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A Hipertensão Arterial Sistêmica (HAS) é uma doença crônica não transmissível com etiologia multifatorial e uma das principais causas de doenças cardiovasculares que são responsáveis pela maioria das mortes mundiais. Por ser tratar de uma doença de alta prevalência e na maioria das vezes assintomática, a adesão do hipertenso ao tratamento tem uma representação muito baixa, o que requer a intervenção educacional dos profissionais da saúde no tratamento, na prevenção das complicações e na manutenção da vida. A qualidade de vida relacionada à saúde (QVRS) dos indivíduos com hipertensão arterial é menor comparada com a população geral. A avaliação dos fatores que influenciam na QVRS dos hipertensos pode servir de subsídios no planejamento de estratégias de tratamento mais eficazes para essa população. Objetivos: Caracterizar os indivíduos com hipertensão arterial participantes do grupo de convivência educativa segundo as variáveis: sócio-demográficas e econômica; hábitos de vida (atividade física, tabagismo, consumo de bebida alcoólica); dados relacionados a HAS(co-morbidades, uso de medicamentos anti-hipertensivos, controle dos níveis pressóricos, tempo de progressão da HAS) e tempo de participação nas atividades educativas em grupo, comparar a QVRS entre hipertensos participantes do grupo de convivência educativa com as variáveis sócio-demográficas, econômicas e clínicas e avaliar a contribuição do grupo de convivência na qualidade de vida dos hipertensos. Material e Métodos: Foi realizado um estudo descritivo do tipo transversal com 131 sujeitos com idade superior a 18 anos e diagnóstico de hipertensão arterial, residentes no município de Sacramento-MG, cadastrados no grupo de convivência no período mínimo de um ano anterior a data da entrevista. Os instrumentos utilizados para a coleta de dados foram: instrumento para caracterização da população quanto aos dados clínicos e sóciodemográficos e econômicos e o Medical Outcomes Short-Form Health Survey (SF-36) para avaliação da QVRS. Resultados: Dos pacientes, 98 eram mulheres e 33 homens, a maioria idosa 88(67,2%), com predomínio na faixa etária de 60 a 69 anos 43(32,8%) e ganham igual ou menos que um salário mínimo por mês 88(67,2%). As dimensões do SF-36 que obtiveram menores escores foram: vitalidade (64,4) e dor (70,3), enquanto as dimensões que apresentaram maiores escores foram: aspectos sociais (86,7) e capacidade funcional (79,4). Os fatores que apresentaram relação com a variação dos escores médios e correlação das dimensões do SF-36 foram: renda, atividade física, número de morbidades, diabetes, obesidade. A participação no grupo apresentou relação estatisticamente significante apenas no domínio saúde mental. Conclusão: Clinicamente os resultados mostraram relevância para intervenções educativas pela equipe de saúde. Os enfermeiros como elementos constituintes destas equipes devem estar presentes e ativos em todas as etapas desse trabalho, desde o planejamento, execução e avaliação colaborando na busca de meios efetivos que vão de encontro com a melhoria da qualidade de vida dessa população. / Arterial Hypertension is a non-transmissible chronic disease with multifactorial etiology and it is one of the main causes of cardiovascular diseases which are the leading cause of death in the world. Since the disease is characterized as having a high prevalence rate and in most cases it is asymptomatic, the treatment adherence rate is low, therefore requiring educational intervention from health professionals during the treatment in order to prevent complications and to keep the patient alive. Health-related quality of life (HRQoL) in patients with high blood pressure is reduced when compared to the general population. The evaluation of factors influencing on the HRQoL of high blood pressure patients point to the strategic planning of more efficient treatments to this population. Aims: Characterize the high blood pressure patients participating in the educational gathering group according to the following variables: socio-demographics and economics; lifestyles (physical activity, smoking, drinking); data related to systemic arterial hypertension (comorbidity, use of antidepressive drugs, blood pressure rate control, systemic arterial hypertension progression rate) and participation time in educational group activities, comparison of HRQoL among the group participating patients with the socio-demographical, economical and clinical variables and evaluate the contribution of the group to the quality of life of the participating patients. Methods and Materials: It was performed a descriptive cross-sectional study with 131 individuals over 18 years of age who suffered from high blood pressure. The patients lived in the city of Sacramento ? MG and had been participating in the gathering group for at least one year prior to the interview. The following tools were used to collect the data: Tools to characterize the population according to clinical, socio-demographical and economical data; Medical Outcomes Short-Form Health Survey (SF-36) to evaluate HRQoL. Results: From the total of 131 patients, 98 were female and 33 were male. Most of them (88 patients or 67.2%) were in an advanced age ranging from 60 to 69 years old (43 patients or 32.8%) and earned minimal wage or less (88 patients or 67.2%). The SF-36 dimensions with the lowest scores were: Vitality (64.4) and pain (70.3), whereas the dimensions with the highest scores were: Social functioning (86.7) and functional status (79.4). The factors presenting relation to the average score variation and dimension correlation in the SF-36 were: Income; physical activity; death rate; diabetes, obesity. The participation in the group was statiscally significant relation only to the mental health dimension. Conclusion: The results clinically showed the relevance of educational interventions performed by the health team. The nurses, as part of this team, must be present and active in all the stages of this work, planning, performing and searching for effective methods that lead to the improvement of life quality for this population.

The transcranial direct current stimulation (tDCS) is a neuromodulatory technique able to modify cortical excitability and presumably modulate the neural activity of cortical areas involved in autonomic regulation, such as the medial prefrontal cortex (MFPC) and insular cortex (IC). Regarding the ANS, there is evidence of hyper-sympathetic activation in people with HTN. To contribute to the discussion, this thesis was divided as follows: The first chapter titled "Heart rate variability (HRV): analytical methods and their applicability " consists of a review article, aiming at the theoretical foundation about methods of assessment of HRV and its prospects for use. The second chapter consists of an original paper entitled "Effect of transcranial direct current stimulation on heart rate variability in hypertensive women". This research applied anodal tDCS, cathodic and simulated (sham) separately on the left temporal lobe (T3) of hypertensive women showed significant increases in parasympathetic activity, only with the application of cathodic tDCS. However, one cannot say which specific area of the brain was responsible for variations in HRV, since the two electrodes were about regions involved in autonomic control and still not know what the real impact of bipolar stimulation on brain physiology. Although there are limitations, our results may assist in developing a new tool to explore noninvasively the autonomic nervous system, and even open new therapeutic perspectives for treatment of their disorders such as hypertension. / Fundação de Amparo a Pesquisa do Estado de Alagoas / A estimulação transcraniana por corrente contínua (ETCC) é uma técnica neuromodulatória capaz de modificar a excitabilidade cortical e supostamente modular a atividade neural de áreas corticais envolvidas na regulação autonômica, como o córtex pré-frontal medial (CPFM) e o córtex insular (CI). Com relação ao SNA, existem evidências de hiper-ativação simpática em pessoas com HAS. Para colaborar com a discussão, esta dissertação foi dividida da seguinte forma: o primeiro capítulo intitulado de Variabilidade da frequência cardíaca (VFC): métodos de análise e sua aplicabilidade , sendo constituído por um artigo de revisão, objetivando a fundamentação teórica a respeito dos métodos de avaliação da VFC e suas perspectivas de utilização. O segundo capítulo é composto por um artigo original intitulado: Efeitos da estimulação transcraniana por corrente contínua sobre a variabilidade da frequência cardíaca de mulheres hipertensas . Neste estudo foi aplicada a ETCC anódica, catódica e simulada (sham), separadamente, sobre o lobo temporal esquerdo (T3) de mulheres hipertensas e evidenciou aumentos significativos na atividade parassimpática, somente com a aplicação da ETCC catódica. Todavia, não se pode afirmar qual área específica do cérebro foi responsável pelas variações na VFC, pois, os dois eletrodos estavam sobre regiões envolvidas no controle autonômico e ainda não sabemos qual o real impacto da estimulação bipolar no cérebro sobre parâmetros fisiológicos. Embora haja limitações, nossos resultados podem auxiliar no desenvolvimento de uma nova ferramenta para explorar de forma não invasiva o sistema nervoso autônomo, e até mesmo abrir novas perspectivas terapêuticas para tratamento de seus distúrbios como é o caso da hipertensão.

A Hipertensão Arterial Sistêmica (HAS) é uma doença crônica não transmissível com etiologia multifatorial e uma das principais causas de doenças cardiovasculares que são responsáveis pela maioria das mortes mundiais. Por ser tratar de uma doença de alta prevalência e na maioria das vezes assintomática, a adesão do hipertenso ao tratamento tem uma representação muito baixa, o que requer a intervenção educacional dos profissionais da saúde no tratamento, na prevenção das complicações e na manutenção da vida. A qualidade de vida relacionada à saúde (QVRS) dos indivíduos com hipertensão arterial é menor comparada com a população geral. A avaliação dos fatores que influenciam na QVRS dos hipertensos pode servir de subsídios no planejamento de estratégias de tratamento mais eficazes para essa população. Objetivos: Caracterizar os indivíduos com hipertensão arterial participantes do grupo de convivência educativa segundo as variáveis: sócio-demográficas e econômica; hábitos de vida (atividade física, tabagismo, consumo de bebida alcoólica); dados relacionados a HAS(co-morbidades, uso de medicamentos anti-hipertensivos, controle dos níveis pressóricos, tempo de progressão da HAS) e tempo de participação nas atividades educativas em grupo, comparar a QVRS entre hipertensos participantes do grupo de convivência educativa com as variáveis sócio-demográficas, econômicas e clínicas e avaliar a contribuição do grupo de convivência na qualidade de vida dos hipertensos. Material e Métodos: Foi realizado um estudo descritivo do tipo transversal com 131 sujeitos com idade superior a 18 anos e diagnóstico de hipertensão arterial, residentes no município de Sacramento-MG, cadastrados no grupo de convivência no período mínimo de um ano anterior a data da entrevista. Os instrumentos utilizados para a coleta de dados foram: instrumento para caracterização da população quanto aos dados clínicos e sóciodemográficos e econômicos e o Medical Outcomes Short-Form Health Survey (SF-36) para avaliação da QVRS. Resultados: Dos pacientes, 98 eram mulheres e 33 homens, a maioria idosa 88(67,2%), com predomínio na faixa etária de 60 a 69 anos 43(32,8%) e ganham igual ou menos que um salário mínimo por mês 88(67,2%). As dimensões do SF-36 que obtiveram menores escores foram: vitalidade (64,4) e dor (70,3), enquanto as dimensões que apresentaram maiores escores foram: aspectos sociais (86,7) e capacidade funcional (79,4). Os fatores que apresentaram relação com a variação dos escores médios e correlação das dimensões do SF-36 foram: renda, atividade física, número de morbidades, diabetes, obesidade. A participação no grupo apresentou relação estatisticamente significante apenas no domínio saúde mental. Conclusão: Clinicamente os resultados mostraram relevância para intervenções educativas pela equipe de saúde. Os enfermeiros como elementos constituintes destas equipes devem estar presentes e ativos em todas as etapas desse trabalho, desde o planejamento, execução e avaliação colaborando na busca de meios efetivos que vão de encontro com a melhoria da qualidade de vida dessa população. / Arterial Hypertension is a non-transmissible chronic disease with multifactorial etiology and it is one of the main causes of cardiovascular diseases which are the leading cause of death in the world. Since the disease is characterized as having a high prevalence rate and in most cases it is asymptomatic, the treatment adherence rate is low, therefore requiring educational intervention from health professionals during the treatment in order to prevent complications and to keep the patient alive. Health-related quality of life (HRQoL) in patients with high blood pressure is reduced when compared to the general population. The evaluation of factors influencing on the HRQoL of high blood pressure patients point to the strategic planning of more efficient treatments to this population. Aims: Characterize the high blood pressure patients participating in the educational gathering group according to the following variables: socio-demographics and economics; lifestyles (physical activity, smoking, drinking); data related to systemic arterial hypertension (comorbidity, use of antidepressive drugs, blood pressure rate control, systemic arterial hypertension progression rate) and participation time in educational group activities, comparison of HRQoL among the group participating patients with the socio-demographical, economical and clinical variables and evaluate the contribution of the group to the quality of life of the participating patients. Methods and Materials: It was performed a descriptive cross-sectional study with 131 individuals over 18 years of age who suffered from high blood pressure. The patients lived in the city of Sacramento ? MG and had been participating in the gathering group for at least one year prior to the interview. The following tools were used to collect the data: Tools to characterize the population according to clinical, socio-demographical and economical data; Medical Outcomes Short-Form Health Survey (SF-36) to evaluate HRQoL. Results: From the total of 131 patients, 98 were female and 33 were male. Most of them (88 patients or 67.2%) were in an advanced age ranging from 60 to 69 years old (43 patients or 32.8%) and earned minimal wage or less (88 patients or 67.2%). The SF-36 dimensions with the lowest scores were: Vitality (64.4) and pain (70.3), whereas the dimensions with the highest scores were: Social functioning (86.7) and functional status (79.4). The factors presenting relation to the average score variation and dimension correlation in the SF-36 were: Income; physical activity; death rate; diabetes, obesity. The participation in the group was statiscally significant relation only to the mental health dimension. Conclusion: The results clinically showed the relevance of educational interventions performed by the health team. The nurses, as part of this team, must be present and active in all the stages of this work, planning, performing and searching for effective methods that lead to the improvement of life quality for this population.

MPH / Department of Public Health / High blood pressure is a global public health problem. High blood pressure shows no signs or symptoms and it can only be detected through BP measurements by a health professionals. It’s a chronic condition which requires long term management. Poor control of high blood pressure can lead to complications and even death. The aim of the study was to determine the prevalence of high blood pressure among University of Venda academic staff. UNIVEN is situated in Thohoyandou, Vhembe District in Limpopo. A cross-sectional design was used. A modified WHO stepwise questionnaire for non-communicable diseases version 3.1 was used to collect data regarding demographic characteristics, BP status, and stress and lifestyle characteristics. Charts and graphs were used to present the results of the study. The Statistical Package of Social Sciences was used to analyse data. The Chi-square test was used to determine the association between blood pressure and risk factors. A total of 179 respondents were selected, their ages of were ranged from 22 to 68 years. Their blood pressure, weight and height of the participants were also measured. The prevalence of high blood pressure was 20%, while 46% were on prehypertension stage and about 34% had a normal BP. About 23% had been previously diagnosed with HBP, while about 90% were on treatment for high blood pressure. Only 13% had their BP under control. The prevalence of high blood pressure was associated with gender, family history, vegetable intake and diabetes. Department of Sports need to introduce sports among academic staff as a way of prevention and management of high blood pressure.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Pre-eclampsia is a common and dangerous condition of pregnancy. During clinical care the sensitive obstetrician will frequently recognise moral ambiguity and ethical conflicts. It is important to understand the pertinent issues and find ways of resolving them. Counselling is an important element of modern medicine. In deciding which counselling model to apply, clinicians must consider many variables including the particular clinical scenario, strength of evidence, and the justifiable limits of paternalism and autonomy in a position of shared responsibility. Couples have a moral right to procreate even when the pursuit of pregnancy involves significant risks. However, with their understanding of care ethics as well as rights ethics, informed women are well placed to negotiate the extremes of these positions when deciding whether to risk a pregnancy or not. The concept of the “fetal patient” is a helpful one. An autonomous woman may choose to confer or deny this status to her previable fetus, while obstetricians must balance autonomy- and beneficence-based obligations to the pregnant woman with beneficence-based obligations to her fetus. Maternal behaviour that harms the fetus and future child is categorised as maternal-fetal conflict. However, any pregnant woman is morally required to avoid harming the fetus, if this can be done without sacrificing her own important interests. The term non-compliance implies a hierarchical nature in the doctor-patient relationship. This reduces patient agency, erodes trust and conflicts with informed choice. Although sometimes justified, this “label” generally does more harm than good. Expectant management of early pre-eclampsia recognises that neonatal intensive care is an expensive and limited resource. The ultimate goal of expectant management remains the safety of the mother and the delivery of a live infant who will not require intensive and prolonged neonatal care. This judicious use of neonatal intensive care improves distributive justice but by consenting to expectant management as an inpatient, the pregnant woman voluntarily restricts her freedom. The decision is morally undergirded by the value accorded to the viable fetus and the scientific evidence informing the decision. When an extremely preterm, growth restricted fetus requires delivery, resuscitation may become an issue for consideration. The distinction between withholding resuscitation in such cases, or initiating but later withdrawing care is morally irrelevant. Categories of optional and obligatory treatments are more helpful, but perinatologists must determine treatment thresholds through understanding the relevant data and ethics issues. Finally, women do not lose their rights when they become terminally ill. When an undelivered woman is declared brain dead following complications of pre-eclampsia, her doctors and family must formulate clear plans for her and her living fetus. She must still be treated with respect and her right to die with dignity not forgotten. Extension of somatic support to optimise the outcome of her fetus can be supported ethically provided that the fetus is at the threshold of viability, the support is not prolonged (distributive justice), advanced level support is available with a successful outcome likely, and that doctors and family are in clear agreement. / AFRIKAANSE OPSOMMING: Pre-eklampsie is ‘n algemene en gevaarlike toestand van swangerskap. Die verloskundige met ‘n fyn waarnemingsvermoë sal dikwels morele dubbelsinnigheid en etiese konflik tydens kliniese sorg erken. Dit is belangrik om die kernaspekte te verstaan en maniere te vind om dit op te los. Berading is ‘n belangrike komponent van moderne geneeskunde. Tydens besluitneming oor watter model van berading toegepas moet word, moet klinici ‘n aantal veranderlikes teen mekaar opweeg insluitend die spesifieke kliniese senario, sterkte van die getuienis, die geregverdigde perke van paternalisme en outonomie in ‘n posisie van gedeelde verantwoordelikheid. Die egpare het ‘n morele reg om voort te plant selfs wanneer die verlange na swangerskap betekenisvolle risiko’s inhou. Vrouens wat goed ingelig is, het die vermoë om die uiterstes van etiek van sorg en regte teen mekaar op te weeg wanneer hulle besluit om die risiko van swangerskap te loop. Die konsep van “fetus as pasiënt” kan wel tot verdere besluitneming bydra. Die outonome vrou mag self besluit of die fetus daardie status het. Aan die ander kant moet die verloskundige outonomie en goedwilligheid- (“beneficence”) gebasseerde verpligtinge teenoor die swanger vrou opweeg teen die goedwilligheid-gebasseerde verpligting teenoor haar fetus. Moederlike gedrag wat die fetus en toekomstige kind skend, word as ‘n moeder-fetus konflik beskou. Enige swanger vrou is egter moreel verplig om nie die fetus skade te berokken nie, mits dit gedoen kan word sonder die prysgawe van haar eie noodsaaklike belange. Die term “nie-inskiklikheid” (“non-compliance”) impliseer hiërargie in die dokter-pasiëntverhouding. Hierdie hiërargie doen afbreuk aan die besluitneming van die pasiënt, ondermyn vertroue en bots met ingeligte keuses. Alhoewel besluitneming op grond van hiërargies-gebaseerde gesag soms geregverdig is, veroorsaak hierdie kategorisering gewoonlik meer kwaad as goed. Afwagtende hantering van vroeë pre-eklampsie gaan van die standpunt uit dat neonatale intensiewe sorg ‘n duur en skaars hulpbron is. Die uiteindelike doel van afwagtende hantering bly die veiligheid en gesondheid van die ma en die verlossing van ‘n lewendige baba wat nie verlengde intensiewe- en neonatale sorg benodig nie. Hierdie oordeelkundige gebruik van neonatale sorg bevorder distributiewe geregtigheid, maar wanneer sy toestemming gee tot afwagtende behandeling as binnepasiënt, beperk die swanger vrou vrywilliglik haar vryheid. Hierdie besluit word moreel ondersteun deur die waarde wat aan die lewensvatbare fetus toegevoeg word en die wetenskaplike gronde waarop die besluit berus. Wanneer ‘n erge voortydse, groeivertraagde fetus verlossing benodig, word ressussitasie soms iets wat oorweeg moet word. Die onderskeid tussen die weerhouding van ressussitasie in sulke gevalle en die onttrekking van sorg waar dit aanvanklik begin is, is moreel irrelevant. Kategorieë van opsionele en verpligte behandelings is meer behulpsaam, maar perinatoloë moet die behandelingsdrempels bepaal deur die relevante data en etiek te verstaan. Laastens, vroue verloor nie hul regte wanneer hulle terminaal siek word nie. Wanneer die komplikasies van pre-eklampsie breindood van die vrou veroorsaak voor die verlossing van haar baba, moet haar dokters en familie duidelike planne vir die hantering van haar en haar fetus ontwikkel. Sy moet nogsteeds met respek behandel word en haar reg om met waardigheid te sterf, mag nie uit die oog verloor word nie. Verlenging van die ondersteuning van lewensfunksies om die uitkoms van haar fetus te verbeter, kan eties ondersteun word, mits die fetus na aan lewensvatbaarheid is, die ondersteuning nie te lank duur nie (distributiewe geregtigheid), gevorderde ondersteuning beskikbaar is met ‘n goeie kans vir suksesvolle uitkoms en dat die dokters en familie ten volle saamstem.

BACKGROUND: Several studies have demonstrated the association between the time to hypertension event and multiple baseline measurements for adults, yet other survival cardiovascular disease (CVD) outcomes such as high cholesterol and heart attack have been somewhat less considered. The Fels Longitudinal Study (FLS) provides us an opportunity to connect adult blood pressure (BP) at certain ages to the time to first CVD outcomes. The availability of long-term serial BP measurements from FLS also potentially allows us to evaluate if the trend of the measured BP biomarkers over time predicts survival outcomes in adulthood through statistical modeling. METHODS: When the reference standard is right-censored time-to-event (survival) outcome, the C index or concordance C, is commonly used as a summary measure of discrimination between a survival outcome that is possibly right censored and a predictive-score variable, say, a measured biomarker or a composite-score output from a statistical model that combines multiple biomarkers. When we have subjects longitudinally followed up, it is of primary interest to assess if some baseline measurements predict the time-to-event outcome. Specifically, in this study, systolic blood pressure, diastolic blood pressure, as well as their variation over time, are considered predictive biomarkers, and we assess their predictive ability for certain time-to-event outcomes in terms of the C index. RESULTS: There are a few summary C index differences that are statistically significant in predicting and discriminating certain CVD metric at certain age stage, though some of these differences are altered in the presence of medicine treatment and lifestyle characteristics. The variation of systolic BP measures over time has a significantly different predicting ability comparing with systolic BP measures at certain given time point, for predicting certain survival outcome such as high cholesterol level. CONCLUSIONS: Adult systolic and diastolic BP measurements may have significantly different ability in predicting time to first CVD events. The fluctuation of BP measurements over time may have better association than BP measurement at a single baseline time point, with the time to first CVD events.

INTRODUÇÃO: As doenças crônicas decorrentes do envelhecimento e o estilo de vida não saudável são os grandes fatores responsáveis pela alta morbi-mortalidade e pela grande sobrecarga no sistema de saúde. OBJETIVO: Este estudo analisa a prevalência de hipertensão e diabetes na população de 60 anos ou mais no município de São Paulo - capital e a utilização dos serviços de saúde segundo as variáveis demográficas e socioeconômicas, condições de saúde e estilo de vida. MÉTODOS: Inquérito domiciliar de saúde do tipo transversal que analisou os dados de 872 idosos residentes no município de São Paulo (ISA- Capital) por meio de um questionário dividido em blocos temáticos aplicado em uma amostra por conglomerados e estratificada segundo a escolaridade do chefe de família e nível socioeconômico. Análises bivariadas e multivariadas foram realizadas e geraram três modelos de regressão múltipla de Poisson para verificar a existência de fatores associados à hipertensão, diabetes e à utilização dos serviços. RESULTADOS: A prevalência de hipertensão referida entre os idosos foi de 46,9% e de diabetes 17,9%, valores superiores ao encontrado na população adulta. As maiores taxas de hipertensão foram encontradas entre os idosos que referiram auto-avaliação de saúde ruim/muito ruim e boa, entre os idosos que nunca beberam ou não bebem mais, entre as mulheres e entre os que se hospitalizaram pelo menos uma vez no último ano, independente da idade. Para diabetes, o mesmo resultado foi encontrado para autoavaliação de saúde, entre os viúvos e entre os idosos que se hospitalizaram pelo menos uma vez no último ano. Quanto ao uso do serviço de saúde pelos idosos em geral, a prevalência de utilização foi aproximadamente 30,6% independente de morbidade. Entre os hipertensos, 59.4% procuraram os serviços e 97,1% deles foi atendido no serviço. Entre os diabéticos 53,4% e 96,1% respectivamente sem diferença na procura ou no uso dos serviços entre os que tinham e não tinham hipertensão e diabetes. Em relação às medidas e práticas de controle sobre a HAS e DM, a medida de controle mais conhecida e praticada entre os hipertensos é tomar a medicação de rotina para controle da doença e entre os diabéticos a mais conhecida é a dieta alimentar e praticada é tomar medicação oral de rotina com distinção do nível socioeconômico para algumas medidas. CONCLUSAO: A falta de informação, conhecimento e utilização de medidas de controle destas doenças ainda são insuficientes entre os idosos. Fazem-se necessárias políticas de saúde com foco na capacitação de profissionais e na orientação familiar; enfim, políticas que incentivem não só mudanças no estilo de vida dos idosos, mas que os tornem sujeitos ativos desta mudança, atuantes neste processo. / INTRODUCTION: Chronic diseases due to the ageing process and to the unhealthy lifestyle are the greatest factors responsible for the high morbimortality and for the health system overload. OBJECTIVE: This study analyzes the prevalence of Hypertension and Diabetes of a population over 60 years old from São Paulo city, and the use of health services according to demographic and socioeconomic variables, health status, and lifestyle. METHODS: A cross-sectional household health survey analyzed data from 872 elderly resident in São Paulo city using a questionnaire divided into thematic blocks applied in a stratified cluster sample according to the educational level of the head of the family and socioeconomic level. Bivariate and multivariate analysis were carried out and generated three models of Poisson regression model in order to verify the existence of factors associated to hypertension, to diabetes and to the use of health services. RESULTS: The prevalence of reported hypertension among the elderly was 46.9% and of Diabetes, 17.9%. Such values were above the ones found in the adult population. The highest hypertension rates were found among the elderly who reported bad/verybad health status, among those who never drank or those who stopped drinking, among women, and among those who were hospitalized at least twelve months prior to the interview, independently of the age. Concerning diabetes, the same result was found for the self-assessment of health, among widows and widowers, and among the elderly who were hospitalized at least once in the past year. Concerning the use of health services by the elderly, the prevalence of use was approximately 30.6% independently of the morbidity. Among the elderly with hypertension, 70.1% searched for the service because of the hypertension, 59.4% of them did it because of reported morbidity, and 97.1% of them were assisted by the service they searched. Among the diabetic, 69.9% routinely searched for the service because of the diabetes, 53.4% of them did it because of reported morbidity and 96.1% were assisted by the service they searched, with no difference regarding the search and use of services between those with and without hypertension and diabetes. Concerning the measures and control practice of HAS and DM, the most known and practiced control measure among the elderly with hypertension is taking routine medicine for the control of the disease; and among the diabetic, the most known practice is diet and the most practiced measure is taking routine oral medicine, with a difference of socioeconomic level for some measures. CONCLUSION: There is a lack of information, knowledge and use of control measures of these diseases among the elderly. Health policies focusing on professional training and family guiding are necessary in order to encourage not only changes in the lifestyle of the elderly, but also to make them active agents of this change, acting in this process.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2018-07-17T19:41:27Z No. of bitstreams: 1 DISSERTA??O FINAL - JESSICA SP COSTA.pdf: 2171220 bytes, checksum: 3e2aa22230a1734216a93121fcc81d04 (MD5) / Made available in DSpace on 2018-07-17T19:41:27Z (GMT). No. of bitstreams: 1 DISSERTA??O FINAL - JESSICA SP COSTA.pdf: 2171220 bytes, checksum: 3e2aa22230a1734216a93121fcc81d04 (MD5) Previous issue date: 2018-04-11 / Funda??o de Amparo ? Pesquisa do Estado da Bahia - FAPEB / Overweight is one of the most common nutritional problems among children from developed and developing countries. Lifestyle changes including the food standard and physical inactivity brought changes on weight state with a potential effect to high the blood pressure. Chronic diseases such as obesity and cardiovascular illness have been associated to cesarean section by its effects on bacterial colonization inside the gastrointestinal tract of children that were born by a cesarean. The study aims to discover the association between overweight and systolic and diastolic blood pressure of preschool according as food standard of consumption and the ones borned through a cesarean. This is a cross-sectional analysis of a prospective population-based cohort, started in 2004, Feira de Santana - BA. The overweight (overweight + obesity) was analyzed by the body mass index and definite out based on Word Health Organization reference. The P.A was considered elevated when it achieved pressure levels ? percentile 90, for the age, gender and height obeying to the recommendations by the Brazilian Cardiology Society. Food consumption was characterized by standards (standard 1: milks consumption and derivates, vegetables and greens, tubers, cereals, fruits and fish; standard 2: salted, soft drinks/ artificial juices, candies, oils and fats and coffee/tea; standard 3: sausages, fast-food, catchup/mayonnaise and eggs; standard 4: red meats and chicken. Assessed covariables were the children characteristics, demographic and reproductive maternal. Were evaluated 618 children (51,7% boys and 48,3% girls). Overweight occurred on 28,6% of children. PAS and PAD elevated values occurred on 17,2% and 5,6% respectively. Overweight was associated with a high PAS (RP: 1,44, IC95%: 1,01 ? 2,05) and a high PAD (RP: 2,16, IC95% 1,13 ? 4,11). Food stands with a moderate to elevated consume of red meats and chicken were associated with ? high PAD (RP: 2,36; IC95%: 1,01-6,10). Positive association between cesarean parturition and a high PAS (RP: 1,65; IC95%: 1,09-2,51). Overweight was a factor associated with ? high PAS/PAD; the average and elevate consume of red meats and chicken were associated with ? high PAD between children with six years old; and the cesarean parturition was associated with a high PAS among the sample of children. / O excesso de peso ? um dos problemas nutricionais mais comuns entre crian?as de pa?ses desenvolvidos e em desenvolvimento. Altera??es no estilo de vida das crian?as, incluindo o padr?o alimentar e a inatividade f?sica, trouxeram mudan?as no estado do peso, com potencial efeito na eleva??o da press?o arterial. Doen?as cr?nicas, como obesidade e doen?as cardiovasculares, t?m sido associadas ao parto ces?reo, pelo seu efeito na coloniza??o bacteriana do tubo digest?rio de crian?as nascidas via cesariana. O objetivo do estudo foi averiguar a associa??o entre o excesso de peso e press?o arterial sist?lica (PAS) e diast?lica (PAD) de pr?-escolares, conforme padr?o de consumo alimentar e nascimento por parto ces?reo. Trata-se de uma an?lise transversal de uma coorte prospectiva de base populacional, iniciada em 2004, em Feira de Santana-BA. O sobrepeso (sobrepeso + obesidade) foi avaliado pelo ?ndice de Massa Corporal e definido com base na refer?ncia da Organiza??o Mundial de Sa?de. A PA foi definida elevada, quando atingiu os n?veis press?ricos ? percentil 90, para idade, sexo e altura obedecendo as recomenda??es da Sociedade Brasileira de Cardiologia. O consumo alimentar foi caracterizado por padr?es (padr?o 1: consumo de leite e derivados, verduras e tub?rculos, cereais, leguminosas, frutas e pescados; padr?o 2: de salgadinhos, refrigerantes/sucos artificiais, doces, ?leos e gorduras e caf?/ch?.; padr?o 3: embutidos, fast-food, catchup/maionese e ovos; padr?o 4: carnes vermelhas e frango). As covari?veis avaliadas foram as caracter?sticas da crian?a, demogr?ficas e reprodutivas maternas. Foram avaliadas 618 crian?as (51,7% meninos e 48,3% meninas). O sobrepeso ocorreu em 28,6% das crian?as. Valores elevados de PAS e PAD ocorreram em 17,2% e 5,6%, respectivamente. O sobrepeso se associou ? PAS elevada (RP: 1,44, IC95%: 1,01 ? 2,05) e a PAD elevada (RP: 2,16, IC95% 1,13 ? 4,11). O padr?o alimentar com consumo moderado a alto de carnes vermelhas e frango se associou ? PAD elevada (RP: 2,36; IC95%: 1,01-6,10). Houve associa??o positiva entre parto ces?reo e a PAS elevada (RP: 1,65; IC95%: 1,09-2,51). O Sobrepeso foi fator associado ? PAS/PAD elevadas; o consumo moderado/alto de carnes vermelhas e frango se associou ? PAD elevada entre as crian?as aos seis anos de idade; e, o parto ces?reo se associou ? PAS elevada entre as crian?as da amostra.

Made available in DSpace on 2017-07-21T19:59:45Z (GMT). No. of bitstreams: 1 Rubia Caldas.pdf: 1293952 bytes, checksum: 52cae77ba14b2beb72e4443c324cd16c (MD5) Previous issue date: 2013-02-28 / High blood pressure (HBP) is a multifactorial clinical condition characterized by high and sustained levels of blood pressure (BP). The renin-angiotensin system is involved in the control of the BP, and has as a component the angiotensin converting enzyme (ACE). Recent studies that relate gene variants of Angiotensin Converting Enzyme (ACE) gene, increase the risk of hypertension, compared with the presence of the allele D. Thus, it becomes necessary studies aimed at investigating the relationship of the polymorphism in intron 16 of the ACE gene with hypertension. The aim of the study was to verify the relationship between I / D polymorphism of the ACE gene and genotypic variants with the installation of HBP in four distinct groups. Participants were 112 individuals arranged in the following groups: normotensive (control), hypertensive and non-obese, hypertensive and obese and hypertensive and with type II diabetes mellitus. We evaluated the possible relationship between I/D polymorphism of the ACE gene in different groups of hypertensive patients, but there was no significant difference between the genotypes in different groups in the sample. Regarding the epidemiology higher the body mass index (BMI), waist circumference, triglycerides and cholesterol levels and physical inactivity, was greater incidence of hypertension in the population. The data obtained in this study reinforce environmental interference that are prevalent in the evolution of the framework of HBP and not related to the frequency of the D allele in the population studied. / A hipertensão arterial sistêmica (HAS) é uma condição clínica multifatorial caracterizada por níveis elevados e sustentados de pressão arterial (PA). O sistema renina-angiotensina está envolvido no controle da PA, e tem como um dos componentes a enzima conversora de angiotensina (ECA). Estudos recentes relacionam que variantes do gene da Enzima Conversora de Angiotensina (ECA) aumentam o risco de HAS, com relação à presença do alelo D. Com isso, se fazem necessários estudos voltados à investigação da relação do polimorfismo no íntron 16 do gene da ECA com a HAS. O objetivo do estudo foi verificar a existência de relação do polimorfismo I/D do gene da ECA e suas variantes genotípicas com a instalação da HAS, em quatro grupos distintos. Participaram da pesquisa 112 indivíduos arranjados nos seguintes grupos: normotenso (controle), hipertenso e não obeso, hipertenso e obeso, e hipertenso e com diabetes mellitus tipo II. Foi avaliada a possível relação do polimorfismo I/D do gene da ECA, em diferentes grupos de hipertensos, porém não foi encontrada diferença significativa quanto aos genótipos nos diferentes grupos na amostra analisada. Em relação à epidemiologia, quanto maior o índice de massa corporal (IMC), cintura abdominal, valores de colesterol e triglicerídeos e sedentarismo, maior foi a incidência de HAS na população. Os dados obtidos no presente estudo reforçam que interferências ambientais são prevalentes na evolução do quadro de HAS, e não relacionado à frequência do alelo D na população analisada.