Milton Roberto Laprega

Avaliação crítica do Sistema de Informação da Atenção Básica (SIAB) e de sua implantação na região de Ribeirão Preto, São Paulo, Brasil

As the health information system used by the Family Health Program teams, the Primary Care Information System (SIAB) is a potential tool for follow-up of registered families and local planning, thus motivating the present study. Semi-structured interviews were held with key individuals in this health information system chain, among Family Health Teams in the municipality of Ribeirao Preto and surrounding region, Sao Paulo State, Brazil, with the objective of analyzing certain characteristics in the system, including: knowledge and having received training to handle it and utilization for local planning and social control. The study concluded that the SIAB is an easy system to handle, but that it presents some limitations already found in other health information systems, such as: difficulty in identifying individuals in the program, limited number of diseases reported, and limited utilization to back planning and decision-making at the local level. Therefore, the analysis of the SIAB was highly important for improving this health information system and can contribute to future improvements and adaptations in the program.

Morbidade psiquiátrica e uso de álcool em gestantes usuárias do Sistema Único de Saúde

OBJETIVO: Investigar a relacao entre consumo de alcool e problemas emocionais em gestantes, verificando se as gestantes com consumo problematico de alcool (uso nocivo ou dependencia) tiveram mais problemas emocionais quando comparadas aquelas cujo consumo nao era problematico. METODOS: Estudo transversal, observacional, sobre uma amostra clinica de um servico obstetrico publico de Ribeirao Preto, SP. A amostra foi nao probabilistica, de conveniencia, do tipo consecutiva, composta por 450 gestantes. Foram aplicados tres questionarios: para dados sociodemograficos, o Questionario de Morbidade Psiquiatrica (QMPA) e um questionario padronizado como parte da anamnese para avaliacao de problemas relacionados ao uso de alcool (uso nocivo ou sindrome de dependencia) de acordo com os criterios da CID-10. Foram utilizados testes univariados (ANOVA) para o exame comparativo entre grupos utilizando medidas de distribuicao central e intervalo de confianca de 95%. RESULTADOS: Foram encontradas 172 gestantes (38,2%) problematicas (escore >7) pelo QMPA. Detectaram-se conforme criterios da CID-10, 41 (9,1%) gestantes com consumo problematico de alcool, sendo 27 (6,0%) com diagnostico de uso nocivo e 14 (3,1%) com dependencia ao alcool. A presenca de diagnostico de uso nocivo ou sindrome de dependencia ao alcool relacionou-se a maior intensidade de sofrimento emocional das gestantes, ou seja, maior media de pontuacao nas subescalas ansiedade, depressao e alcool do QMPA. CONCLUSOES: Considerando a prevalencia de problemas emocionais, o consumo de alcool durante a gestacao e os riscos de problemas a saude materno-infantil sugere-se que sejam realizadas avaliacoes mais criteriosas pelos profissionais de saude.

Quedas de idosos institucionalizados: ocorrência e fatores associados

Quedas entre pessoas idosas constituem importante problema de saude publica, devido a sua incidencia, as complicacoes para a saude e aos altos custos assistenciais. Estudos realizados no Brasil e em outros paises referem que as quedas sao mais frequentes em idosos institucionalizados e apresentam causa multifatorial. Com o objetivo de verificar a ocorrencia de quedas em idosos institucionalizados e identificar seus fatores associados, foi realizado um levantamento de dados de 105 individuos com idade igual ou superior a 60 anos, residentes em quatro instituicoes asilares do municipio de Catanduva, Sao Paulo. O metodo utilizado para a coleta dos dados foi entrevista. Foram utilizados os instrumentos: Escala de Depressao Geriatrica e Mini-Exame do Estado Mental, instrumentos estes destinados a avaliacao dos estados de humor e cognitivo, respectivamente. Os achados mostraram que 40% dos idosos relataram quedas nos ultimos seis meses, e os fatores de risco considerados significativos foram: sexo feminino (p=0,035), uso de medicamentos (p=0,047), visao deficiente (p=0,029), ausencia de atividade fisica (p=0,035), presenca de osteoartrose (p=0,000), depressao (p=0,034), deficit de forca de preensao palmar (p=0,0165) e disturbios no equilibrio e marcha (p=0,038). Os resultados apontam para a necessidade da implementacao de programas de prevencoes de quedas em instituicoes asilares, atraves de intervencao multidisciplinar buscando, portanto, uma melhoria na qualidade de vida dessa populacao.

Consumo de álcool na gestação: desempenho da versão brasileira do questionário T-ACE

OBJETIVO: Avaliar as caracteristicas de desempenho da versao brasileira do questionario Tolerance, Annoyed, Cut down e Eye-opener (T-ACE), para rastreamento do consumo de alcool na gestacao. METODOS: Estudo observacional, transversal, em amostra sequencial de 450 mulheres no terceiro trimestre de gestacao, assistidas em maternidade no municipio de Ribeirao Preto, estado de Sao Paulo, em 2001. Foram aplicados: questionario para coleta de dados sociodemograficos, T-ACE, questionario para levantamento da historia de consumo de alcool ao longo da gestacao e entrevista clinica para identificacao de uso nocivo e dependencia ao alcool, segundo criterios diagnosticos da CID-10. Foram feitos testes de concordância entre diferentes entrevistadores e de confiabilidade teste/re-teste. RESULTADOS: Do total, 100 gestantes (22,1%) foram consideradas positivas pelo T-ACE. Os indices kappa para concordância e confiabilidade foram 0,95, com 97% de respostas concordantes. Quando comparado aos parâmetros da CID-10 e ao padrao de consumo, o T-ACE com ponto de corte igual ou acima de dois pontos, apresentou coeficientes de sensibilidade e especificidade de 100% e 85% e de 97,9% e 86,6% respectivamente. CONCLUSOES: A versao brasileira do T-ACE mostrou preencher adequadamente os criterios de desempenho que a qualificam ao papel de instrumento basico para o rastreamento do consumo de alcool durante a gravidez. Sua utilizacao e recomendavel nas rotinas e praticas dos servicos obstetricos devido a tendencia de aumento do consumo alcoolico feminino, dificuldades para identificacao do abuso de alcool pela gestante e riscos de problemas de desenvolvimento nos filhos.

Intervenções breves para o uso abusivo de álcool em atenção primária

Summary This work aimed to identify, and characterize the field of evaluation studies of brief interventions (BI) for alcohol abuse in primary health care. A bibliographical search was carried out, using databases (Medline, PsycInfo, Lilacs), to identify empirical studies – clinical trials – with comparative evaluation of the results of BIs, published between January 1990 and December 2003. Twenty six studies were identified, most of them published in the United States of America during 1997. These studies evaluated the effectiveness of brief counseling intervention with the use of educational materials and follow up evaluation on problematic alcohol users. The majority showed that BIs reduce the consumption of alcohol. The most common study design was longitudinal, randomized clinical trial. The most frequent outcome measure was the alcohol drinking consumption pattern. There is no standardization of BIs procedures. BI were found to be effective in 25 studies. No Latin American and Caribbean studies in Lilacs were found.

Avaliação do desempenho do CAGE com pacientes psiquiátricos ambulatoriais

Descriptive and transversal study to evaluate the performance of CAGE among psychiatric outpatients at a tertiary-level university hospital. Convenience sample composed of patients from HCFMRP-USP (n=127). The instruments used were CAGE and the diagnostic interview based on ICD-10 criteria for harmful use and alcohol dependence. The performance of CAGE scores was evaluated through the analysis of ROC curve, using the ICD-10 clinical diagnostic as a gold standard. The sensitivity and specificity in accordance with the cut-off points are: > or =0, Sens=100%, Spec=0%; > or =1, Sens=100%, Spec=73.7%; > or =2, Sens=53.8%, Spec=87.7%; > or =3, Sens=53.8%, Spec=94.7%; > or =4, Sens=0%; Spec=100%. Score 1 showed to be the ideal critical point for sensibility/specificity. > or =1 was the best cut-off point for CAGE among psychiatric outpatients from a tertiary-level university hospital. To increase the diagnostic power of the test and the reliability of its results, its performance in the study population should be assessed.Descriptive and transversal study to evaluate the performance of CAGE among psychiatric outpatients at a tertiary-level university hospital. Convenience sample composed of patients from HCFMRP-USP (n=127). The instruments used were CAGE and the diagnostic interview based on ICD-10 criteria for harmful use and alcohol dependence. The performance of CAGE scores was evaluated through the analysis of ROC curve, using the ICD-10 clinical diagnostic as a gold standard. The sensitivity and specificity in accordance with the cut-off points are: ³0, Sens=100%, Spec=0%; ³1, Sens=100%, Spec=73.7%; ³2, Sens=53.8%, Spec=87.7%; ³3, Sens=53.8%, Spec=94.7%; ³4, Sens=0%; Spec=100%. Score 1 showed to be the ideal critical point for sensibility/ specificity. ³1 was the best cut-off point for CAGE among psychiatric outpatients from a tertiary-level university hospital. To increase the diagnostic power of the test and the reliability of its results, its performance in the study population should be assessed.

Rastreamento da função cognitiva de idosos não-institucionalizados

This study aimed to evaluate the cognitive function of elderly people and determine the frequency of cognitive impairment, stratified by age, education, hobby, social relationship, informed chronic diseases and depression. In a random sample of 394 elderly aged over 60 years in the city of Batatais, state of Sao Paulo, Brazil, was administered a questionnaire on socioeconomic conditions, health and Geriatric Depression Scale (GDS). To track the cognitive impairment, we used the MMSE - Mini Mental State Examination modified. In the assessment of cognitive performance, we used a cutoff point of 23. It was observed that 81.7% of the subjects were above this point and 18.3% were below. The elderly who had higher scores were associated with factors such as age (60-69 years), educational level, reading habits, good social relations, especially with family and no hypertension, diabetes, urinary incontinence, cataracts and/or depressive symptoms. The global cognitive performance of older people assessed by the tool based on the MMSE showed that those with socres below the cutoff point had a similar proportion to that found in other studies.

Sobrevivência de pacientes com aids em uma cidade do sudeste brasileiro

OBJECTIVE To assess survival in patients diagnosed with AIDS in the city of Ribeirão Preto, Brazil, between 1986 and 1997. METHODS The epidemiological records of 2,214 patients diagnosed during the study period were retrospectively reviewed. From those, 1,231 patients with at least 30 days of follow-up after the date of diagnosis were included in the study. Information concerning deaths was obtained from hospitals and vital-records offices. RESULTS Survival for the group as a whole was 310 days (10.3 months) over the period of 1986 through 1997. Median survival was 362 days for 1986 to 1990, 260 days for 1991 to 1995, and 864 days for 1996 and 1997. The Kaplan-Meier survival curves and the log-rank test showed significant differences for the following variables: sex, age, period when diagnosis was made, and presence of candidiasis and of cerebral toxoplasmosis. Coxs regression showed an association between reduction of survival and the following variables: age (in comparison to individuals younger than 15 years, hazard ratio = 1.435 for age between 15 and 34 years, and 1.681 for age above 35 years); period of diagnosis (in comparison to the period of 1996 and 1997, hazard ratio = 1.682 for the period from 1986 to 1990, and 2.324 for the period from 1991 to 1995); and presence of candidiasis (hazard ratio = 1.391). The hazard ratio for the presence of cerebral toxoplasmosis was 1.063, with a probability value close to the limit of significance. CONCLUSIONS Our results show a striking increase in survival in 1996 and 1997, coinciding with the availability and utilization of highly active antiretroviral drugs.

Performance assessment of CAGE screening test among pschiatric outpatients

Descriptive and transversal study to evaluate the performance of CAGE among psychiatric outpatients at a tertiary-level university hospital. Convenience sample composed of patients from HCFMRP-USP (n=127). The instruments used were CAGE and the diagnostic interview based on ICD-10 criteria for harmful use and alcohol dependence. The performance of CAGE scores was evaluated through the analysis of ROC curve, using the ICD-10 clinical diagnostic as a gold standard. The sensitivity and specificity in accordance with the cut-off points are: > or =0, Sens=100%, Spec=0%; > or =1, Sens=100%, Spec=73.7%; > or =2, Sens=53.8%, Spec=87.7%; > or =3, Sens=53.8%, Spec=94.7%; > or =4, Sens=0%; Spec=100%. Score 1 showed to be the ideal critical point for sensibility/specificity. > or =1 was the best cut-off point for CAGE among psychiatric outpatients from a tertiary-level university hospital. To increase the diagnostic power of the test and the reliability of its results, its performance in the study population should be assessed.Descriptive and transversal study to evaluate the performance of CAGE among psychiatric outpatients at a tertiary-level university hospital. Convenience sample composed of patients from HCFMRP-USP (n=127). The instruments used were CAGE and the diagnostic interview based on ICD-10 criteria for harmful use and alcohol dependence. The performance of CAGE scores was evaluated through the analysis of ROC curve, using the ICD-10 clinical diagnostic as a gold standard. The sensitivity and specificity in accordance with the cut-off points are: ³0, Sens=100%, Spec=0%; ³1, Sens=100%, Spec=73.7%; ³2, Sens=53.8%, Spec=87.7%; ³3, Sens=53.8%, Spec=94.7%; ³4, Sens=0%; Spec=100%. Score 1 showed to be the ideal critical point for sensibility/ specificity. ³1 was the best cut-off point for CAGE among psychiatric outpatients from a tertiary-level university hospital. To increase the diagnostic power of the test and the reliability of its results, its performance in the study population should be assessed.

Equilíbrio e marcha de idosos residentes em instituições asilares do município de Catanduva, SP

This paper aims to evaluate balance and gait in elderly people who live at retirement homes and to characterize alterations in balance a...