Incidence of dementia in a population cohort of older people from São Paulo, Brazil.

OBJECTIVES: To estimate the incidence of dementia in a community-dwelling older population from São Paulo city, Brazil. METHODS/DESIGN: This two-phase prospective cohort study evaluated a representative cluster sample of 1370 individuals aged 60 years old and over from three different socioeconomic levels. The community screening phase consisted of a tested combination of cognitive and functional tests administered among the subjects and informants. In the hospital diagnosis phase, the Cambridge Examination was performed; the diagnosis of dementia and dementia subtypes was made according to DSM IV criteria. Incidence rates were expressed in person-years, multiplied by 1000. The risk of developing dementia was calculated using Cox regression. RESULTS: Among 1370 eligible subjects, 678 were accessed, and 489 completed the evaluation. Forty-two subjects were diagnosed with dementia. The incidence rate of dementia and Alzheimer's disease (AD) were 11.2 (95% CI: 8.0-15.1) and 8.9 (95% CI: 6.1-12.5) per 1000 person-years, respectively; there were high age-specific rates of dementia among younger individuals. There was a trend of a higher risk of developing AD for women than for men. Multivariate analysis showed that older age, the presence of diabetes and the presence of amnestic MCI increased the risk of developing dementia. CONCLUSIONS: The age-specific rates in younger individuals were expressively higher than in worldwide studies and supposedly affected by cardiovascular morbidity. The higher risk in women in a younger sample corroborated the interaction between sex and AD. The increased risk of amnestic MCI reinforced its contribution to the progression to dementia and AD.

Evaluation of the quality of life of children with celiac disease and their parents: a case-control study.

PURPOSE: The purpose of the present study was to evaluate the quality of life (QoL) of children with CD and of their parents and to compare it with that of children without CD and of their parents. METHODS: A case-control study was conducted to evaluate the quality of life of children (5-12 years) with CD and one of their parents, compared to the QoL of children without CD (and their parents as their caregivers ). The QoL was assessed by applying the following questionnaires: AUQUEI (children) and WHOQOL-BREF (parents). RESULTS: QoL was evaluated in 33 children with CD, 63 children without CD, and of their respective parents as their parent caregivers (96 adults). QoL total scores were similar between the groups of children with and without CD. However, in the Leisure dimension, the scores of children with CD were significantly lower than those of the controls (P = 0.029). Similarly, when assessing the QoL of the parents, we found scores significantly lower in the social dimension (P = 0.0196) for parents of children with CD compared to parents of children without CD. Family income presented an impact on the QoL in adults, but did not affect children. In CD group, children of mothers who had lower educational levels presented better scores in the function dimension, regarding self-care and autonomy. CONCLUSIONS: There is an impairment of the QoL of children with CD and of their parents, with regard to social life, particularly in the leisure (children) and social (adults) dimensions.

User satisfaction with asynchronous telemedicine: a study of users of Santa Catarina's system of telemedicine and telehealth.

User satisfaction analyses in synchronous telemedicine and teleconsultation environments have been widely performed and generally show satisfied users. In the field of asynchronous telemedicine, however, satisfaction studies were performed only in one single location or with a restricted set of users. With the aim of offering an exemplar evaluation of the impact of the statewide use of a large-scale asynchronous telemedicine network on the satisfaction of the involved users, this study presents the results obtained from a survey of the perceived quality of the service by both patients and healthcare staff. For this purpose, a survey with satisfaction questionnaires was performed with 564 patients from seven upstate municipalities and 56 healthcare professionals from 46 municipalities, using a methodology from the process improvement field. The collected data were quantified and underwent statistical analysis, which showed a clear perception of the improvement in the quality of service by both patients and healthcare professionals. The present findings also showed that both patients and healthcare professionals felt that introducing these new technologies was a positive step, even in upstate areas and when they involved great changes in the usual processes of primary care.

Probabilistic model for assessing occupational risk during the handling of nanomaterials.

Exposure to nanomaterials (NMs) can be considered as human, occupational or environmental. Occupational exposure may be experienced by the workers and/or researchers who develop and produce these products and the hazards inherent to exposure are not yet fully known. Quantitative and qualitative methods are available to estimate the occupational risks associated with the handling of NMs, however, both have limitations. In this context, the objective of this study was to create a Bayesian network (BN) that will allow an assessment of the occupational risk associated with the handling of NMs in research laboratories. The BN was developed considered variables related to exposure, the hazards associated with NMs and also the existing control measures in the work environment, such as collective protection equipment (CPE), administrative measures and personal protection equipment (PPE). In addition to assessing the occupational risk, simulations were carried out by the laboratory manager to obtain information on which actions should be taken to reduce the risk. The development of a BN to assess the occupational risk associated with the handling of NMs is a novel aspect of this study. As a distinctive feature, the BN has measurement control variables in addition to considering CPE, administrative measures and PPE. An advantage of this network in relation to other risk assessment models is that it allows the easy execution of simulations and provides a guide for a decision making by identifying which actions should be taken to minimize the risk.

A neuro-fuzzy system to support in the diagnostic of epileptic events and non-epileptic events using different fuzzy arithmetical operations.

OBJECTIVE: To investigate different fuzzy arithmetical operations to support in the diagnostic of epileptic events and non epileptic events. METHOD: A neuro-fuzzy system was developed using the NEFCLASS (NEuro Fuzzy CLASSIfication) architecture and an artificial neural network with backpropagation learning algorithm (ANNB). RESULTS: The study was composed by 244 patients with a bigger frequency of the feminine sex. The number of right decisions at the test phase, obtained by the NEFCLASS and ANNB was 83.60% and 90.16%, respectively. The best sensibility result was attained by NEFCLASS (84.90%); the best specificity result were attained by ANNB with 95.65%. CONCLUSION: The proposed neuro-fuzzy system combined the artificial neural network capabilities in the pattern classifications together with the fuzzy logic qualitative approach, leading to a bigger rate of system success.

[Clinical profile of Santa Catarina members of Brazilian Celiac Association]. / Perfil clínico dos membros da associação dos celíacos do Brasil--regional de Santa Catarina (ACELBRA-SC).

BACKGROUND: Celiac disease is an enteropathy induced by gluten in genetically predisposed individuals. AIM: To establish the demographic and clinical characteristics of this disease in Santa Catarina State, Brazil. METHODS: A descriptive transversal study was performed involving members of a regional celiac association, to whom a questionnaire focusing various aspects of the disease was sent. RESULTS: From a total of 506 members, 145 (28.7%) were enrolled in the study--all of them biopsy-proven celiacs. Their mean age was 30.8 years (range, 3.3-82.5 years). Female to male rate was 2.1:1. The mean age at diagnosis was 16 years for men and 26.7 years for women. Most frequently reported symptoms were: abdominal distention (71.8%), abdominal pain (71%) and diarrhea (65.5%). Anemia, aphthous ulcers and constipation were more related by women, while diarrhea and low weight were more frequent in men. Only 42.1% of the participants had been submitted to biopsies compatible with a correct investigation of the disease (44.2 % had been submitted to biopsy only after gluten exclusion of the diet and 11.7% did not mentioned whether they were in a gluten-free diet when biopsied). Only 61.4% had been submitted to serological tests for diagnostic or dietary control purposes. Associated diseases were related by 65% of the individuals, of which the most common was lactose intolerance (33%). Vitaminic or mineral supplementation was indicated to 45% and only 32.5% have had bone mineral density measured. Of these, 59% had altered results. CONCLUSIONS: The results suggest a tendency of diagnosis of celiac disease in older ages, specially among women. This may indicate the necessity of improving public and medical knowledge in Santa Catarina concerning the diagnosis and treatment of this disease.

[Meta analysis of the use of Bayesian networks in breast cancer diagnosis]. / Metanálise do uso de redes bayesianas no diagnóstico de câncer de mama.

The aim of this study was to determine the accuracy of Bayesian networks in supporting breast cancer diagnoses. Systematic review and meta-analysis were carried out, including articles and papers published between January 1990 and March 2013. We included prospective and retrospective cross-sectional studies of the accuracy of diagnoses of breast lesions (target conditions) made using Bayesian networks (index test). Four primary studies that included 1,223 breast lesions were analyzed, 89.52% (444/496) of the breast cancer cases and 6.33% (46/727) of the benign lesions were positive based on the Bayesian network analysis. The area under the curve (AUC) for the summary receiver operating characteristic curve (SROC) was 0.97, with a Q* value of 0.92. Using Bayesian networks to diagnose malignant lesions increased the pretest probability of a true positive from 40.03% to 90.05% and decreased the probability of a false negative to 6.44%. Therefore, our results demonstrated that Bayesian networks provide an accurate and non-invasive method to support breast cancer diagnosis.

[Pediatric cancer: analysis of hospital records]. / Câncer pediátrico: análise de um registro hospitalar.

OBJECTIVE: To analyze pediatric cancer hospital records regarding the occurrence of new cases; to verify the relation between sex, age, race, origin and the disease clinical extension; to describe the mortality of children with cancer; to explore the association of new cases with proposed demographic variables, disease clinical extension and vital status. METHODS: Observational, descriptive, longitudinal study in children up to 14 years old, from Santa Catarina. Three hundred and seventy-one new cases of cancer were treated in a regional reference outpatient clinic (1994-98) and recorded according to the International Classification of Childhood Cancer. Multiple Correspondence Analysis was applied to evaluate the categorical variables. RESULTS: Three-hundred and seventy-one new cases of cancer were recorded with constant distribution in each year. Cancer affected preschoolers (41.5%) and males (55.8%). Leukemia was observed in 36.6% of the cases. Non-localized stage on the diagnosis occurred in 55.7%. The death occurred in 55.7% of the cases with non-localized disease and 16.3% with localized disease. At the end of the study 58.8% of the children were alive. CONCLUSIONS: We observed more cases of cancer at pre-school age and among male subjects. Leukemia is the most frequent type of cancer. Non-localized disease predominates on the diagnosis. The death frequency is higher in the group with non-localized disease. There is direct association with non-localized disease, living vital status, school age, adolescent age, female, and for non-localized disease with death vital status, infant age, pre-school age and male.

[Family dynamics in the caring context of adults on the fourth age]. / Dinâmica da família no contexto dos cuidados a adultos na quarta idade.

This study aimed to determine the pattern of family functioning on everyday care relationships of adults in the fourth age. This is a study of diagnostic-evaluative nature of adults with 80 or more years old who depend on care, and of their relatives as caregivers. The participants were selected among the registered patients of a Family Health Unit in a district in the suburbs of Belém-PA, Brazil. They were evaluated according to the dynamics of their family, and quality of life related health lifestyle. Most of the elderly rated their families with good functionality. However, data on the elderly and caregivers' quality of life and caregivers' life style only reached the median level, showing some difficulty in the family functioning system. It was concluded that the multiple results obtained through the assessments indicate some practical implications of care to the family unity and confirm the need for multidimensional assessment about the family intervention.

Transepithelial transport of glucose and mRNA of glucose transporters in the small intestine of rats with iron-deficiency anemia.

OBJECTIVE: To evaluate the transepithelial transport of sodium, glucose, potassium, and water and the mRNA level of the sodium-glucose cotransporter (SGLT1) and the facilitated sugar transporter (GLUT2) in the small intestine of iron-deficient rats. METHODS: After 6 wk of receiving diets with low or normal iron content, rats (Wistar-EPM) were subjected to two experiments: 1) evaluation of the transepithelial transport of sodium, glucose, potassium, and water by an "in vivo" experimental model of intestinal perfusion and 2) determination of relative SGLT1 and GLUT2 mRNA levels in the proximal, intermediate, and distal portions of the small intestine by the northern blotting technique. RESULTS: Hemoglobin and hepatic iron levels were statistically lower in the anemic rats. The mean transepithelial transports of sodium (-33.0 µEq · min(-1) · cm(-1), glucose (426.0 µM · min(-1) · cm(-1), and water (0.4 µL · min(-1) · cm(-1) in the small intestine of the anemic rats were significantly lower than in the control group (349.1 µEq · min(-1) · cm(-1), 842.6 µM · min(-1) · cm(-1), and 4.3 µl · min(-1) · cm(-1), respectively, P < 0.05). The transepithelial transport of potassium was similar for both groups. The relative SGLT1 mRNA levels of the anemic rats in the intermediate (1.796 ± 0.659 AU) and distal (1.901 ± 0.766 AU) segments were significantly higher than the values for the control rats (intermediate 1.262 ± 0.450 AU, distal 1.244 ± 0.407 AU). No significant difference was observed for the relative SLGT1 mRNA levels in the proximal segment or for the GLUT2 mRNA levels in all segments. CONCLUSION: Iron deficiency decreases the absorption of glucose, sodium, and water and increases SGLT1 mRNA in the intermediate and distal segments of the small intestine of rats.

Metanálise do uso de redes bayesianas no diagnóstico de câncer de mama / Meta analysis of the use of Bayesian networks in breast cancer diagnosis / Metaanálisis del uso de los modelos bayesianos en el diagnóstico de cáncer de mama

O objetivo deste estudo foi avaliar a acurácia das redes bayesianas no apoio ao diagnóstico de câncer de mama. Foram realizadas revisão sistemática e metanálise, que incluíram artigos e relatórios publicados entre Janeiro de 1990 e Março de 2013. Foram incluídos estudos transversais prospectivos e retrospectivos que avaliaram a acurácia do diagnóstico de lesões de mama (condição alvo) usando as redes bayesianas (teste em avaliação). Quatro estudos primários que incluíram 1.223 lesões de mama foram analisados, 89,52% (444/496) dos casos de câncer de mama e 6,33% (46/727) das lesões benignas foram positivas tendo-se como base a análise das redes bayesianas. A área dentro da curva SROC (característica de operação do receptor sumária) foi 0,97, com um valor Q* de 0,92. O uso de redes bayesianas no diagnóstico de lesões malignas aumentou a probabilidade pré-teste para um verdadeiro positivo de 40,03% para 90,05% e diminuiu a probabilidade de um falso negativo para 6,44%. Portanto, nossos resultados demonstraram que as redes bayesianas oferecem um método acurado e não invasivo no apoio ao diagnóstico de câncer de mama.

The aim of this study was to determine the accuracy of Bayesian networks in supporting breast cancer diagnoses. Systematic review and meta-analysis were carried out, including articles and papers published between January 1990 and March 2013. We included prospective and retrospective cross-sectional studies of the accuracy of diagnoses of breast lesions (target conditions) made using Bayesian networks (index test). Four primary studies that included 1,223 breast lesions were analyzed, 89.52% (444/496) of the breast cancer cases and 6.33% (46/727) of the benign lesions were positive based on the Bayesian network analysis. The area under the curve (AUC) for the summary receiver operating characteristic curve (SROC) was 0.97, with a Q* value of 0.92. Using Bayesian networks to diagnose malignant lesions increased the pretest probability of a true positive from 40.03% to 90.05% and decreased the probability of a false negative to 6.44%. Therefore, our results demonstrated that Bayesian networks provide an accurate and non-invasive method to support breast cancer diagnosis.

El objetivo de este estudio fue evaluar la exactitud de las redes bayesianas para apoyar el diagnóstico de cáncer de mama. Se realizó una revisión sistemática y un metaanálisis, que incluyeron artículos y estudios publicados entre enero de 1990 y marzo de 2013. Se incluyeron estudios transversales prospectivos y retrospectivos, que evaluaron la exactitud del diagnóstico de lesiones mamarias (condición de destino), utilizando redes bayesianas (prueba de evaluación). Se analizaron cuatro estudios que incluyeron 1.223 lesiones de mama primarias, un 89,52% (444/496) de los casos de cáncer de mama, y un 6,33% (46/727) de las lesiones benignas se tomaron como base de análisis de las redes bayesianas. El área bajo la curva SROC (característica operativa del receptor) fue de un 0,97, con un valor de Q* de un 0,92. El uso de las redes bayesianas en el diagnóstico de las lesiones malignas aumentó la probabilidad pre test de un verdadero positivo desde un 40,03% a un 90,05%, y la disminución de la probabilidad de un falso negativo de un 6,44%. Por lo tanto, nuestros resultados demuestran que las redes bayesianas ofrecen un método preciso y no invasivo en el apoyo del diagnóstico del cáncer mamario.

[Evaluate the clonidine use for sedoanalgesia in intensive care unit patients under prolonged mechanical ventilation]. / Avaliação do uso da clonidina para sedoanalgesia de pacientes sob ventilação mecânica prolongada, internados em unidade de terapia intensiva.

BACKGROUND AND OBJECTIVES: The control of patient discomfort in the intensive care unit (ICU) has become an integral part of critical care practice. The sedoanalgesic drugs could influence critically ill patient's morbimortality. Alpha²-adrenoceptor agonists might have an interesting future in ICU. The objective of this study is to evaluate the clonidine use for sedoanalgesia in ICU patients under prolonged mechanical ventilation. METHODS: Historical cohort study. Admitted patient files, January-December 2006, which stayed under mechanical ventilation, analgesia and sedation > 7days were analyzed. Demographic, clinical features and therapeutic data concerning analgesia and sedation were remarked. The data allowed classify the patients in three different groups: G1 = patients that used clonidine and other drugs; G2 = patients that used three or more drugs, without clonidine and G3 = patients that used fentanyl and midazolam. The mean daily doses of infused clonidine were registered, and the values of heat rate (HR), blood arterial pressure (BAP) before starting use of clonidine, after six hours and 24 hours were also registered. Statistical analyzes were performed using Variance Analysis (ANOVA), t tests and x² (significance p < 0.05). RESULTS: Were selected 55 patients. Fifteen (27.2%) belonged to G1, 11 (20%) belonged to G2 and 29 (52.7%) belonged to G3. The mean age of patients was 44 (G1), 50 (G2) and 56 (G3) (p = NS). The mean score APACHE II was 18 (G1), 20.4 (G2) and 20.7 (G3) (p = NS). G1 and G2 patients presented higher ICU length-of-stay (p < 0.05). The mean dose of clonidine used was 1.21 ± 0.54 mg/kg/min. G1 patients had HR and BAP decreased, however these effects were not considered clinically relevant. The mortality was lower in the patients from G1 (20%) when compared to G2 (54.5%) and G3 (62%) (p < 0.05). CONCLUSIONS: The clonidine use to analyzed patients did not result in clinical relevant side effects. The lower mortality index in patients that used clonidine was statistical significant.

Dinâmica da família no contexto dos cuidados a adultos na quarta idade / Family dynamics in the caring context of adults on the fourth age / Dinámica de la familia en el contexto de los cuidados de adultos en la cuarta edad

Objetivou-se identificar o padrão de funcionamento familiar nas relações de cuidado cotidiano de adultos na quarta idade. Trata-se de estudo de natureza diagnóstico-avaliativa de idosos de 80 e mais anos, dependentes de cuidados, e de seus familiares cuidadores, selecionados entre os cadastrados nas unidades de Saúde da Família de um distrito de periferia de Belém-PA, avaliando-os quanto à dinâmica de família, qualidade de vida e estilo de vida relacionado à saúde. Observou-se que a maioria dos idosos avaliou sua família como tendo boa funcionalidade. Porém, os demais dados relativos à qualidade de vida de idosos e cuidadores, como também, estilo de vida dos cuidadores recaíram no nível mediano, levando a inferir certa dificuldade no padrão de funcionamento familiar. Conclui-se que os múltiplos resultados obtidos sinalizam implicações práticas de atenção à unidade familiar e confirmam a necessidade de avaliação multidimensional em intervenção de família.

This study aimed to determine the pattern of family functioning on everyday care relationships of adults in the fourth age. This is a study of diagnostic-evaluative nature of adults with 80 or more years old who depend on care, and of their relatives as caregivers. The participants were selected among the registered patients of a Family Health Unit in a district in the suburbs of Belém-PA, Brazil. They were evaluated according to the dynamics of their family, and quality of life related health lifestyle. Most of the elderly rated their families with good functionality. However, data on the elderly and caregivers' quality of life and caregivers' life style only reached the median level, showing some difficulty in the family functioning system. It was concluded that the multiple results obtained through the assessments indicate some practical implications of care to the family unity and confirm the need for multidimensional assessment about the family intervention.

Este estudio tuvo como objetivo identificar el patrón de funcionamiento de la familia en las relaciones de cuidado diario de adultos en la cuarta edad. Trata-se de estudio de naturaleza diagnóstico-evaluativo de personas de 80 años o más, dependientes de cuidados, y de sus familiares cuidadores, seleccionados entre aquellos registrados en las unidades de Salud de la Familia, de un distrito de la periferia de Belém-PA. Los mismos fueron evaluados en relación a la dinámica de la familia, calidad de vida y estilo de vida relacionado con la salud. Fue observado que los ancianos, en su mayoría, evaluaron su familia como teniendo una buena funcionalidad. Sin embargo, los demás datos relativos a la calidad de vida de los ancianos y cuidadores, así como al estilo de vida de los cuidadores, fueron de nivel medio, mostrando una cierta dificultad en el padrón de funcionamiento familiar. En conclusión, los múltiples resultados obtenidos en la evaluación señalan implicaciones prácticas para la atención a la unidad familiar y confirman la necesidad de una evaluación multidimensional en la intervención de esta clientela.

Mudança de atitudes dos estudantes durante o curso de medicina: um estudo de coorte / Changes in medical students' attitudes during the medical course: a cohort study

INTRODUÇÃO: Devido ao possível potencial preditivo das atitudes apresentadas pelos estudantes durante o curso de graduação em Medicina, o diagnóstico e o acompanhamento de aspectos atitudinais necessários ao exercício profissional poderiam propiciar mudanças no processo de formação da identidade profissional para efetivação de uma prática médica renovada. MÉTODO: Estudo de coorte, descritivo e quantitativo, por meio da aplicação, em dois momentos, de uma escala de atitudes (tipo Likert com alpha de Cronbach = 0,87), em que se analisam cinco aspectos (ambiência, conhecimento, crença, ética e social) segundo as Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina. Os sujeitos foram 202 estudantes de Medicina (52,85% mulheres e 47,15% homens), da primeira à oitava fase, com média de idade de 21,45 anos (Q inf: 21 e Q sup: 22,50); 91,50% provenientes da escola particular; 97,52% solteiros; de família de bom padrão de escolaridade e econômico; 91,54% da Região Sul, sendo 48,77% do próprio Estado; 86,63% não exerciam atividades extracurriculares; e 86,07% tinham como meta ingressar na residência médica após a graduação. RESULTADO: Identificados dois grupos, com provável homogeneidade de comportamento, com tendência atitudinal positiva, mais frequente no sexo feminino, demonstrando provável conflito na dimensão crença. CONCLUSÕES: Os estudantes apresentaram alguns aspectos atitudinais positivos relevantes para a prática médica, não havendo diferenças substanciais considerando-se as fases e o período estudado. Foram percebidos possíveis conflitos atitudinais quando analisados os itens de determinados aspectos, permitindo uma reflexão para possível associação com as questões educacionais e fornecendo subsídios para estudos futuros.

INTRODUCTION: During medical school, the students' values and attitudes are affected by knowledge, environment and training. Due to the possible predictive potential, __ the diagnoses and monitoring of the attitude aspects needed for the professional exercise could propitiate changes in the process of the professional identity formation for the implementation of a renewed medical practice. OBJECTIVES: To measure the attitudes and to evaluate the behavior changes during the graduation process. METHOD: A cohort study, descriptive and quantitative, in which it was utilized a questionnaire, that applied in two moments an attitude range (Miranda, 2006) analyzing five aspects: environment, knowledge, beliefs, ethics and society. The attitudes were categorized in positive, negative and conflicting. The subjects were 202 medical students (52.85% women and 47.15% men), from the first to the eighth periods, with a mean age of 21.45 years; 91.50% from private schools; 97.52% single; from good socio-cultural family standards; 91.54% from the South Region, being 48,77% from the State; 86.63% did not perform extracurricular activities; and 86.07% had as their goal to join the residency program after graduation. RESULT: Identified two groups, with a probable homogeneity of behavior, with positive attitudinal trend, more common in females, demonstrating a probable conflict in belief dimension. CONCLUSIONS: Students tended to positive attitudinal aspects___ relevant to the medical practice, and showed no substantial differences considering the phases and the periods studied. Were perceived attitudinal conflicts in certain areas, allowing for a reflection of a possible association with educational issues, and providing subsidies for future studies.

Women with type 2 diabetes mellitus: sociodemographic profile, biometrics and health

OBJECTIVE: To understand the profile of women with type 2 diabetes mellitus, focusing on sociodemographic factors, biometrics and health. METHODS: A quantitative, transversal, prospective study with a stratified random sample, conducted in Florianópolis/SC with 147 women by means of home visits between April and August of 2009. RESULTS: The women had a mean age of 66 years, presented elevated indexes of body weight, capillary glycemia and abdominal circumference, along with a low adherence to non-pharmacological treatment. A low educational level was associated with inadequate glycemic control, no physical activity, and inadequacy of the diet. CONCLUSIONS: Women with lower education constitute a vulnerable group and require health interventions congruent with their capacities of understanding and possibilities of adaptation to treatment.

OBJETIVO: Conhecer o perfil de mulheres com Diabetes mellitus tipo 2, enfocando fatores sociodemográficos, biométricos e de saúde. MÉTODOS: Estudo de abordagem quantitativa, transversal, prospectivo com amostra estratificada aleatória, desenvolvido em Florianópolis/SC com 147 mulheres por meio de visitas domiciliares entre abril e agosto de 2009. RESULTADOS: As mulheres tinham idade média de 66 anos, apresentaram elevados índices de massa corporal, glicemia capilar e circunferência abdominal, além de baixa adesão ao tratamento não medicamentoso. A baixa escolaridade associou-se ao controle inadequado da glicemia, não realização de atividade física e inadequação da dieta. CONCLUSÕES: Mulheres com baixa escolaridade constituem grupo vulnerável e necessitam de intervenções em saúde congruentes com suas capacidades de compreensão e possibilidades de adaptação ao tratamento.

OBJETIVO: Conocer el perfil de mujeres con Diabetes mellitus tipo 2, enfocando factores sociodemográficos, biométricos y de salud. MÉTODOS: Estudio de abordaje cuantitativo, transversal, prospectivo realizado con una muestra estratificada aleatoria, desarrollado en Florianópolis/SC con 147 mujeres por medio de visitas domiciliarias entre abril y agosto del 2009. RESULTADOS: Las mujeres tenían edad promedio de 66 años, presentaron elevados índices de masa corporal, glicemia capilar y circunferencia abdominal, además de baja adhesión al tratamiento no medicamentoso. La baja escolaridad se asoció al control inadecuado de la glicemia, no realización de actividad física e inadecuación de la dieta. CONCLUSIONES: Las mujeres con baja escolaridad constituyen un grupo vulnerable y necesitan intervenciones en salud congruentes con sus capacidades de comprensión y posibilidades de adaptación al tratamiento.

Estresse em mulheres com Diabetes mellitus tipo 2 / Stress in women with type-2 Diabetes Mellitus / Estrés en mujeres con Diabetes Mellitus tipo 2

OBJETIVO: O objetivo do estudo foi investigar a relação entre estresse e Diabetes Mellitus Tipo 2 em mulheres. MÉTODO: Estudo transversal prospectivo, desenvolvido com 147 mulheres, utilizando a Escala de Estresse Percebido (PSS). RESULTADOS: Houve associação entre as variáveis testadas, sendo possível inferir que as mulheres com estresse elevado são as que vivenciaram sofrimento e apresentam controle glicêmico alterado, ou seja, com valores superiores a 180 mg/dL. A maioria relatou sofrimento decorrente de problemas nas relações interpessoais, óbito, doença de familiares e solidão. CONCLUSÃO: Mulheres com DM2 que convivem com estresse e/ou sofrimento constituem grupo vulnerável ao desenvolvimento de agravos à saúde demandando aos serviços de saúde o desenvolvimento de estratégias que modifiquem esta situação.

OBJECTIVE: The objective of this study was to investigate the relation between stress and type 2 Diabetes Mellitus (DM2) in women. METHOD: A transversal prospective study, developed with 147 women, using the Perceived Stress Scale (PSS). RESULTS: There was an association between the variables tested, being possible to infer that women with high stress are those who experienced suffering and have glycemic control with alteration, in other words, with values above than 180 mg /dL. The majority reported suffering due to interpersonal relationship, death, illness in the family and loneliness. CONCLUSION: Women with DM2 that living with stress and / or suffering constitute a group vulnerable to the development of health problems, requiring health services to develop strategies to change this situation.

OBJETIVO: El objetivo del estudio fue investigar la relación entre estrés y Diabetes Mellitus Tipo 2 en mujeres. MÉTODO: Estudio transversal prospectivo, desarrollado con 147 mujeres, utilizando la Escala de Estrés Percibido (PSS). RESULTADOS:Hubo asociación entre las variables evaluadas, siendo posible inferir que las mujeres con estrés elevado son las que vivieron sufrimiento y presentaron control glicémico alterado, o sea, con valores superiores a 180 mg/dL. La mayoría relató sufrimiento derivado de problemas en las relaciones interpersonales, muerte, enfermedad de familiares y soledad. CONCLUSIÓN: Mujeres con DM2 que conviven con estrés y/o sufrimiento constituyen grupo vulnerable al desarrollo de problemas de salud, demandando a los servicios de salud el desarrollo de estrategias que modifiquen esta situación.

The family dynamics of elder elderly in the context of Porto, Portugal / A dinâmica da família de idosos mais idosos no contexto de Porto, Portugal / La dinámica de la familia de ancianos con edad avanzada en el contexto de la ciudad de Porto, Portugal

Descriptive study aiming to understand the family dynamics of elderly people aged 80 years or older, receiving family care at home. Caregivers and elderly, registered at the family health unit of Greater Porto, comprised a sample of 107 pairs. Data were collected between 09/2009 and 03/2010. The following instruments were applied: family APGAR, quality of life and lifestyle scale. The results that stand out are: increase in male partners serving as caregivers for dependent partners; substantial inclusion in the list of family caregivers: grandchildren, nieces, nephews, siblings. The caregiver lifestyle was considered regular, as well as the caregiver and elderly’s quality of life, although the family dynamics showed to work well. Limitations prevent further generalizations, but offer relevant support for the development of the family health and family nursing program.

Este é um estudo descritivo que objetivou conhecer a dinâmica de família de idosos com 80 anos ou mais, sob cuidados do familiar cuidador, em domicílio. Cuidadores e idosos, registrados na unidade de saúde familiar da grande região do Porto, compuseram amostra de 107 unidades. Dados colhidos entre 9/2009 e 3/2010, por instrumentos de dinâmica familiar, qualidade de vida e de estilo de vida, resultaram em: aumento de cuidador masculino e de cônjuge idoso de seu par dependente e inclusão substancial no elenco de familiares cuidadores: netas(os), sobrinhas(os) e irmãs(os). Estilo de vida do cuidador revelou-se regular como também a qualidade de vida de ambos: cuidador e idoso, apesar de a dinâmica de família se mostrar de boa funcionalidade. Limitações impedem a generalização dos resultados, porém, fornece subsídios relevantes para o desenvolvimento do programa de saúde familiar e de enfermagem de família.

Se trata de un estudio descriptivo, que tuvo por objetivo conocer la dinámica de familia de ancianos con 80 años o más, bajo cuidados de familiar, en su domicilio. El cuidador y el anciano, que estaban registrados en la unidad de salud familiar de la grande región de la ciudad de Porto, en Portugal, compusieron la muestra de 107 sujetos pareados. Los datos fueron recolectados entre 09/2009 y 03/2010 por medio del APGAR familiar, de calidad de vida y de estilo de vida; los resultados mostraron: aumento de cuidador masculino; conyugue anciano dependiente de su par; e, inclusión substancial de familiares en el elenco de cuidadores (nietas(os), sobrinos(os), hermanas(os). A pesar de la dinámica de la familia mostrarse de buena funcionalidad, el estilo de vida del cuidador y la calidad de vida de ambos (cuidador y anciano) se mostraron regulares. Las limitaciones del estudio impiden la generalización de los resultados; sin embargo ofrece subsidios relevantes para el desarrollo del programa de salud familiar y de enfermería de familia.

O convívio familiar do idoso na quarta idade e seu cuidador / Family dynamics of the older elderly and his caregiver / La convivencia familiar del anciano en la cuarta edad y su cuidador

O atual fenômeno de prolongamento da vida entre idosos de modo a chegarem aos 80 anos ou mais não constitui um fato excepcional, porém a tal condição associa-se fragilização pelo envelhecimento, tornando-osmais vulneráveis a várias circunstâncias, constituindo-se um subestrato de idosos da quarta idade que amiúde necessita de cuidados de outrem. Assim, objetivou-se conhecer os padrões de funcionamento das famílias no convívio e cuidados cotidianos de idosos mais velhos no contexto de Florianópolis, SC. O estudo consiste deuma pesquisa diagnóstico-avaliativa pelo método de questionamento entre idosos de 80 e mais anos,dependentes de cuidados e de seus respectivos familiares cuidadores, selecionados entre os inscritos nas unidades de Estratégia de Saúde da Família para avaliar a dinâmica familiar pelo Family APGAR, a qualidade devida pelo WHOQOL e o estilo de vida pela Escala de Nahas. Em sua maioria, os idosos avaliaram sua família como de boa funcionalidade, embora esse dado deva ser visto com reserva, pois, na avaliação tanto da qualidade de vida de ambos quanto do estilo de vida dos cuidadores, as respostas recaíram sobre um nível mediano, denotando certa dificuldade de enfrentamento em família com situações prolongadas de cuidado deidosos da quarta idade.

Nowadays he phenomenon observed in life prolongation among elders with 80 or more years of age, is no longer exceptional. However, that condition is usually associated with fragility due to aging turning the elderly more vulnerable to several circumstances of his life, becoming a substratum from elders in the fourth age who of tenneed care from others. Thus, the aim is to understand families functioning patterns on their daily basis and daily care of the elderly in the context of Florianópolis, SC. Descriptive evaluative diagnosis research, using the method of questioning, had the participation of seniors of 80 years old and over dependent on care along withfamily caregiver that were selected among the ones registered at the Family Health Program, in order to assessfamily dynamics, by Family APGAR, quality of life by WHOQOL and life style by Nahas Scale. Results: The elderly rated their families with good functionality. But, it must be considered with reservations, because on both quality of life evaluations from the elderly and the caregiver, responses were related to an average level,denoting some difficulty on coping within the family regarding care to the elderly.

El prolongamiento de la vida de ancianos que llegan hoy a los 80 años o más ya no es excepcional. Pero, tal condición está asociada a la fragilidad por el envejecimiento, hacién dolos más vulnerables a varias circunstancias, constituyéndose en subestrato de ancianos de la cuarta edad que a menudo necesita de los cuidados de otras personas. Así, el objetivo fue conocer los padrones de funcionamiento de las familias en elconvivio y en los cuidados cotidianos a los ancianos de Florianópolis, SC. El estudio consiste de una investigación diagnóstico-evaluativa con el método de cuestionamiento entre ancianos de 80 años o más, dependientes de cuidados y sus familiares respectivos cuidadores, que fueron seleccionados entre los inscriptosen las unidades de Estrategia de Salud de la Familia para evaluar la dinámica familiar por el Family APGAR, lacalidad de vida por el WHOQOL y el estilo de vida por la Escala de Nahas. En su mayoría, los ancianos evaluaron a su familia como de buena funcionalidad, pero ese dato debe ser visto con moderación, pues en la evaluación de la calidad de vida de ambos en cuanto al estilo de vida de los cuidadores, las respuestas sereferían a nivel promedio, denotando cierta dificultad de enfrentamiento en familia con situaciones prologadas decuidado a los ancianos de la cuarta edad.

Construção de uma escala para avaliar atitudes de estudantes de medicina / The construction of a scale to measure medical students' attitudes

INTRODUÇÃO: Estudos têm mostrado que as atitudes influenciam o comportamento. O desenvolvimento e a manutenção de determinadas atitudes dos estudantes durante o curso médico podem influenciar a qualidade do cuidado médico dado aos pacientes no exercício da profissão. As Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina reforçam a importância de aspectos atitudinais relevantes para a prática médica. OBJETIVO: Construção e validação de uma escala de atitude do tipo Likert, para avaliar atitudes de estudantes de Medicina considerando as Diretrizes Curriculares Nacionais, adaptadas à realidade sociocultural brasileira. MÉTODO: Na construção da escala foram considerados cinco aspectos: social, ambiência, crença, conhecimento e ética. Os sujeitos foram 202 estudantes do curso de graduação em Medicina, da primeira à oitava fase, sendo 52,85% mulheres e 47,15% homens. Estudo de coorte, descritivo e quantitativo. Os dados foram coletados por meio da aplicação de um questionário e de uma escala de atitudes (do tipo Likert) com 102 proposições. A escala foi aplicada em dois momentos. RESULTADOS: A confiabilidade da escala, medida pelo coeficiente α, de Cronbach, foi igual a 0,87. A escala foi validada (validade de construto) por cinco especialistas. Não houve diferença estatisticamente significante entre as oito fases analisadas. As atitudes observadas foram predominantemente positivas. CONCLUSÃO: O trabalho desenvolvido resultou na definição de um instrumento válido e confiável para medir as atitudes de estudantes de Medicina segundo as dimensões social, ambiência, crença, conhecimento e ética.

INTRODUCTION: Studies have shown that attitudes influence behavior. Developing and maintaining certain attitudes can influence the quality of health care delivered by medical students to their patients. The Brazilian National Guidelines for Medical Education emphasize the significance of the students' attitudes relevant for the medical practice. OBJECTIVES: This study aimed designing and validating an attitude scale to evaluate the impact of the medical curriculum on students' attitudes. METHODOLOGY: The subjects were 202 students (female = 52.85%, male = 47.15%), attending from the first to the eighth phase of the medical undergraduate course. The data for this descriptive and quantitative cohort study were collected using a questionnaire and an attitude measurement scale (5-point Likert scale) containing 102 propositions covering five different factors (social, environmental, belief, knowledge and ethics). RESULTS: Several analyses were undertaken to establish the internal validity of the instrument, including reliability (total = 0.87 and 0.89) and correlation studies. There were no statistically significant differences among the eight analyzed phases. The students showed predominantly positive attitudes. CONCLUSIONS: The final version of the scale was therefore regarded valid and reliable for the assessment of medical students' attitudes.

Avaliação do uso da clonidina para sedoanalgesia de pacientes sob ventilação mecânica prolongada, internados em unidade de terapia intensiva / Evaluate the clonidine use for sedoanalgesia in intensive care unit patients under prolonged mechanical ventilation

JUSTIFICATIVA E OBJETIVOS: O controle do desconforto dos pacientes internados em unidade de terapia intensiva (UTI) tem-se tornado essencial na prática da Medicina intensiva. Os fármacos sedoanalgésicos podem influenciar na morbimortalidade do paciente crítico. Agentes a2-agonistas podem ter um futuro interessante nas UTI. O objetivo deste estudo foi avaliar a administração da clonidina para a sedoanalgesia de pacientes sob ventilação mecânica (VM) prolongada. MÉTODO: Estudo de coorte histórico, onde foram selecionados os prontuários dos pacientes internados na UTI entre janeiro e dezembro de 2006, sob sedação, analgesia e ventilação mecânica por período > 7 dias. Foram anotados os dados demográficos, clínicos e terapêuticos desses pacientes, que foram subdivididos em três grupos: G1 - medicados com clonidina e outros sedoanalgésicos, G2 - medicados com mais de três fármacos sedoanalgésicos, exceto clonidina, e G3 - medicados com midazolam e fentanil. Registrou-se a dose média diária da clonidina, anotando-se, antes da sua administração, 6 e 24 horas após, os valores da freqüência cardíaca e pressão arterial. Para a análise estatística foram utilizados os testes Análise de Variância (ANOVA), t de Student, c² sendo considerado significativo quando p < 0,05. RESULTADOS: Foram avaliados 55 pacientes. Quinze (27,3 por cento) pertenciam ao G1, 11 (20 por cento) ao G2, 29 (52,7 por cento) ao G3. A idade média dos pacientes foi 44 (G1), 50 (G2) e 55 (G3) anos (p = NS). O índice APACHE II médio dos grupos foi 18 (G1), 20,4 (G2), 20,7 (G3) (p = NS). Os pacientes do G1 e G2 permaneceram mais tempo internados na UTI e no hospital (p < 0,05). A dose média administrada de clonidina foi 1,21 ± 0,54 mg/kg/h. Houve diminuição da freqüência cardíaca e da pressão arterial nos pacientes do G1. Esses efeitos não tiveram repercussão clínica nem relação com a dose da clonidina. A mortalidade foi significativamente menor nos pacientes do G1 (20 por cento) em...

BACKGROUND AND OBJECTIVES: The control of patient discomfort in the intensive care unit (ICU) has become an integral part of critical care practice. The sedoanalgesic drugs could influence critically ill patient's morbimortality. Alpha²-adrenoceptor agonists might have an interesting future in ICU. The objective of this study is to evaluate the clonidine use for sedoanalgesia in ICU patients under prolonged mechanical ventilation. METHODS: Historical cohort study. Admitted patient files, January-December 2006, which stayed under mechanical ventilation, analgesia and sedation > 7days were analyzed. Demographic, clinical features and therapeutic data concerning analgesia and sedation were remarked. The data allowed classify the patients in three different groups: G1 = patients that used clonidine and other drugs; G2 = patients that used three or more drugs, without clonidine and G3 = patients that used fentanyl and midazolam. The mean daily doses of infused clonidine were registered, and the values of heat rate (HR), blood arterial pressure (BAP) before starting use of clonidine, after six hours and 24 hours were also registered. Statistical analyzes were performed using Variance Analysis (ANOVA), t tests and x² (significance p < 0.05). RESULTS: Were selected 55 patients. Fifteen (27.2 percent) belonged to G1, 11 (20 percent) belonged to G2 and 29 (52.7 percent) belonged to G3. The mean age of patients was 44 (G1), 50 (G2) and 56 (G3) (p = NS). The mean score APACHE II was 18 (G1), 20.4 (G2) and 20.7 (G3) (p = NS). G1 and G2 patients presented higher ICU length-of-stay (p < 0.05). The mean dose of clonidine used was 1.21 ± 0.54 mg/kg/min. G1 patients had HR and BAP decreased, however these effects were not considered clinically relevant. The mortality was lower in the patients from G1 (20 percent) when compared to G2 (54.5 percent) and G3 (62 percent) (p < 0.05). CONCLUSIONS: The clonidine use to analyzed patients did not result in clinical...