Armando José China Bezerra

Controle do tabagismo em instituição de longa permanência para idosos: relato de experiência

The scope of this investigation was to establish the prevalence of diabetic foot amputations and analyze associations with factors related to the individual and to primary health care. It is a cross-sectional epidemiological study and the sample included 214 inpatients with diabetic feet in one of the four hospitals specialized in vascular surgery in the state of Pernambuco. Data were collected using semi-structured questionnaires. In the data analysis, chi-square association, Poisson regression (p < 0.05) and descriptive statistics procedures were applied. The prevalence of amputation ascertained was 50%. The following factors related to the individual were associated with its occurrence: low education (p = 0.027); two or more people living in the household (p = 0.046); and patient income below the minimum wage (p = 0.004). The following factors related to primary health care were associated with amputation: not having feet examined (PR = 1.17); not receiving guidance on foot care (PR = 2.24) in consultations in the past year; not using the drug for DM control as prescribed (PR = 1.60); and inadequate glycemic control (PR = 1.83). Understanding these factors helps to identify aspects of preventive care that require improvement.Estudos sobre tabagismo em idosos institucionalizados sao importantes, para que se desenvolvam intervencoes apropriadas. Estudo transversal, base populacional, em individuos com 60 anos ou mais, internados em ILPI do DF. Verificou-se prevalencia de tabagismo, perfil sociodemografico e clinico: genero, escolaridade, provavel depressao, grau de motivacao para cessacao tabagica, uso anterior de auxilio medicamentoso para abolicao do tabagismo e percepcao de prejuizo do fumo para a saude. Realizadas espirometria, medicao do monoxido de carbono exalado e classificacao segundo gravidade da dependencia nicotinica. O Programa seguiu diretrizes para cessacao do tabagismo, sendo avaliado apos um ano do inicio. Do total, 25,7% eram fumantes, sendo 22,8% homens e 2,9% mulheres, com idade media 68,3 ± 8,5 anos. Surgiu significativa reducao da prevalencia de tabagismo nos mais idosos e associacoes significativas entre grau de dependencia nicotinica e escolaridade, provavel depressao, grau de motivacao para cessacao de tabagismo e percepcao de prejuizo do fumo para saude. Identificaram-se maiores valores de monoxido de carbono naqueles com obstrucao grave. Inicialmente, 37,9% dos tabagistas concordaram em participar da Campanha, obtendo-se exito, apos um ano, em 9% deles.

Relação médico-paciente idoso: desafios e perspectivas

ABSTRACT Theaimofthisarticlewastodiscusschallengesandperspectivesinthephysician-elderlypati-ent relationship. In interpersonal relations, inherent to medical practice, it is the quality of the en -counter that determines its efficiency. Thus, in training and identifying good medical professio -nals, the physician-elderly patient relationship is essential for promoting quality of care. Physici -ans should prioritize the feelings and values of elderly patients and their families, encouragingthe necessary joint decision-making, that is, democratization of the physician-patient relations-hip, reclaiming its humanization. This proposal aspires to the birth of a new image for these pro -fessionals, who are responsible for effective health promotion, by considering elderly patients intheirphysical,psychological,andsocialentirety,andnotmerelyfromthebiologicalpointofview.150 REVISTA BRASILEIRA DE EDUCACAO MEDICA34 (1) : 150 – 159 ; 2010 I Universidade Catolica de Brasilia, Brasilia, DF, Brasil.

A osteoporose e a mulher envelhecida: fatores de risco

Osteoporosis is a silent disease which involves the recognition of risk factors inherent to every woman in the determination of strategies to improve the quality of life. OBJECTIVE: to analyze the chance of women having risk factors for osteoporosis using the questionnaire proposed by the EVOS study and evaluate the performance in activities of daily living in relation to actions performed on most days by the IADLs questionnaire. The examination of bone densitometry was performed to diagnose osteoporosis. METHODOLOGY: we applied the plug with socio-demographic data and questionnaire EVOS the first time and after the IADLs questionnaire and examination of bone densitometry in postmenopausal women, aged = 60 years. RESULTS: we analyzed 58 women with a mean age of 67.3 years. The BMI, a risk factor, was considered as a predictor for the absence of osteoporosis, since women in this study were overweight. Sixteen (28%) had osteoporosis, with mean scores significantly lower than those who do not have osteoporosis of items: get shopping (p = 0.006), manages to do manual labor (p = 0.018) and taking care of finances (p = 0.014). CONCLUSION: the BMI variable in the logistic EVOs had relevance in the questionnaire. In the questionnaire analysis of IADLs, women with osteoporosis showed significance for those without osteoporosis for the items: go shopping, can make crafts and take care of finances.

Campaign against smoking in a home for the elderly: the report of an experiment

Studies on institutionalized elderly smokers are important for developing appropriate preventive measures. This was a cross-sectional population-based study of individuals over 60 admitted to a Home for the Elderly in the Federal District. The following aspects were investigated: smoking prevalence, socio-demographic and clinical profile, gender, education, probable depression, degree of motivation to stop smoking, prior use of medication to stop smoking and perception of the harm of smoking to health. Spirometry, the measurement of exhaled carbon monoxide and classification according to severity of nicotine dependence were conducted. The program followed guidelines for stopping smoking, and was evaluated one year later. Results revealed that 25.7% were smokers, 22.8% men and 2.9% women, mean age 68.3 ± 8.5 years. A significant decrease in smoking among the more elderly was detected. Significant associations emerged between the degree of nicotine dependence and education, probable depression, degree of motivation for stopping smoking and perception of the harm of smoking to health. Higher indices of carbon monoxide were identified in individuals with severe obstruction. Initially, 37.9% of smokers agreed to participate in the campaign, and after a year 9% of them succeeded in stopping smoking.

ANATOMICAL RELATIONSHIP BETWEEN VERTEBRAL ARTERIES AND CERVICAL VERTEBRAE: A COMPUTERIZED TOMOGRAPHY STUDY

Las arterias vertebrales ascienden lateralmente a la columna vertebral. Estudios para definir las relaciones entre estos vasos y la columna han sido realizados por medio de examenes tomograficos no contrastados, no habiendo mostrado directamente la presencia ni la posicion de las arterias vertebrales. El objetivo de este estudio es mostrar la localizacion de las arterias vertebrales en relacion a los planos medio, anterior y posterior de los cuerpos vertebrales cervicales. Se trata de un estudio anatomico descriptivo realizado con tomografias computarizadas bidimensionales, despues de la inyeccion de contraste venoso. Se consideraron para este estudio, pacientes adultos, de ambos sexos de quienes fueron evaluadas 52 arterias vertebrales, sin lesiones estructurales que pudieran distorsionar la anatomia normal. Al final, fue efectuada una prueba estadistica para evaluar diferencias en las distancias entre las arterias vertebrales y los distintos cuerpos vertebrales cervicales. Fue encontrado que en C1 y C7, las arterias vertebrales estan mas alejadas del plano mediano que en las demas regiones (p<0,0001). Al nivel de C1, la arteria vertebral izquierda se encuentra mas cercana que la arteria vertebral derecha, con respecto al plano mediano (p=0,0461). A medida que ascienden en el cuello, las arterias vertebrales se distancian del plano anterior. Con relacion al plano posterior, las arterias vertebrales realizan una migracion posterior que muestra diferencia estadistica en C7 y C1 (respectivamente p<0,0001 y p<0,0001). A medida que ascienden en el cuello las arterias vertebrales, no tienen trayecto rectilineo. En los extremos superior e inferior, estas se apartan del plano mediano. Existen migraciones laterales, posteriores y anteriores con respecto a los planos de los cuerpos vertebrales. Estos desplazamientos dejan las arterias vertebrales menos vulnerables en los abordajes anteriores en C1 y en las descompresiones de foramenes intervertebrales a nivel de C7

Correlation between preoperative anxiety and acute postoperative pain in elderly patients submitted to transvesical prostatectomy

BACKGROUND AND OBJECTIVES: The objective of this study was to correlate the level of anxiety presented in the preoperative period with the intensity of pain reported by elderly in the immediate postoperative period of transvesical prostatectomy. METHODS: Sixty-four elderly patients submitted to transvesical prostatectomy were studied, using the following instruments: the numeric pain scale and Hamilton anxiety rating scale in the preoperative; and the short-form McGill pain questionnaire (Portuguese version adapted) in the immediate postoperative period. The elderly divided into four groups, according to the level of anxiety presented in the preoperative period: absent, mild, moderate and intense. The Spearman correlation was established between preoperative anxiety levels and postoperative pain intensity. RESULTS: There was a significant positive correlation between the level of preoperative anxiety and pain intensity in the immediate postoperative period. The pain curves (sensitive and affective) presented a significant increase at moments 6, 18 and 24h in all groups. These curves were significantly higher in the elderly with moderate and intense anxiety than in those without anxiety and mild anxiety. The pain peak was recorded at 18h after surgery in all groups. CONCLUSION: In the elderly, the level of anxiety presented in the preoperative period was positively correlated with the pain response in the immediate postoperative of transvesical prostatectomy. The use of preoperative measures that reduce anxiety can improve analgesia in the immediate postoperative period of this surgery and, therefore, reduce the amount of analgesics used in this period. There was also a need for intervention with adequate analgesia at the postoperative pain peak which occurred 18h after surgery.

Relação médico-paciente idoso no cinema: visões de atendimento

This article aims to describe different views of care through the doctor-elderly patient relationship as addressed in feature films. Research was carried out based on national and international filmography, seeking films containing scenes in which the doctor-elderly patient relationship was portrayed in different ways. In the ten films analyzed, it was possible to identify expectations regarding the care of the elderly patient, both from the patient’s and their family’s view, describing the feelings and socio-cultural values present in the interrelationship established during the professional practice of medicine. It was concluded that cinematographic language is useful for the training of physicians, who should be concerned with the human aspect of their work, as well as for the interpretation of elements involving the complex doctor-patient relationship, particularly among the elderly.

Suicide and suicide attempts by the elderly in film: related factors as shown in feature films

Objective: to analyze cases of suicide and suicide attempts by elderly persons in feature films. Method: a survey of specialized internet cinema portals was carried out. A total of 19 feature films produced between 1950 and 2014 were identified. After the authors watched the films, synopses were written describing the circumstances of the suicide and dialogue that described the profile of the elderly character was transcribed. Results: films that described suicide among the elderly were classified as follows: male gender in 13 films (68%), depression with hopelessness in 12 (63%), existence and efficiency of health services, physical illness and absence of familiar support in ten (for each category) (53%), cognitive rigidity in eight (42%), suicidal thinking in seven (37%), dysfunctional assumptions and a self-perception of negativity in six (32%), problem-solving deficits in five (26%) and a lack of social support in five (26%). Conclusion: the portrayal of suicide among the elderly in films helps to raise awareness of this subject and prevent it.