Analysis of blood pressure measurement in Czech pharmacies I. Author: Jakub Prouza Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Introduction: Arterial hypertension is one of the most serious health problems of today and its therapy must be approached comprehensively. In addition to medical care, to the improvement of the health status of the patient significantly contribute properly implemented pharmaceutical care and blood pressure measurement in pharmacy. Objectives: The aim of the thesis was to describe and analyse conditions of blood pressure measurement in a sample of Czech pharmacies. Methods: Data were collected via questionnaire survey in 2012 and 2013 in three districts. The survey was conducted using two questionnaires, which were filled at pharmacies with possible help of trained interviewer. The first questionnaire was completed by the authorized employee representative of the pharmacy and included questions characterizing the pharmacy. Furthermore the question whether they provided blood pressure measurement in the pharmacy. If they did, further questions were on the frequency of measurement, instrumentation and space equipment in pharmacy. The second questionnaire was completed by the pharmacy...

BACKGROUND: Pulmonary Hypertension (PH) is a common form of high blood pressure in the lungs. It affects the pulmonary arteries, which normally allow blood to flow from the right heart to the lungs. Nitric Oxide (NO) is a potential mediator for establishing PH and decreasing its availability is implicated in the pathogenesis of PH. HYPOTHESIS: We tested the hypothesis that Fractional Exhaled Nitric Oxide (FeNO) is a good indicator to assess disease severity that may add to understanding the disease. METHODS: The aim of the study was to measure FeNO levels in consecutive PH patients and seek correlations with the 6 Minute walk distance (6MWD) within different World Health Organization (WHO) groups and New York Health Association Function Class (NYHA FC). Assignment to groups I or IV was done respecting the current guidelines. All values were taken at Tufts Medical Center PAH clinic visits. FeNO levels were measured utilizing the NIOX device. RESULTS: FeNO levels were highest in WHO Group 1 and lowest in WHO Group 5 patients. There was a strong inverse correlation between FeNO and 6MWD for each NYHA FC. (Pearson correlation of -0.986, p = 0.014). Within WHO Groups, we found significantly inverse correlations between FeNO and 6MWD in PH Group 4 (p= 0.012) and PH Group 5 (p=0.001). NYHA FC correlated with 6MWD across all WHO Groups (P=0.001). CONCLUSION: We report for the first time FeNO levels in all WHO Groups of PH. FeNO levels are low in early disease. FeNO levels correlate inversely with the severity of PH in WHO Group 4 and 5 patients. The increase in FeNO in more severe patients may reflect the degree of oxidative stress and inflammation in severe PH. Further studies to determine whether FeNO may be a biomarker in early disease, especially in PH Group 4 and 5 warrants further investigation.

Background: The proportion of adults suffering from hypertension worldwide was estimated at 31.1 % in 2010. The aim of this study was to evaluate the effects of lifestyle changes in patients with arterial hypertension (AH) in primary care. Material and methods: Systematic literature search in the online databases PubMed, Embase, Cochrane and Opengrey. Only randomized controlled trials of the years 2005 to 2017 in German or English were considered. Results: 11 studies out of 458 identified references were evaluated. The patient groups investigated were very heterogeneous and underwent different types of intervention. Educating patients about the clinical picture, regular self-measurements of blood pressure, or patient memories of maintaining a healthy lifestyle have been used most frequently. Conclusion: There is a need for further studies focusing on primary care. However, many lifestyle interventions seem to show very good effects in patients with pre-existing AH (secondary prophylaxis), so these measures should form the basis of antihypertensive therapy in all patients with AH. In addition, it is important to maintain advice on a healthy lifestyle during drug therapy.

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Yes / Pulmonary Arterial Hypertension (PAH) is a devastating cardiovascular disorder characterised by the remodelling of pre-capillary pulmonary arteries. The vascular remodelling observed in PAH patients results from excessive proliferation and apoptosis resistance of pulmonary arterial smooth muscle (PASMCs) and endothelial cells (PAECs). We have previously demonstrated that mutations in the type II receptor for bone morphogenetic protein (BMPRII) underlie the majority of the familial and inherited forms of the disease. We have further demonstrated that BMPRII deficiency promotes excessive proliferation and attenuates apoptosis in PASMCs, but the underlying mechanisms remain unclear. The major objective of this study is to investigate how BMPRII deficiency impairs apoptosis in PAH. Using multidisciplinary approaches, we demonstrate that deficiency in the expression of BMPRII impairs apoptosis by modulating the alternative splicing of the apoptotic regulator, Bcl-x (B-cell lymphoma X) transcripts: a finding observed in circulating leukocytes and lungs of PAH subjects, hypoxia-induced PAH rat lungs as well as in PASMCs and PAECs. BMPRII deficiency elicits cell specific effects: promoting the expression of Bcl-xL transcripts in PASMCs whilst inhibiting it in ECs, thus exerting differential apoptotic effects in these cells. The pro-survival effect of BMPRII receptor is mediated through the activin receptor like kinase 1 (ALK1) but not the ALK3 receptor. Finally, we show that BMPRII interacts with the ALK1 receptor and pathogenic mutations in the BMPR2 gene abolish this interaction. Taken together, dysfunctional BMPRII responsiveness impairs apoptosis via the BMPRII-ALK1-Bcl-xL pathway in PAH. We suggest Bcl-xL as a potential biomarker and druggable target. / This work was supported by a fellowship (awarded to MTN) from the Department of Health via the NIHR Comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London, Heptagon Life Science Proof of Concept Fund (grant KCL24 to MTN), the Great Britain Sasakawa Foundation (grant B70 to MTN), the Royal Society (grant 43049 to MTN), the Medical Research Council (grant G900865 to RCT, MTN and NWM) and the University of Bradford (grants 003200, 66006/001NAS and DH005 to MTN). NS and MYB were supported by scholarships from the Commonwealth Scholarship Commission, UK and Scientific and Technological Research Council of Turkey (TUBITAK), respectively.

Este estudo transversal teve como objetivos: conhecer o sistema HIPERDIA e descrever a qualidade das informações contidas na ficha do HIPERDIA em Guarapuava/PR, no período de maio de 2002 a novembro de 2004. A coleta de dados deu-se na cidade de Guarapuava/PR, no mês de abril de 2005, quando foram pesquisadas 5.500 fichas do HIPERDIA, extraímos aleatoriamente 612 amostras do total das fichas, que transcrevemos, codificamos com o programa Microsoft EXCEL e apresentamos com o programa estatístico Statistical Package For The Social Sciences (SPSS) for Windows. Os resultados mostram que o sistema de informação em saúde HIPERDIA foi criado para ajudar na reorganização da assistência às pessoas portadoras de hipertensão arterial e diabetes mellitus, tanto no município estudado quanto em âmbito nacional, estando ainda em fase de implantação. Alguns dados considerados obrigatórios deixaram de ser informados em algumas fichas por exemplo: raça, escolaridade, estado civil, cintura, peso, altura, data da consulta e assinatura do responsável pelo atendimento. Consideramos que a omissão destas informações pode interferir, além de não completar, o processamento final dos cadastros, influenciando negativamente em possíveis estudos do perfil epidemiológico desta população, bem como impossibilitar o acompanhamento e implementação de estratégias que poderiam transformar a atual condição clínica desses indivíduos. Sugerimos que os responsáveis pelos SIS no Brasil possam oferecer treinamento específico para os profissionais envolvidos diretamente com o cadastramento e acompanhamento de hipertensos e diabéticos. Outra ação importante seria a avaliação dos SIS, pelo modo como a organização da assistência está sendo prestada nos serviços de saúde, bem como pela satisfação dos usuários. Com efeito Starfield,(2002,p.597) diz que: “a informatização tornou-se uma ferramenta epidemiológica que veio com seu potencial para melhorar não apenas a atenção clínica, mas também o planejamento, a prestação de serviços e a avaliação dos serviços". / This traverse study had as objectives: to know the system HIPERDIA and to describe the quality of the information contained in the record of HIPERDIA in Guarapuava/PR, in the period of May of 2002 to November of 2004. The collection of data happened in the city of Guarapuava/PR, in the month of April of 2005, when they were researched 5.500 records of HIPERDIA, being sampled in aleatory way 612 of this total of records, which were transcribed for the program Microsoft EXCEL and codified and presented being used the statistical program Statistical Package it Goes Social The Sciences (SPSS) it goes Windows. The results show that the system of information in health HIPERDIA was created to help in the reorganization of the attention to the people bearers of arterial hypertension and diabetes mellitus, so much in the studied municipal district as in national ambit, being still in implantation phase. Some data considered obligatory they stopped being informed in some records: race, education, civil status, waist, weight, height, dates of the consultation and signature of the responsible for the attendance. We considered that the omission of these information can interfere, besides not completing the final processing of the cadasters, influencing negatively in possible studies of the epidemic profile of this population, as well as to disable the accompaniment and implantation of strategies that could transform those individuals' current clinical condition. We suggested that the responsible for SIS in Brazil can offer specific training for the professionals involved directly with the registration and hipertensos accompaniment and diabetics. Another important action would be the evaluation of SIS, for the way as the organization of the attendance is being rendered in the services of health as well as for the users' satisfaction. Since Starfield,(2002,p.597) says that: the development of the computer science became an epidemic tool that it came with your potential to not just improve the clinical attention, but also the planning, the services rendered and the evaluation of the services ".

Introdução: Vários genes, particularmente os envolvidos na via de transcrição Transforming Growth Factor beta, estão claramente associados ao risco de desenvolvimento de hipertensão arterial pulmonar. Entretanto, pouco ou quase nada se sabe sobre a existência de fatores genéticos que possam estar associados a uma das formas mais prevalentes de hipertensão arterial pulmonar no mundo, a hipertensão arterial pulmonar associada a esquistossomose (HAP-Sch). O objetivo deste estudo foi avaliar a associação dos genes já descritos na hipertensão arterial pulmonar idiopática (HAPI) com a HAP-Sch. Método: Estudo transversal, comparando amostras de pacientes seguidos no ambulatório de Circulação Pulmonar no Instituto do Coração do HCFMUSP, com diagnóstico de HAP-Sch ou HAPI. Foram avaliadas as características genéticas nestes grupos quanto à presença de variantes patogênicas dos genes:BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, andSMAD9. Resultados: Foram incluídos 69 pacientes com HAP-Sch e 74 pacientes com HAPI. O grupo HAP-Sch apresentou idade mais avançada (52.1 ± 11.8 vs 41.5 ± 15.0; p = < 0,001) e débito cardíaco mais preservado ao diagnóstico (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). Cerca de 24% dos pacientes com HAPI apresentaram resposta aguda durante o teste de vasorreatividade, enquanto nenhum paciente com HAP-Sch apresentou resposta (p =< 0.001). Pacientes com HAP-Sch apresentaram 7% de variantes patogênicas, comparado com11% dos HAPI(p=0,782). Em ambos os grupos, pacientes portadores de variantes patogênicas possuíam características clínicas e hemodinâmicas semelhantes aos demais pacientes. No grupo HAP-Sch, a sobrevida dos portadores de variantes patogênicas foi significativamente menor (p=0.035). Conclusão: A prevalência de variantes patogênicas na HAP-Sch é semelhante à encontrada na HAPI e, da mesma forma, sua presença está associada a pior prognóstico / Background: Several genes, mainly those involved with the Transforming Growth Factor ? transcription pathway, are well-defined as risk factors for developing pulmonary arterial hypertension. Nevertheless, little is known about the existence of a genetic background associated with one of the most prevalent forms of pulmonary arterial hypertension worldwide, which is schistosomiasis associated pulmonary arterial hypertension (Sch-PAH). The aim of this study was to evaluate the association of genes already described in idiopathic pulmonary arterial hypertension (IPAH) with Sch-PAH. Method: A cross-sectional study comparing samples from patients followed at the Pulmonary Circulation clinic at the Heart Institute of HCFMUSP, diagnosed as Sch-PAH or IPAH. Genetic characteristics in these groups were evaluated for the presence of pathogenic variants of the genes: BMPR2, ACVRL1, KCNK3, KCNK5, CAV-1, CBLN2, ENG, and SMAD9.Results: A total of 69 patients with Sch-PAH and 74 patients with IPAH were included. The Sch-PAH group presented older age (52.1 ± 11.8 vs 41.5 ± 15.0, p =< 0.001) and higher cardiac output at diagnosis (4.7 ± 1.9 vs 4.0 ± 1.4 p = 0.019). About 24% of patients with IPAH presented acute response during the vasoreactivity test, whereas no Sch-PAH patient presented response (p = < 0.001). Patients with PAH-Sch had 7% prevalence of pathogenic variants, compared to 11% in IPAH (p = 0.782). In both groups, patients with pathogenic variants had clinical and hemodynamic characteristics similar to the other patients. In the Sch-PAH group, the survival of patients with pathogenic variants was significantly lower (p = 0.035). Conclusion: The prevalence of pathogenic variants in Sch-PAH is similar to that found in IPAH and, likewise, its presence is associated with worse prognosis

Os transtornos mentais caracterizam-se por serem perturbações clinicamente significativas na cognição, regulação emocional ou comportamento do indivíduo e refletem uma disfunção nos processos psicológicos, biológicos ou de desenvolvimento subjacentes ao funcionamento mental. Indivíduos com este diagnóstico, podem ser acometidos por outras condições crônicas associadas ao tratamento medicamentoso, entre elas a hipertensão arterial, necessitando dessa forma de um monitoramento constante. Objetivos: Avaliar o monitoramento da pressão arterial, e índice de massa corporal de pessoas com transtornos mentais acompanhados pelos serviços de atenção psicossocial tipo II de Palmas no período de 2010 a junho de 2016. Metodologia: Estudo transversal descritivo, analítico, de caráter retrospectivo, com levantamento de dados em prontuários em associação ao estudo de campo, com abordagem qualitativa na perspectiva da grounded theory. Coleta de dados realizada entre abril e setembro de 2017, através de um formulário, estruturado elaborado pela pesquisadora e diário de campo. Incluídos no estudo os prontuários de pessoas admitidas na unidade com idades entre 18 anos completos e 60 anos incompletos, atendidos no período entre janeiro de 2010 a junho de 2016, sendo um total de 246 participantes. Para o processamento e a análise dos dados foi utilizado os aplicativo Microsoft Excel ano 2010 e Epi Info 3.4.3. Resultados: Da amostra coletada, cento e vinte e três participantes eram do sexo feminino e cento e vinte e três do sexo masculino, entre 29 e 50 anos (69%), A proporção de usuários com esquizofrenia e outros transtornos psicóticos mostrou –se em 56,95% e a de transtornos bipolar e outros transtornos psicóticos 21,3%. Entre as medicações prescritas, houve predomínio de antipsicóticos e neurolépticos (33,1%), seguida dos estabilizadores de humor (18,51%), estando em consonância com os diagnósticos médicos. A maioria dos casos não possui monitoramento continuo da pressão arterial, peso, altura e IMC, sendo que da amostra selecionada, apenas 28,05% possuíam todos os dados necessários em prontuário. Quanto ao uso de álcool, tabaco e outras drogas 17,88% referiam o uso de uma ou mais drogas, 23,57% negaram uso de qualquer substância, e 58,53% não possuía informações nos prontuários analisados. Conclusão: Os resultados apontam que o monitoramento da pressão arterial, a verificação do índice de massa corporal, bem como a existência de outros fatores que influenciam o tratamento entre usuários de um serviço de saúde mental, auxilia a repensar as ações preventivas e educacionais neste público. A atenção secundária à saúde no município, necessita efetivar a qualidade de acesso ao usuário, trabalhando como ordenadora da rede de atenção psicossocial. O CAPS II como um serviço especializado nos transtornos psiquiátricos, deve atentar para as necessidades dos usuários como um todo, com foco nas discussões de caso na atenção primária possibilita a articulação entre a atenção primária e especializada trabalhando o cuidado integral. / Introduction: Mental disorders are characterized by being clinically significant disturbances in the cognition, emotional regulation or behavior of the individual and reflect a dysfunction in the psychological, biological or developmental processes underlying mental functioning. Individuals with this diagnosis may be affected by other chronic conditions associated with drug treatment, including arterial hypertension, requiring constant monitoring. Objectives: Evaluate the monitoring of blood pressure and body mass index of people with mental disorders accompanied by Palmas psychosocial care services type II, from 2010 to June 2016. Methodology: Descriptive cross-sectional, analytical, retrospective, with data collection in medical records in association with the field study, with a qualitative approach from the grounded theory perspective. Data collection performed between April and September 2017, through a structured form elaborated by the researcher and field diary. Included in the study were the records of persons admitted to the unit aged 18 years and 60 years, who were attended in the period between January 2010 and June 2016, with a total of 246 participants. Microsoft Excel 2010 and Epi Info 3.4.3 applications were used for data processing and analysis. Results: One hundred twenty-three participants were female and one hundred twenty-three males, aged between 29 and 50 years (69%). The proportion of users with schizophrenia and other psychotic disorders were 56.95% and that of bipolar disorders and other psychotic disorders was 21.3%. Among the medications prescribed, there was a predominance of antipsychotics and neuroleptics (33.1%), followed by mood stabilizers (18.51%), being in consonance with the medical diagnoses. Most cases do not have continuous monitoring of blood pressure, weight, height and BMI, and of the sample selected, only 28.05% had all the necessary data in the medical record. Regarding the use of alcohol, tobacco and other drugs, 17.88% reported using one or more drugs, 23.57% refused to use any substance, and 58.53% didn’t have information in medical records. Conclusion: The results indicate that monitoring of blood pressure, verification of body mass index, as well as the existence of other factors that influence treatment among users of a mental health service, helps to rethink the preventive and educational actions in this public . Secondary health care in the city requires the quality of access to the user, working as a coordinator of the psychosocial care network. The CAPS II as a specialized service in psychiatric disorders should pay attention to the needs of the users as a whole, and with a focus on the discussion of cases in primary care, allows the articulation between primary and specialized care working full care.

Made available in DSpace on 2016-07-27T14:21:56Z (GMT). No. of bitstreams: 1 ERIVANEA GARCIA RIBEIRO.pdf: 797586 bytes, checksum: cad71fc000533a3a0126f50fc437f49e (MD5) Previous issue date: 2010-01-22 / Arterial Hypertension (HT) is considered an illness of great magnitude, classified as a multi-factorial clinical entity of asymptomatic nature, regarded as a syndrome and characterized by the presence of high levels of arterial pressure (AP), associated to metabolic and hormonal alterations as well as atrophic phenomena. It is estimated that, in Brazil, HT affects 15% to 20% of the adult population; 2% to 13% of children and adolescents; 65% of the senior population and around 80% among women over 75 years old. Due to the severity and possible complications of this disease, a study was conducted on the treatment adhesion of HT patients. By adhesion, it is meant the establishment of a joint activity, in which the patient is not a mere follower of medical advice, but that contemplates and it makes relative decisions the prescribed recommendation. It is a dynamic process, with multi-determination and coresponsibility between the patient and the heath care team. The research was developed at the Reference Center of Hypertension and Diabetes CRHD) of Rio Verde/GO and had as its objectives: identify the socio-demographic and clinical profile of the HD patient; analyze quantitative indicators of adhesion; correlate the quantitative indicators of adhesion to HD treatment with the socio-demographic and clinical data; verify which and how the multidimensional factors influence the degree of adhesion to the treatment of hypertension disease, and verify the health beliefs of the HD patient. The dissertation is divided into three chapters. The first refers to the literature review, titled Arterial Hypertension: a worldwide public health phenomenon which deals with treatment adhesion in regard to the concepts, presumptions and relevancy, as well as the multidimensional and complex factors of adhesion and the methods of evaluating. The second chapter refers to an article of quantitative subject, titled Analysis of indicators related to the degree of treatment adhesion of HD patients and the third chapter refers to an article of qualitative study, designated Analysis of relative significance to treatment adhesion of HD patients . / A hipertensão arterial (HA) é considerada uma doença de grande magnitude e qualificada como uma entidade clínica multifatorial, de natureza assintomática, conceituada como síndrome e caracterizada pela presença de níveis elevados de pressão arterial (PA), associados as alterações metabólicas e hormonais e a fenômenos tróficos. No Brasil, estima-se que a HA acomete 15% a 20% da população adulta; 2% a 13% de crianças e adolescentes; 65% do público idoso e cerca de 80% das mulheres com idade superior a 75 anos. Devido à severidade da doença e pelas possibilidades de agravamento, realizou-se um estudo sobre adesão a tratamento dos portadores de HA. Por adesão, entende-se o estabelecimento de uma atividade conjunta na qual o paciente não é um mero seguidor da orientação médica, mas aquele que reflete e toma decisões relativas a prescrição recomendada. É um processo dinâmico, multideterminado e de (cor)responsabilidade entre paciente e equipe de saúde. A pesquisa foi desenvolvida no Centro de Referência de Hipertensão e Diabetes - CRHD de Rio Verde/GO e teve como objetivos: identificar o perfil sociodemográfico e clínico dos portadores de HA; analisar indicadores quantitativos da adesão; correlacionar os indicadores quantitativos de adesão ao tratamento da HA com os dados sociodemográficos e clínicos; verificar quais e como os fatores multidimensionais influenciam o grau de adesão ao tratamento da doença hipertensiva e verificar as crenças em saúde do portador de HA. A dissertação divide-se em três capítulos. O primeiro refere-se à revisão de literatura, intitulado Hipertensão Arterial: um fenômeno mundial de saúde pública , onde abordou-se sobre adesão ao tratamento, os conceitos, pressupostos e relevância, os fatores multidimensionais e complexos da adesão e os métodos de avaliação. O segundo capítulo refere-se a um artigo de cunho quantitativo, intitulado Análise dos indicadores relacionados ao grau de adesão ao tratamento de portadores de HA e o terceiro capítulo refere-se a um artigo com abordagem qualitativa, denominado Análise de significados relativos à adesão ao tratamento de portadores de HA .