Demandas de cuidado en niños(as) y adolescentes con necesidades especiales (NANEAS) de baja complejidad: perspectiva de madres o cuidadoras y enfermeras(os) / Demands for care in children and adolescents with special needs (NANEAS) of low complexity: perspective of mothers or caregivers and nurses

INTRODUCCIÓN: La atención de salud de los NANEAS de baja complejidad, es realizada en los niveles secundario y terciario y las familias no concurren a la atención primaria (AP), a pesar que esta cuenta con el Modelo de Salud Familiar, instancia que promueve el enfoque integral biopsicosocial para el seguimiento de los NANEAS. El proyecto se apoya en la filosofía del cuidado de Martinsen, (ética del cuidar) y la perspectiva ecológica de Bronfenbrenner. OBJETIVO: develar las demandas de cuidado en NANEAS de baja complejidad, en el nivel primario de atención, de una ciudad del sur de Chile. METODOLOGÍA: Estudio fenomenológico bajo referencial de Schütz en 6 cuidadoras principales de NANEAS y 9 enfermeros(as). Cumplió criterios bioéticos de Ezequiel Emanuel. RESULTADOS Y DISCUSIÓN: Se describen categorías: a) Desigualdad en las políticas de cuidados: déficit en inclusión (control de salud), y en capacitación de enfermeras (os); b) Invisibilidad de NANEAS en APS: desconocimiento de magnitud e inexistencia de vínculo con las familias c) Cuidado integral: apoyo psicosocial y económico, beneficios (licencia parental para asistencia). CONCLUSIÓN: El cuidado en NANEAS de baja complejidad en APS es difícil, complejo, e insuficiente. La protección social con enfoque de derechos es una dimensión a desarrollar, expresando el derecho a la calidad de la atención, con la instauración de estándares en salud primaria con accesibilidad, adaptabilidad, aceptabilidad y adecuación mediante la instauración de corresponsabilidades y participación.

INTRODUCTION: The health care of low-complexity NANEAS is carried out at the secondary and tertiary levels of health care. Families do not participate in their primary health care (PHC), despite its association with the Family Health Model, which promotes a comprehensive biopsychosocial approach for the follow-up of NANEAS. GOAL: The project is based on Martinsen's philosophy of care (ethics of care) and the ecological perspective of Bronfenbrenner. OBJECTIVE:To reveal the demands for care in low-complexity NANEAS, at the primary care level, in a city in southern Chile. METHODOLOGY: Schütz referential phenomenological study in 6 main caregivers of NANEAS and 9 nurses. The study met the bioethical criteria of Ezequiel Emanuel. RESULTS AND DISCUSSION: Categories are described: a) Inequality in care policies: deficit in inclusion (health control), and in training for nurses; b) Invisibility of NANEAS in PHC: ignorance of magnitude and non-existence of therapeutic links with families c) Comprehensive care: psychosocial and economic support, benefits (parental leave for care). CONCLUSION: PHC in low-complexity NANEAS is difficult, complex, and insufficient. Social protection with a rights-based approach should be further developed, expressing the right to quality care and the establishment of primary health standards ensuring accessibility, adaptability, acceptability and adequacy through the establishment of co-responsibilities and participation.

Proyecto de intervención para prevenir enfermedades cerebrovasculares en adultos mayores vinculados a una casa de abuelos / Project Intervention to Prevent Stroke in Older Adults Attending to a Senior Care Home

Introducción: en el municipio de Sagua la Grande se produjo durante el último quinquenio un incremento de la morbilidad y mortalidad en adultos mayores por enfermedades cerebrovasculares, problema de salud que preocupa por el grado de incapacidad funcional permanente que provoca cuando se logra que el paciente sobreviva. Objetivos: caracterizar y determinar los factores de riesgos de las enfermedades cerebrovasculares en los adultos mayores; identificar el nivel de conocimientos en relación con las enfermedades cerebrovasculares y su prevención; y elaborar alternativas de solución que permitan minimizar o atenuar el problema de salud que dio origen a esta investigación. Métodos: se realizó una investigación cuanticualitativa de tipo descriptivo transversal, en adultos mayores vinculados a la casa de abuelos del Consejo Popular “Villa Alegre” perteneciente al Policlínico “Idalberto Revuelta”, municipio de Sagua la Grande, provincia Villa Clara, en el periodo comprendido entre los meses de enero de 2012 a junio de 2013. El universo estuvo constituido por 30 adultos mayores y la muestra quedó integrada por 25, seleccionados por el método de muestreo no probabilístico intencional por criterios. Resultados: los adultos mayores con factores de riesgo de enfermedades cerebrovasculares se caracterizaron por el predomino del sexo femenino, raza blanca y edad mayor de 75 años. Se identificó que la mayoría tienen hábitos tóxicos y presentan al menos, uno o dos factores de riesgo, entre los más frecuentes: la hipertensión arterial, la cardiopatía isquémica y la diabetes mellitus. La mayoría no poseen adecuados conocimientos sobre las enfermedades cerebrovasculares.Conclusiones: debido a que los adultos mayores con factores de riesgo de enfermedades cerebrovasculares vinculados a la casa de abuelos presentaron en su mayoría, uno o dos factores de riesgos y poseen inadecuados conocimientos sobre las enfermedades...(AU)

Introduction: in the municipality of Sagua the Big one took place during the last five year period an increment of the morbilidad and the mortality in bigger adults for illnesses cerebrovasculares, problem of health that worries for the grade of functional permanent inability that provokes when it is achieved the patient to survive.Objetive: he/she was carried out an investigation cuanticualitativa of descriptive traverse type, in bigger adults linked to the house of grandparents, of the Popular Council Cheerful" "Villa belonging to Policlínico Revolved" "Idalberto, of the municipality of Sagua the Big one, county Villa Clara, in the period understood among the months of January from 2012 to June of 2013. The universe was constituted by bigger 30 adults and the sample was integrated by 25, selected by the non probabilistic intentional sampling method by approaches. Results: that the biggest adults with factors of risk of illnesses cerebrovasculares were characterized for the I prevail of the feminine sex, the white race and the age bigger than 75 years. It was identified that most has toxic habits and they present one or two factors of risk at least, among the most frequent the arterial Hypertension; ischemic Cardiopatía and the Diabetes Mellitus. Most possesses inadequate knowledge on the illnesses cerebrovasculares. Conclusions: because older adults with risk factors for cerebrovascular diseases linked to the grandparents' house had mostly one or two risk factors and have inadequate knowledge about cerebrovascular diseases, specialists consider relevant and feasible project for prevention of these(AU)

Prevalence of metabolic syndrome and of its specific components among adolescents from Niterói City, Rio de Janeiro State, Brazil.

OBJECTIVE: To compare the prevalence of metabolic abnormalities (MA) and metabolic syndrome (MS) assessed by different criteria among Brazilian adolescents. SUBJECTS AND METHODS: Weighted prevalence of MA and MS were estimated using criteria adapted from the International Diabetes Federation (IDF), National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III), and the World Health Organization (WHO) in a probabilistic sample of 577 students aged 12-19. RESULTS: The most prevalent MA was low concentration of HDL-C as per IDF (32.5%) and NCEP/ATP III (41.6%) criteria and hypertension as per the WHO's criterion (12.4%). Prevalence of MS using the NCEP/ATP III criterion (6.04%) was five times higher than the WHO's (1.1%) and the IDF's (1.6%) criteria. As expected, MS was significantly higher among overweight than among non-overweight adolescents. CONCLUSION: Low prevalence of MS but high prevalence of some MA were found. These findings suggest that the diagnosis of MA is more relevant in clinical practice especially in overweight adolescents.

Prevalence of metabolic syndrome and of its specific components among adolescents from Niterói City, Rio de Janeiro State, Brazil / Prevalência de síndrome metabólica e de componentes específicos da síndrome em adolescentes de Niterói, Rio de Janeiro, Brasil

OBJECTIVE: To compare the prevalence of metabolic abnormalities (MA) and metabolic syndrome (MS) assessed by different criteria among Brazilian adolescents. SUBJECTS AND METHODS: Weighted prevalence of MA and MS were estimated using criteria adapted from the International Diabetes Federation (IDF), National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III), and the World Health Organization (WHO) in a probabilistic sample of 577 students aged 12-19. RESULTS: The most prevalent MA was low concentration of HDL-C as per IDF (32.5 percent) and NCEP/ATP III (41.6 percent) criteria and hypertension as per the WHO's criterion (12.4 percent). Prevalence of MS using the NCEP/ATP III criterion (6.04 percent) was five times higher than the WHO's (1.1 percent) and the IDF's (1.6 percent) criteria. As expected, MS was significantly higher among overweight than among non-overweight adolescents. CONCLUSION: Low prevalence of MS but high prevalence of some MA were found. These findings suggest that the diagnosis of MA is more relevant in clinical practice especially in overweight adolescents.

OBJETIVO: Comparar a prevalência de alterações metabólicas (AM) e de síndrome metabólica (SM) avaliadas por três diferentes critérios nos adolescentes brasileiros. SUJEITOS E MÉTODOS: Foram estimadas prevalências expandidas de AM e SM pelos critérios adaptados do International Diabetes Federation (IDF), National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III) e o World Health Organization (WHO), em uma amostra probabilística de 577 estudantes de 12 a 19 anos. RESULTADOS: Baixa concentração de HDL-C foi a AM mais prevalente segundo critérios do IDF (32,5 por cento) e do NCEP/ATP III (41,6 por cento), e hipertensão pelo critério do WHO (12,4 por cento). A prevalência de SM pelo critério NCEP/ATP III (6,04 por cento) foi cinco vezes mais alta do que pelos critérios WHO (1,1 por cento) e IDF (1,6 por cento) e, como era esperado, foi significantemente mais elevada entre adolescentes com sobrepeso. CONCLUSÃO: Foram encontradas menores prevalências de SM e maiores prevalências de algumas AM. Esses resultados sugerem que o diagnóstico das AM é mais relevante na prática clínica especialmente para adolescentes com excesso de peso.

Validation of capillary glycemia as a strategy for the screening of diabetes mellitus in adolescents.

OBJECTIVE: To compare the degree of concordance between plasma and capillary glucose for screening of diabetes mellitus in adolescents. METHODS: The plasma and capillary glucose of 119 adolescents aged 10-19 yr (36 males and 83 females) from public schools in Niterói, Rio de Janeiro State, Brazil, were verified after a 12-h fast. Agreement was assessed through kappa statistics (k), McNemar's chi-squared test, and the intraclass correlation coefficient (ICC). The paired Student's t-test for comparison of means, the approaches by Altman and Bland, and the survival-agreement plot were also applied. RESULTS: Mean values of plasma glucose were 7.9 points higher than the capillary values (91.5 vs. 83.6 mg/dL, p < 0.001; ICC = 0.419). A regular agreement between the methods (k = 0.31, p < 0.001) for assessing proportions of adolescents with glycemia > or =100 mg/dL is observed. Using the strategy of adding 8 mg/dL to the capillary levels, the agreement improved (k = 0.46, p < 0.001) and a significant difference was not observed between the estimated prevalences (p = 0.815). CONCLUSIONS: The results suggest a satisfactory agreement between the two methods when capillary glucose is corrected, and this may be a useful and low-cost tool for the epidemiologic investigation of diabetes mellitus prevalence in adolescents.

Body mass index for predicting hyperglycemia and serum lipid changes in Brazilian adolescents / Índice de massa corporal para predizer hiperglicemia e alterações lipídicas em adolescentes brasileiros / Índice de masa corporal para predecir hiperglicemia y alteraciones lipídicas en adolescentes brasileros

OBJECTIVE: To determine the best cut-offs of body mass index for identifying alterations of blood lipids and glucose in adolescents. METHODS: A probabilistic sample including 577 adolescent students aged 12-19 years in 2003 (210 males and 367 females) from state public schools in the city of Niterói, Southeastern Brazil, was studied. The Receiver Operating Characteristic curve was used to identify the best age-adjusted BMI cut-off for predicting high levels of serum total cholesterol (>150mg/dL), LDL-C (>100mg/dL), serum triglycerides (>100mg/dL), plasma glucose (>100mg/dL) and low levels of HDL-C (< 45mg/dL). Four references were used to calculate sensitivity and specificity of BMI cut-offs: one Brazilian, one international and two American. RESULTS: The most prevalent metabolic alterations (>50 percent) were: high total cholesterol and low HDL-C. BMI predicted high levels of triglycerides in males, high LDL-C in females, and high total cholesterol and the occurrence of three or more metabolic alterations in both males and females (areas under the curve range: 0.59 to 0.67)...

OBJETIVO: Determinar os melhores pontos de corte do índice de massa corporal (IMC) para identificar alterações no perfil lipêmico e glicêmico em adolescentes. MÉTODOS: Foram avaliados 577 adolescentes de 12 a 19 anos (210 meninos e 367 meninas) em uma amostra probabilística de estudantes de escolas estaduais da cidade de Niterói (RJ), em 2003. Foi utilizada a curva Receiver Operating Characteristic para identificar o melhor ponto de corte, ajustado para idade, para predizer valores elevados de colesterol total sérico (>150mg/dL), LDL-C (>100mg/dL), triglicérides (>100mg/dL), glicose plasmática (>100mg/dL) e baixos valores de HDL-C (<45mg/dL). Quatro referências foram utilizadas para verificar a sensibilidade e especificidade dos pontos de corte: uma nacional, uma internacional e duas americanas. RESULTADOS: As alterações metabólicas de maior prevalência (>50 por cento) foram: colesterol total elevado e HDL-C baixa. O IMC foi capaz de predizer valores elevados de triglicérides nos meninos, LDL-C nas meninas e colesterol total e presença de três ou mais alterações metabólicas em ambos os sexos (área sob a curva - 0,59 a 0,67)...

OBJETIVO: Determinar los mejores puntos de corte del índice de masa corporal (IMC) para identificar alteraciones en el perfil lipémico y glicérico en adolescentes. MÉTODOS: Fueron evaluados 577 adolescentes de 12 a 19 años (210 niños y 367 niñas) en una muestra probabilística de estudiantes de escuelas estaduales de la ciudad de Niteroi, Sureste de Brasil, en 2003. Fue utilizada una curva Receiver Operating Characteristic para identificar el mejor punto de corte, ajustado a la edad, para predecir valores elevados de colesterol total sérico (=150mg/dL), LDL-C (=100mg/dL), triglicéridos (=100mg/dL), glicosis plasmática (>100mg/dL) y bajos valores de HDL-C (<45mg/dL). Cuatro referencias fueron utilizadas para verificar la sensibilidad y especificidad de los puntos de corte: una nacional, una internacional e dos americanas. RESULTADOS: Las alteraciones metabólicas de mayor prevalencia (>50 por ciento) fueron: colesterol total elevado y HDL-C bajo. El IMC fue capaz de predecir valores elevados de triglicéridos en los niños, LDL-C en las niñas y colesterol total y presencia de tres o más alteraciones metabólicas en ambos sexos (área bajo la curva - 0,59 a 0,67)...

Body mass index for predicting hyperglycemia and serum lipid changes in Brazilian adolescents.

OBJECTIVE: To determine the best cut-offs of body mass index for identifying alterations of blood lipids and glucose in adolescents. METHODS: A probabilistic sample including 577 adolescent students aged 12-19 years in 2003 (210 males and 367 females) from state public schools in the city of Niterói, Southeastern Brazil, was studied. The Receiver Operating Characteristic curve was used to identify the best age-adjusted BMI cut-off for predicting high levels of serum total cholesterol (> or =150 mg/dL), LDL-C (> or =100 mg/dL), serum triglycerides (> or =100 mg/dL), plasma glucose (> 100 mg/dL) and low levels of HDL-C (< 45 mg/dL). Four references were used to calculate sensitivity and specificity of BMI cut-offs: one Brazilian, one international and two American. RESULTS: The most prevalent metabolic alterations (>50%) were: high total cholesterol and low HDL-C. BMI predicted high levels of triglycerides in males, high LDL-C in females, and high total cholesterol and the occurrence of three or more metabolic alterations in both males and females (areas under the curve range: 0.59 to 0.67), with low sensitivity (57%-66%) and low specificity (58%-66%). The best BMI cut-offs for this sample (20.3 kg/m(2) to 21.0 kg/m(2)) were lower than those proposed in the references studied. CONCLUSIONS: Although BMI values lower than the International cut-offs were better predictor of some metabolic abnormalities in Brazilian adolescents, overall BMI is not a good predictor of these abnormalities in this population.

[Association between central body anthropometric measures and metabolic syndrome components in a probabilistic sample of adolescents from public schools]. / Associação das medidas antropométricas de localização de gordura central com os componentes da síndrome metabólica em uma amostra probabilística de adolescentes de escolas públicas.

It was investigated the association of waist circumference (WC), abdominal circumference (AC), Waist-to-Hip ratio(WHR) and Waist-Height ratio (WHtR) adjusted by body mass index (BMI) and % body fat (BF) with metabolic syndrome components in a probabilistic sample of 610 adolescents aged 12-19 years (222 boys and 388 girls) from public schools of Niterói, Rio de Janeiro. Fasting glucose and lipids were assayed using automated enzymatic method and insulin was determined by radioimmuno assay. Systolic (SBP) and diastolic (DBP) blood pressure were measured using an automated recorder and % BF by electric bioimpedance. The association of the anthropometric measures with metabolic syndrome components was evaluated by multivariate linear regression adjusted according to the age, BMI or %BF. In boys, a positive association between WC (beta=1.03 p<0.01) and WHtR (beta= 2.33, p< 0.05; beta=2.12 and p< 0.01) with triglycerides was maintained after BMI and % BF adjusting, respectively. WC was associated with SBP after % BF adjusting both for boys (beta= 0.70 p<0.01) and girls (beta=0.68 p<0.01). In conclusion, WC was the measure of central body fat that presented the best association with components of metabolic syndrome in adolescents.

Associação das medidas antropométricas de localização de gordura central com os componentes da síndrome metabólica em uma amostra probabilística de adolescentes de escolas públicas / Association between central body anthropometric measures and metabolic syndrome components in a probabilistic sample of adolescents from public schools

Avaliou-se a associação entre medidas antropométricas de localização de gordura central: circunferências da cintura (CC) e abdominal (CA) e as razões cintura/quadril (RCQ) e cintura/estatura (RCE), independente do percentual de gordura corporal ( por centoGC) e índice de massa corporal (IMC), com os componentes da síndrome metabólica (SM) em uma amostra probabilística de 610 (222 meninos e 388 meninas) adolescentes de 12 a 19 anos de escolas públicas de Niterói, RJ. Foram avaliados glicose e perfil lipídico pelo método enzimático automatizado, insulina pela técnica de radioimunoensaio, por centoGC pela bioimpedância elétrica e a pressão arterial sistólica (PAS) e diastólica com manômetro digital. A associação entre as medidas antropométricas foi verificada por meio de regressão linear múltipla, com ajuste para IMC, por centoGC e idade. Nos meninos, a associação positiva entre CC (b = 1,03, p < 0,01) e RCE (b = 2,33, p < 0,05; b = 2,12 e p < 0,01) com triglicerídios foi mantida independente de IMC e por cento de GC, respectivamente. A CC se correlacionou com a PAS independente do por centoGC, tanto nos meninos (b = 0,70 p < 0,01) quanto nas meninas (b = 0,68 p < 0,01). Conclui-se que a CC foi a medida de gordura central que apresentou a melhor associação com os componentes da SM nos adolescentes.

It was investigated the association of waist circumference (WC), abdominal circumference (AC), Waist-to-Hip ratio(WHR) and Waist-Height ratio (WHtR) adjusted by body mass index (BMI) and percent body fat (BF) with metabolic syndrome components in a probabilistic sample of 610 adolescents aged 12-19 years (222 boys and 388 girls) from public schools of Niterói, Rio de Janeiro. Fasting glucose and lipids were assayed using automated enzymatic method and insulin was determined by radioimmuno assay. Systolic (SBP) and diastolic (DBP) blood pressure were measured using an automated recorder and percent BF by electric bioimpedance. The association of the anthropometric measures with metabolic syndrome components was evaluated by multivariate linear regression adjusted according to the age, BMI or percentBF. In boys, a positive association between WC (b=1.03 p<0.01) and WHtR (b= 2.33, p< 0.05; b=2.12 and p< 0.01) with triglycerides was maintained after BMI and percent BF adjusting, respectively. WC was associated with SBP after percent BF adjusting both for boys (b= 0.70 p<0.01) and girls (b=0.68 p<0.01). In conclusion, WC was the measure of central body fat that presented the best association with components of metabolic syndrome in adolescents.

Desempenho de pontos de corte do índice de massa corporal de diferentes referências na predição de gordura corporal em adolescentes / Accuracy of different body mass index reference values to predict body fat in adolescents

Avaliamos a acurácia de pontos de corte do índice de Massa Corporal (IMC) para identificar adolescentes com sobrepeso, comparando com percentual de gordura corporal, estimado pela bioimpedância elétrica, em uma amostra probabilística de 610 adolescentes de 12 a 19 anos (222 meninos e 388 meninas), estudantes de escolas públicas de Niterói, Rio de Janeiro, Brasil. A curva ROC foi utilizada para avaliar a sensibilidade e especificidade de pontos de corte de IMC de uma referência nacional, duas norte-americanas e uma internacional. Os pontos de corte da amostra estudada foram inferiores aos das demais referências, com sensibilidade de 76 por cento a 95 por cento e especificidade de 75 por cento a 95 por cento. Os pontos de corte nacionais foram também mais sensíveis (53 por cento a 100 por cento), se comparados às outras referências (40 por cento a 86 por cento). O critério internacional apresentou melhor sensibilidade para adolescentes mais velhos e as referências americanas, para os mais jovens. O IMC foi um bom proxy de adiposidade, mas o uso de pontos de corte de referências de outras populações merece cautela, pois pode gerar erro na classificação de adolescente com sobrepeso em até 60 por cento.

[Accuracy of different body mass index reference values to predict body fat in adolescents]. / Desempenho de pontos de corte do índice de massa corporal de diferentes referências na predição de gordura corporal em adolescentes.

This study evaluates the accuracy of cutoff points in the body mass index (BMI) for identifying adolescents with overweight, compared to the percentage of body fat, estimated by electric bioimpediance, in a probabilistic sample of 610 adolescents from 12 to 19 years of age (222 boys and 388 girls) enrolled in public schools in Niterói, Rio de Janeiro, Brazil. ROC was used to evaluate the sensitivity and specificity of BMI cutoffs from one Brazilian, two North American, and one international reference. The cutoff points in the study sample were lower than the other references, with 76% to 95% sensitivity and 75% to 95% specificity. The Brazilian cutoff points were also more sensitive (53% to 100%) as compared to the other references (40% to 86%). The international parameter showed better sensitivity for older adolescents, and the Northern American references for younger adolescents. BMI was a good proxy for adiposity, but cutoff points from other population references should be used with caution, since they can lead to classification errors in adolescents with overweight.

Insulin resistance in Brazilian adolescent girls: association with overweight and metabolic disorders.

We assessed the association between insulin resistance, overweight and metabolic disorders in a probabilistic sample of 388, 12-19-year-old girls from public schools in Niterói, Rio de Janeiro State, Brazil. Insulin resistance was determined using Homeostatic Model Assessment-Insulin Resistance (HOMA-IR). Overweight and obesity were defined by the sex- and age-specific body mass index cut-offs recommended by the International Obesity Task Force. Metabolic syndrome (MS) was identified by the presence of at least three of the following factors: fasting glucose >or=100mg/dL, triglycerides >130 mg/dL, LDL-C >or=110 mg/dL, HDL-C <35 mg/dL and overweight. The combined prevalence of obesity (2.9%) and overweight was 14.2%. The average HOMA-IR level was 2.24 (95% confidence interval=1.40-3.10) in the overweight group and 1.91 (95% CI=1.32-2.50) in the non-overweight one, and MS prevalence was 20 times higher in the first group (21.4 and 0.1%). MS prevalence in the overweight group was 6.3 times higher in adolescents above the 66th percentile of HOMA-IR (55.9%) than those under the 33rd percentile (8.9%). Brazilian overweight girls with higher insulin resistance had high risk of developing MS. Therefore, prevention should occur at an early age to impair the evolution of this process.

Ìndice de massa corporal na avaliação de sobrepeso e obesidade em crianças e adolescentes: concordâncias e controvérsias / Body mass index in assessment of overweight and obesity in children and adolescents: agreement and disagreement

A obesidade na infância e adolescência vem aumentando rapidamente no Brasil e no mundo sem necessários métodos de investigação práticos e viáveis que estimem sua prevalência e permitam comparações internacionais. O índice de massa corporal (IMC - massa corporal/estatura) foi proposto pela OMS como o melhor índice para esta avaliação, considerando a sua alta correlação em medidas de adiposidade e de massa corporal, a facilidade de ser obtido e ainda o fato de permitir uma continuidade do critério usado para adultos. Todavia, algumas limitações como a correlação com a estatura que, apesar de baixa significativa, e o fato de não refletir adequadamente as mudanças na composião corporal que ocorrem na adolescência, sugerem cautela na interpretaão desse índice como medida de adiposidade em fase de crescimento...

Servicios farmacéuticos del HCC: ¿qué son y hacia donde van? / Pharmaceuticals services of HCC

En el Hospital de Clínicas Caracas (H.C.C.) funciona el Departamento de Servicios Farmacéutico (S.F.) desde el año 1989, integrado por las unidades de Dosis Unitaria, Mezclas Intravenosas, Area Quirúrgica, Unidad de Terapia Intensiva, Emergencia y Depósito de Farmacia, siendo esta institución una de las pioneras en Venezuela en la implantación de estos servicios.Esta nueva modalidad de servicios farmacéutico tiene como base brindar una óptima atención al paciente.En continua evaluación de la efectividad, se ha comprobado que se puede alcanzar un mejor funcionamiento a través de la implementación de Farmacias Satélites, logrando así mayor integración con otros departamentos como enfermería

Una evaluación de tres métodos de predicción de dosis de warfarina para la estabilización de una terapia inicial dentro de un hospital / An evaluation of methods three of prediction of warfarm to stabilization dose of a initial therapy within of the hospital

Actualmente el uso de los computadores ha abarcado las áreas profesionales y de trabajo en su totalidad. Se sabe de la utilidad de la computación en nuestra profesión, siendo una herramienta de trabajo diario, sin importar el área de la farmacia en la cual nos desempeñamos

Nodulo tiroideo hiperfuncionante en la infancia / Hyperfunctioning thyroid nodule in infancy

Se presentó una paciente de 8 años de edad, con un nódulotiroideo, el cual por las características del gammagrama tiroideo se trataba de un adenoma tóxico compensado. El test de inhibición con T3 demostró que era un nódulo autónomo de la hormona hipofisiaria estimulante del tiroides (TSH). La paciente se presenta clínicamente eutiroidea. Se realiza una revisión del tema. (AU)