RESUMO
The six-minute walk test (6MWT) and two-minute step test (2MST) are submaximal tests widely used in the elderly population functional capacity evaluation. Objective: To investigate whether the cardiac rehabilitation (CR) program was able to promote an increase in these tests and if there was an association between them; and to compare the hemodynamic stress caused by each of the tests. Methods: Retrospective, observational study in elderly participants in CR program. 24 elderly people were evaluated and classified according to the Fried frailty phenotype. The 6MWT and the 2MST were applied, observing the mean distance walked and the number of steps performed, respectively, as well as the double cardiac product (DP) at the beginning and after 4 months of the CR program. Results: There was an increase of 57 meters in the mean distance covered by the 6MWT (364.31±108.01 vs. 421.65±108.73, P<0.001) and 14 steps performed in the 2MST (62.17±22.50 vs. 76.17±25.56, P= 0.011) after 4 months of CR and we found a significant correlation between the tests and their results (P <0.001). When comparing the DP, both tests had a significant reduction (14469.92±2497.91 vs. 13348.21±2839.36, P= 0.022 and 15744.17±3591.87 vs. 13222.29±2505.39, P<0.001; respectively). Conclusion: A relationship between the number of steps performed in the 2MST with the mean distance covered of 6MWT suggest the use of them as an effective indicator in CR program and the association between them offers greater possibilities for treatment and evaluation of an elderly population.
O teste de caminhada de seis minutos (TC6m) e o teste de marcha estacionária de dois minutos (TME2min) são testes submáximos amplamente utilizados na avaliação da capacidade funcional da população idosa. Objetivo: Investigar se o programa de reabilitação cardíaca (RC) foi capaz de promover melhora nesses testes e se houve associação entre eles; além de comparar o estresse hemodinâmico causado por cada um dos testes nessa população. Métodos: Estudo retrospectivo e observacional em idosos participantes do programa de RC. Foram avaliados 24 idosos e classificados de acordo com o fenótipo de fragilidade de Fried. Foram aplicados o TC6m e o TME2min, observando-se a distância média percorrida e o número de passos realizados, respectivamente, bem como o duplo produto cardíaco (DP) no início e após 4 meses do programa de RC. Resultados: Houve aumento de 57 metros na distância média percorrida no TC6m (364,31±108,01 vs. 421,65±108,73, P<0,001) e 14 passos realizados no TME2min (62,17±22,50 vs. 76,17±25,56, P= 0,011) após 4 meses de RC e encontramos correlação significativa entre os testes e seus resultados (P<0,001). Ao comparar o DP, ambos os testes tiveram redução significativa (14.469,92±2.497,91 vs. 13.348,21±2.839,36, P= 0,022 e 15.744,17±3.591,87 vs. 13.222,29±2.505,39, P<0,001; respectivamente). Conclusão: A relação entre o número de passos realizados no TME2min com a distância média percorrida no TC6m sugere a utilização deles como um indicador eficaz em programa de RC e a associação entre eles oferece maiores possibilidades de tratamento e avaliação de uma população idosa.
RESUMO
Abstract Background Cognitive impairment, anxiety, and depression are present in patients with heart failure (HF), but their mutual correlation in hospitalized patients is not well established. Objectives The aims of this study were to identify the presence of cognitive impairment and the most affected domain, to investigate possible associations of cognitive impairment with depression and/or anxiety, and to observe whether they correlated with occurrence of readmission within 30 days following hospital discharge. Methods This is a prospective observational study including patients with HF from a private hospital. Psychological distress and cognition were evaluated by the Hospital Anxiety and Depression Scale (HADS) and by the Mini Mental State Exam (MMSE), respectively. Clinical data were obtained from the medical record at the time of inclusion, and outpatient follow-up was performed 30 days after discharge via telephone calls. Results This study included 71 patients (83% men, 75 ± 11 years). Cognitive impairment was present in 53.5% of the patients, and recall memory was the most altered cognitive domain. The proportion of possible/probable anxiety and depression was 21.1% and 34.2% in patients with cognitive impairment, respectively. However, only depression demonstrated association with cognitive impairment (p = 0.018). Cognitive impairment, anxiety, and depression showed no relationship with the occurrence of readmission within 30 days. Conclusions Cognitive impairment and depressive symptoms are prevalent and associated, and recall memory was the most altered cognitive domain in patients hospitalized with HF. However, there was no relationship between these factors and readmission within 30 days.
RESUMO
Com um intenso consumo, e graças ao surgimento de novas técnicas analíticas, a presença de fármacos e cafeína tem sido detectada em meios aquáticos por todo o mundo, mesmo que em baixas concentrações. No entanto, os impactos que podem ocasionar à saúde e ao ambiente ainda não são bem compreendidos. Dessa forma, o objetivo deste trabalho foi avaliar a presença dos fármacos atenolol, carbamazepina, clonazepam, fluoxetina, haloperidol, ibuprofeno, paracetamol, sinvastatina e venlafaxina e da cafeína em água bruta e tratada por uma estação de tratamento convencional, caracterizar as águas de acordo com as características físico-químicas e microbiológicas e verificar as conformidades com os padrões legais, e avaliar os impactos dos compostos detectados nas amostras para o ambiente aquático. As análises foram realizadas por cromatografia líquida acoplada à espectrometria de massas sequencial. As coletas das amostras foram realizadas nos períodos chuvoso e seco. As características físico-químicas analisadas foram cor aparente, turbidez, condutividade e pH. Para a caracterização microbiológica foram quantificados os coliformes totais e Escherichia coli. O impacto dos contaminantes foi avaliado com base em teste de toxicidade aguda, pela coleta de dados na literatura cientifica acerca dos efeitos subletais para organismos aquáticos e pela avaliação de risco, realizada de acordo com o cálculo do quociente de risco. O método analítico mostrou-se adequado em suas figuras de mérito para a análise dos contaminantes. A carbamazepina, a fluoxetina, a venlafaxina e a cafeína, presentes na água bruta foram removidas pelo tratamento da água. As características físico-químicas e microbiológicas da água bruta e da tratada enquadraram-se nos valores estabelecidos pela Resolução Conama nº 357 e pela Portaria de Consolidação nº 5, respectivamente. Os compostos identificados neste estudo podem ocasionar danos a organismos não-alvos e risco ao ambiente aquático.
With an intense consumption, and thanks to the emergence of new analytical techniques, the presence of pharmaceuticals and caffeine has been detected in aquatic environments all over the world, even in low concentrations. However, the impacts they can have on health and the environment are still not well understood. Thus, the objective of this work was to evaluate the presence of the pharmaceuticals atenolol, carbamazepine, clonazepam, fluoxetine, haloperidol, ibuprofen, paracetamol, simvastatin and venlafaxine and caffeine in raw water and treated by a conventional treatment plant, to characterize the waters according to the physical-chemical and microbiological characteristics and check the compliance with legal standards, and evaluate the impacts of the compounds detected in the samples for the aquatic environment. The analyses were performed by liquid chromatography coupled with sequential mass spectrometry. Sample collections were carried out in the rainy and dry periods. The physical-chemical characteristics analyzed were apparent color, turbidity, conductivity and pH. For microbiological characterization, total coliforms and Escherichia coli were quantified. The impact of contaminants was assessed based on an acute toxicity test, by collecting data in the scientific literature on sublethal effects for aquatic organisms and by assessing risk, carried out according to the calculation of the risk quotient. The analytical method proved to be adequate in its figures of merit for the analysis of contaminants. Carbamazepine, fluoxetine, venlafaxine and caffeine, present in raw water, were removed by water treatment. The physical-chemical and microbiological characteristics of raw and treated water were in line with the values established by Conama Resolution nº 357 and Consolidation Ordinance nº 5, respectively. The compounds identified in this study can cause damage to non-target organisms and risk to the aquatic environment.