White Coat Uncontrolled Hypertension in Teleconsultation: A New and Frequent Entity.

INTRODUCTION: Cardiovascular risk seems not to be greater in patients with white coat uncontrolled hypertension (WUCH) than in patients with sustained blood pressure (BP) control. Therefore, its detection is important to avoid overtreatment. The COVID-19 pandemic determined a massive migration of hypertension consultations from the face-to-face modality to teleconsultations, and it is unknown whether WUCH exists in this context. AIM: We aimed to evaluate the prevalence of WUCH through home BP monitoring (HBPM) in treated hypertensive patients evaluated by teleconsultation. METHODS: We included treated hypertensive patients that owned a digital BP monitor. During teleconsultation, patients were asked to perform two BP measurements and then a 7-day HBPM, using the same device. Patients were classified as having WUCH if BP was ≥ 140 and/or 90 mmHg in teleconsultation and < 135/85 mmHg on HBPM. The prevalence of WUCH and its 95% confidence interval were estimated. One-way ANOVA, the Chi-square test or Fisher's exact test were used to compare the characteristics of these patients with the other groups. RESULTS: We included 341 patients (45.2% male, mean age 62.3 years). The prevalence of WUCH was 33.1% (95% CI 28.3-38.3%). Significant differences were found in terms of age, the number of antihypertensive drugs and the use of calcium channel blockers, all lower in the WUCH group as compared with the groups with elevated BP on HBPM. CONCLUSION: WUCH exists in teleconsultation and is very frequent. It can be easily detected though HBPM, thus avoiding overmedication, and its potential impact on side-effects and health costs.

Psychiatric illness, emotional distress, glycemic control and chronic complications in type 1 diabetes subjects

ABSTRACT Objectives: To assess the prevalence of psychiatric disorders in patients with type 1 diabetes mellitus (T1D) and to compare patients with and without psychiatric disorder. Materials and methods: We made a cross-sectional study including patients with T1D assisted in the outpatient clinics of the Brazilian National Health System. To assess depression and anxiety, we used the PHQ-9 questionnaire and the DSM-5th edition criteria, respectively. B-PAID evaluated the level of emotional distress associated with diabetes; EAT-26, eating disorders; SCI-R, adherence to the proposed clinical treatment. Results: We analyzed 166 patients aged 33 (22-45.2) years, 53.6% female. The prevalence of depression and anxiety was 20.5% and 40.4%, respectively. HbA1c was worse in the depressed (9.0% vs. 8.4%, p = 0.008), in the anxious ones (9.0% vs. 8.3%, p = 0.012) and in the patients with high levels of B-PAID (8.8 % vs. 8.3 %, p = 0.009). There was no difference in the prevalence of complications related to diabetes. Conclusions: The prevalence of psychiatric disorders and emotional distress related to diabetes was high in our population of T1D patients, and depression and high levels of B-PAID were associated with the worse glycemic control.

Psychiatric illness, emotional distress, glycemic control and chronic complications in type 1 diabetes subjects.

OBJECTIVE: To assess the prevalence of psychiatric disorders in patients with type 1 diabetes mellitus (T1D) and to compare patients with and without psychiatric disorder. METHODS: We made a cross-sectional study including patients with T1D assisted in the outpatient clinics of the Brazilian National Health System. To assess depression and anxiety, we used the PHQ-9 questionnaire and the DSM-5th edition criteria, respectively. B-PAID evaluated the level of emotional distress associated with diabetes; EAT-26, eating disorders; SCI-R, adherence to the proposed clinical treatment. RESULTS: We analyzed 166 patients aged 33 (22-45.2) years, 53.6% female. The prevalence of depression and anxiety was 20.5% and 40.4%, respectively. HbA1c was worse in the depressed (9.0% vs. 8.4%, p = 0.008), in the anxious ones (9.0% vs. 8.3%, p = 0.012) and in the patients with high levels of B-PAID (8.8 % vs. 8.3 %, p = 0.009). There was no difference in the prevalence of complications related to diabetes. CONCLUSION: The prevalence of psychiatric disorders and emotional distress related to diabetes was high in our population of T1D patients, and depression and high levels of B-PAID were associated with the worse glycemic control.

Sucessão de respostas em humanos: análise dos procedimentos sucessivo e simultâneo

O objetivo deste trabalho foi o de analisar e comparar o efeito de dois procedimentos de treino na aquisição e manutenção de uma sucessão de respostas. Os sujeitos foram 24 estudantes universitários, divididos em dois grupos. Os sujeitos do Grupo 1 foram submetidos ao procedimento foram submetidos ao procedimento de treino com apresentação simultânea dos estímulos. Seguia-se a Fase de Manutenção, com as mesmas contingências experimentais para os dois grupos, com apresentação simultânea e sem conseqüências para respostas corretas. A análise estatística não mostrou diferenças significativas para as medidas total de tentativas, total de erros e erros reais na fase de Aquisição, mas foi observado padrão de desempenho distinto entre os sujeitos do Grupo 1 e do Grupo 2. Na fase de Manutenção, os resultados não diferiram entre os grupos na maior parte das medidas. Parece que independentemente do procedimento a que os sujeitos foram submetidos na fase de aquisição todos aprenderam a seqüência de maneira sucessiva, tal como proposto pelo modelo tradicional de encadeamento. Ou seja, cada membro da seqüência foi sendo gradativamente colocado sob controle discriminativo. Os resultados indicaram a efetividade de se investigar a história de aquisição para explicar o desempenho em seqüências de respostas (AU)