportunity for testing and treating HCV. ECHO model arises as a useful tool to support assessment and treatment for inmates with chronic HCV.
Assuntos
Hepatite C , Prisioneiros , Feminino , Hepacivirus , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C , Humanos , Masculino , Projetos Piloto , Prevalência , Prisões , Fatores de RiscoRESUMO
The ECHO model was developed to expand access to medical care for populations with HCV infection in underserved areas. We aimed to compare HCV treatment outcomes in community-based clinics with the Austral University Hospital (AUH) and to assess improvement in physician knowledge and skills. In October 2015, we established an HCV ECHO clinic at the AUH in Buenos Aires. To evaluate the impact of this programme, we conducted a prospective cohort study comparing treatment for HCV infection at the AUH with healthcare providers from different Argentinean provinces. A survey evaluating skills and competence in HCV care was administered, and results were compared. The primary endpoint was sustained virologic response (SVR) and under direct-acting antivirals. Since the implementation of ECHO clinics, a total of 25 physicians participated in at least one session (median 10.0; IQR 3.0-18.0). SVR rates (n = 437 patients) were 94.2% (95% CI 90.4-96.8) in patients treated at AUH clinic (n = 227/242) and 96.4% (95% CI 92.7-98.5) in those treated at ECHO sites (n = 188/195), with a nonsignificant difference between sites, 2.2% SVR difference (95% CI -0.24-0.06; P = 0.4). We also found a significant improvement in all the evaluated skills and abilities. Replicating the ECHO model helped to improve participants' skills in the management of HCV achieving similar SVR rates. ECHO model was demonstrated to be an effective intervention able to multiply and expand HCV treatment, a critical barrier to access to care that needs to be solved if we are committed with WHO goals to eliminate HCV by 2030.
Assuntos
Competência Clínica , Hepatite C/epidemiologia , Assistência ao Paciente , Padrões de Prática Médica , Telemedicina , Adulto , Idoso , Antivirais/uso terapêutico , Argentina/epidemiologia , Quimioterapia Combinada , Feminino , Geografia , Hepatite C/diagnóstico , Hepatite C/terapia , Hepatite C/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Resposta Viral Sustentada , Telemedicina/métodosRESUMO
Objetive: To quantify the contribution of risk factors and treatments in the reduction of mortality due to coronary heart disease in Argentina between 1995 and 2010. Results: We used the validated IMPACTCHD model integrating data on effectiveness, use of treatments and changes in the risk factors between 1995 and 2010 in people older than 25 years in Argentina. The difference between the coronary deaths observed and expected in 2010 was distributed between treatments and risk factors. Conclusions: One out of every two MPP due to coronary heart disease in Argentina between 1995 and 2010 was due to treatments and one third to the improvement of risk factors. The decrease in blood pressure, cholesterol and smoking was limited by increases in the prevalence of obesity, sedentary lifestyle and diabetes. This study was possible thanks to the collaborative work to the cardiovascular epidemiology.
Objetivos: Cuantificar la contribución de los factores de riesgo (FR) y de los tratamientos en el descenso de mortalidad por enfermedad coronaria en Argentina entre 1995 y 2010. Métodos: Utilizamos el modelo validado IMPACTCHD integrando datos de efectividad y utilización de tratamientos y cambios en los FR en 1995 y 2010 en mayores de 25 años en Argentina. La diferencia entre las muertes coronarias observadas y esperadas en el 2010 se distribuyó entre los tratamientos y los FR. Resultados: Entre 1995 y 2010 las tasas ajustadas de mortalidad por enfermedad coronaria descendieron 29,8% (8 500 muertes prevenidas o pospuestas - MPP). Las mejoras en los tratamientos explicaron un 49,9%, en su mayoría por prevención secundaria del infarto agudo de miocardio (8,2%); tratamiento antihipertensivo (11,9%) y para insuficiencia cardíaca (13,2%). Las mejoras en los FR explicaron 32,9% de las MPP: presión arterial sistólica 34,6%; colesterol total 12,8%; tabaquismo 6,8%. Se encontró un exceso de muertes debido al aumento de diabetes (9,4%), obesidad (6,9%) y sedentarismo (5%). Un 17,2% de las MPP no fue explicado por el modelo. Conclusiones: Una de cada dos MPP por enfermedad coronaria en Argentina entre 1995 y 2010 se debió a los tratamientos y un tercio a la mejora de los FR. El descenso de la presión arterial, colesterol y tabaquismo fue limitado por aumentos en la prevalencia de obesidad, sedentarismo y diabetes. Este trabajo fue posible gracias al trabajo colaborativo en pos de la epidemiología cardiovascular.
Assuntos
Doença das Coronárias/mortalidade , Adulto , Argentina/epidemiologia , Humanos , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: To estimate the impact of reducing saturated fat, trans-fat, salt and added sugar from processed culinary ingredients and ultra-processed foods in the Brazilian diet on preventing cardiovascular deaths by 2030. DESIGN: A modelling study. SETTING: Data were obtained from the Brazilian Household Budget Survey 2008/2009. All food items purchased were categorized into food groups according to the NOVA classification. We estimated the energy and nutrient profile of foods then used the IMPACT Food Policy model to estimate the reduction in deaths from CVD up to 2030 in three scenarios. In Scenario A, we assumed that the intakes of saturated fat, trans-fat, salt and added sugar from ultra-processed foods and processed culinary ingredients were reduced by a quarter. In Scenario B, we assumed a reduction of 50 % of the same nutrients in ultra-processed foods and processed culinary ingredients. In Scenario C, we reduced the same nutrients in ultra-processed foods by 75 % and in processed culinary ingredients by 50 %. RESULTS: Approximately 390 400 CVD deaths might be expected in 2030 if current mortality patterns persist. Under Scenarios A, B and C, CVD mortality can be reduced by 5·5, 11·0 and 29·0 %, respectively. The main impact is on stroke with a reduction of approximately 6·0, 12·6 and 32·0 %, respectively. CONCLUSIONS: Substantial potential exists for reducing the CVD burden through overall improvements of the Brazilian diet. This might require reducing the penetration of ultra-processed foods by means of regulatory policies, as well as improving the access to and promotion of fresh and minimally processed foods.
Assuntos
Doenças Cardiovasculares/mortalidade , Dieta , Características da Família , Fast Foods , Idoso , Brasil/epidemiologia , Doenças Cardiovasculares/sangue , Açúcares da Dieta/administração & dosagem , Açúcares da Dieta/sangue , Ácidos Graxos/administração & dosagem , Ácidos Graxos/sangue , Feminino , Manipulação de Alimentos , Humanos , Masculino , Micronutrientes/administração & dosagem , Micronutrientes/sangue , Pessoa de Meia-Idade , Avaliação Nutricional , Política Nutricional , Adoçantes Calóricos/administração & dosagem , Cloreto de Sódio na Dieta/administração & dosagem , Cloreto de Sódio na Dieta/sangue , Ácidos Graxos trans/administração & dosagem , Ácidos Graxos trans/sangueRESUMO
OBJECTIVE: Assess the usefulness of the SNAP-IV scale as an instrument for detecting attention deficit hyperactivity disorder (ADHD) in Argentine children aged 4 to 14 years. METHODS: The SNAP-IV scale was adapted and administered to a group of 1 230 schoolchildren in the province of Buenos Aires, Argentina. The diagnosis was determined with the clinical control, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The sensitivity and specificity, as well as the cut-off scores for the SNAP-IV scale in the population studied, were determined. RESULTS: The score on the SNAP-IV scale with the best correlation between sensitivity and specificity was established in order to determine the true positive cases that in fact had a clinical diagnosis. The cut-off scores obtained were: 1.66 (15/27 points) for the attention deficit subscale and 1.77 (16/27 points) for hyperactivity/impulsivity in the population studied. CONCLUSIONS: The SNAP-IV scale for detection of ADHD is considered to be valid in the population studied as long as the cut-off scores are modified to obtain the best sensitivity/specificity ratio based on the cultural and socioeconomic features of the population.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Testes Psicológicos , Inquéritos e Questionários , Adolescente , Argentina , Criança , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
OBJETIVO: Valorar la utilidad de la escala SNAP IV como instrumento de detección de trastorno por déficit de atención con hiperactividad (TDAH) en niños argentinos de 4 a 14 años de edad. MÉTODOS: Se adaptó y se administró la escala SNAP IV a un grupo de 1 230 escolares de la provincia de Buenos Aires, Argentina. Se determinó el diagnóstico con el control clínico de acuerdo a los criterios del Manual diagnóstico y estadístico de los trastornos mentales, 4.ª edición. Se determinaron la sensibilidad y especificidad así como los puntajes de corte para la escala SNAP IV en la población estudiada. RESULTADOS: Se estableció el puntaje en la escala SNAP IV que tuviera la mejor correlación entre sensibilidad y especificidad para determinar los casos verdaderos positivos que realmente tuvieran un diagnóstico clínico. Los puntajes de corte obtenidos fueron: un índice de 1,66 (15/27 puntos) para la subescala déficit de atención y de 1,77 (16/27 puntos) para hiperactividadimpulsividad en la población estudiada. CONCLUSIONES: La escala SNAP IV para detección de TDAH se considera válida en el caso de la población estudiada, siempre y cuando se modifiquen los puntajes de corte para obtener la mejor relación sensibilidad/especificidad, con base en las particularidades culturales y socioeconómicas de dicha población.
OBJECTIVE: Assess the usefulness of the SNAP-IV scale as an instrument for detecting attention deficit hyperactivity disorder (ADHD) in Argentine children aged 4 to 14 years. METHODS: The SNAP-IV scale was adapted and administered to a group of 1 230 schoolchildren in the province of Buenos Aires, Argentina. The diagnosis was determined with the clinical control, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The sensitivity and specificity, as well as the cut-off scores for the SNAP-IV scale in the population studied, were determined. RESULTS: The score on the SNAP-IV scale with the best correlation between sensitivity and specificity was established in order to determine the true positive cases that in fact had a clinical diagnosis. The cut-off scores obtained were: 1.66 (15/27 points) for the attention deficit subscale and 1.77 (16/27 points) for hyperactivity/impulsivity in the population studied. CONCLUSIONS: The SNAP-IV scale for detection of ADHD is considered to be valid in the population studied as long as the cut-off scores are modified to obtain the best sensitivity/specificity ratio based on the cultural and socioeconomic features of the population.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Testes Psicológicos , Inquéritos e Questionários , ArgentinaRESUMO
To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the authors evaluated 549 patients admitted to the emergency department. They were first assigned to a 30-minute rest period, then a follow-up blood pressure measurement was carried out. Patients who did not respond to rest were randomly assigned to receive an oral dose of an antihypertensive drug with different mechanisms of action and pharmacodynamic properties (perindopril, amlodipine, or labetalol), and blood pressure was reassessed at 60- and 120-minute intervals. A satisfactory blood pressure response to rest (defined as postintervention systolic blood pressure < 180 mm Hg and diastolic blood pressure < 110 mm Hg, with at least a 20 mm Hg reduction in basal systolic blood pressure and/or a 10-mm Hg reduction in basal diastolic blood pressure) was observed in 31.9% of population. Among nonresponders, 79.1% had a satisfactory blood pressure response to the antihypertensive drug treatment in a 2-hour average follow-up period. No major adverse events were observed. This treatment strategy, based on standardized rest as an initial step and different antihypertensive drugs, can be effective and safe for the management of patients with hypertensive urgencies.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Emergências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hipertensão/terapia , Descanso/fisiologia , Anlodipino/uso terapêutico , Terapia Combinada , Feminino , Seguimentos , Humanos , Hipertensão/fisiopatologia , Labetalol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Perindopril/uso terapêutico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Snoring is common in pregnancy, but there are only a few studies that have investigated the relationship of snoring and pregnancy complications. We aimed to investigate the relationship of snoring and witnessed sleep apnoeas with pregnancy-induced hypertension. METHODS: A questionnaire was administered on the day of delivery to 456 women at the Department of Obstetrics, Hospital Donación F. Santojanni, Buenos Aires, Argentina. Pregnancy complications and blood pressure measurements were recorded from each woman's medical chart. RESULTS: Some 156 (35%) of 447 women with singleton pregnancies who answered the questionnaire, snored at some time during their pregnancy. Snoring was related to pregnancy-induced hypertension and pre-eclampsia combined, with an adjusted odds ratio of 1.82 (95% CI: 1.16-2.84; p <0.01), independent of body mass index before pregnancy, weight gain during pregnancy, neck circumference, smoking, alcohol and age. Witnessed sleep apnoeas were also related to pregnancy-induced hypertensive disease, with an adjusted odds ratio of 8.00 (95% CI: 2.71-23.55; p <0.001). Daytime sleepiness was more prevalent in snoring women. CONCLUSIONS: Snoring and witnessed sleep apnoeas are independently related to pregnancy-induced hypertensive disease.
Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Complicações na Gravidez/epidemiologia , Síndromes da Apneia do Sono/epidemiologia , Ronco/epidemiologia , Adulto , Argentina/epidemiologia , Feminino , Humanos , Lactente , Modelos Logísticos , Gravidez , Síndromes da Apneia do Sono/etiologia , Ronco/etiologia , Inquéritos e QuestionáriosRESUMO
Objetivos: Determinar la prevalencia de consultas por HTA severa (HTS) en los servicios de emergencia (SE), caracterizar esa población y evaluar la eficacia de una guía de práctica clínica (GPC) basada en las Normas para el Manejo de la HTS del Consejo Argentino de Hipertensión Arterial, Sociedad Argentina de Cardiología. Material y métodos: Se incluyeron pacientes con HTS que consultaron en SE de 31 centros participantes. Se distinguieron dos fases: I o de relevamiento de datos epidemiológicos de toda la población y II o de intervención que sólo incluyó a aquellos pacientes con HTS sin daño agudo de órgano blanco (DAOB). En esta última fase se aplicó una GPC que incluía en forma secuencial reposo y la aleatorización a drogas antihipertensivas de diferente mecanismo y velocidad de acción (amlodipina 10 mg o labetalol 200 mg o perindopril 4 mg). Resultados: Se incluyeron 816 pacientes (60,4 ± 14,7 años, el 50,4 por ciento de sexo masculino, el 87,4 por ciento sin DAOB); la prevalencia de HTS fue del 9 por ciento. En el 83,4 por ciento ya se conocía la presencia de hipertensión y de ellos, el 86,2 por ciento recibía tratamiento pero mantenía una PAS > 150 mm Hg. Se observó el 32 por ciento de respuesta al reposo y entre los no respondedores, el 79,1 por ciento respondió al tratamiento farmacológico. Los parámetros de seguridad considerados fueron: reducción menor igual 20 por ciento de la presión arterial media (PAM) basal y ausencia o número reducido de eventos en el SE. La PAM se redujo > 20 por ciento en el 5,6 por ciento de respondedores al reposo y en el 15,9 por ciento de los que requirieron drogas, sin que se observaran eventos. Conclusiones: El presente relevamiento proporciona datos para caracterizar clínicamente a los pacientes con HTS y sugiere que la GPC propuesta podría constituir una alternativa eficaz y segura para su manejo en el SE.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Emergências , Hipertensão/tratamento farmacológico , Hipertensão/terapia , Argentina/epidemiologia , HomeostaseRESUMO
Road accidents are a major cause of death, and sleep deprivation affects driving skills. We conducted a cross-sectional study to evaluate sleep habits and accident risk in long-haul truck drivers in Buenos Aires, Argentina. Questionnaires regarding sleep habits, snoring, and daytime sleepiness were administered, and a limited physical examination was performed. We obtained 738 complete answers (response rate 85%). Mean sleep hours during working days was 3.76 (SD 2.40). Mean driving hours was 15.9 (SD 5.60) per day. Frequent sleepiness while driving was reported by 43.7% of responders. Sleepiness while driving was associated with Epworth Sleepiness Scale values >10 (odds ratio 1.85, 95% confidence interval = 1.20-2.85). Snoring was reportea by 71% of drivers and was frequent in 43.8%. Snoring more than 3 times a week (odds ratio 1.73, 95% confidence interval = 1.23-2.44), sleepiness while driving (OR 1.92, 95% confidence interval = 1.08-1.96), and Epworth Sleepiness Scale score > 10 (odds ratio 2.53, 95% confidence interval = 1.61-3.97) were independently associated with reporting of accidents or near accidents. Sleep deprivation and long driving shifts were prevalent in our study. Accident risk was associated with frequent snoring, daytime sleepiness, and reporting of sleepiness at the wheel. This study highlights the need of improving working conditions in this highly exposed population.