RESUMO
O recurso à internet para obtenção de informações sobre saúde tem provocado avaliações geralmente favoráveis por parte de pacientes e médicos nas indagações a respeito. No entanto, com maior atenção, percebe-se que nem todos os profissionais ratificam essas avaliações ou comungam do otimismo dispensado a essa variável. O objetivo deste estudo foi alinhar seus desdobramentos na relação médico-paciente, buscando um contraponto entre o caráter facilitador e o caráter de desafios inerentes a essa inclusão, abordando, inclusive, seus riscos potenciais à adesão ao tratamento. Sobre a expansão desse recurso, acessível tanto aos médicos quanto ao público leigo, foram lançadas perguntas básicas: quem recorre aos portais de saúde, quando e por que o faz, e quais os desdobramentos desse recurso sobre o médico e sobre seu vínculo com o paciente? Pacientes e médicos se beneficiam do uso da internet. Os primeiros, adquirindo segurança e capacidade de participação no tratamento; os últimos, obtendo atualização e informação facilmente disponíveis. No entanto, alheios a qualquer regulamentação ou validação do que veiculam, os portais sobre saúde trazem também os riscos da informação enganosa, ou de seu mau uso, uma vez que, na falta de uma base teórica e de experiência prática, nem sempre é possível ao paciente lidar positivamente com os dados obtidos. Assim, sua atitude participativa pode vir a se transformar em confrontação e/ou autossuficiência, colocando em risco a relação médico-paciente e, consequentemente, a adesão ao tratamento...
The use of the internet to obtain health information has led to generally favorable reviews by patients and doctors in inquiries about it. However, when paying closer attention one is led to realize that not all professionals ratify these reviews or share the optimism with which this variable is addressed. This article aimed to align its ramifications in the patient-physician relationship, seeking a counterpoint between the facilitating and challenging aspects inherent to this inclusion, focusing, as well, the potential risks to adherence to treatment. Regarding the expansion of the use of internet as a source of health information accessible to both physicians and lay people, basic questions were launched: who consults health websites, why and when does he/she do it, and what are the repercussions of this action on the physician and also on his/her relationship with the patient? Patients and physicians benefit from the use of the internet. The former acquires safety and ability to participate in treatment; the latter gets easily available updated knowledge. However, disregarding regulations or validation about what they convey, health websites also bring the risks of misleading information, or of its misuse, since when there is lack of a theoretical basis and practical experience, not always can the patient deal positively with the obtained data. Thus, patient's participatory attitude may turn into confrontation and/or self-reliance, putting patient-physician relationship and, consequently, adherence to treatment at risk...
Assuntos
Avaliação em Saúde , Internet , Relações Médico-Paciente , AutocuidadoRESUMO
INTRODUCTION: In recent years, a role for aldosterone in pathophysiology of metabolic syndrome and hypertension in this syndrome has been suggested. However, the treatment with antagonists of mineralocorticoid receptor in these individuals has not properly addressed. OBJECTIVE: To evaluate the effects of mineralocorticoid receptor blockade on blood pressure, inflammatory, metabolic and renal parameters in non-diabetic hypertensive individuals with the metabolic syndrome. METHODS: Twenty nine patients with metabolic syndrome were enrolled in a prospective protocol that consisted of 2 periods: baseline (2 weeks) in which demographic data were obtained and antihypertensive medicines were withdrawn, and treatment period when the individuals were treated with spironolactone 25-50 mg once-a-day, for 16 weeks. In both periods, inflammatory, metabolic and renal parameters were assessed and the 24-hour ambulatory blood pressure monitorization was performed. RESULTS: After spironolactone treatment, 24 hour systolic and diastolic blood pressure decreased from 143.5 ± 15.17 mmHg to 133.2 ± 17.34 mmHg (p = 0.025) and from 85.2 ± 11.10 mmHg to 79.3 ± 11.78 mmHg (p = 0.026), respectively. HDL-cholesterol increased from 44.0 ± 8.67 mg/dl to 49.0 ± 6.75mg/dl (p = 0.000) and C-reactive protein decreased significantly from 6.3 ± 7.54 mg/l to 4.6 ± 6.3 mg/l (p = 0.009). Fasting plasma glucose, insulin, HOMA-IR and triglycerides did not change significantly after mineralocorticoid receptor blockade. Estimated glomerular filtration rate did not change whereas the logarithm of albuminuria decreased significantly from 2.5 ± 0.92 to 2.0 ± 0.9 (p = 0.028). CONCLUSION: In hypertensive subjects with MS the administration of spironolactone in monotherapy was effective for hypertension control, decreased urinary albumin excretion and increased HDL-cholester ol plasma.