Made available in DSpace on 2014-06-11T19:22:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-10-11Bitstream added on 2014-06-13T19:08:25Z : No. of bitstreams: 1 bottcher_lb_me_rcla.pdf: 835026 bytes, checksum: 0b0dfd25252a19bd6bfa407b8820f384 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A hipertensão arterial (HA) tem sido indicada como o fator de risco conhecido de maior importância para a morbidade e mortalidade precoces causadas por doenças cardiovasculares (CDC, 1996). Programas regulares de atividade física (AF) são fator necessário na terapia de pacientes hipertensos. Estudos apontam uma relação inversa entre taxa de mortalidade por qualquer causa, AF e nível de aptidão física. Sabendo que a falta de AF piora o nível de aptidão física e é fator de risco para HA, se torna necessário avaliar em quais aspectos relacionados à aptidão física o hipertenso é diferente do normotenso. O objetivo do presente trabalho foi verificar se existe diferença na aptidão física entre hipertensos e normotensos; verificar se existe efeito da prática regular de AF sobre a aptidão física em hipertensos similar aquelas encontradas em normotensos e verificar se testes de flexibilidade, agilidade, coordenação, força e resistência aeróbia, discriminam os casos de HA. Participaram desse estudo 214 mulheres, com idades acima de 40 anos, que fizeram parte, por 6 meses, do Programa de Atividade Física. Todos os pacientes foram submetidos a uma avaliação para obtenção de medidas antropométricas e físicas (AAHPERD-Agilidade, coordenação, força, flexibilidade e resistência aeróbia. Elas foram divididos em 2 grupos: Hipertensos (GH, N =120) e Normotensos (GN, N= 94). Com os resultados da ANOVA é possível afirmar que hipertensos possuem pior condição inicial em relação à agilidade (GH média inicial = 24,2 + 0,4 seg. e o GN = 20,9 + 0,8 seg., p < 0,01), coordenação (GH média inicial = 17,5 + 0,7 seg. e o GN média inicial = 11,5 + 1,2 seg., p < 0,01) e resistência aeróbia (GH média inicial = 568,5 + 12,2 seg. e o GN média inicial = 506,8 + 21,7 seg., p < 0,02). Essa diferença entre os indivíduos na performance...

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Este estudo teve como objetivo avaliar à assistÃncia prÃ-natal de mulheres com SÃndrome Hipertensiva Gestacional. Estudo de avaliaÃÃo, descritivo, transversal com abordagem quantitativa, realizado na MEAC em Fortaleza. A amostra foi constituÃda por 230 mulheres admitidas na referida maternidade com diagnÃstico de SÃndrome Hipertensiva Gestacional (SHG). A coleta de dados ocorreu no perÃodo de marÃo a novembro de 2010, tendo sido utilizado um formulÃrio estruturado, alÃm de consultas aos prontuÃrios das participantes. A idade prevalente foi a faixa etÃria de 20-34anos com 134 (58,3%) mulheres, a maioria (65,7%) proveniente da capital. Das 230 mulheres 126 (54,8) eram primÃparas e 37 (16,1%) tinham histÃria prÃvia de prÃ-eclÃmpsia. Foram analisados separadamente 230 prontuÃrios, desses 194 gestantes foram admitidas por prÃ-eclÃmpsia correspondendo a 88,8%, porÃm com maior prevalÃncia a prÃ-eclÃmpsia grave, com 57,0% das internaÃÃes. Nos achados referentes aos fatores de risco, o principal fator associado à SHG foi a prÃ-eclÃmpsia prÃvia com 37(16,1%) casos, seguida de HAC 34 (14,8%). Entre os principais sinais e sintomas apresentados à admissÃo foram: aumento da PA num total de 200 mulheres, com uma mÃdia de PAS de 164,2 com DP 22,4, seguido por proteinÃria (148) e cefaleia (127). A idade gestacional variou de 18 a 42 semanas, com mÃdia de 36,4, obtendo DP de 3,82. A via de parto prevalente foi a cesÃrea com (77,4%). Quanto aos dados do prÃ-natal 147 (63,91%) mulheres iniciaram as consultas no primeiro trimestre, 121 (48,5%) realizaram de 6 a 13 consultas com uma mÃdia de 5,9 e DP de 2,2. Do total dessas mulheres 128 foram acompanhadas pelos dois profissionais mÃdico e enfermeiro. Observou-se a cobertura de todos os exames laboratoriais e procedimentos preconizados pelo PHPN, superiores a 80%, exceto a realizaÃÃo da segunda amostra dos seguintes exames: VDRL, Urina, HIV e Glicemia. Portanto, nÃo cumprindo o que à estabelecido pelo PHPN, ou seja, a realizaÃÃo desta segunda amostra em torno da 30 semana de gestaÃÃo. Conclui-se, portanto que o estudo tem sua relevÃncia por trilhar o percurso da assistÃncia prÃ-natal atà o desfecho no atendimento a nÃvel hospitalar, mostrando-nos os fatores relacionados ao acompanhamento prÃ-natal, reafirmando que a sua simples realizaÃÃo nÃo assegura a minimizaÃÃo do aparecimento da SHG, sendo fundamental o investimento qualitativo dessa aÃÃo. / This study aimed to evaluate prenatal care given to women with Gestational Hypertensive Syndrome. This is a descriptive, transversal and evaluation study with quantitative approach, held in the Maternity School Assis Chateaubriand (MEAC) in Fortaleza. The sample consisted of 230 women admitted at the maternity, diagnosed with Gestational Hypertensive Syndrome (GHS). The data was collected from March to November 2010, using a structured form and examination of the patientsâ medical records. Most women, 134 (58.3%), were between the age of 20-34years, being the majority (65.7%) from the capital. 126 (54.8%) of the 230 women were young first-time mothers and 37 (16.1%) had a prior history of preeclampsia. 230 medical records were individually analyzed. From this it was found that 194 pregnant women were admitted with preeclampsia corresponding to 88.8%. However severe preeclampsia was the higher prevalence with 57.0% of admissions. Regarding risk factors, the main factor associated with SHG was prior preeclampsia with 37 (16.1%) cases, followed by HAC with 34 (14.8%). Among the key signs and symptoms at the time of admission were: increased High blood pressure totaling 200 women, with an average Systolic blood pressure of 164.2 with DP of 22.4, followed by proteinuria (148), and headache (127). The gestational age ranged from 18 to 42 weeks, with an average of 36.4, with a DP of 3.82. Caesarean was the prevalent choice of childbirth (77.4%). Regarding the pre natal data, 147 (63.91%) women began their appointments in the first trimester, 121 (48.5%) attended from 6 to 13 appointments with an average of 5.9 and DP of 2.2. 128 of these women were accompanied by two professionals: a doctor and a nurse. All laboratory tests and procedures recommended by PHPN were noted, over 80%, excepting the second samples of the following tests: VDRL, urine, HIV and blood glucose. Therefore, not fulfilling what is established by PHPN, in other words, the running of the second sample around the 30th week of gestation. In conclusion, this study has its relevance by reinforcing the route of prenatal assistance until the outcome in the attendance at the hospital. It shows us the factors related to prenatal follow-up, reaffirming that the mere realization does not ensure the minimization of the emergence of GHS, being fundamental the qualitative investment of this action.

Background: In the United States, one-third of adults have hypertension (HTN). Among African American (AA) adults, 43% of men and 45.7% of women have HTN. HTN in the AA adult population is more severe and occurs earlier in life compared to Caucasian adults, putting them at increased risk for cardiovascular events and renal disease. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) Guideline Recommendations 7 and 8 were developed to aid in appropriate treatment and management of hypertensive AA adults. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to improve the care, management, and outcomes of hypertensive AA adults by identifying current JNC 8 guideline prescribing patterns among a sample of hospitalized patients. The first project aim was to determine provider-prescribing rates of thiazide diuretics (TDs) and calcium channel blockers (CCBs) in newly diagnosed AA adults with HTN. The second project aim was to determine if AA adults previously diagnosed with HTN were currently prescribed TD and/or CCB medications. Methods: A retrospective medical record review of AA adult patients with a new HTN diagnosis or previously diagnosed with HTN was selected for this project. Participants were discharged from Medical City Dallas between 01/01/2017 and 03/31/2017. Results: In newly diagnosed participants with HTN, none were prescribed a TD (0%) and two were prescribed a CCB (40%). In previously diagnosed participants with HTN, 30 participants (16.3%) were prescribed a TD and/or CCB upon admission and 29 participants (15.76%) were prescribed a TD and/or CCB upon discharge. Among prescribing providers, beta blockers and other class hypertensive medications (i.e., furosemide, hydralazine, clonidine, and spironolactone) were most widely ordered for participants. Conclusions: The results of this DNP project display low provider compliance rates to guideline-recommended pharmacological therapy AA adults. This outcome highlights several potential reasons for the low adherence rates, including lack of provider documentation, lack of provider rationale for treatment selections, provider knowledge of HTN CPGs, and data analysis of prescribed medications. These factors present the opportunity for further research to identify the root cause of low compliance.

Masters of Science / Hypertension is the leading cause of cardiovascular diseases worldwide. There is evidence of the rising incidence and prevalence of chronic diseases of lifestyle in developing countries. Physical activity has been regarded as a commonly accepted modality for treating hypertension. The aim of this study was to determine if physical activity levels are associated with hypertension among employees of Kigali Institute Science and Technology in Kigali, Rwanda. A quantitative, cross- sectional design was used and all staff members (325 employees) of Kigali Institute of Science and Technology (KIST) represented the study population. Random sampling was used to determine the study sample. Data was collected by means of a self-administered questionnaire adopted from The International Physical Activity Questionnaire (IPAQ).Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 15.0. Descriptive statistics using frequencies, percentages, means, and standard deviations and inferential statistics using Chi-square tests were employed. The data were presented with use of tables, figures, graphs, and pie charts. Ethical issues including obtaining permission for conducting the study,informed consent,anonymity,confidentiality, voluntary participation, and the right to withdraw from the study was observed in this study. The study found a prevalence of 34% participants with hypertension. The prevalence of hypertension was associated with age, smoking, drinking alcohol, suffering for diabetes mellitus, and body mass index (BMI). Over one-fifth of the participants in the physically active group were hypertensive while 68% of the participants in the physically inactive group were hypertensive. This study shows that hypertension status is strongly associated with physical activity levels [X² = 20.381 with(P<0.001)].The study further showed that smoking and suffering from diabetes mellitus were also associated with levels of physical activity (P = 0.003 and p = 0.004 respectively). The current study concludes that physical activity is needed for employees at Kigali Institute of Science and Technology as part of preventive measures for chronic diseases of lifestyle.Therefore, the recommendations were proposed to various categories of people and stakeholders to be actively involved in the promotion of physical activity among employees of Kigali Universities in Rwanda.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Hypertension is one of the most common non-communicable diseases, and it is the leading cause of cardiovascular diseases, death and disability worldwide, especially in developing countries. Physical activity has been regarded as a commonly accepted modality for preventing and treating hypertension. However, despite its known benefits, this modality of treatment and prevention of hypertension continues to be underused.The present study aimed to determine the demographic, social and health-related factors that are associated with levels of physical activity participation among adults with hypertension in Kigali, Rwanda. This cross-sectional study was conducted with 252 adults with hypertension and 87 healthcare professionals through the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and Physical Activity Exit Interview (PAEI). Two thirds of the participants (69.44%) were classified as sedentary. The following factors were found to be significantly (P<0.05) associated with the levels of physical activity:age, marital status, and level of education, residence, tobacco; past and current users, alcohol; current user, diabetes mellitus, BMI, perceived health status, self-efficacy, and blood pressure. None of the healthcare professionals were considered good physical activity counsellor. The findings of the present study highlight the need for the implementation of health promotion strategies aimed at promoting physical activity lifestyle among individuals with hypertension in Rwanda. Efforts should be made in educating people with hypertension on the benefits of integrating regular physical activity in their daily lives. Furthermore, healthcare professionals should be educated concerning how to promote physical activity to all patients especially those with hypertension.

Magister Public Health - MPH / Background: Adherence is the extent to which a person takes medication as prescribed by health-care providers. It includes both dosing regularity and timing of intake. Antihypertensive medication reduces high blood pressure effectively and reduces the risk of heart failure, renal failure and stroke. Hypertension is considered a public health problem due to its impact of high mortality and morbidity. According to the Namibia Ministry of Health and Social Services a total of 34,826 people, aged 18 years and older in the Windhoek District, were diagnosed with hypertension in 2006-2007; the premature death toll due to uncontrolled hypertension increased from 88 deaths per 1,000 cases in 2006 (MOHSS, 2006) to 301 deaths per 1,000 cases in 2007 (MOHSS, 2007). Despite the availability, accessibility and affordability of medication at clinics and health centers, non-adherence is increasing, especially among the young productive population. The purpose of this study was to gain an understanding into the perceptions of non-adherent hypertension patients in Katutura Township in the Windhoek District about their treatment regimens. The research provided information that can be used by policy-makers in the development of a hypertension policy to improve interventions. Aim: The study aimed to explore the perceptions of non-adherent hypertensive patients in Katutura Township by looking at what they considered to be the factors influencing their non-adherence to antihypertensive medication. Methodology: An explorative qualitative study was conducted, using individual in-depth interviews among eight non-adherent hypertension patients, aged 35 years and older. The eligible respondents were purposively selected. A thematic content analysis of transcribed data was conducted where themes were related to patients‟ perceptions for non–adherence. Results: The results showed that the respondents were not adhering to medication. There were several reasons given for this. An important factor was their limited knowledge about the hypertension disease and medication, in part due to ineffective health education. Other factors included the side effects of the medication as well as the belief that antihypertensive medications are poisonous and addictive. Cultural and religious beliefs were also found to be contributing factors to non-adherence. The findings also revealed that the doctors appeared not to have time to examine patients. The attitudes of the nurses were identified as factors that influence non-adherence. It is reported that they do not listen to patients‟ complaints and patients do not feel respected by them. Additional factors included the cost of traveling to the health center which was considered to be prohibitive, long distances to get to the health center as well as 3-5 hours waiting time at the health center influenced non-adherence. Some respondents claimed that they do not want to mix medication with alcohol so that when they are drinking alcohol, they skip their medications. Lastly, some of the patients earn low income and as they are paid per hour, they cannot afford to take time off from work and this further results in non-adherence to medication. Conclusion: The findings concurred with findings of other research done in developing and developed countries. These included poor interpersonal relationships between health-care providers and patients, a lack of knowledge about hypertension and its treatment; cultural beliefs and traditions, and standards of health care provision. Improvement in communication between health-workers and hypertensive patients may promote better adherence. The study indicates an urgent need to design intervention measures to enhance adherence among hypertension patients.

Health care provider perceptions of typical practices play a significant role in evaluating the efficacy of screening and diagnosis of teen high blood pressure in African Americans. African American adults are more likely to develop high blood pressure than are any other ethnic group; however, there is a gap in the literature concerning high blood pressure in teens. Approximately 1 to 5 of every 100 children has high blood pressure. This purpose of this phenomenological study was to explore the perspectives of health care providers on high blood pressure screening and diagnosis of African American asymptomatic teens. The health belief model (HBM) was the conceptual framework used to describe how beliefs and attitudes influence provider high blood pressure screening. Purposive sampling resulted in 9 health care providers (8 pediatricians and 1family medicine physician), who completed a hypertension survey and individual interview. Data were coded and analyzed using thematic analysis. Atlas.ti was used for data management. Theoretical saturation was reached after 9 interviews. Emergent themes included observations from the participants that the absence of initial standardized high blood pressure screening for teens is a significant problem and that age-appropriate high blood pressure resources are not used consistently. Study results contribute to social change by providing an opportunity for heightened awareness and education among health care providers in teen high blood pressure screening and diagnosis processing. Ongoing education and research may engender proactive steps to develop universal guidelines, tools and practices to consistently and accurately detect high blood pressure in teens.

Intimate partner violence (IPV) is a public health issue that transcends cultures and nationalities. Women and men have been impacted by sexual violence through rape and other types of IPV. Each year, women experience IPV before and during pregnancies and are impacted by physical and psychological outcomes as a result. The purpose of the study was to examine the impact of IPV on the health outcomes of diabetes (Types 1, 2, and gestational), high blood pressure before pregnancy, and depression/anxiety among adult women before and during pregnancy. The social ecological model provided the framework for this quantitative cross-sectional study that included national data from the Pregnancy Risk Assessment Monitoring System between 2012 and 2015. A series of binary logistic regressions was conducted. Findings indicated significant predictive relationships between IPV and diabetes before pregnancy (OR = 1.20, 95% CI = 1.01-1.43), high blood pressure before pregnancy (OR = 1.65, 95% CI =1.47-1.85), and depression/anxiety before and during pregnancy, respectively (OR = 3.14, 95% CI 2.91-3.35 and OR = 9.03, 95% CI 7.37-11.05) after controlling for age, income, and race. A social change implication of this study is that results from this project may assist in increasing societal knowledge of what IPV is and its physical and psychological impacts on women before and during pregnancy.

This integrative review of the literature focused on sodium (Na) content in drinking water (H?O) supplies and the subsequent effect on blood pressure levels in children. Studies for this review were drawn from the Cumulative Index of Nursing and Allied Health, PubMED, Science and Technology Databases, PsychInfo, United States (US) Environmental Protection Agency (EPA) and EPA in Florida websites. Criterion for inclusion in the data base searches were hypertension, high blood pressure, sodium in drinking water, drinking water salinity, children or preg'. Subsequently, further article selection criteria included children (under 18 years of age) and published in the English language (N=59). Findings of the review as summarized in this thesis could guide nursing research, education, policy and practice related to primary, secondary and tertiary interventions associated with sodium levels in drinking as a contributing factor to blood pressure levels in children.

PURPOSE: Hypertension (HTN) affects one in every three adults in the United States. Often associated with the older population, this silent killer has emerged in an unsuspecting group, young military soldiers. With the rapid succession of multiple deployments, long intervals between blood pressure (BP) assessments, and the absence of cardiovascular (CV) measures during the pre and post deployment health screenings; soldiers may be at higher risk for HTN than their civilian counterparts of the same age. The purpose of this study was to explore real-time continuous CV measures of soldiers before, during, and after exposure to a simulated combat stressor as well as to assess which personal characteristics played a significant role. METHODS: Applying the Allostasis/Allostatic Load theoretical framework, a repeated measure quasi-experimental design was used to compare the CV measures of two groups: one exposed to a physical combat stressor (experimental) and the other exposed to a psychological combat stressor (control). A convenience sample of 60 college Army Reserve Officer Training Corps cadets were fitted with Tiba Medical Ambulo 2400 ambulatory BP monitors for 48 continuous hours. Several CV indices were analyzed using one-way Analysis of Variance (ANOVA), paired t-test, and independent sample t-test. Four instruments (Participant Information Sheet, State-Trait Anxiety Inventory, Paintball Perceived Stress Questionnaire, and Army Physical Fitness Test) were used to assess which characteristics played the most significant role in the CV response. RESULTS: Demographic characteristics between the two 30-cadet groups were not statistically different, with the exception of deployment history (experimental = 4, control= 0). Hours after the stress exposure, subjects in the experimental group had a higher mean awake systolic blood pressure (SBP) when compared to the control group (113.76 mm Hg vs 102.98 mm Hg, p= 009). When assessing pre and post stressor morning BP surge and evening BP decline, the control group showed the biggest change. Significant bivariate correlations (p > .05) found that: Females consistently had higher pulse rates (PR) throughout each of the phases. Age positively correlated with elevated BP during the stressor, and increased morning BP surge post stressor. African Americans had higher sleep BPs pre stressor, and decreased SBP recovery post stressor; Hispanics had higher PRs during and after the stressor. Waist circumference positively correlated with elevated BP morning surge pre stressor but, body mass index (BMI) positively correlated with elevated BP morning surge post stressor as well as elevated BP during the stressor. Family history of HTN played no significant role; however, deployment history correlated with mean awake SBP post stressor. Trait anxiety scores negatively correlated with SBP recovery while state anxiety scores positively correlated with post stressor awake mean arterial pressure and evening SPB decline. Perceived stress during the stressor negatively correlated with post stressor SBP morning surge with females reporting higher anxiety and stress. Finally, Army Physical Fitness (APFT) total scores as well as APFT run scores negatively correlated with pre and post stressor sleep PRs. DISCUSSION/IMPLICATIONS: Age, female gender, African American descent, Hispanic ethnicity, waist circumference, BMI, previous deployment history, level of fitness and the psychological stress state during and after a stressor played significant roles in soldiers' CV response. SBP was the most dynamic and informative of the CV indices and a psychological stressor was comparable to a physical stressor when observing the residual effect of stress. If a combat exercise was enough of a stressor to produce residual CV effects that lasted well into following morning, the residual effect of a lengthy strenuous deployment may be alarming. This study not only provided a snapshot of the CV health of incoming young soldiers, but also provided evidence to support policy change regarding the implementation of regular CV health assessments before and after deployment.