Orientador: Otávio Rizzi Coelho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T02:56:20Z (GMT). No. of bitstreams: 1 Araujo_LucianedaSilva_M.pdf: 3413673 bytes, checksum: 9384c3dac9238ae4974311f0d582d05a (MD5) Previous issue date: 2010 / Resumo: As doenças cardiovasculares são a maior causa de morte e morbidade em todo mundo e os tradicionais fatores de risco vêm aumentando em muitos países devido ao estilo de vida baseado em maus hábitos de vida. Hábitos cotidianos de prática regular de exercícios físicos, alimentação saudável e controle de estresse são fatores determinantes na prevenção e reabilitação das doenças cardiovasculares. Contudo, fatores sócioeconômicos e disponibilidade de tratamento são quesitos determinantes para àqueles que dependem do serviço público. Esta pesquisa analisou o perfil de pessoas com doença arterial coronariana (DAC) do Sistema Público de Saúde (SUS) que fazem Reabilitação Cardíaca Supervisionada (RCS), comparando com pessoas com DAC do SUS que nunca fizeram RCS e com pessoas com DAC do SUS que já fizeram a RCS e que já receberam alta do programa. MÉTODOS: Fizeram parte desta pesquisa 105 (cento e cinco) pessoas de ambos os sexos com doenças coronarianas provindas do SUS (Sistema Único de Saúde). Destas, 35 pessoas (23 homens e 12 mulheres) com idade média de 62 anos (dp 7,5 anos) fizeram parte do grupo I (participantes da RCS), 35 pessoas (26 homens e 9 mulheres) com idade média de 66 anos (dp 5,8 anos) fizeram parte do grupo II (exparticipantes da RCS) e 35 pessoas (18 homens e 17 mulheres) com idade média de 63 anos (dp 6,5 anos) fizeram parte do grupo III (controle). Os intrumentos de medida utilizados foram: Questionário de Qualidade de Vida (SF-36); Questionário Internacional de Atividade Física (IPAQ-forma longa); Questionário de Freqüência Alimentar (QFA) Semi-Quantitativo; Questionário Sócio-Econômico (ABEP); medidas antropométricas (peso, altura e circunferência abdominal); exames laboratoriais (glicemia de jejum, colesterol total, Hdl-col, Ldl-col e triglicerídeos); e ficha complementar (questões sobre exercício e tabagismo). A análise estatística adotada para as variáveis intervalares foi a razão F e DHS de Tukey. Para as variáveis nominais foi utilizado o teste Qui-quadrado. O nível de significância utilizado foi de p ? 0,05. O programa SPSS 17.0 foi utilizado na descrição e análise dos dados. RESULTADOS: Todos os domínios do SF-36 obtiveram escores melhores no grupo I e piores no grupo III. O IPAQ retratou nível de atividade física moderada para todos os grupos, onde a dimensão Lazer foi a que mais contribui nos escores total dos grupos I e II, e a dimensão Trabalho foi a que mais contribui no escore total do grupo III. Nos hábitos alimentares foi detectado défice de Vitamina A no grupo III feminino; défice de Zinco em todos os grupos masculinos e nos grupos II e III femininos; e excesso de ingestão de colesterol em todos os grupos femininos e masculinos. O ABEP mostrou que o grupo III é o que tem menor padrão econômino (classe C1). Todos os grupos apresentaram classificação Sobrepeso no IMC, contudo observou-se distribuição de gordura diferenciada entre os grupos através da circunferência abdominal, onde o grupo I não apresentou risco, o grupo II apresentou risco no gênero feminino e o grupo III apresentou risco em ambos os gêneros. Nos exames laboratoriais todos os grupos apresentaram glicemia de jejum alterada. CONCLUSÃO: Os pacientes do programa RCS apresentaram melhor qualidade de vida, maior nível de atividade física regular e caracterísiticas antropométricas de circunferência abdominal ausente de risco para doença cardiovascular. A RCS é efetiva na inserção da prática regular de exercício físico e controle dos fatores de risco para doença cardiovascular e a presença de um professor/orientador foi considerada o fator determinante na prática regular de exercício físico alegado pela maioria das pessoas em todos os grupos estudados / Abstract: The cardiovascular diseases are the largest cause of death and morbidity in all the world and traditional risk factors are increasing in a lot of countries because a bad life style. Regular exercise, health alimentation and stress control are determinative factors in the cardiovascular prevention and rehabilitation. However, socioeconomic factors and availability of treatments are crucial questions for those who depend on public service. Therefore, this research suggests to analyze people with Coronary Arterial Disease (CAD) from the Public Health Service (PHS) that make a Cardiac Rehabilitation (CR), confronting people with CAD from the PHS that never made CR and people with CAD from the PHS that made CR and finished the CR program stage 3. METHODS: The sampling was composed of 105 people with coronary arterial disease from the public health service. 35 people (23 men and 12 women), average age of 62 years (SD=7,5) composed the group I (participants of cardiac rehabilitation); 35 people (26 men and 9 women), average age of 66 years (SD=5,8) composed the group II (former participants of cardiac rehabilitation); and 35 people (18 men and 17 women) average age of 63 years (SD=6,5) composed the group III (control). The instruments used were: Quality of Life Questionnaire SF-36, International Physical Activity Questionnaire (IPAQ- long form), Food Frequency Questionnaire, Socioeconomic Questionnaire (ABEP), Anthropometric measure (weight, stature and abdominal circumference), Laboratory test (glucose concentration, total cholesterol, cholesterol-HDL, cholesterol-LDL and triglycerides), and complementary card (questions about exercise and smoking). The statistical analysis adopted for the variable interval was the statistical F and DHS of Turkey method. For the nominal variables, it was used the square-X test. The significance level used was p ? 0,05. The Statistical Program SPSS 17.0 was used on the description and analysis of the data. RESULTS: The group I showed the best scores in quality of life in all domains. The higher difference was observed between the groups I and III in all domains. The IPAQ showed moderate physical activity level for all the groups in MET-minute/week (I=2757,3 II=1712,9 III=2125,3). The dimension that contributed the most to the average in each group was the Leisure for the groups I and II and Work for the group III. The food habits showed vitamin A nutrient deficit in the III female group; zinc deficit in the all male groups and II/III female groups; and cholesterol excess in all the female and male groups. The smallest socioeconomic level (C1/ABEP)) was in the III group. All the groups showed the same IMC classification (overweight), but different body fat distribution between the groups beyond abdominal circumference analysis (I= no risk, II= risk (female) and III= risk (gender both). All the groups showed altered glucose concentration (I=108,2 II=112,6 III=118,2). CONCLUSION: The patients from Cardiac Rehabilitation Program showed the best quality of life, the greater physical activity regular level and abdominal circumference without risk to cardiovascular disease. The CR is effective in the regular physical activity practice and risk factors control to cardiovascular disease and the teacher/instructor was considered the determinant factor in the regular physical activity practice alleged almost every patient from all the groups / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

Major depression and coronary heart disease are two strongly linked, major causes of death and disability. After an acute coronary event, many patients are referred to cardiac rehabilitation (CR), a medically supervised exercise intervention and lifestyle training program. Depression may partially account for poor CR adherence and resulting cardiovascular problems in patients with a history of heart disease; however, underlying mechanisms through which depression impacts cardiac functioning are not well understood. The current project tests a theoretical model in which CR adherence (i.e., number of CR sessions attended) mediates the relation between baseline depression and cardiorespiratory fitness after CR. A community sample of 858 older adults initiating CR after hospitalization for a coronary event completed a symptom-limited exercise stress test before and after the 12-week program. Cardiorespiratory fitness was measured via VO2max, peak MET, and total duration of the stress test. Depression was measured at baseline using the Patient Health Questionnaire Depression Scale. CR adherence did not mediate the relation between baseline depression scores and fitness outcomes. Path analyses revealed that higher baseline depression severity predicted lower likelihood of CR completion (i.e., completion of all 36 sessions, or fewer if limited by insurance or terminated early for good prognosis) in the full sample. Higher levels of depression predicted poorer CR adherence in a subsample of 74 patients with moderate to severe depression. These findings lend support to depression as a predictor of treatment nonadherence in CR. Screening for depression in the context of coronary heart disease and implementing evidence-based depression interventions in secondary prevention settings can help alleviate a massive public health burden.

Tratou-se de início o problema da reabilitação do cardíaco a partir de uma fundamentação de seus conceitos e análise de sua história. Em seguida estudou-se os aspectos orgânico, social e psíquico que influem no atendimento do paciente coronariano. A partir destes elementos elaborou-se uma metodologia para a reabilitação deste tipo de paciente. Ressaltou-se a importância da equipe de atendimento, bem como recursos de equipamento e planta física. Caracterizou-se a equipe como multiprofissional e multidisciplinar e definiu-se suas atribuições. Estudou-se a situação atual da reabilitação cardíaca no Brasil, com a finalidade de possibilitar o planejamento e a organização de um serviço de reabilitação para o paciente cardíaco, devido ao aumento da morbimortalidade por doença coronariana. Procurou-se determinar a localização geográfica, a situação e os tipos de serviços de reabilitação cardíaca no Brasil, usando-se questionários enviados pelo correio aos serviços de cardiologia do país, indexados no Anuário Estatístico. Realizou-se a análise in loco dos serviços de reabilitação cardíaca da capital do Estado de São Paulo. Posteriormente, comparou-se os demais serviços com o Instituto \"Dante Pazzanese\" de Cardiologia (IDPC). Para se obter dados mais precisos analisou-se a planta física, os recursos humanos, o equipamento, a administração e a avaliação dos serviços de reabilitação cardíaca. Verificou-se que os serviços de reabilitação cardíaca estão localizados apenas nas Regiões Sul (5) e Sudeste (15), incluindo o IDPC. Foi verificado que nas Regiões Sul e Sudeste encontram-se 64.571.000 habitantes o que eventualmente poderá gerar 6.457 cardiopatas. Nestas mesmas áreas notou-se que existe um cardiologista para atender 1.793.638 habitantes. Constatou-se, por outro lado, que as necessidades em área para condicionamento físico, salas para atendimento, pessoal e equipamento necessário são bastante deficientes nas duas Regiões, principalmente quando comparadas à organização do IDPC, que foi utilizada como padrão. Concluiu-se pela necessidade de se encarar a reabilitação cardíaca como um processo dinâmico, que depende do trabalho da equipe, do equipamento, da planta física, da orientação e educação do paciente e seus familiares, da motivação da comunidade, e que o serviço de reabilitação cardíaca não pode estar desvinculado do Hospital e da Comunidade para a qual foi criado. É necessária a preparação de equipes multidisciplinares para suprir as Regiões carentes em reabilitação do paciente cardíaco, bem como a criação de unidades que atendam às necessidades. / The problem of the cardiac patient rehabilitation was initially studied, taken into consideration its concepts and its clinical history. Next, organic, social and psychological aspects that influence the attendance of coronary patients were studied. Based on these elements, rehabilitation methodology for these patients was elaborated. The importance of the attending team, as well as of equipment and physical plant, was stressed. The team was characterized as a multiprofessional and multidisciplinary one and the role of each member was defined. The current situation of cardiac rehabilitation in Brazil was studied, in order to facilitate the planning and organization of a rehabilitation service for cardiac patients, since morbidity and mortality caused by coronary disease are increasing. An attempt was done in order to point out the geographic area, the actual situation and the types of the cardiac rehabilitation services in Brasil. This was done by means of a questionnaire mailed to the indexed services in the \"ANUÁRIO ESTATÍSTICO DO BRASIL\". Concomitantly, an analysis \"in loco\" of the cardiac rehabilitation services in São Paulo City was performed and latter on all services were compared to Instituto \"Dante Pazzanese\" de Cardiologia. In order to obtain more precise data, the plant, human resources, equipment, administration and evaluation of services were analysed. It was found that the cardiac rehabilitation services are located in the southerhand south-eastern areas of Brazil only, where we can find 64.571,000 inhabitants which can eventually present 6.457 cases of cardiopathy. These areas present 1 (one) cardiologist to attend to 1,793,638 inhabitants. On the other hand, the existing material and equipment, as well as appropriate buildings are deficient in both areas, mainly when compared to IDPC organization, that was used as model. It was concluded that we must consider cardiac rehabilitation as a dynamic process, dependant on the work of a team, on the equipment, on the building, on the orientation and education of the patient and his family, on the motivation of the community, and that the cardiac rehabi1itation service cannot be separated Cdetached) from the Hospital and the community it was created for.

Kardiovaskulära sjukdomar är den vanligaste dödsorsaken i världen. Hjärtrehabilitering är en omtumlande situation för de drabbade. Att som vårdpersonal ha insikt om patienters erfarenheter av hjärtrehabilitering efter kardiovaskulär sjukdom är betydelsefullt för att kunna tillgodose en god och personcentrerad omvårdnad. Den strukturerade litteraturstudiens syfte var att belysa patienters erfarenheter av hjärtrehabilitering vid kardiovaskulära sjukdomar. Studiens resultat grundades på 11 vetenskapliga artiklar med kvalitativ ansats. Tre huvudteman framkom i resultatet; Erfarenhet av stöd, Erfarenhet av information och Erfarenhet av fysisk aktivitet. I resultatet framkom det att peer support har en betydande roll i hjärtrehabiliteringen, både ur ett socialt- och psykiskt perspektiv. Det fanns en osäkerhet kring fysisk aktivitet efter insjuknande, framförallt vid kroppsliga reaktioner som påminde om insjuknandet. Den stora mängd information som gavs i den akuta fasen ansågs vara svår att absorbera. Den erhållna informationen ansågs vara mer generell och inte skräddarsydd efter patientens egna hinder och möjligheter. Det finns ett behov av vidare utbildning om patienters erfarenheter hos vårdpersonal för att kunna applicera en god och personcentrerad omvårdnad till patientgruppen. / Cardiovascular diseases is the most common cause of death in the world. Cardiac rehabilitation is an difficult time for the affected. Health professionals need insight in patients experiences of cardiac rehabilitation to be able to provide good and person centered care. The aim of the structured literature study was to explore patients affected by cardiovascular diseases experiences of cardiac rehabilitation. the result of the study was based on 11 scientific articles with a qualitative approach. Three main themes emerged: Experiences of support, Experiences of information and Experiences of physical activity. The result illustrate the significance of peer support in cardiac rehabilitation for participants, both social and psychological. Participants experienced insecurity regarding physical activity, especially because it reminded them of their negative experiences of chest pain and increased heart rate.The information received at the acute phase was hard for the patients to absorb. The information was perceived as general by the patients and not customized for their specific situation. A need for further education about patients experiences for health professionals is seen for them to be able to provide a good and person centered care

Bakgrund: Hjärtinfarkt är den vanligaste dödsorsaken i Sverige bland både män och kvinnor. Hjärtrehabilitering är en viktig funktion för att förbättra personens fysiska status och undvika återinsjuknande i hjärtinfarkt. Personen genomför en hjärtrehabilitering som innebär ett övervakat program i flera steg, där målet är att kunna återgå till sitt normala liv. I sjuksköterskans roll ingår bland annat att informera patienten om tillståndet samt stödja och uppmuntra personer till nödvändiga livsstilsförändringar. Syfte: Syftet med studien var att beskriva personers upplevelser av rehabilitering efter hjärtinfarkt. Metod: En beskrivande litteraturstudie utifrån en sammanställning av 12 kvalitativa vetenskapliga artiklar. Huvudresultat: Socialt stöd från familj, vänner, vårdpersonal och kamrater upplevdes värdefullt. Hjärtrehabiliteringen hade en positiv inverkan på personernas hälsa tack vare kunskap och information. Önskemål om familjens delaktighet i rehabiliteringen framkom. Personliga copingstrategier användes för att hantera situationen som uppstått i livet. Upplevelser av rädsla vid fysisk aktivitet var vanligt hos personerna där pulsökningen förknippades med ännu en hjärtinfarkt. Även rädsla över att vara ensam upplevdes. Slutsats: Personerna upplevde hjärtrehabiliteringen mestadels positiv där det sociala stödet var avgörande. Även negativa upplevelser som rädsla och brist på information var framträdande. Resultatet speglade hur personen hanterade sina livsstilsförändringar med hjälp av olika copingstrategier. Det framkom även att familjen önskades vara mer involverad i processen. Sjuksköterskans roll i hjärtrehabiliteringen upplevdes betydelsefull, dock finns det utvecklingsområden som hälso- och sjukvården bör uppmärksamma och ta hänsyn till gällande personernas individuella behov under ett hjärtrehabiliteringsprogram. / Background: Myocardial infarction is the most common cause of death in Sweden amongst men and women. Cardiac rehabilitation is an important function to improve the persons physical status and avoid relapse in myocardial infarction. The person goes through cardiac rehabilitation which involves a supervised program in several steps, the goal being that the person should be able to return to a normal life. The nurses role comprises for instance to inform the patient about the condition, and also support and encourage to necessary lifestyle changes. Aim: The aim of this study was to explore how persons experienced the rehabilitation after a myocardial infarction. Method: A descriptive literature study based on 12 qualitative scientific articles. Results: The social support from family, friends, health professionals and peers was experienced as valuable. The cardiac rehabilitation had a positive impact on the person's health thanks to knowledge and information. Wishes for family involvement in the rehabilitation also emerged. They used personal coping strategies to deal with the situation that have occurred in life. Fear of physical activity was common and also fear of being alone. Conclusion: The person experienced the cardiac rehabilitation mostly positive where the social support was crucial. Also negative experiences such as fear and lack of information appeared. The result reflected how the person handled the lifestyle changes and also found that the family wished to be more involved in the process. The nurses role in the cardiac rehabilitation was important. However there is areas of development that the public health care should pay attention to and take into consideration about the persons individual needs.

Philosophiae Doctor - PhD / Cardiovascular disease is amongst the top three leading causes of mortality in South Africa and the world. The effects of cardiovascular disease can be seen in limitations of function within all spheres of life, including work function. Cardiac rehabilitation programmes have been documented to improve functional abilities, but little is known about the return to work rate after cardiac rehabilitation. Access to cardiac rehabilitation programmes in the Western Cape is limited. This study aimed to determine the return to work rates and influencing factors after cardiac rehabilitation as well as to design an intervention programme that is accessible and could facilitate return to work for individuals with cardiovascular disease.

Bakgrund: Att drabbas av en hjärtinfarkt är livsomställande för patienten. Genom livsstilsförändringar kan riskfaktorer elimineras och risk för att återinsjukna reduceras. Genom att patienten är följsam i sin egenvård och deltar i hjärtrehabiliteringsprogram kan risken minska. Trots det är följsamheten låg och dödligheten är fortfarande en ledande dödsorsak i Sverige.   Syfte: Syftet är att beskriva patientens upplevelse av egenvård efter hjärtinfarkt.   Metod: Studien har en induktiv ansats och de 15 kvalitativa resultatartiklarna har analyserats med hjälp av Fribergs femstegsanalys.    Resultat: Tre teman framkom i resultatet, “Betydelsen av stöd från omgivningen för att kunna bedriva egenvård ”, “Sjukvårdens betydelse för att möjliggöra egenvård” och “Begränsande och främjande upplevelser av egenvård”.  Socialt stöd, hjärtrehabilitering samt information och kunskap var några av de drivande komponenterna till att patienten upplevde motivation till att utföra betydande livsstilsförändringar. De komponenter som begränsade patienten var bland annat att rehabiliteringen inte ansågs vara individuellt anpassad men även att informationen som gavs av sjuksköterskan var bristande.    Slutsatser: Patienter som har drabbats av hjärtinfarkt behöver tydlig information för att de ska få kunskap och rätt verktyg till sin egenvård. Närstående och sjukvården är en viktig del av stödet då patienten ofta ställs inför prövningar i livet efter hjärtinfarkten, både fysiskt och mentalt.

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13121号 / 論社医博第10号 / 社新制||医||9(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川村 孝, 教授 妹尾 浩, 教授 福原 俊一 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

Bakgrund: Trots stark evidens för att fysisk aktivitet och träning vid kranskärlssjukdom är viktiga ur ett livslångt perspektiv för individer med kranskärlssjukdom finns begränsat med forskning kring vilka metoder som kan ha effekt på vidmakthållandet av fysisk aktivitet efter att individen genomgått den centerbaserade träningen. Syfte: Syftet med den här litteraturstudien var att granska effekten av vidmakthållande hjärtrehabilitering på fysisk aktivitet och fysisk kapacitet i sex månader eller mer hos individer med kranskärlssjukdom som genomgått centerbaserad hjärtrehabilitering. Vidare var syftet att undersöka kvalitet och tillförlitlighet i ingående artiklar.  Metod: Systematiska sökningar i databaserna AMED, PubMed och PsycINFO. Tio randomiserade kontrollerade studier inkluderades. Kvalitet bedömdes med PEDro-skalan och resultatens samlade tillförlitlighet bedömdes enligt SBU GRADE.  Resultat: Kvalitén på ingående artiklar var måttlig till medelgod. Tillförlitligheten bedömdes som mycket låg enligt SBU GRADE. Resultatet indikerade, trots stor variation av interventioner, att vidmakthållande hjärtrehabilitering kan ha effekt på fysisk aktivitet och till viss del på fysisk kapacitet (kondition). För muskelstyrka ses ingen effekt.  Konklusion: Kvalitén på de ingående artiklarna var måttlig till medelgod. Enskilda artiklar visar på signifikanta resultat som indikerar att vidmakthållande hjärtrehabilitering kan ha effekt på fysisk aktivitet och kapacitet hos individer med kranskärlssjukdom. Det sammanvägda resultatet för vidmakthållande hjärtrehabiliterings effekt på fysisk aktivitet hos individer med kranskärlssjukdom har låg tillförlitlighet bedömt med SBU GRADE. För vidmakthållande hjärtrehabiliterings effekt på fysisk kapacitet (kondition och styrka) bedöms tillförlitligheten som mycket låg. / Background: Despite evidence that physical activity and training in coronary artery disease are important from a lifelong perspective for individuals with coronary artery disease, there is limited research on which methods that can support physical activity maintenance after center-based training.  Aim: The aim of this literature study was to examine the effect of maintenance cardiac rehabilitation (M-CR) on physical activity and physical capacity for six months or more in individuals with coronary artery disease after center-based cardiac rehabilitation. The aim was also to examine the quality and reliability of included articles. Method: Systematic searches in the AMED, PubMed and PsycINFO databases. Ten randomized controlled trials were included. Quality was assessed using the PEDro scale.The overall reliability of the results was assessed according to SBU GRADE guidelines. Result: The quality of included articles was moderate to average. Reliability was assessed as low to very low according to SBU GRADE. The result indicated, despite variation of interventions, that M-CR can have an effect on physical activity and to some extent on physical capacity (fitness). For muscle strength, no significant effect is seen. Conclusion: Individual articles show significant results indicating that M-CR can have an effect on physical activity and capacity in individuals with coronary artery disease. The quality of the included articles was moderate to average. The overall reliability on physical activity was assessed as low according to SBU GRADE. And the overall reliability on physical capacity (fitness and muscle strength) was assessed as very low according to SBU GRADE.

No description available.