The D allele of angiotensin-converting enzyme gene is associated with a worse autonomic heart control in community-based older adults.

The relationship between the Renin-Angiotensin-Aldosterone System (RAAS) and modulation of the Autonomic Nervous System (ANS) is reported as complex and bidirectional. Thus, the present study aimed to compare autonomous heart control, through symbolic analysis parameters, in the older adults carrying different ACE I/D gene polymorphisms (rs4646994). Two hundred four older adults comprised the study population and were grouped according to the ACE I/D gene polymorphism: II + ID genotype and DD genotype. Successive RR intervals were recorded along 5 min and analyzed with Symbolic Analysis (SA) method. 0 V%, 1 V% and 2 V% patterns were quantified and compared between groups. A linear mixed model analysis was used to determine between-group differences in symbolic analysis parameters (0 V%, 1 V% and 2 V%), taken groups as fixed factor and sex, use of ACE inhibitors and Angiotensin II receptor type I blockers as random factors. The Bayesian analysis was carried out to check the magnitude of the evidence. The results of this study indicate that older adults carrying the DD genotype have statistically greater sympathetic modulation (0 V%) and poor sympathovagal balance (1 V%), but the Bayesian analysis indicate only an anecdotal effect. Sympathetic predominance is recognized a worrying condition, since may predisposes to cardiovascular risk.

Hyperuricemia is associated with sympathovagal imbalance in older adults.

PURPOSE: This study aimed to compare heart rate variability (HRV) parameters obtained through symbolic analysis (SA), between older adults with and without hyperuricemia. METHODS: This is a cross-sectional study including 202 community-dwelling old adults, which was clinically stratified as with or without hyperuricemia, according to the cutoff point of serum uric acid ≥ 6 mg/dL for women and ≥ 7 mg/dL for men. Successive RR intervals were recorded along 5 min and analyzed with SA method. 0 V%, 1 V% and 2 V% patterns were quantified and compared between groups. Comparisons were carried out through parametric or nonparametric tests, according to the data distribution characteristics, evaluated by Kolmogorov-Smirnov test. The significance level was set as p ≤ 0.05 for all statistical procedures. RESULTS: The prevalence of hyperuricemia was 67.8 %, and the hyperuricemic older adults exhibited significant higher values for V0% and lower values for V2% parameters when compared to normouricemic older adults. CONCLUSION: These results suggesting a sympathovagal imbalance in hyperuricemic older adults, characterized by greater sympathetic predominance (0 V%) and lower vagal modulation (2 V%) at rest conditions.

Different anthropometric indicators of central obesity can predict hypertension in older adults

Abstract Objective: to investigate the association between hypertension and anthropometric indicators of central obesity, obtained from two anatomical sites in old adults. Methodology: a cross-sectional study including 145 elderly people, from whom socioeconomic and demographic data and anthropometric indicators of central obesity (Waist Circumference [CC] and Abdominal Circumferency [CA]) were obtained, which were considered independent variables. A logistic regression model was used to analyze the associations, and for the discriminatory power of the cutoff points of the anthropometric indicators for hypertension, a Receiver Operating Characteristic (ROC) curve was performed. Comparisons between ROC curves were performed, aiming to identify a significant difference in the discriminatory power of the anthropometric indicators studied. Results: among the 145 individuals, 79 were female (54%) and 66 were male (46%). The results showed a high prevalence of hypertension among men (69.7%) and women (73.4%). Both WC and AC were significantly associated to hypertension in both sexes. The ROC curve parameters indicated that both anthropometric indicators of central obesity exhibit a good discriminatory power for hypertension in this studie. For the studied population, the WC cutoff point for hypertension was > 83.2 cm for men and > 82.6 cm in women, while for CA it was > 85.1 cm and > 85.4 cm in men and women, respectively. Conclusion: AC and WC are significantly associated with hypertension in both sexes, and there is no superiority among them to predict hypertension in the elderly population.

Resumen Objetivo: investigar la asociación entre hipertensión e indicadores antropométricos de obesidad central, obtenidos de dos sitios anatómicos en adultos mayores. Metodología: estudio transversal que incluyó a 145 adultos mayores, de los cuales se obtuvieron datos socioeconómicos y demográficos e indicadores antropométricos de obesidad central (circunferencia de cintura [CC] y circunferencia abdominal [CA]), que fueron considerados variables independientes. Se utilizó un modelo de regresión logística para analizar las asociaciones, además del poder discriminatorio y los puntos de corte para la hipertensión de los indicadores antropométricos, que se obtuvieron a partir de los parámetros de la curva Receiver Operating Characteristic (ROC). Se hicieron comparaciones entre las curvas ROC, con el objetivo de identificar diferencias significativas en el poder discriminatorio de los indicadores antropométricos estudiados. Resultados: de los 145 individuos 79 eran del sexo femenino (54 %) y 66 del masculino (46 %). Los resultados mostraron una alta prevalencia de hipertensión arterial en hombres (69,7 %) y mujeres (734 %). Tanto CC como CA se asociaron significativamente a la hipertensión en ambos sexos. Los parámetros de la curva ROC revelaron que ambos indicadores antropométricos de obesidad central exhiben un buen poder discriminatorio para la hipertensión en la población estudiada. El punto de corte para la CC fue > 83,2 cm para hombres y de > 82,6 cm para mujeres; mientras que para CA fue > 85,1 cm y > 85,4 cm para hombres y mujeres, respectivamente. Conclusión: CA y CC están significativamente asociadas a la hipertensión en ambos sexos, y no hay superioridad entre ellas para predecir la hipertensión en la población anciana.

Resumo Objetivo: investigar a associação entre hipertensão e indicadores antropométricos de obesidade central obtidos de dois sítios anatômicos em idosos. Metodologia: estudo transversal incluindo 145 idosos, dos quais foram obtidos dados socioeconô-micos e demográficos e indicadores antropométricos de obesidade central (circunferência de cintura [CC] e cirfunferência abdominal [CA]), que foram considerados como variáveis independentes. Um modelo de regressão logística foi utilizado para analisar as associações, além do poder discriminatório e os pontos de corte para a hipertensão dos indicadores antropométricos, que foram obtidos a partir dos parâmetros da curva Receiver Operating Characteristic (ROC). Comparações entre as curvas ROC foram realizadas, objetivando identificar diferença significativa no poder discriminatório dos indicadores antropométricos estudados. Resultados: entre os 145 indivíduos, 79 eram do sexo feminino (54 %) e 66 do masculino (46 %). Os resultados mostraram uma alta prevalência de hipertensão arterial entre homens (69,7 %) e mulheres (73,4 %). Tanto a CA quanto a CC foram associadas à hipertensão em ambos os sexos de maneira significativa. Os parâmetros da curva ROC indicaram que ambos os indicadores antropométricos da obesidade central exibiram um bom poder discriminatório para a hipertensão na população estudada. O ponto de corte para a CC foi > 83,2 cm para homens e > 82,6 cm para mulheres, enquanto para CA foi > 85,1 cm e > 85,4 cm para homens e mulheres, respectivamente. Conclusão: as CA e CC estão significativamente associadas à hipertensão em ambos os sexos e não há superioridade entre elas para prever a hipertensão na população idosa.

The Physical Activity Level, Body Composition and Diabetes Mellitus Influence the Association Between Depression and Hypertension in Community-Dwelling Elders

Depression and hypertension are highly prevalent among elderly people. Although the relationship between these conditions is well recognized, however, the factors that may influence such association are not clearly understood. Objective: To analyze the association between depression and hypertension in community-dwelling elders. Methods: Two-hundred and thirty-one community-dwelling elders provided information regarding the following variables: sex, age, ethnicity, smoking habit, physical activity level (PA), body mass index (BMI) and diabetes mellitus (DM). These variables can potentially influence depression and hypertension, as well as its relationship. Screening for depression was made using the Geriatric Depression Scale (GDS). The presence of hypertension was defined based on self-reported data and/or the use of antihypertensive drugs. The logistic regression technique was applied, using hypertension as the dependent variable and depressive state as a predictive variable. Logistic regression was applied with and without adjustment for the potential intervening variables. Results: The prevalence of depressive state and hypertension in the studied population was 14% and 59%, respectively. The association between depression and hypertension without adjustments was not significant (odds ratio [OR] = 2.28, 95% confidence interval [95%CI] = 0.98 - 5.32; p = 0.06). However, after adjusting for PA, BMI and DM, the strength of association between depression and hypertension significantly increased (OR = 3.08, 95%CI = 1.12 - 8.46; p = 0.03). Conclusion: The association between depression and hypertension in the elderly is directly influenced by PA, BMI and DM. This finding may guide strategies to increase the adherence to a healthier lifestyle

Responsabilidade dos profissionais de saúde na notificação dos casos de violência / Responsibility of health professionals in the notification of cases of violence / Responsabilidad de los profesionales de salud en la notificación de casos de violencia

Resumo A violência, em suas diversas formas e manifestações, não pode ser vista pelos profissionais de saúde como questão alheia a seu trabalho. Este estudo teve como objetivo analisar a responsabilidade desses profissionais na notificação dos casos de violência. A busca foi realizada na Biblioteca Virtual em Saúde, considerando o período entre 2008 e 2013. Da análise surgiram três eixos temáticos: "legislação brasileira"; "responsabilidade dos profissionais de saúde no processo de notificação" e "códigos de ética dos profissionais de saúde". Conclui-se que a maioria dos artigos relativos aos códigos de ética aponta a necessidade de denunciar os casos de violência aos respectivos conselhos, autoridades e órgãos competentes. Porém, nota-se que não explicitam a obrigatoriedade da notificação em casos de violência. Assim, torna-se necessário revisar cada um dos códigos deontológicos da área da saúde, considerando a importância de referirem-se especificamente à violência.

Abstract Violence, characterized by various forms and manifestations, cannot continue to be seen by health professionals as a matter unrelated to their work. This study aimed to analyze the responsibility of health professionals in reporting cases of violence. The search was performed through the Virtual Health Library, in the period 2008-2013. From the analysis, three thematic axes emerged: "Brazilian legislation"; "health professional's responsibility in the reporting process"; and "health professionals' code of ethics". It is concluded that the majority of articles regarding codes of ethics point to the need to report cases of violence to their respective councils, authorities and competent bodies. Though, it is noted that they do not make explicit the obligation to notify cases of violence. Thus, it is necessary to review each of the codes of ethics in the field of health, considering the importance of referring specifically to violence.

Resumen La violencia, en sus diversas formas y manifestaciones, no puede ser vista por los profesionales de salud como una cuestión ajena a su trabajo. Este estudio tuvo como objetivo analizar la responsabilidad de estos profesionales en la notificación de casos de violencia. La búsqueda se realizó en la Biblioteca Virtual en Salud, considerando el período 2008-2013. Del análisis surgieron tres ejes temáticos: "legislación brasileña"; "responsabilidad de los profesionales de salud en el proceso de notificación" y "códigos de ética de los profesionales de salud". Se concluye que la mayoría de los artículos relativos a los códigos de ética señalan la necesidad de denunciar los casos de violencia ante los respectivos consejos, autoridades y órganos competentes. Sin embargo, se percibe que no explicitan la obligatoriedad de la notificación en casos de violencia. Así, se torna necesario revisar cada uno de los códigos deontológicos del área de la salud, considerando la importancia de que se refieran específicamente a la violencia.

Improving the comprehension of sarcopenic state determinants: An multivariate approach involving hormonal, nutritional, lifestyle and genetic variables.

It is known that sarcopenia is a multifaceted phenomenon, which involves genetic, nutritional, hormonal and living habits aspects. Then, an integrated analysis, as a multivariate approach, could improve the comprehension about the determinants of sarcopenic state in old adults. The present study aimed to investigate the interaction among serum vitamin D, daily caloric and protein intake, lifestyle habits, ACE I/D gene polymorphism and sarcopenic state in community-dwelling old adults. One hundred one community-dwelling old adults were clinically stratified as sarcopenic or non-sarcopenic. Serum vitamin D, daily caloric and protein intake, lifestyle habits (smoking, physical activity level and sedentary behavior) and ACE I/D gene polymorphism were recorded. A multivariate logistic regression technique was applied to investigate the interaction among the selected independent variables and the sarcopenic state. The independent variables age, smoking, serum Vitamin D and ACE I/D polymorphism achieved the statistical criteria to be inserted in the multivariate analysis. After a stepwise procedure from the multivariate logistic regression, the variables age, serum Vitamin D and ACE I/D polymorphism remained, together, in the final model. Sarcopenic state was significantly associated to older age, II-genotype and low serum Vitamin D in old adults from 60 years old.

Sarcopenia is associated to an impaired autonomic heart rate modulation in community-dwelling old adults.

PURPOSE: The aims of this study were to compare the autonomic heart control parameters from sarcopenic and non-sarcopenic community-dwelling elders. METHODS: This is a cross-sectional study including 76 community-dwelling old adults, which was clinically stratified as sarcopenic or non-sarcopenic, according to the current recommendations. They were submitted to 5-min recordings of successive RR intervals. The analysis of the RR intervals variability was carried out in time (mean RR, RMSSD, pNN50, SDNN and triangular index) and frequency domains (LFnu, HFnu and LF/HF ratio), and with nonlinear methods (SD1, SD2, and D2). The parameters of autonomic heart rate modulation (AHRM) were adjusted for potential confounders: sex, diabetes, beta-blockers use, cardiovascular disease, body mass index and physical activity level, smoking habit. Normality of the data was tested by Kolmogorov-Smirnov test and, since most variables did not exhibit a normal distribution the Mann-Whitney test was used to compare the parameters of AHRM. The significance level was set as p ≤ 0.05 and all statistical procedures were performed with SPSS®. RESULTS: Adjusted parameters of AHRM obtained from time domain and nonlinear methods were significantly different between sarcopenic and non-sarcopenic elders (p < 0.05), while parameters obtained from frequency domain analysis did not were different between groups (p > 0.05). CONCLUSION: Sarcopenic old adults exhibited lower parasympathetic-associated modulation, suggesting a poor cardioprotection associated to this condition.

The smoking habit negatively influences autonomic heart control in community-dwelling elderly adults.

OBJECTIVE: The present study aimed to analyze the influence of smoking on heart autonomic control in elderly adults who did and did not smoke. METHODS: In a population-based study, all community-dwelling elderly adults (≥60 years old) from Aiquara, Bahia, Brazil, were invited to participate in the study. Two-hundred-thirty-two (232) elderly adults provided information about their smoking habits and underwent 5-min recordings of successive RR intervals. Analysis of the variability of the RR intervals was performed in time and frequency domains and with nonlinear methods. The HAC parameters were adjusted for the following potential confounders: age, sex, diabetes, beta-blocker use, cardiovascular disease, body mass index and physical activity level. After exclusions, 210 elderly adults were divided into 2 groups, nonsmokers or those who stopped smoking (NSMOK [n=190]) and current smokers (SMOK [n=20]). Owing to the absence of a normal distribution, the Mann-Whitney test was used for group comparisons. RESULTS: For unadjusted HAC parameters, a significant difference was observed (p<0.05) between groups for the following parameters in the time domain: CV_RR; SDNN; RMSSD; pNN50; triangular index TINN; and nonlinear parameters SD1, SD2 and D2. All of the adjusted HAC parameters (including the Mean RR and frequency domain parameters) were significantly different between the groups. CONCLUSION: Together, the HAC parameters indicated a higher variability of successive RR intervals in NSMOK elderly adults. Notwithstanding, adjustment of the HAC parameters was an important step to improve data analysis. These results indicate an impaired sympathovagal balance on the heart of elderly adult smokers.

Qualidade de Vida de hipertensos atendidos na Atenção Primária à Saúde / Quality of life of people with high blood pressure at the Primary Health Care

Objetivou-se analisar a Qualidade de Vida de hipertensos em Jequié-BA, e identificar possíveis fatores depressores. Trata-se de um estudo de corte transversal no qual aplicaram-se dois questionários e examinou-se cada indivíduo. A média da Qualidade de Vida geral foi de 67,5 [IC: 64.21-70.78]. O domínio manifestações psicológicas apresentou média de 88.01 [IC: 86.57-89.44] e o domínio manifestações somáticas 91.84 [IC: 90.76 - 92.91]. A Qualidade de Vida dos usuários acometidos por hipertensão arterial foi satisfatória. Quanto aos fatores depressores da Qualidade de Vida identificou-se que a escolaridade e a raça/cor dos entrevistados influenciam de forma acentuada nesta quantificação.

This study aimed to analyze the quality of life of hypertensive patients in Jequié-BA, and identify possible factors depressants. This is a cross-sectional study in which were applied two questionnaires and examined each individual. The overall quality of life mean was 67.5 [CI: 64.21-70.78]. The psychological manifestations domain showed an average of 88.01 [CI: 86.57-89.44] and the somatic manifestations domain average 91.84 [CI: 90.76-92.91]. The Quality of Life of users affected by hypertension was satisfactory. Regarding factors that influence quality of life it was identified that education and race/color of the respondents influence in this quantification.

Prevalência e fatores associados à adesão ao tratamento medicamentoso por pacientes com hipertensão arterial / Prevalence and factors associated with adherence to drug treatment in hypertensive patients / Prevalencia y factores asociados con la adherencia al tratamiento farmacológico en pacientes con hipertensión

A adesão à terapia medicamentosa influencia no controle da pressão arterial (PA) e na ocorrência de complicações decorrentes do seu descontrole. Objetivou-se avaliar a prevalência e os fatores associados à adesão ao tratamento medicamentoso por pacientes hipertensos. Estudo transversal e descritivo. Utilizou-se questionário na coleta de dados. Evidenciou-se prevalência de 72,8% de adesão ao tratamento; diferenças significativas na adesão segundo situação marital de união estável (p=0,043), controle da PA por meio de tratamento medicamentoso combinado com mudanças no estilo de vida (p=0,003) e tempo de diagnóstico da hipertensão inferior a 10 anos.

The adherence to drug therapy influences blood pressure (BP) control and in the occurrence of complications due to its lack of control. The aim was to evaluate the prevalence and factors associated to adherence to drug therapy by hypertensive patients. Cross-sectional, descriptive study. A questionnaire was used in data collection. The prevalence of 72.8% was evidenced for treatment adherence; significant differences in treatment adherence according to the marital status of stable relationships individuals in marital status of a stable union with BP control through drug treatment combined with the adoption of healthy lifestyle habits and hypertension diagnostic time of less than 10 years.

La adherencia a la terapia farmacológica influye en el control de la presión arterial (PA) y en la ocurrencia de complicaciones debido a su descontrol. Se objetivó evaluar la prevalencia y factores asociados a adhesión al tratamiento farmacológico en los pacientes hipertensos. Estudio transversal y descriptivo. Un cuestionario fue utilizado en la recolección de datos. Se evidenció 72,8% del prevalencia de adherencia al tratamiento; diferencias significativas en adhesión según estado civil de relaciones estables (p=0,043), control de la PA mediante tratamiento farmacológico combinado con cambios en estilo de vida (p=0,003) y tiempo de diagnóstico de la hipertensión inferior a 10 años.

Hand dominance during constant force isometric contractions: evidence of different cortical drive commands.

The purpose of this study was to investigate force variability and sensoriomotor strategies of dominant and nondominant hands of right and left-handed subjects during a submaximal isometric force production task. Twelve right-handed adults (9 men and 3 women; 23 ± 3 year) and twelve left-handed adults (4 men and 8 women; 24 ± 3 year) performed an isometric constant force contraction sustained at 30 and 50% of maximal force for 10 s. Surface EMG signals were obtained from forearm flexors and extensors. Force signals were analyzed in the time (CV of force) and frequency (0-10 Hz) domain. The neural activation of the involved muscles was investigated from the EMG structure using the cross-wavelet spectra of the interference EMG signals of six different frequency bands of the EMG signals were quantified (5-13, 13-30, 30-60, 60-100, 100-150 and 150-200 Hz). The major findings were: (1) dominant and nondominant hands of right- and left-handed subjects exhibited similar CV of force; (2) the power spectrum of force is influenced by handedness, with greater 1-3 Hz oscillations for left-handed subjects when compared to right-handed subjects; (3) right-handed subjects have greater 30-60 Hz neuromuscular activation when compared to left-handed subjects. Our results indicate that right-handed individuals may rely preferentially in visual feedback to carry out a task with visual and proprioceptive feedback because of the left hemisphere specialization on the visuomotor control.