Capacidade funcional de idosos dependentes cadastrados na estratégia saúde da família do município de Londrina,PR

Pós-graduação em Saúde Coletiva - FMB

Capacidade funcional de idosos dependentes cadastrados na estratégia saúde da família do município de Londrina,PR

Pós-graduação em Saúde Coletiva - FMB

Medical adverse events in elderly hospitalized patients: A prospective study

OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e. g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score II). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events, the patients with medical adverse events had a significantly longer hospital stay (21.41 +/- 15.08 days versus 10.91 +/- 7.21 days) and a higher mortality rate (39 deaths [41.5%] versus 17 deaths [22.1%]). Mortality was significantly predicted by the Simplified Acute Physiology Score II score (odds ratio [OR] = 1.13, confidence interval [CI] 95%, 1.07 to 1.20), the Katz score (OR = 1.47, CI 95%, 1.18 to 1.83), and medical adverse events (OR = 3.59, CI 95%, 1.55 to 8.30). CONCLUSION: Medical adverse events should be monitored in every elderly hospitalized patient because there is no risk profile for susceptible patients, and the consequences of adverse events are serious, sometimes leading to longer hospital stays or even death.

Discussões sobre saúde e doença: revisitando a obra adulta de Monteiro Lobato

As opiniões de Monteiro Lobato a respeito dos temas saúde e doença não se esgotaram na discussão sobre a situação do Jeca Tatu; ele foi além, e em diversos trechos de sua obra adulta observam-se suas opiniões, seus relatos sobre a experiência de adoecer. O presente artigo resgata as concepções de saúde e doença observadas nos escritos de Monteiro Lobato. Por meio da análise de sua obra adulta, pudemos destacar opiniões, relatos sobre a experiência de adoecer de pessoas próximas e queridas, a possibilidade que a doença oferece de socializar as pessoas, o corporativismo médico, a atuação na Liga Pró-Saneamento, o paternalismo das práticas de saúde e a vulnerabilidade daqueles que possuem condição social desfavorável, além de outros tópicos, ora com traços de comicidade, ora com resignação e até com revolta. Assim, o presente estudo analisou a obra adulta do autor, discutindo trechos que tratam da saúde e da doença como experiência vivenciada nas primeiras décadas do século XX.

La salute detenuta: tra diritto e sicurezza”. Un’ indagine nella Casa Circondariale di Rimini.

The survey approachs the issue of health and the problem of its effective protection in a context of deprivation of liberty and coercion, which is the prison. The theoretical reflection born from the reform of the Legislative Decree 230/99 which marked the transition from an employee by the Prison Health within prison a fully integrated in the National Health Service. The comparison between an institution of health promotion and institution of punishment which may operate on the same subject held produces multiple attrits, making their relationship problematic. The work shows the daily difficulties in the management of prison health within the institution, physician-patient between different health care roles, and between the latter and prison workers. The coexistence, in fact, is not always harmonious though quite often it is common sense and the willingness of operators to reduce barriers: overcrowding, limited resources and insufficient staff make the application of the rule and therefore the right to goal a difficult to be pursued. It is designed for a scheme of semi-structured interview essay is divided into 3 sections covering: "staff and its functions", "health reform" and "health of the prisoner"; questions were directed to doctors, nurses and psychologists engaged inside the prison of Rimini with the specific aim of examining the ambivalent relationship between the demand for health care in prisons and the need for security and a clear - albeit partial - point of view. We tried to reconstruct the situation of prison health care through the perception of prison operators, capturing the problematic issues that deal on both issues is instrumental to the experience of persons detained by analyzing, in terms of operators , what happens inside of a prison institution in everyday health care.

The prehistoric inhabitants of the Wadi Howar : an anthropological study of human skeletal remains from the Sudanese part of the Eastern Sahara

All currently available human skeletal remains from the Wadi Howar (Eastern Sahara, Sudan) were employed in an anthropological study. The study’s first aim was to describe this unique 5th to 2nd millennium BCE material, which comprised representatives of all three prehistoric occupation phases of the region. Detecting diachronic differences in robusticity, occupational stress levels and health within the spatially, temporally and culturally heterogeneous sample was its second objective. The study’s third goal was to reveal metric and non-metric affinities between the different parts of the series and between the Wadi Howar material and other relevant prehistoric as well as modern African populations. rnThe reconstruction and comprehensive osteological analysis of 23 as yet unpublished individuals, the bulk of the Wadi Howar series, constituted the first stage of the study. The analyses focused on each individual’s in situ position, state of preservation, sex, age at death, living height, living weight, physique, biological ancestry, epigenetic traits, robusticity, occupational stress markers, health and metric as well as morphological characteristics. Building on the results of these efforts and the re-examination of the rest of the material, the Wadi Howar series as a whole, altogether 32 individuals, could be described. rnA wide variety of robusticity, occupational stress and health variables was evaluated. The pre-Leiterband (hunter-gatherer-fisher/hunter-gatherer-fisher-herder) and the Leiterband (herder-gatherer) data of over a third of these variables differed statistically significantly or in tendency from each other. The Leiterband sub-sample was characterised by higher enamel hypoplasia frequencies, lower mean ages at death and less pronounced expressions of occupational stress traits. This pattern was interpreted as evidence that the adoption and intensification of animal husbandry did probably not constitute reactions to worsening conditions. Apart from that, the relevant observations, noteworthy tendencies and significant differences were explained as results of a broader spectrum of pre-Leiterband subsistence activities and the negative side effects of the increasingly specialised herder-gatherer economy of the Leiterband phase. rnUsing only the data which could actually be collected from it, multiple, separate, individualised discriminant function analyses were carried out for each Wadi Howar skeleton to determine which prehistoric and which modern comparative sample it was most similar to. The results of all individual analyses were then summarised and examined as a whole. Thus it became possible to draw conclusions about the affinities the Wadi Howar material shared with prehistoric as well as modern populations and to answer questions concerning the diachronic links between the Wadi Howar’s prehistoric populations. When the Wadi Howar remains were positioned in the context of the selected prehistoric (Jebel Sahaba/Tushka, A-Group, Malian Sahara) and modern comparative samples (Southern Sudan, Chad, Mandinka, Somalis, Haya) in this fashion three main findings emerged. Firstly, the series as a whole displayed very strong affinities with the prehistoric sample from the Malian Sahara (Hassi el Abiod, Kobadi, Erg Ine Sakane, etc.) and the modern material from Southern Sudan and, to a lesser extent, Chad. Secondly, the pre-Leiterband and the Leiterband sub-sample were closer to the prehistoric Malian as well as the modern Southern Sudanese material than they were to each other. Thirdly, the group of pre-Leiterband individuals approached the Late Pleistocene sample from Jebel Sahaba/Tushka under certain circumstances. A theory offering explanations for these findings was developed. According to this theory, the entire prehistoric population of the Wadi Howar belonged to a Saharo-Nilotic population complex. The Jebel Sahaba/Tushka population constituted an old Nilotic and the early population of the Malian Sahara a younger Saharan part of this complex. The pre-Leiterband groups probably colonised the Wadi Howar from the east, either during or soon after the original Saharo-Nilotic expansion. Unlike the pre-Leiterband groups, the Leiterband people originated somewhere west of the Wadi Howar. They entered the region in the context of a later, secondary Saharo-Nilotic expansion. In the process, the incoming Leiterband groups absorbed many members of the Wadi Howar’s older pre-Leiterband population. The increasing aridification of the Wadi Howar region ultimately forced its prehistoric inhabitants to abandon the wadi. Most of them migrated south and west. They, or groups closely related to them, probably were the ancestors of the majority of the Nilo-Saharan-speaking pastoralists of modern-day Southern Sudan and Eastern Chad.

Internet information and medical consultations: experiences from patients' and physicians' perspectives

OBJECTIVE: Many patients use the Internet to obtain health-related information. It is assumed that health-related Internet information (HRII) will change the consultation practice of physicians. This article explores the strategies, benefits and difficulties from the patients' and physicians' perspective. METHODS: Semi-structured interviews were conducted independently with 32 patients and 20 physicians. Data collection, processing and analysis followed the core principles of Grounded Theory. RESULTS: Patients experienced difficulties in the interpretation of the personal relevance and the meaning of HRII. Therefore they relied on their physicians' interpretation and contextualisation of this information. Discussing patients' concerns and answering patients' questions were important elements of successful consultations with Internet-informed patients to achieve clarity, orientation and certainty. Discussing HRII with patients was appreciated by most of the physicians but misleading interpretations by patients and contrary views compared to physicians caused conflicts during consultations. CONCLUSION: HRII is a valuable source of knowledge for an increasing number of patients. Patients use the consultation to increase their understanding of health and illness. Determinants such as a patient-centred consultation and timely resources are decisive for a successful, empowering consultation with Internet-informed patients. PRACTICAL IMPLICATIONS: If HRII is routinely integrated in the anamnestic interview as a new source of knowledge, the Internet can be used as a link between physicians' expertise and patient knowledge. The critical appraisal of HRII during the consultation is becoming a new field of work for physicians.

An ethnographic study of home remedy use for African-American children

Background and significance. The use of herbs and other remedies by adult and elderly African-Americans has been documented. However, little is understood regarding the use of herbs for African-American children. The purpose of this study was to document and describe the historical and present day uses of herbal and other remedies, specifically for the health and illness of African-American children. This information will provide health care providers with a better understanding of their African-American patients. This information may also contribute to the emerging appreciation of indigenous uses of phytotherapeutics. ^ Methods. A focused ethnographic approach was used to describe the cultural context, including the beliefs, values, customs, and behaviors of a particular culture. The use of intensive fieldwork, including participant observation, audiotaped formal interviews, photographs, and specimen collection of plants helped to describe herb use in this population. Information on the growing, harvesting, preparation, and storage of these plant remedies, as well as the amount and dosage of these compounds was collected in a typology. Detailed information was gathered to discern how, when, and under what conditions these remedies were used and their expected results. Further data collection focused on the history of herbal use, and explanations for how and why informants thought the herbs work. ^ Setting and participants. The setting for this study was in East Texas and field work extended over the period of one year. Thirty African-Americans, age 38 to 98, were interviewed for the study. The African-American population in this area has been relatively stable, with roots dating back prior to the reconstruction period, which allowed excellent historical information. Informants were chosen by a nominated sampling technique starting with two key informants knowledgeable about the use of home remedies for children. ^ Findings. The findings of this study suggest that African-American children in East Texas have a long history of receiving herbs and home remedies for health promotion and illness. Data further suggests that there is a strong connection between spirituality and the health beliefs and practices of this community. This spiritual component underlies the accuracy of oral recall for remedies that have been used over many generations and the use of natural folk remedies. A typology of the herbal remedies was developed with folk and Latin name, herb place of origin, known scientific properties, and informant folk usage and dosage information. ^

¿Nuestro destino está escrito en los genes?: Una mirada desde la película gattaca

Este artículo analiza algunas ideas, imágenes y creencias relacionadas con las nuevas "ciencias de la vida", y cuestiona su influencia en las redefiniciones de la condición humana, la salud y la enfermedad que están actualmente en curso en nuestra cultura, a partir de las reflexiones suscitadas por la película Gattaca. Los abusos del "determinismo genético" constituyen el eje central de esa discusión, aliados a una serie de metáforas informáticas y digitales que emanan cada vez con más fuerza de ciertos discursos tecnocientíficos. Esas nuevas verdades tienden a encontrar causas biológicas y a ofrecer soluciones técnicas para los más diversos conflictos humanos, tanto a escala individual como colectiva, desdeñando otras influencias e interrogantes. Ante el riesgo de un reduccionismo excesivamente simplificador de la condición humana y de su potencial de acción en el mundo, se impone un cuestionamiento de orden filosófico y antropológico de estas verdades cada vez más hegemónicas que afectan a los cuerpos y a las subjetividades.

¿Nuestro destino está escrito en los genes?: Una mirada desde la película gattaca

Este artículo analiza algunas ideas, imágenes y creencias relacionadas con las nuevas "ciencias de la vida", y cuestiona su influencia en las redefiniciones de la condición humana, la salud y la enfermedad que están actualmente en curso en nuestra cultura, a partir de las reflexiones suscitadas por la película Gattaca. Los abusos del "determinismo genético" constituyen el eje central de esa discusión, aliados a una serie de metáforas informáticas y digitales que emanan cada vez con más fuerza de ciertos discursos tecnocientíficos. Esas nuevas verdades tienden a encontrar causas biológicas y a ofrecer soluciones técnicas para los más diversos conflictos humanos, tanto a escala individual como colectiva, desdeñando otras influencias e interrogantes. Ante el riesgo de un reduccionismo excesivamente simplificador de la condición humana y de su potencial de acción en el mundo, se impone un cuestionamiento de orden filosófico y antropológico de estas verdades cada vez más hegemónicas que afectan a los cuerpos y a las subjetividades.

¿Nuestro destino está escrito en los genes?: Una mirada desde la película gattaca

Este artículo analiza algunas ideas, imágenes y creencias relacionadas con las nuevas "ciencias de la vida", y cuestiona su influencia en las redefiniciones de la condición humana, la salud y la enfermedad que están actualmente en curso en nuestra cultura, a partir de las reflexiones suscitadas por la película Gattaca. Los abusos del "determinismo genético" constituyen el eje central de esa discusión, aliados a una serie de metáforas informáticas y digitales que emanan cada vez con más fuerza de ciertos discursos tecnocientíficos. Esas nuevas verdades tienden a encontrar causas biológicas y a ofrecer soluciones técnicas para los más diversos conflictos humanos, tanto a escala individual como colectiva, desdeñando otras influencias e interrogantes. Ante el riesgo de un reduccionismo excesivamente simplificador de la condición humana y de su potencial de acción en el mundo, se impone un cuestionamiento de orden filosófico y antropológico de estas verdades cada vez más hegemónicas que afectan a los cuerpos y a las subjetividades.

Fundamentos antropológicos de las tecnologías biomédicas no terapéuticas

The important developments in technology in all areas of human life have generated high expectations and hopes with regard to the health sector. Science and technology have favored the development of incredible therapeutic treatments to help resolve numerous problems relating to illness and disability. Nonetheless, many developments in the therapeutic realm have given rise to discussions over the possibility of whether this same scientific and technological progress could be beneficial even for those who may not be sick. One may ask: why not apply the same knowledge and technology used for treatment of illness for conditions where therapy is not necessary, but there is a desire to care for, improve and enhance human person? These new horizons offered by biomedical technologies undoubtedly express a deep desire of every person for health, happiness, and a long life. In order to offer a response to these questions, current biomedical technologies and those in development offer a wide range of possibilities. Therefore, in this investigation we attempt to identify and define four areas of non-therapeutic treatment: illness prevention, health promotion, improving human nature, and human enhancement. These four areas, which do not directly regard illness, give rise to a series of questions, which range from those regarding the meaning of health and illness to those concerning anthropological questions, such as situations and conditions that must be taken into account so human dignity is respected. The treatment, improvement and enhancement of the human being imply clarifying in scientific and technological terms the truth and meaning of the human person as such. This research identifies and looks at the relationship between the four anthropological cornerstones which non-therapeutic biomedical technologies should be based upon so as not to impact or violate the dignity of the human person. This research presents the anthropological boundaries which non-therapeutic biomedical technologies should take into consideration so as not to alter or violate the dignity of the human person. At the same time, the research proposes an anthropological foundation on which to build a code of ethics for non-therapeutic biomedical technologies. El gran desarrollo de las tecnologías en todos los ámbitos de la vida del hombre ha generado una gran expectativa y esperanza en lo que se refiere a la salud. Ciencia y técnica están aportando grandes beneficios en materia terapéutica, ayudando a resolver muchos problemas concernientes a la enfermedad y a la discapacidad. Pero este desarrollo que se ha producido en el ámbito terapéutico nos conduce a la formulación de preguntas sobre las posibilidades que esos avances técnico-científicos pueden aportar en beneficio del hombre, cuando no se encuentra enfermo: ¿por qué no pueden aplicarse los conocimientos y tecnologías usados en terapia a un ámbito diferente, no terapéutico, con el fin de mantener, mejorar o incluso potenciar al hombre? Ciertamente los nuevos horizontes que abren las Tecnologías Biomédicas encuentran repercusión en el deseo de bienestar, de felicidad e incluso de prolongación de la vida presente en todos los hombres. Para responder a esta pregunta las Tecnologías Biomédicas han desarrollado y están desarrollando una gama muy amplia de posibilidades. En este trabajo intentamos organizar en cuatro áreas los conceptos de los tratamientos no-terapéuticos: prevención de la enfermedad, promoción de la salud, mejoramiento de la naturaleza humana y potenciación del hombre. Estas cuatro áreas, que no se refieren directamente a la enfermedad, generan una serie de interrogantes que van desde las preguntas sobre el significado de salud y enfermedad, hasta las cuestiones antropológicas relativas a la posibilidad y las condiciones que se han de dar para que tales acciones respeten la dignidad humana. Cuidar, mejorar y potenciar al hombre implica que los objetivos de la ciencia y de la técnica mantengan siempre claros los valores y la realidad del hombre en cuanto tal. ... Este Trabajo de Investigación presenta los límites antropológicos dentro de los cuales deben moverse las Tecnologías Biomédicas no-terapéuticas para no alterar el ser ni menoscabar la dignidad del hombre. Y ofrece los fundamentos antropológicos sobre los cuales se pueda construir un código ético y deontológico para las Tecnologías Biomédicas no-terapéuticas.

Salud y condiciones de trabajo en trabajadores mayores

Introducción: En los últimos años, la población española ha experimentado un crecimiento acelerado de personas mayores. Las previsiones demográficas a corto-medio plazo describen un importante predominio de trabajadores mayores en el mercado laboral. Objetivos: Identificar las diferencias según dos grupos de edad (<55 años y ≥55 años) en la percepción de las condiciones de trabajo y salud de la población trabajadora española. Metodología: Las diferencias entre los dos grupos de edad se analizaron a partir de indicadores de condiciones de trabajo y de salud pertenecientes a la VII Encuesta Nacional de Condiciones de Trabajo del Instituto de Seguridad e Higiene en el Trabajo (VII_ENCT). El análisis consistió en el cálculo de las prevalencias y la odds ratio cruda-ORc y ajustada por sexo con su correspondiente intervalo del confianza al 95% Resultados: El grupo de trabajadores más jóvenes presentan más riesgo de exposición a seis de los siete indicadores relacionados con las condiciones de trabajo (ruido, vibraciones, carga física, carga mental, autonomía y motivación). No obstante los trabajadores mayores tienen una peor percepción de su estado de salud (ORa= 2,06 [1,75-2,42]) y presentan en mayor medida problemas de salud que si bien les conducen a la visita médica más frecuentemente los relacionan menos con su actividad laboral. Conclusiones: A tenor de los resultados, los trabajadores de 55 años y más refieren tener menos quejas respecto a sus condiciones laborales e incluso se sienten más autónomos y motivados. Es el deterioro físico y mental la principal limitación que encuentran estos trabajadores a la hora de ejercer sus tareas. Sería recomendable establecer políticas de promoción de la salud dentro de las empresas para mejorar los indicadores de salud y promover el envejecimiento activo de la población trabajadora española.

On overwork and premature mental decay: its treatment.

Mode of access: Internet.

Herbicides implicated as the cause of severe mangrove dieback in the Mackay region, NE Australia: consequences for marine plant habitats of the GBR World Heritage Area

Herbicides, particularly diuron, were correlated with severe and widespread dieback of the dominant mangrove, Avicennia marina (Forsk.) Vieth. var. eucalyptifolia (Val.) N.C. Duke (Avicenniaceae), its reduced canopy condition, and declines in seedling health within three neighbouring estuaries in the Mackay region of NE Australia. This unusual species-specific dieback, first observed in the early 1990s, had gotten notably worse by 2002 to affect > 30km(2) of mangroves in at least five adjacent estuaries in the region. Over the past century, agricultural production has responded well to the demands of increasing population with improvements in farm efficiency assisted by significant increases in the use of agricultural chemicals. However, with regular and episodic river flow events, these chemicals have sometimes found their way into estuarine and nearshore water and sediments where their effects on marine habitats have been largely unquantified. Investigations over the last three years in the Mackay region provide compelling evidence of diuron, and possibly other agricultural herbicides, as the most likely cause of the severe and widespread mangrove dieback. The likely consequences of such dieback included declines in coastal water quality with increased turbidity, nutrients and sediment deposition, as well as further dispersal of the toxic chemicals. The implications of such findings are immense since they describe not only the serious deterioration of protected and beneficial mangrove habitat but also the potential for significant direct and indirect effects on other highly-valued estuarine and marine habitats in the region, including seagrass beds and coral reefs of the Great Barrier Reef lagoon. This article reviews all key findings and observations to date and describes the essential correlative and causative evidence. (c) 2004 Elsevier Ltd. All rights reserved.