Introdução: A linfangioleiomiomatose (LAM) está associada a HP e está incluída no grupo 5 da classificação atual (mecanismos multifatoriais desconhecidos). No entanto, os dados referentes à ocorrência de HP na LAM são escassos. Os objetivos do estudo foram avaliar a prevalência e as características da HP em pacientes com LAM em diferentes estágios de evolução, além de comparar as características clínicas, funcionais, do teste de caminhada de 6 minutos (TC6M) e da qualidade de vida das pacientes com e sem HP. Metodologia: Cento e cinco pacientes com LAM foram submetidos a ecocardiograma, prova de função pulmonar (PFP) e TC6M. Pacientes com suspeita de HP no ecocardiograma, definida pela presença de pressão arterial pulmonar sistólica estimada (PsAP) acima de 35 mmHg, ou PFP mostrando DLco abaixo de 40% do valor previsto, foram submetidos a cateterismo cardíaco direito para confirmar o diagnóstico de HP. Resultados: Oito pacientes (7,6%) tinham HP confirmada no cateterismo cardíaco direito, seis pacientes (5,7%) tinham padrão pré-capilar e dois pacientes (1,9%) tinham padrão pós-capilar. Apenas um paciente (1%) apresentou pressão média de artéria pulmonar (PAPm) acima de 35 mmHg. Os pacientes com HP apresentaram menor VEF1 e DLco em PFP e maior dessaturação de oxigênio e intensidade de dispneia durante o TC6M comparado com aqueles sem PH. Em 63% dos pacientes com HP confirmada, o cateterismo cardíaco direito foi realizado devido ao resultado do DLco. Conclusões: A prevalência de HP é baixa em pacientes com LAM. A hipertensão pulmonar é de pouca gravidade e significativamente associada ao envolvimento parenquimatoso pulmonar. A capacidade de difusão de monóxido de carbono foi bastante útil na identificação de HP em pacientes com LAM / Introduction: Lymphangioleiomyomatosis (LAM) is associated with pulmonary hypertension (PH) and is included in group 5 of the current classification (unknown multifactorial mechanisms). However, data regarding the occurrence of PH in LAM are scarce. The objectives of the study were to evaluate the prevalence and characteristics of PH in patients with LAM at different stages of evolution, as well as to compare the clinical and functional characteristics of the 6-minute walk test (6MWT) and the quality of life of patients with and without PH. Methodology: One hundred and five patients with LAM underwent echocardiogram, pulmonary function test (PFT) and 6MWT. Patients with suspected PH on the echocardiogram, defined as the presence of estimated systolic pulmonary arterial pressure (PsAP) above 35 mmHg, or PFT showing carbon monoxide diffusion (DLco) below 40% of the predicted value, were submitted to right cardiac catheterization to confirm the diagnosis of PH. Results: Eight patients (7.6%) had PH confirmed in right cardiac catheterization, six patients (5.7%) had a pre-capillary pattern and two patients (1.9%) had a post capillary pattern. Only one patient (1%) presented mean pulmonary artery pressure (PAPm) above 35 mmHg. Patients with PH had lower FEV1 and DLco in PFP and greater oxygen desaturation and dyspnea intensity during the 6MWT compared to those without PH. In 63% of patients with confirmed PH, right heart catheterization was performed because of the DLco result. Conclusions: The prevalence of PH is low in patients with LAM. Pulmonary hypertension is commonly mild and is significantly associated with pulmonary parenchymal involvement. The measure DLco has improved the identification of PH in patients with LAM

Introdução: A linfangioleiomiomatose (LAM) está associada a HP e está incluída no grupo 5 da classificação atual (mecanismos multifatoriais desconhecidos). No entanto, os dados referentes à ocorrência de HP na LAM são escassos. Os objetivos do estudo foram avaliar a prevalência e as características da HP em pacientes com LAM em diferentes estágios de evolução, além de comparar as características clínicas, funcionais, do teste de caminhada de 6 minutos (TC6M) e da qualidade de vida das pacientes com e sem HP. Metodologia: Cento e cinco pacientes com LAM foram submetidos a ecocardiograma, prova de função pulmonar (PFP) e TC6M. Pacientes com suspeita de HP no ecocardiograma, definida pela presença de pressão arterial pulmonar sistólica estimada (PsAP) acima de 35 mmHg, ou PFP mostrando DLco abaixo de 40% do valor previsto, foram submetidos a cateterismo cardíaco direito para confirmar o diagnóstico de HP. Resultados: Oito pacientes (7,6%) tinham HP confirmada no cateterismo cardíaco direito, seis pacientes (5,7%) tinham padrão pré-capilar e dois pacientes (1,9%) tinham padrão pós-capilar. Apenas um paciente (1%) apresentou pressão média de artéria pulmonar (PAPm) acima de 35 mmHg. Os pacientes com HP apresentaram menor VEF1 e DLco em PFP e maior dessaturação de oxigênio e intensidade de dispneia durante o TC6M comparado com aqueles sem PH. Em 63% dos pacientes com HP confirmada, o cateterismo cardíaco direito foi realizado devido ao resultado do DLco. Conclusões: A prevalência de HP é baixa em pacientes com LAM. A hipertensão pulmonar é de pouca gravidade e significativamente associada ao envolvimento parenquimatoso pulmonar. A capacidade de difusão de monóxido de carbono foi bastante útil na identificação de HP em pacientes com LAM / Introduction: Lymphangioleiomyomatosis (LAM) is associated with pulmonary hypertension (PH) and is included in group 5 of the current classification (unknown multifactorial mechanisms). However, data regarding the occurrence of PH in LAM are scarce. The objectives of the study were to evaluate the prevalence and characteristics of PH in patients with LAM at different stages of evolution, as well as to compare the clinical and functional characteristics of the 6-minute walk test (6MWT) and the quality of life of patients with and without PH. Methodology: One hundred and five patients with LAM underwent echocardiogram, pulmonary function test (PFT) and 6MWT. Patients with suspected PH on the echocardiogram, defined as the presence of estimated systolic pulmonary arterial pressure (PsAP) above 35 mmHg, or PFT showing carbon monoxide diffusion (DLco) below 40% of the predicted value, were submitted to right cardiac catheterization to confirm the diagnosis of PH. Results: Eight patients (7.6%) had PH confirmed in right cardiac catheterization, six patients (5.7%) had a pre-capillary pattern and two patients (1.9%) had a post capillary pattern. Only one patient (1%) presented mean pulmonary artery pressure (PAPm) above 35 mmHg. Patients with PH had lower FEV1 and DLco in PFP and greater oxygen desaturation and dyspnea intensity during the 6MWT compared to those without PH. In 63% of patients with confirmed PH, right heart catheterization was performed because of the DLco result. Conclusions: The prevalence of PH is low in patients with LAM. Pulmonary hypertension is commonly mild and is significantly associated with pulmonary parenchymal involvement. The measure DLco has improved the identification of PH in patients with LAM

National Kidney Disease Education Program has initiated a serum creatinine standardization program. Glomerular filtration rate (GFR) can be re-estimated from standardized serum creatinine measurements. How the standardized estimated GFR (eGFR) influences hypertension prevalence has not been evaluated. In this study, cross-sectional data from 21 205 participants aged 18 years in the National Health and Nutrition Examination Survey 1999-2006 were analyzed. The differences between standardized and non-standardized eGFRs in the prevalence of hypertension and low eGFR were evaluated. Multiple logistic regression models were conducted to determine the association of standardized eGFR with hypertension prevalence. The prevalence of low eGFR estimated from standardized eGFR was higher than that from non-standardized eGFR (all P0.01), except for the 2005-2006 survey. The prevalence of hypertension under standardized eGFR was not significantly different from that under non-standardized eGFR in both groups of participants with eGFR60 and eGFR60 ml min 1 per 1.73 m 2. Adjusted for age, education, gender, race/ethnicity, smoking, serum cholesterol and diabetes mellitus, the participants with standardized eGFR60 ml min 1 per 1.73 m 2 had 56.1% more chance to be hypertensive patients than those with normal eGFR (P0.0001). The difference in the relationship to hypertension prevalence between standardized and non-standardized eGFR was not found significant.

Introdução: A Hipertensão Arterial Sistêmica (HAS) é um importante problema de saúde pública mundial, por sua alta prevalência e por ser causa de doenças que são fatais ou que levam a invalidez permanente. Objetivo: Conhecer a prevalência da hipertensão arterial sistêmica e as relações existentes entre os fatores de risco e a HAS, em adultos, da população cadastrada pelo Programa de Agentes Comunitários de Saúde (PACS), no bairro Piratininga da cidade de Osasco. Métodos: O presente estudo epidemiológico foi realizado através de amostra autoponderada e estratificada por microárea, de 1733 moradores do bairro Piratininga, na cidade de Osasco, com mais de 20 anos cadastrados no PACS. O trabalho de campo foi feito junto com os agentes comunitários de saúde e a enfermeira do PACS, por meio da aplicação de questionário e de medidas de peso, altura e pressão arterial. Resultados: Foram entrevistadas 1576 pessoas, da amostra sorteada de 1733, resultando em 9 por cento de perdas. Eram 32 por cento do sexo masculino e 68 por cento do sexo feminino. A prevalência de HAS encontrada foi de 47 por cento. A análise estatística mostrou associação com HAS com a idade, com acentuado aumento de prevalência a partir dos 30 anos; escolaridade, com maiores prevalências para as pessoas sem escolaridade e até 4 anos de estudo, com p<0,001. Observou-se o efeito protetor familiar com menores prevalências de hipertensão em famílias mais numerosas. A presença de diabetes mostrou aumento da prevalência de HAS com p<0,01; e o IMC>30 também associou-se significativamente. Os demais fatores como sexo, cor, tabagismo, consumo de álcool e histórico familiar não influíram na prevalência de HAS. Conclusão: O conhecimento da prevalência da HAS e dos fatores de risco a ela relacionados permite subsidiar medidas objetivas para obter melhor controle da HAS, com ênfase em ações educativas, que podem ser desenvolvidas por programas tais como o PACS / The objective of this paper was to describe and analyze the articulation of interventions between Family Health Strategy (ESF) and Psychosocial Care Centers for children and adolescents (CAPSi) teams considering mental health care for children and adolescents. In addition, we aimed to identify the factors that facilitate or hinder the articulation of actions between the teams in daily work; to understand workers expectations of these factors and other kinds of mental health support received by ESF teams. In order to achieve these objectives, semi-structered interviews were conducted with five CAPSi and 13 ESF managers, or other professionals of the teams suggested by him/her, from five different regions of São Paulo city, Brazil. The 18 interviews have been transcribed and subjected to content analysis techniques. It was found that the relationship between ESF and CAPSi occurs mostly by referral of cases, matrix support or partnership for cases concerning CAPSi. The contact between them occurs occasionally, according to the demand and usually happens by phone, personally or through paper reports. In some cases, contact takes place via regular meetings between the services involving the managers or other workers of CAPSi and ESF teams, depending on the region. The strategies used for the contact of teams mentioned in the interviews were case discussions, joint interventions, management meetings and mental health forums. The main goals of the joint work were to increase case resolution, strengthen care networks and give support to the ESF teams to deal with mental health. The main obstacles mentioned were: lack of CAPSi in the city, lack of human resources in the existing services; overhead tasks, rigid schedule, lack of training in mental health and frequent changes of ESF professionals; as well as lack of services and professionals in the mental health network. Personal connection among workers from different services was considered an important factor to facilitate the development of partnerships between teams. All the surveyed regions have Family Health Strategy Support Centers that helps ESF teams on issues involving mental health. The referral of users to specialized services, the lack of responsibility for mental health cases, the hegemonic biomedical model, the departmentalization of work by specialized sections and the fragmentation of care have been found as main working procedures in the services

Introdução: A Hipertensão Arterial Sistêmica (HAS) é um importante problema de saúde pública mundial, por sua alta prevalência e por ser causa de doenças que são fatais ou que levam a invalidez permanente. Objetivo: Conhecer a prevalência da hipertensão arterial sistêmica e as relações existentes entre os fatores de risco e a HAS, em adultos, da população cadastrada pelo Programa de Agentes Comunitários de Saúde (PACS), no bairro Piratininga da cidade de Osasco. Métodos: O presente estudo epidemiológico foi realizado através de amostra autoponderada e estratificada por microárea, de 1733 moradores do bairro Piratininga, na cidade de Osasco, com mais de 20 anos cadastrados no PACS. O trabalho de campo foi feito junto com os agentes comunitários de saúde e a enfermeira do PACS, por meio da aplicação de questionário e de medidas de peso, altura e pressão arterial. Resultados: Foram entrevistadas 1576 pessoas, da amostra sorteada de 1733, resultando em 9 por cento de perdas. Eram 32 por cento do sexo masculino e 68 por cento do sexo feminino. A prevalência de HAS encontrada foi de 47 por cento. A análise estatística mostrou associação com HAS com a idade, com acentuado aumento de prevalência a partir dos 30 anos; escolaridade, com maiores prevalências para as pessoas sem escolaridade e até 4 anos de estudo, com p<0,001. Observou-se o efeito protetor familiar com menores prevalências de hipertensão em famílias mais numerosas. A presença de diabetes mostrou aumento da prevalência de HAS com p<0,01; e o IMC>30 também associou-se significativamente. Os demais fatores como sexo, cor, tabagismo, consumo de álcool e histórico familiar não influíram na prevalência de HAS. Conclusão: O conhecimento da prevalência da HAS e dos fatores de risco a ela relacionados permite subsidiar medidas objetivas para obter melhor controle da HAS, com ênfase em ações educativas, que podem ser desenvolvidas por programas tais como o PACS / The objective of this paper was to describe and analyze the articulation of interventions between Family Health Strategy (ESF) and Psychosocial Care Centers for children and adolescents (CAPSi) teams considering mental health care for children and adolescents. In addition, we aimed to identify the factors that facilitate or hinder the articulation of actions between the teams in daily work; to understand workers expectations of these factors and other kinds of mental health support received by ESF teams. In order to achieve these objectives, semi-structered interviews were conducted with five CAPSi and 13 ESF managers, or other professionals of the teams suggested by him/her, from five different regions of São Paulo city, Brazil. The 18 interviews have been transcribed and subjected to content analysis techniques. It was found that the relationship between ESF and CAPSi occurs mostly by referral of cases, matrix support or partnership for cases concerning CAPSi. The contact between them occurs occasionally, according to the demand and usually happens by phone, personally or through paper reports. In some cases, contact takes place via regular meetings between the services involving the managers or other workers of CAPSi and ESF teams, depending on the region. The strategies used for the contact of teams mentioned in the interviews were case discussions, joint interventions, management meetings and mental health forums. The main goals of the joint work were to increase case resolution, strengthen care networks and give support to the ESF teams to deal with mental health. The main obstacles mentioned were: lack of CAPSi in the city, lack of human resources in the existing services; overhead tasks, rigid schedule, lack of training in mental health and frequent changes of ESF professionals; as well as lack of services and professionals in the mental health network. Personal connection among workers from different services was considered an important factor to facilitate the development of partnerships between teams. All the surveyed regions have Family Health Strategy Support Centers that helps ESF teams on issues involving mental health. The referral of users to specialized services, the lack of responsibility for mental health cases, the hegemonic biomedical model, the departmentalization of work by specialized sections and the fragmentation of care have been found as main working procedures in the services