Orientador: Sandro Caramaschi / Banca: Rinaldo Correr / Banca: Ana Claudia Bortolozzi Maia / Resumo: A hipertensão arterial é uma doença relacionada a estilos de vida, causas ambientais e padrões comportamentais. Apresenta curso crônico e assintomático, com múltiplos fatores de risco complexos, sendo seu controle necessário para a preservação ou redução na incidência de complicações e para a melhoria na qualidade de vida. O objetivo dessa pesquisa foi analisar os relatos de homens e mulheres portadores de hipertensão arterial sobre comportamentos, crenças e sentimentos com relação à doença e os cuidados com a saúde, além de correlacionar crenças e sentimentos com comportamentos relativos à saúde e/ou doença. Participaram da pesquisa 40 portadores de hipertensão arterial, 20 homens e 20 mulheres, usuários de um serviço de saúde privada destinado à preservação e controle de doenças. Todos os participantes estavam inseridos em um grupo de educação em saúde. O instrumento utilizado foi uma entrevista estruturada, cujas perguntas abertas e fechadas abrangiam aspectos relacionados à hipertensão arterial. As análises foram feitas por meio de análise de conteúdo e testes estatísticos. Os resultados apontaram como se constitui a história da hipertensão e como esta é definida pelos participantes, foram descritos os processos de causalidade e prevenção, os comportamentos adotados a partir do diagnóstico, os sentimentos frente à doença e o vínculo com o seviço de saúde e com profissionais de saúde. Comportamento de proscratinação, sentimento de culpa, medos e dificuldades relacionadas a mudanças de hábitos também foram investigados. De modo geral, o caráter assintomático e imprevisível da hipertensão arterial foi ressaltado. Observou-se que os participantes possuíam conhecimentos sobre fatores de risco para o aumento da pressão arterial e sobre os comportamentos necessários ao seu controle demonstrando que as ações de prevenção estavam centralizadas em práticas de vida. O fator... / Abstract: The arterial hypertension is an illness linked to lifestyle, reasons of ambiental and behavioral patterns. Show chronic and asymptomatic process, with multiple factors of complex risk having your control necessary to prevention or reduction on incidence of complications and to improve the quality of life. The goal of this research was to analyze accounts of men and woman suffering from high blood pressure on behaviors, beliefs and feelings about illness and health care, besiders correlate beliefs and feelings with behaviors relating the health and illness. Had participate this research 40 carrier disease of arterial hypertension, 20 men and 20 women, patients of private health service destined to prevention and control of ills. All participants were inserting in a group of health education. The way used was structured interviews, with opened and closed questions that include aspects about arterial hypertension. The reviews were made by analysis of content and statistical tests. The results showed how was established the history of hypertension and what was the definition about hypertension by participants, were described the process of causality and prevention, the behaviors displayed after diagnosed, the feelings related to illness and connection with the service and professionals of health system. Behavior of procrastination, feelings of guilt, afraid and difficulty with changes of habits were studied too. In a general, the character asymptomatic and unpredicatable of hypertension was highlighted. Was note that participants had knowledge about factors of risk to increase of pressure and the behaviors required to control showing that action of prevention was focused in practice of life. The emotional factors were said many times, mainly to blame it for aggravation and contextualize it. The feelings identified had indicated the possibility of live peacefully with illness to some participants and worries with diagnosed to others, especially... / Mestre

Introdução: o controle da hipertensão é pouco satisfatório e medidas devem ser implementadas para aumentá-lo. Realizou-se um estudo para avaliar o controle da hipertensão após intervenções educativas junto a hipertensos e equipe de enfermagem em duas unidades básicas de saúde. Casuística e Métodos: foram estudados com 55 membros da equipe de enfermagem e 290 hipertensos, separados em dois grupos: grupo I, que recebeu intervenções educativas e grupo II que seguiu a rotina normal da unidade. Os dados biossocial-econômicos, as avaliações antropométricas e medida da pressão arterial foram coletados. Foram realizadas entrevista e três medidas de pressão arterial com aparelho automático validado, manguito adequado e na posição sentada. A adesão ao tratamento foi avaliada pela presença de fatores dificultadores e Teste de Morisky e Green. Para ingestão de bebida alcoólica usou-se o Alcohol Use Disorders Identification - AUDIT, presença de transtornos mentais comuns pelo Self Report Questionnaire - SRQ-20 e apoio social pela escala de Apoio Social. As análises univariada e multivariada foram realizadas com nível de significância de p<0,05. Os membros da equipe de enfermagem foram avaliados no conhecimento sobre hipertensão antes e após processo educativo. Resultados: o conhecimento dos enfermeiros, técnicos e auxiliares de enfermagem elevou-se após processo educativo (84,6±12,0% vs 92,7±15,0%, p<0,05) e para agentes comunitários de saúde não houve mudança significante (80,8±12,2% vs 83,5±24,0%). Os hipertensos estudados tinham idade maior que 60 anos (54,8%), sexo feminino (62,1%), etnia branca (54,5%), primeiro grau (56,9%), autônomos (42,5%) e renda de um a três salários mínimos (52,7%). A maioria não referiu tabagismo (60,6%) nem etilismo (64,3%). A adesão ao tratamento avaliada pelo Teste Morisky e Green mostrou que 64,75% dos hipertensos do grupo I e 72,7% do grupo II não eram aderentes ao tratamento. Na avaliação pelos fatores que interferem ao tratamento, 77,3% do grupo I e 67,8% para o grupo II eram aderentes ao tratamento. Houve presença de transtornos mentais comuns em 40,0% dos hipertensos do grupo I e 43% do grupo II. A Escala de apoio Social revelou valores das médias do total da escala, bem como de seus diferentes domínios bem próximas entre os dois grupos de hipertensos estudados e alto valor de apoio social (76,1±17,9 grupo I e 76,9±14,0 grupo II). O controle da pressão arterial antes e após intervenção educativa foi, respectivamente, para o grupo I: 46,5% e 63,2% (p<0,05). e grupo II: 33,6% e 56,8% (p<0,05) e o controle foi mais elevado nos hipertensos do grupo I. Com relação ao controle da pressão, houve diferença estatisticamente significante (p<0,05) nas variáveis: sexo, predomínio de mulheres mais controladas que homens (66,7% vs 33,3%), etnia, brancos mais controlados que não brancos (62,3% vs 37,7%), os que tinham escolaridade de ensino fundamental/ médio mais controlados que os analfabetos (64,0% vs 47,1%) e nunca beberam (70,4% vs 28,6%). Os que possuíam renda < três salários apresentaram-se menos controlados (73,5% vs 26,5%) e os que não praticavam atividades físicas regularmente (75,0 vs 25,0%).. A análise de regressão logística indicou associação do controle da pressão para (OR Odds ratio, IC intervalo de confiança a 95%): 1) etnia, (p=0,030, OR=1,939, IC 1,064-3,533), 2) renda familiar (p=0,020, OR=0,447, IC 0,227-0,881) e 3) ingestão de bebida alcoólica (p=0,001, OR=3,206, IC 1,573-6,536). Conclusão: O processo educativo influenciou no maior controle da pressão dos pacientes e melhorou o conhecimento dos profissionais da equipe de enfermagem / Introduction: The control of the hypertension is little satisfactory and measures should be implemented to increase it. It took place study to evaluate the control of the hypertension close to after educational interventions hypertensions and nursing team in two basic units of health. Populations and Methods: They were studied with 55 members of the nursing team and 290 hypertensive patients, separate in two groups: group I, that received educational interventions and group II that it followed the normal routine of the unit. Bio-partner-economical data were collected; evaluations anthropometrics and measure of the blood pressure. Made interview and three blood pressure measures with validated automatic device, appropriate cuff and in a sitting position . The compliance to the treatment was evaluated by the presence of factors difficults and Morisky and Green Test. For ingestion of alcoholic drink Alcohol was used Uses Disorders Identification - AUDIT, presence of common mental upset for Self Report Questionnaire - SRQ-20 and social support for the scale of Social Support. It took place analysis univaried and multivariate with level of significance of p <0.05. The members of the nursing team were before appraised in the knowledge on hypertension and after educational process. Results: The nurses\' knowledge, technicians and nursing auxiliaries rose after educational process (84.6±12.0% vs. 92.7±15.0%, p <0.05) and for community agents of health there was not significant change (80.8±12.2% vs. 835±24.0%). The studied hypertensive patients had larger age than 60 years (54.8%), female (62.1%), white ethnic (54.5%), first degree (56.9%), autonomous (42.5%) and income from 1 to 3 minimum wages (52.7%). most didn\'t refer tobacco (60.6%) and neither alcohol intake (64.3%). The compliance to the treatment evaluated by the Morisky and Green Test showed that 64.75% of the hypertensive of the group I and 72.7% of the group II were not adherent to the treatment. In the evaluation for the factors that interfere to the treatment 77.3% of the group I and 67.8% for of the group II they were adherent to the treatment. There was presence of common mental upset in 40.0% of the hypertensions of the group I and 43% of the group II. The Scale of Social support revealed values of the averages of the total of the scale, as well as of their different domains very close between the two groups of studied hypertensive patients and high value of social support (76.1±17.9 group I and 76.9±14.0 group II). The control of the blood pressure before and after educational intervention it was, respectively, for the group I: 46.5% and 63.2% (p <0.05). and group II: 33.6% and 56.8% (p <0.05) and the control was higher for the hypertensive patients of the group I. In a relation to the control of the pressure, there was difference significant statistically (p <0,05) in the variables: sex, women\'s prevalence more controlled that men (66.7% vs. 33.3%), ethnic, white more controlled that no white (62.3% vs. 37.7%), the ones that had education of teaching high school and junior high school more controlled that the illiterates (64.0% vs. 47.1%) and they never drank (70.4% vs. 28.6%). The ones that possessed income <3 wages came less controlled (73.5% vs. 26.5%) and the ones that didn\'t practice physical activities regularly (75.0 vs. 25.0%). The analysis of regression logistics indicated association of the control of the pressure for (OR Odds ratio, CI confidence interval to 95%): 1) ethnic, (p=0.030, OR=1.939, CI 1.064-3.533), 2) family income (p=0.020, OR=0.447, CI 0.227-0.881) and 3) ingestion of alcoholic drink (p=0.001, OR=3.206, CI 1.573-6.536). Conclusion: The educational process influenced in the largest control of the patients\' pressure and it improved the professionals\' of the nursing team knowledge

L'hypertension pulmonaire (HTP) est une affection marquée par une dysfonction endothéliale et des thromboses in situ. L'état hypercoagulable a souvent été postulé mais il n'a jamais été clairement été démontré. Notre objectif principal était de déterminer si les patients atteints d'hypertension artérielle pulmonaire idiopathique (HTAPi), d'hypertension artérielle associée (HTAP associée) ou d'hypertension pulmonaire secondaire à une maladie respiratoire présentaient une hypercoagulabilité in vitro grâce la thrombinographie. Le second objectif de ce travail était d'étudier la dysfonction endothéliale chez les patients atteints d'HTAPi. Nous avons montré que certains patients atteints d'HTAPi présentent une hypercoagulabilité in vitro. Par contre nous n'avons pas pu montrer d'hypercoagulabilité dans les autres groupes de patients. La maladie sous-jacente pourrait expliquer en partie la différence mais cela reste encore à établir. Nous avons également montré que les patients atteints d'HTAPi ont une dysfonction endothéliale marquée par une augmentation du facteur von Willebrand, du Tissue Factor Pathway Inhibitor et une diminution de la thrombomoduline. / Pulmonary hypertension (PH) is an affection with an endothelial dysfunction and in situ thromboses. Hypercoagulable state was postulated but was never clearly demonstrated. Our main objective was to determine if patients with idiopathic pulmonary arterial hypertension (iPAH), associated PAH or PH of respiratory diseases had in vitro hypercoagulability with calibrated automated thrombography (CAT). The second objective was to study the endothelial dysfunction in patients with iPAH. We have shown that some patients with iPAH had a hypercoagulable state in vitro. But patients of the other groups had no hypercoagulability. The underlying disease could explain at least in part the difference but it still remain to establish. We have shown that patients with iPAH had an endothelial dysfunction with increase of von willebrand factor, Tissue Factor Pathway Inhibitor and decrease of thrombomodulin

Reabsorbing ~7% of the sodium load, the distal convoluted tubule plays key roles in blood pressure (BP) homeostasis. Here, Na-Cl co-transport (NCC) is the major route for apical Na entry making thiazide diuretics (NCC inhibitors) a mainstay hypertension treatment. Predictive adaptations of sodium excretory rhythms are supported by an intrinsic renal clock, which regulates transporter activity according to physiological need. Peripheral clocks can be influenced by glucocorticoids, which also have a circadian rhythm. We therefore hypothesized that NCC’s diurnal rhythm is regulated by glucocorticoids. C57BL6 mice were kept on a 12h light cycle with subjective day starting at 7am. Urine was collected in 12h periods and kidneys harvested at 1am (night) and 1pm (day). Slc12a3 (NCC encoding gene) mRNA and NCC protein abundance were similar between day and night but NCC phosphorylation at threonine 53 was significantly higher at night compared to day. Plasma and urinary corticosterone levels were elevated at night. Glucocorticoid inducible leucine zipper (GILZ) and serum and glucocorticoid inducible kinase (SGK1) transcripts also increased at night. Chronic corticosterone infusion flattened the plasma corticosterone rhythm within an intermediate physiological range. The diurnal rhythm of pT53 NCC was dampened in these mice but not in vehicle-treated mice. Blood pressure was monitored in the mice by radiotelemetry. After 2 weeks of baseline measurements mice received chronic corticosterone or vehicle for 3weeks, during the last 10 days of which they received ~80 mg/kg hydrochlorothiazide in their drinking water. At night systolic BP (SBP) was unaffected by any treatment whereas during the day SBP significantly increased following corticosterone but was unaffected by vehicle. Cosinor analysis of SBP in corticosterone and vehicle treated mice showed a marked reduction in rhythmicity, increased MESOR and reduced amplitude. In animals receiving corticosterone HCTZ partially rescued daytime SBP. This manoeuvre also improved SBP rhythmicity, reduced MESOR and increased amplitude. These data indicate that NCC phosphorylation has a diurnal rhythm that is in part regulated by glucocorticoids. They also show that alteration of the glucocorticoid rhythm affects the blood pressure rhythm in part through its effect on NCC phosphorylation. These findings may be clinically relevant in the pathogenesis of hypertension in conditions associated with elevated glucocorticoid levels such as metabolic syndrome and chronic stress.

Lau Siu Wai Maggie. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 236-245). / List of Figures --- p.i / List of Tables --- p.viii / List of Abbreviations --- p.x / Abstract --- p.xii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Postulated Pathophysiology of Essential Hypertension --- p.1 / Chapter 1.2 --- Measurement of Cardiac Output (CO) by Transthoracic Electrical Bioimpedance (TEB) and Other Methodologies --- p.6 / Chapter 1.3 --- Measurement of Blood Pressure --- p.10 / Chapter 1.4 --- Use of Antihypertensive Agents in Essential Hypertension --- p.12 / Chapter Chapter 2. --- The Method of Transthoracic Electrical Bioimpedance --- p.15 / Chapter 2.1 --- Introduction --- p.15 / Chapter 2.2 --- Development of Theory --- p.18 / Chapter 2.3 --- Measurements of Haemodynamic Parameters --- p.24 / Chapter 2.4 --- Literature Review - Validity of the Technique --- p.30 / Chapter Chapter 3 --- A Study on Reproducibility of Thoracic Electrical Bioimpedance in Healthy Subjects --- p.39 / Chapter 3.1 --- Objectives --- p.39 / Chapter 3.2 --- Methodology --- p.39 / Chapter 3.2.1 --- Subjects --- p.39 / Chapter 3.2.2 --- Study design --- p.41 / Chapter 3.2.3 --- Non-invasive haemodynamic monitoring --- p.41 / Chapter 3.2.4 --- Blood Pressure Measurement --- p.43 / Chapter 3.2.5 --- Isometric Exercise --- p.43 / Chapter 3.2.6 --- Data analysis --- p.44 / Chapter 3.2.7 --- Statistical analysis --- p.46 / Chapter 3.3 --- Results --- p.50 / Chapter 3.3.1 --- Systolic blood pressure --- p.50 / Chapter 3.3.2 --- Diastolic blood pressure --- p.52 / Chapter 3.3.3 --- Mean arterial pressure --- p.54 / Chapter 3.3.4 --- Heart rate --- p.55 / Chapter 3.3.5 --- Thoracic fluid index --- p.58 / Chapter 3.3.6 --- Stroke index --- p.60 / Chapter 3.3.7 --- Cardiac index --- p.62 / Chapter 3.3.8 --- Systemic vascular resistance index --- p.65 / Chapter 3.4 --- Discussion --- p.70 / Chapter Chapter 4 --- Literature Review --- p.73 / Chapter 4.1 --- Atenolol: Beta-adrenoceptor antagonists with β1-selectivity --- p.73 / Chapter 4.2 --- Pindolol: Beta-adrenoceptor antagonists with ISA --- p.78 / Chapter 4.3 --- Alpha1-adrenoceptor antagonists --- p.81 / Chapter 4.4 --- Angiotensin Converting Enzyme Inhibitors --- p.84 / Chapter 4.5 --- Calcium Channel Blockers --- p.87 / Chapter 4.6 --- Central Alpha Agonist --- p.91 / Chapter 4.7 --- Thiazide Diuretics --- p.94 / Chapter Chapter 5 --- The Integrated Hypertension Study --- p.97 / Chapter 5.1 --- Objectives --- p.97 / Chapter 5.2 --- Methodology --- p.97 / Chapter 5.2.1 --- Subjects --- p.97 / Chapter 5.2.2 --- Study design --- p.109 / Chapter 5.2.3 --- Non-invasive haemodynamic monitoring --- p.110 / Chapter 5.2 4 --- Blood Pressure Measurement --- p.111 / Chapter 5.2.5 --- Isometric Exercise --- p.111 / Chapter 5.2.6 --- Data analysis --- p.111 / Chapter 5.2.7 --- Statistical analysis --- p.112 / Chapter 5.2.8 --- Limitations of the study --- p.113 / Chapter 5.3 --- Results --- p.117 / Chapter 5.3.1 --- Atenolol --- p.117 / Chapter 5.3.2 --- Pindolol --- p.125 / Chapter 5.3.3 --- Doxazosin --- p.132 / Chapter 5.3.4 --- Enalapril --- p.138 / Chapter 5.3.5 --- Nifedipine Retard --- p.145 / Chapter 5.3.6 --- Methyldopa --- p.152 / Chapter 5.3.7 --- Cyclopenthiazide --- p.160 / Chapter 5.4 --- Comparisons of the anti-hypertensive drugs studied --- p.167 / Chapter 5.4.1 --- Baseline values --- p.167 / Chapter 5.4.2 --- Percentage changes after active treatment --- p.170 / Chapter 5.5 --- Discussion --- p.196 / Chapter 5.5.1 --- Atenolol --- p.196 / Chapter 5.5.2 --- Pindolol --- p.199 / Chapter 5.5.3 --- Doxazosin --- p.200 / Chapter 5.5.4 --- Enalapril --- p.202 / Chapter 5.5.5 --- Nifedipine Retard --- p.203 / Chapter 5.5.6 --- Methyldopa --- p.204 / Chapter 5.5.7 --- Cyclopenthiazide --- p.205 / Chapter 5.5.8 --- Comparison of the anti-hypertensive drugs studied --- p.206 / Chapter Chapter 6 --- Acute haemodynamic effects of Atenolol and Pindolol --- p.208 / Chapter 6.1 --- Objectives --- p.208 / Chapter 6.2 --- Methodology --- p.208 / Chapter 6.2.1 --- Subjects --- p.208 / Chapter 6.2.2 --- Study Design --- p.209 / Chapter 6.2.3 --- Statistical analysis --- p.209 / Chapter 6.3 --- Results --- p.211 / Chapter 6.3.1 --- Acute haemodynamic changes of atenolol --- p.211 / Chapter 6.3.2 --- Acute and short-term haemodynamic changes of atenolol --- p.219 / Chapter 6.3.3 --- Acute haemodymmic changes of pindolol --- p.221 / Chapter 6.3.4 --- Acute and short-term haemodymmic changes of pindolol --- p.222 / Chapter 6.3.5 --- Comparison of the acute haemodymmic effects of atenolol and pindolol --- p.226 / Chapter 6.4 --- Discussion --- p.230 / Chapter Chapter 7 --- Conclusion --- p.232 / References --- p.236 / Acknowledgements

Chronic lung diseases are often complicated with pulmonary hypertension (PH). This can lead to disability and poor prognosis. Oxidative stress has been implicated in the development of PH and right ventricular hypertrophy (RVH).A possible new way to treat lung disease related pulmonary hypertension is allopurinol (a xanthine oxidase inhibitor) which decreases both uric acid and oxidative stress. We hypothesised that allopurinol could regress RVH in patients with pulmonary hypertension associated with chronic lung disease (PH-CLD).In a double-blind, randomised controlled clinical trial, 72 patients with PH-CLD (93% diagnosed with chronic obstructive pulmonary disease and 17% with interstitial lung disease) were randomised to receive either allopurinol 300 mg twice daily or placebo for twelve months. The primary outcome was the mean change in right ventricular mass (RVM) as assessed by cardiac magnetic resonance imaging (CMRI) at twelve months. The secondary outcomes were the change in other cardiac parameters measured by CMRI, St George's Respiratory Questionnaire, Short Form 36, spirometry and six-minute walk test (6MWT).The mean age was 71 years, the mean FEV1 was 60% with mean resting SaO2 of 96%. After 12 months, there was no significant change in RVM. There were also no significant changes in other cardiac parameters measured on CMRI, quality of life questionnaires, spirometry and 6MWT. Post-hoc subgroup analysis showed that allopurinol reduced RVM (allopurinol -6.16 g vs placebo 0.75 g, p = 0.02) in COPD patients with more severe airflow limitation. Patients with higher NT-proBNP (> 489 pg/ml) had a greater improvement in left ventricular ejection fraction with allopurinol 5.12 vs placebo -1.62, p = 0.02.In summary, allopurinol had no overall impact but reduced RV mass in COPD patients with more severe airflow limitation. Further studies are warranted to assess the longer term impact of allopurinol in more severe COPD.

Preeclampsia (PE) is a major cause of perinatal and maternal morbidity and mortality. In the United Kingdom, the National Institute for Clinical Excellence (NICE) has issued guidelines on routine antenatal care recommending that at the booking visit a woman’s level of risk for PE should be determined and the subsequent intensity of antenatal care should be based on this risk assessment. This method relies on a risk scoring system derived from maternal characteristics and medical history; the performance of screening by this method is poor with detection of less than 50% of cases of preterm-PE and term-PE. The objective of this thesis is to develop a method for the estimation of the patient-specific risk for PE by combining the a priori risk based on maternal characteristics and medical history with the results of biophysical and biochemical markers obtained at 11-13 weeks’ gestation. Such early identification of high-risk pregnancies could lead to the use of pharmacological interventions, such as low-dose aspirin, which could prevent the development of the disease. The data for the thesis were derived from two types of studies: First, prospective screening in 65,771 singleton pregnancies, which provided data for maternal factors and serum pregnancy associated plasma protein-A (PAPP-A). In an unselected sequential process we also measured uterine artery pulsatility index (PI) in 45,885 of these pregnancies, mean arterial pressure (MAP) in 35,215 cases and placental growth factor (PLGF) in 14,252 cases. Second, cases-control studies for evaluating the ten most promising biochemical markers identified from search of the literature; for these studies we used stored serum or plasma samples obtained during screening and measured PLGF, Activin-A, Inhibin-A, placental protein-13 (PP13), P-selectin, Pentraxin-3 (PTX-3), soluble Endoglin (sEng), Plasminogen activator inhibitor-2 (PAI-2), Angiopoietin-2 (Ang-2) and soluble fms-like tyrosine kinase-1 (s-Flt-1). A competing risk model was developed which is based on Bayes theorem and combines the prior risk from maternal factors with the distribution of biomarkers to derive patient-specific risk for PE at different stages in pregnancy. The prior risk was derived by multiple regression analysis of maternal factors in the screening study. The distribution of biophysical and biochemical markers was derived from both the screening study and the case-control studies. The prior risk increased with advancing maternal age, increasing weight, was higher in women of Afro-Caribbean and South-Asian racial origin, those with a previous pregnancy with PE, conception by in vitro fertilization and medical history of chronic hypertension, type 1 diabetes mellitus and systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS). The estimated detection rate (DR) of PE requiring delivery at < 34, < 37 weeks’ gestation and all PE, at false positive rate (FPR) of 10%, in screening by maternal factors were 51, 43 and 40%, respectively. The addition of biochemical markers to maternal factors, including maternal serum PLGF and PAPPA, improved the performance of screening with respective DRs of 74, 56 and 41%. Similarly, addition of biophysical markers to maternal factors, including uterine artery PI and MAP, improved the performance of screening with respective DRs of 90, 72 and 57%. The combination of maternal factors with all the above biophysical and biochemical markers improved the respective DRs to 96, 77 and 54%. The findings of these studies demonstrate that a combination of maternal factors, biophysical and biochemical markers can effectively identify women at high-risk of developing PE.

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Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-26Bitstream added on 2014-06-13T20:28:22Z : No. of bitstreams: 1 addad_mt_me_botfm.pdf: 674800 bytes, checksum: 101691ff84e6e0c57b104e36c6ab28a2 (MD5) / Comparar pico e flutuação de pressão intra-ocular (PIO) entre curva tensional diária e teste de sobrecarga hídrica, detectar os horários de pico de PIO, comparar os valores da PIO nos horários das 6 horas da manhã deitado e sentado. 30 olhos direitos de 30 pacientes portadores de glaucoma primário de ângulo aberto (GPAA) ou hipertensão ocular (HO), foram submetidos à curva tensional diária de 24 horas (CTD) e teste de sobrecarga hídrica (TSH). Foram avaliados: pico (maior valor da PIO durante a CTD e TSH ) e flutuação (maior valor da PIO menos o menor valor da PIO durante o CTD e TSH). A PIO foi avaliada, com tonômetro de aplanação de Goldmann às 9, 12, 15, 18, 21, 24 e 6h, com paciente sentado. As medidas das 3 e 6 horas da manhã foram realizadas no leito com tonômetro de Perkins com o paciente em posição supina (deitado). Imediatamente após a medida no leito deitado, foi realizada outra medida das 6 horas com o paciente sentado. Para realização do TSH, os pacientes ingeriam 1 litro de água, em até 5 minutos. A PIO foi avaliada imediatamente antes e durante uma hora após a ingestão de água, com intervalos de 15 minutos entre as medidas. O TSH foi realizado logo após a avaliação da PIO às 6h da manhã. Foram calculados valores de média (M) e desvio padrão (s) para pico e flutuação e mediana (Md) e quartís (Q2) para flutuação em porcentagem (%). Para comparação de médias foi realizado o teste t de Student para amostras dependentes. Foi utilizado teste de Wilcoxon para comparação de medianas entre amostras dependentes. Para todas as análises foi considerado nível de significância p <0,05. A média dos valores de pico de PIO foi significativamente maior na CTD (20,39 ±1,03 mmHg) do que no TSH (17,37 ± 0,78 mmHg), p < 0,001. A média dos valores de flutuação também foi maior na CTD (10,17 ± 0,90) do que no TSH (5,0 ± 0,45), p < 0,001... / Comparing peak and fluctuation of intraocular pressure (IOP) between diurnal tension curve and water drinking test, detect the peak of IOP, compare the IOP at 6AM in supine and sitting position. 30 right eyes of 30 glaucoma patients with open angle glaucoma (OAG) or ocular hypertension (HO) were submitted to water drinking test (WDT) and diurnal tension curve (DTC). Were evaluated: peak (higher value of IOP observed during WDT and DTC), fluctuation (difference between highest and lowest value of IOP WDT and DTC). IOP was measured with applanation Goldmann tonometry at 9AM, 12AM, 3PM, 6PM, 9PM, 12PM and 6 AM, with the patient sitting. Measurements of 3AM and 6AM were made in bed with Perkins tonometer with the patient in the supine position. Immediately after the measure in supine position, another measure was done at 6AM, with the patient seated. The WDT involved ingestion of 1 liter of tap water in 5 minutes. IOP was measured immediately before and one hour after ingestion of water at intervals of 15 minutes between measurements. The WDT was performed immediately after the measure IOP at 6 AM. For comparison of means was performed Student's t test for dependent samples. Wilcoxon test was used to compare medians between dependent samples. The level of significance was considered p <0.05. The mean peak IOP was significantly higher in the DTC (20.39 ± 1.03 mmHg) than in TSH (17.37 ± 0.78 mmHg), p <0.001. The mean fluctuation was also higher in the DTC (10.17 ± 0.90) than in WDT (5.0 ± 0.45), p <0.001. The value of the fluctuation in the DTC percentile was 90.46% (70.00, 129.90) while the WDT was 35.42% (27.92, 56.95), p <0.001. The IOP of 6 AM showed a statistically significant when performed with the patient in supine position (17,47 mmHg) and sitting (14,30 mmHg) and was significantly higher with the patient in supine position. (p < 0,001). The WDT peak and underestimates of ... (Complete abstract click electronic access below)

Background. Hypertension carries a high risk of cardiovascular complications. Patient medication non-compliance has been identified to be an major factor for suboptimal blood pressure control in clinical practice. Different strategies have been proposed to improve patient medication compliance but their effects on clinical outcomes were inconsistent. Methods . A telephone survey was conducted to examine patient medication compliance with anti-hypertensive drugs in Hong Kong. I then established a Pharmacist-managed Compliance Clinic in a public out-patient setting and provided individualized patient education to non-compliant patients identified by physicians. A telephone follow-up was arranged at 4-week after intervention followed by a more in-depth reassessment on subsequent physician clinic visit day. The immediate endpoint was patient compliance rate. Intermediate endpoint was systolic and diastolic blood pressure control. Other outcome measures were control of other cardiovascular risk factors and level of healthcare resources utilization. / Conclusion. Pharmacist-managed Compliance Clinic is effective in improving patient medication compliance and has positive impact on clinical outcomes. (Abstract shortened by UMI.) / Results. A total of 853 patients were successfully contacted and completed the patient survey. According to our definition, 80.4% of patients interviewed were considered to be compliant. Factors associated with medication compliance included multiple drug therapy, presence of drug adverse effects, patient's awareness of preventive nature of medication, rapport between patient and physician, and full-time working status. A causal model was successfully established with latent factors identified for medication non-compliance. The factors included patient's functional status, provision of health advice and concern from physician, and patient's knowledge regarding reasons for drug taking. Another two hundreds hypertensive patients were followed at the Pharmacist-managed Compliance Clinic. On average, each patient attended 1.3 pharmacist visits. The non-compliance rate fell from 100% to 20% after a single pharmacist intervention. Significant improvement was observed in patients' mean blood pressures readings as well as the diabetic and lipid control. Positive impacts on healthcare resources utilization were also observed. / Chan Man Chi Grace. / "June 2005." / Adviser: Juliana C.N. Chan. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3730. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 126-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.