The Relationship between Anemia, Hemoglobin Concentration and Frailty in Brazilian Older Adults.

OBJECTIVE: to explore the relationship between anemia, hemoglobin concentration and frailty syndrome in older adults. RESEARCH METHODS AND PROCEDURES: This was a cross-sectional population-based study, with adults ≥60 years (n=1,256) from the third wave of the SABE Cohort Study (Health, Well-being and Aging) conducted in 2010 in São Paulo, Brazil. Frailty syndrome was evaluated according to Fried´s phenotype. Anemia was defined using the WHO criteria (hemoglobin concentration <12 g/dL for women and <13 g/dL for men). Four approaches were used to verify the associations between anemia, hemoglobin concentration and frailty status or number of frailty criteria. We used logistic regression and Poisson regression in the analyses, and they were adjusted in three hierarchical models using three blocks of variables: basic characteristics; clinical characteristics; cognitive status. RESULTS: Mean hemoglobin concentration was significantly lower in frail elderly (13.3g/dL, versus 14.3g/dL in non-frail; p<0.001). Prevalence of anemia was also significantly higher in frail when compared to non-frail elderly (24.2% and 3.8%; p<0.001). Anemia was significantly associated to low physical activity, weakness and slowness. In the fully adjusted regression models, anemia was strongly associated to frailty (OR=3.27, 95%IC=1.89,5.65; p<0.001), and lower levels of hemoglobin were associated to higher number of frailty criteria. CONCLUSIONS: We found important associations between anemia, hemoglobin concentration and frailty; anemic older adults were more likely to be frail, and lower levels of hemoglobin were associated to higher number of frailty criteria showing a clear dose-response effect.

Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly.

BACKGROUND: Sarcopenia and dynapenia have been associated with poorer physical performance, disability and death. The aim of this study was to compare the association between sarcopenia and dynapenia with mortality. METHODS: We studied 1,149 Brazilians aged 60 years or older residing in São Paulo. Sarcopenia was defined according to the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP), which includes three components: low muscle mass (LMM) assessed by skeletal muscle mass index ≤ 8.90kg/m2 (men) and ≤ 6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and < 20kg (women); and low physical performance (LPP) assessed by walking speed ≤ 0.8m/s. Diagnosis of sarcopenia required presence of LMM plus LMS or LPP. Dynapenia was defined as handgrip strength < 30kg (men) and < 20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, and disability in activities of daily living or instrumental activities of daily living. The outcome was all-cause mortality over five-year follow-up. RESULTS: During the five-year follow-up, 187 subjects died. The mortality rate for those with or without sarcopenia were 65.9/1,000 person/years and 20.1/1,000 person/years and for dynapenia were 44.3/1,000 person/years and 14.9/1,000 person/years. The adjusted model showed that sarcopenia (HR=1.52, 95%CI: 1.06 - 2.19) and dynapenia (HR=2.04, 95%CI: 1.24 - 3.37) are independent risk factors for death. CONCLUSIONS: The EWGSOP definition of sarcopenia and dynapenia can help to determine risk for mortality and can be used as a screening instrument in public health.

Sarcopenia according to the european working group on sarcopenia in older people (EWGSOP) versus Dynapenia as a risk factor for disability in the elderly.

BACKGROUND: Sarcopenia, defined as low muscle mass (LMM), and dynapenia have been associated with adverse outcomes in elderly. OBJECTIVE: Contrast the association of sarcopenia versus dynapenia with incidence of disability. DESIGN: A four-year prospective study (2006-2010). SETTING: São Paulo, Brazil. PARTICIPANTS: 478 individuals aged 60 and older from the Saúde, Bem-Estar e Envelhecimento (SABE) study who were non-disabled at baseline. MEASUREMENTS: Sarcopenia, measured according to the European Working Group on Sarcopenia in Older People (EWGSOP), includes: LMM assessed by skeletal muscle mass index ≤8.90kg/m2 (men) and ≤6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and <20kg (women); and low physical performance (LPP) assessed by gait speed ≤0.8m/s. Diagnosis of sarcopenia required LMM plus LMS or LPP. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, perception of vision, hearing and body mass index. OUTCOMES: Disability in mobility or instrumental activities of daily living (IADL) or disability in activities of daily living (ADL) and IADL. RESULTS: The incidence density of mobility or IADL disability was 43.4/1000 person/year and 22.6/1000 person/year for IADL and ADL disability. There was no significant difference in incidence density according sarcopenia or dynapenia status. After controlling for all covariates, sarcopenia was associated with mobility or IADL disability (relative risk ratio = 2.23, 95%Confidence Interval: 1.03-4.85). Dynapenia was not associated with disability. CONCLUSIONS: Sarcopenia according to the EWGSOP definition can be used in clinical practice as a screening tool for early functional decline (mobility or IADL disability).

Prevalence and associated factors of sarcopenia among elderly in Brazil: findings from the SABE study.

OBJECTIVES: The aim of the present study was to examine the prevalence and factors associated with sarcopenia in older residents in São Paulo, Brazil. DESIGN: Cross-sectional study. SETTING: São Paulo, Brazil. PARTICIPANTS: 1,149 older individuals from the second wave of the Saúde, Bem-Estar e Envelhecimento (SABE) study from 2006. MEASUREMENTS: The definition of sarcopenia was based on the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP), which include three components: low muscle mass, assessed by a skeletal muscle mass index of ≤8.90 kg/m2 for men and ≤6.37 kg/m2 for women; low muscle strength, assessed by handgrip strength <30 kg for men and <20 kg for women; and low physical performance, assessed by gait speed <0.8 m/s. Diagnosis of sarcopenia required presence of low muscle mass plus low muscle strength or low physical performance. Socio-demographic and behavioral characteristics, medical conditions and nutritional status were considered as independent variables to determine the associated factors using a logistic regression model. RESULTS: The prevalence of sarcopenia was 16.1% in women and 14.4% in men. Advanced age with a dose response effect, cognitive impairment, lower income, smoking, undernutrition and risk for undernutrition (p<0.05) were factors associated with sarcopenia. CONCLUSIONS: The EWGSOP algorithm is useful to define sarcopenia. The prevalence of sarcopenia in the Brazilian elderly population is high and several associated factors show that this syndrome is affected by multiple domains. No differences were observed by gender in any age groups.

The association of hemoglobin concentration with disability and decreased mobility among older Brazilians.

OBJECTIVE: To examine the association between hemoglobin concentration and disability and mobility difficulty among older adults living in São Paulo, Brazil. DESIGN: Cross-sectional study. SETTING: Population-based study conducted in São Paulo, Brazil. PARTICIPANTS: Adults age 60 and over (n=1,256) from the third data collection wave of the SABE Study (Health, Well-being, and Aging) conducted in 2010. MEASUREMENTS: Two outcome measures were included in the analyses: 1) a difficulty to perform at least one of the instrumental activities of daily living (IADL) and 2) mobility difficulty, which was assessed using the Short Physical Performance Battery (SPPB). Logistic regression models assessed the association between hemoglobin and each of the outcome measures. All analyses were adjusted for sociodemographic and health characteristics. RESULTS: The prevalence of IADL disability was 26.8% and 10.7% of participants had mobility difficulty. The mean hemoglobin concentration was significantly lower in older adults who already presented disability (13.7g/dL versus 14.4g/dL among independent elderly) or decreased mobility (13.4g/dL versus 14.3g/dL among elderly with preserved mobility). Higher values of hemoglobin concentration were associated with lower the risk of IADL disability (OR=0.88; p=0.04) and mobility difficulty (OR=0.81; p=0.02). Hemoglobin concentrations showed a dose-response effect in the probability of each outcome. CONCLUSIONS: Lower hemoglobin concentration was associated with a higher probability of IADL disability and mobility difficulty, showing a clear dose-response effect.

Appendicular Lean Soft Tissue: Development and Cross-Validation of Predictive Models for Older Men and Women.

BACKGROUND: Sarcopenia may explain, in a large proportion, physical disability, falls and fractures, especially in aged elderly. However, a diagnosis in an operationally systematic, simple and low cost way is extremely important, particularly for home-based, epidemiological studies. OBJECTIVE: The purpose of this study was to develop and validate predictive equations of appendicular lean soft tissue (ALST) in elderly older than 80 years. DESIGN AND SETTINGS: A validation study was performed in 106 elderly (men and women) aged 80 years and older. MEASUREMENTS: Body weight, height, circumference (arm, midcalf, hip and waist) and triceps skinfold were measured in the elderly. ALST were measured using as the reference method dual-energy X-ray absorptiometry (DXA). RESULTS: Two models were predicted. The first model (ALST, in kg = 0.074*height + 0.277*weight - 0.144*triceps skinfold - 0.103*waist circumference + 1.831*gender -0.966), which considered all possible variables in stepwise multiple regression, presented better statistical performance (r2 = 0.82; SEE = 1.67 kg), compared to the second model (ALST, in kg = 0.138*height + 0.103*weight + 3.061*gender - 12.489), a more practical equation, due to a lesser quantity of predictive variables (r2 = 0.75; SEE = 1.94 kg). Both models were validated, however, it was verified trend (p<0.05) for overestimation of predicted ALST. CONCLUSION: In summary, two models for predicting ALST in men and women with age ≥ 80 years were developed and cross-validated. Model 1, with a greater number of predictive variables, presented a better accuracy than did the model with only three variables (height, weight, and gender). Validation studies are needed to test the usefulness of both models in other populations.

[Nocturia is not associated with falls among the elderly: a population study in the city of São Paulo]. / La nicturia no se asocia con las caídas del anciano: un estudio de población en la ciudad de São Paulo.

INTRODUCTION: the present study aims to evaluate the association between nocturia and falls in a group of community-living elderly men in the city of São Paulo (Brazil). MATERIAL AND METHODS: under the coordination of the Pan American Health Organization and World Health Organization, a multicenter study named Health, Welfare and Aging (SABE Study) is being conducted to evaluate the living and health conditions of older people in Latin America and Caribbean. In Brazil, this study is evaluating the elderly population (60 years or more) in São Paulo since 2000. The presence of nocturia was taken as the response "yes" to the question "Do you need to void three times or more at night?" .The presence of falls was also taken as the response "yes" to the question "Did you have any fall during the last 12 months?" The intergroup analysis used was the logistic regression. RESULTS: total of 865 men was interviewed, mean age 68 years. It was observed high prevalence of nocturia and falls in all groups, with higher prevalence of both in the eldest group (p<0.001), however, the association of nocturia and falls was not statistically significant in any of the groups (p=0.45). CONCLUSION: this is one of the pioneering studies that assess only the male population, showing that nocturia was not significantly associated with falls. Nocturia and falls are highly prevalent conditions in the elderly, but no association was found between both, so that these variables may be correlated to age and other clinical conditions.

La nicturia no se asocia con las caídas del anciano: un estudio de población en la ciudad de São Paulo / Nocturia is not associated with falls among the elderly: a population study in the city of São Paulo

Introducción: el propósito de este estudio es evaluar la relación entre nictura y caídas en un grupo de hombres ancianos que viven en comunidad en la ciudad de São Paulo (Brasil). Materiales y métodos: bajo la coordinación de la Organización Panamericana de Salud y la Organización Mundial de la Salud, un estudio multicéntrico denominado Salud, Bienestar y Envejecimiento (Estudio SABE) se está llevando a cabo para evaluar las condiciones de vida y salud de los ancianos en América Latina y el Caribe. En Brasil este estudio evalúa la población anciana (60 años o más) en São Paulo desde 2000. La presencia de nicturia se tomó como la respuesta “sí” a la pregunta “¿Necesita orinar tres veces o más por la noche?” La presencia de caídas también se tomó como la respuesta “sí” a la pregunta “¿Ha sufrido una caída en los últimos 12 meses?” Se aplicó la regresión logística para el análisis intergrupal. Resultados: se entrevistó a un total de 865 hombres con una edad media de 68 años. Se identificó una alta prevalencia de nicturia y caídas en todos los grupos, con una mayor prevalencia de ambas en el grupo de los más mayores (p<0,001); sin embargo, la asociación de nicturia y caídas no fue estadísticamente significativa en ninguno de los grupos (p=0,45). Conclusión: éste es uno de los estudios pioneros que solamente evalúa la población masculina, demostrando que la nicturia no está asociada con caídas de manera significativa. La nicturia y las caídas son condiciones altamente prevalentes en los ancianos, pero no se encontró ninguna relación entre ambas, por lo tanto estas variables se podrían correlacionar con la edad y otras condiciones clínicas (AU)

Introduction: the present study aims to evaluate the association between nocturia and falls in a group of community-living elderly men in the city of São Paulo (Brazil). Material and methods: under the coordination of the Pan American Health Organization and World Health Organization, a multicenter study named Health, Welfare and Aging (SABE Study) is being conducted to evaluate the living and health conditions of older people in Latin America and Caribbean. In Brazil, this study is evaluating the elderly population (60 years or more) in São Paulo since 2000. The presence of nocturia was taken as the response “yes” to the question “Do you need to void three times or more at night?” .The presence of falls was also taken as the response “yes” to the question “Did you have any fall during the last 12 months?” The intergroup analysis used was the logistic regression. Results: total of 865 men was interviewed, mean age 68 years. It was observed high prevalence of nocturia and falls in all groups, with higher prevalence of both in the eldest group (p<0.001), however, the association of nocturia and falls was not statistically significant in any of the groups (p=0.45). Conclusion: this is one of the pioneering studies that assess only the male population, showing that nocturia was not significantly associated with falls. Nocturia and falls are highly prevalent conditions in the elderly, but no association was found between both, so that these variables may be correlated to age and other clinical conditions (AU)

Prognostic factors for local necrosis in Bothrops jararaca (Brazilian pit viper) bites.

The prognostic factors related to envenoming are not very well known. This study aims to identify prognostic factors for necrosis in envenoming by Bothrops jararaca. We analysed 779 medical records of patients bitten by B. jararaca and treated at the Hospital Vital Brazil, Butantan Institute, São Paulo, Brazil, between 1982 and 1990: 111 cases with necrosis were compared with the remaining cases. The length of the snake, the bite site, the month of the accident, pain, oedema, ecchymosis, blisters, systemic bleeding, shock, and the use of tourniquet were statistically associated with the presence of necrosis (P < 0.05) in the univariate analysis. The size of the snake, the bite site (leg and finger), the sex of the patient, the month of the accident, systemic bleeding, and the use of tourniquet were independent prognostic factors within the variables tested in the multivariate analysis. The size of the snake was the most important independent prognostic factor related to the presence of necrosis.

[Morbidity and mortality due to traumatic brain injury in São Paulo City, Brazil, 1997]. / Morbimortalidade por traumatismo crânio-encefálico no município de São Paulo, 1997.

There are few epidemiological studies on traumatic brain injury (TBI), and those that allow broad comparative analyses of this problem are even more scarce, due to methodological obstacles. Usually, the studies address head injury (they include the cranial envelopments and content) but are reported as TBI, given the difficulty of mutual exclusion. It is also common for them to be centered at specific severity levels, only for hospitalized victims or according to the external cause, such as traffic accidents. With full respect to these limits, this study had as its objective the estimation of the TBI incidence in patients resident and in-hospital, in the hospital network in the city of São Paulo, Brazil, in 1997, as well as the estimation of TBI-caused mortality amongst external causes, at this same time and locale. Data for the study consisted of Ministério da Saúde data on hospital discharges, analyzed based on Autorizações de Internação Hospitalar (AIH) and obituary data on external causes, contained in the Programa de Aprimoramento das Informações de Mortalidade (PROAIM) data base. It was found that 29 717 patients were hospitalized due to lesions and poisoning; of these 3 635 (12%) had TBI; the hospitalization rate was 0.36/1000 pop.; and hospital mortality was 10%. The mortality coefficient due to external causes was 87.3/100 000 pop. Minimum TBI mortality rate is estimated at a minimum of 26.2 and a maximum of 39.3/100000 pop.

[Hospital morbidity determinants in a region of São Paulo State (Brazil)]. / Determinantes da morbidade hospitalar em região do Estado de São Paulo (Brasil).

INTRODUCTION: Many changes in the morbidity of patients attended to the Country's hospitals have occurred in recent years, wether resulting from demographic, epidemiological, financial and technological factors or from those related to the structure of the services themselves. METHODS: The change in diagnoses occurring over this period was analyzed using two data banks relating to hospital discharges during 1975 and 1988, in the Vale do Paraíba, Southeastern Brazil, taking into account the factors mentioned above. Both data banks covered the same variables: hospital, dwelling, patient's age and sex, health status at discharge, financing sources, duration of stay and main diagnosis. RESULTS: Among the results were to be found: an ageing of the population of the region, with an increase in life expectancy and a decrease in the general and infant mortality coefficients, with a proportional diminution of mortality from "infectious and parasitic diseases" and an increase in "neoplasms", "diseases of the circulatory system" and "injury and poisoning". There was a drop in the number of hospitalizations by some diagnostic groups such as "symptoms, signs and ill-defined conditions" and "infectious and parasitic diseases" and an increase in others, particularly the "neoplasms" and "diseases of the circulatory system". There was a shift from the poorly-defined to better defined diagnoses, further, there was a decrease in the duration of stay for all groups. It was possible to identify some factors which might have caused these changes, although there was no one behavioral pattern for all diagnoses.

[Deaths caused by venomous snakes in the State of São Paulo: evaluation of 43 cases from 1988 to 1993]. / Obitos por serpentes peçonhentas no Estado de São Paulo: avaliação de 43 casos, 1988/93.

UNLABELLED: The prognostic factors and the causes for obit occurrence in ophidian envenoming are yet not completely clear. PURPOSE: To determine the prognostic factors and the most probable causes for obit occurrence in ophidian envenoming. METHODS: In the State of São Paulo were notified 12,639 cases of accidents by venomous snakes from 1988 to 1993. There were 43 deaths (0.34%). The variables from the accident notification reports were compared with the promptuary notes and/or with the death records (in lethal cases). RESULTS: The snake genus was classified in 11,297 accidents and in 41 from the lethal ones. Bothrops was responsible for 9,828 (87%) accidents and 28 (68.3%) deaths, Crotalus for 1,359 (12.0%) accidents and 13 deaths (31.7%) and Micrurus for 110 (1%) accidents and no death (p < 0.05). The information regarding to sex and age of the patients was available, respectively, in 12,620 and 12,527 accidents and in all lethal ones. There were 9,783 (77.5%) male patients in the accidents and 35 (81.4%) in the lethal cases (p > 0.05). Regarding to age, 15.9% of the patients and 41.8% of the ones who died were 50 years-old or more (p < 0.05). The most frequently bitten anatomic regions were: foot (42.2%), hand (20.6%), leg (17.6%), and ankle (13.1%) in the accidents, and foot (35.7%) and leg (35.7%) in the lethal cases (p < 0.05). Coagulation disorders occurred in 34 (91.9%) from 37 patients who died (those where this datum was available). The information above was not available in non lethal cases. The most common manifestations and complications implicated as possible death causes were: acute renal failure (34-79.1%), acute respiratory failure (28-65.1%), shock (18-41.9%), and sepsis (18-41.9%). Among all lethal cases but one without information, 29.4% of the patients died within the first two days after bite and 67.6% within the first 5 days. Acute respiratory failure was most common among the patients who died owing to crotalic envenoming, and sepsis was only seen in bothropic envenoming. CONCLUSION: Most of the accidents and obits are caused by Bothrops; Crotalus envenoming, leg bites, and accidents in 50 year-old patients (or more) are frequently lethal; the most common complication in lethal cases is acute renal failure.

Obitos por serpentes peçonhentas no Estado de Säo Paulo: avaliaçäo de 43 casos, 1988/93 / Obits by venomous snakes in the State of Säo Paulo: evaluation of 43 cases from 1988 to 1993

Sao ainda mal estabelecidos os fatores prognósticos para a ocorrência de óbito nos envenenamentos por serpentes e as causas que o determinam. Objetivo. Determinar, no envenenamento ofídico, os fatores prognósticos e as causas mais prováveis do óbito. Métodos. No período de 1988 a 1993 foram notificados 12.639 casos de acidentes por serpentes peçonhentas no Estado de Sao Paulo, com 43 óbitos (0,34 por cento). Foram comparadas as variáveis obtidas das fichas de notificaçao dos acidentes com aquelas dos prontuários e/ou dos relatórios médicos dos casos de óbito. Resultados. O diagnóstico quanto ao gênero da serpente foi realizado em 11.297 acidentes, sendo 9.828 (87 por cento) por Bothrops, 1.359 (12 por cento) por Crotalus e 110 (1 por cento) por Micrurus, e em 41 casos de óbito, sendo 28 (68,3 por cento) por Bothrops e 13 (31,7 por cento) por Crotalus (p<0,05). Informaçao quanto a sexo e idade dos pacientes foi fornecida em, respectivamente, 12.620 e 12.527 acidentes. Pertenciam ao sexo masculino 9.783 (77,5 por cento) pacientes picados e 35 (81,4 por cento) que faleceram (p>0,05). Tinham 50 anos ou mais 15,9 por cento dos pacientes picados e 41,8 por cento daqueles que faleceram (p<0,05). As regioes anatômicas mais freqüentemente picadas foram: pé (42,2 por cento), maos (20,6 por cento), perna (17,6 por cento) e tornozelo (13,1 por cento), nos acidentes, e pé (35,7 por cento) e perna (35,7 por cento), nos casos de óbito (p<0,05). A alteraçao da coagulaçao ocorreu em 34 (91,9 por cento) de 37 pacientes que evoluíram para o óbito. As manifestaçoes e complicaçoes mais referidas como possíveis causas de óbito foram: insuficiência renal (34-79,1 por cento), insuficiência respiratória (28- 65,1 por cento), choque (18- 41,9 por cento) e septicemia (18- 41,9 por cento). Dentre os pacientes que evoluíram para óbito, excluindo-se um caso sem informaçao, 29,4 por cento faleceram dentro dos primeiros dois dias após a picada. A insuficiência respiratória foi mais comum entre os que faleceram devido ao envenenamento crotálico e a septicemia só foi referida para o envenenamento botrópico. Conclusao. A maioria dos acidentes e dos óbitos é causada por Bothrops; sao mais freqüentemente letais os envenenamentos por Crotalus, as picadas na perna e em pessoas com mais de 50 anos; a complicaçao mais comum nos casos fatais é a insuficiência renal.

[Accidents and acts of violence in Brazil: II--Hospital morbidity from lesions and poisonings]. / Morbidade hospitalar por lesões e envenenamentos.

Today in Brazil the "Hospital Internment Authorizations" (AIH) represents about 80% of the total internments in the country and constitutes a data base of easy access available in CD-ROM. This high coverage allows one to draw a reasonable picture, close to reality, of the morbidity demanding hospitalization. Among the causes there is the diagnostic category lesions and poisonings noteworthy for severity and frequency. Hospital internments by this diagnostic category occurring in a month in 1994 have been focused on. Some epidemiological and hospital use characteristics, such as demographic aspects, specific diagnostic category, length of stay and mortality are described. It was observed that lesions and poisonings accounted for 5% to 6% of all hospital internments in the country, being predominantly among men under 65 of age. This diagnostic category was the first cause of hospital internments among men of from 15 to 29 years of age. Fractures were the most frequent specific diagnosis (about 37.5%), almost all of them involving members (legs or arms). The injuries were mainly located in hands, arms, head and neck and occurred predominantly among young men, leading to the believe that they were due to work or traffic accidents. Regarding burns, the fragment occurrence among children under 5 years of age is worthy of note. The authors lament the lack of information as to their causes such as would enable appropriate preventive actions to be taken.

Avaliaçäo dos óbitos por acidentes por serpentes peçonhentas no Estado de Säo Paulo, 1988/1989 / Evaluation of death by accidents with venomous snakes in the State of Säo Paulo, 1988/1989

Está começando a ser freqüente no Brasil, a discussao sobre a avaliaçao da qualidade da atençao médica. OBJETIVO. Avaliar os casos de óbitos por acidentes por serpentes peçonhentas que ocorreram no Estado de Sao Paulo. MÉTODOS. os autores analisam os 21 óbitos ocorridos por acidentes por serpentes peçonhentas no Estado de Sao Paulo nos anos de 1988 e 1989, utilizando a técnica de critérios implícitos com três revisores, que responderam a um questionário. Dois dos autores fazem, ainda, uma análise qualitativa do atendimento prestado aos pacientes. RESULTADOS. Os resultados mostram maior freqüência de óbitos no sexo masculino e na faixa etária de 50 anos e mais. Em resposta à pergunta se o óbito era previsível, houve unanimidade de que nao em cinco casos e maioria em seis, o que dá 52,4 por cento de respostas como nao previsíveis. na questao se havia evidência de que a complicaçao nao foi reconhecida, a maioria afirmou que sim ou que nao havia informaçao suficiente. porém na pergunta se foram tomadas medidas apropriadas às complicaçoes, houve três casos que se considerou que nao. Em relaçao à questao se o óbito era prevenível, houve maioria de sim em três casos. CONCLUSAO. A grande questao levantada foi a má qualidade das informaçoes contidas nos prontuários. A avaliaçao qualitativa dos dois autores mostrou, algumas vezes, inadequaçao de procedimentos realizados.

[Evaluation of deaths by accidents with venomous snakes in the State of São Paulo, 1988/1989]. / Avaliação dos óbitos por acidentes por serpentes peçonhentas no estado de São Paulo, 1988/1989.

UNLABELLED: In Brazil, the discussion about the quality of medical care evaluation is beginning. PURPOSE: Assessment of the cases of death by venomous snake bite in the State of São Paulo. METHODS: Twenty one deaths caused by venomous snakebite, that occurred in the State of S-ao Paulo, Brazil, during 1988 and 1989 were analysed. The method of three audits implicit criteria was used to evaluate the care given to these cases. Two of the authors did also a qualitative analysis of the care. RESULTS: The results showed a higher frequency of males and adults of 50 and more years of age. The answers to the question "if the death was predictable" were all negative, in 5 cases, and the majority agreed in 6 cases (52.4% of answers were "not predictable"). The question "if there was evidence that the complication was recognized" had answers as "yes" or "there was not sufficient information" in the majority. As to the question "all the appropriate measures were taken in view of the complications", in three cases the answer was "no". CONCLUSION: The main question mentioned was the bad quality of the information in the medical records. The qualitative analysis of the two authors, showed, some inadequate procedures.

[Study of morbidity in patients hospitalized at the Clinic Hospital at the Medical School of the USP-1989]. / Estudo da morbidade dos pacientes internados no Hospital das Clínicas da Faculdade de Medicina da USP-1989.

The diagnostic categories of the patients discharged from the "Hospital das Clínicas" of the University of São Paulo in 1989 were arranged according the International Classification of Diseases (I.C.D.) and analysed. In each Group sex, age and the reason of discharge or death was indicated. The data concerning 39,601 cases were provided by the Medical Data Service of the "Instituto Central" of the "Hospital das Clínicas". Only the principal diagnosis was taken into account. In the "Instituto de Psiquiatria" most the patients (55.4%) were males between 20 and 49 years of age. The main diagnostic categories were affective psychoses (20.3%), schizophrenic disorders (15%), and disorders related to alcoholism (9.5%). The mortality rate was 0.27%. In the "Instituto da Criança" 56% of the patients that left the hospital were male children and 45.8% of them were less than one year old. Regarding to the diagnostic categories the most important one was that of the diseases of the respiratory system with 27.1% of cases, followed by that of infectious and parasitic diseases with 16.0% of cases. Within the respiratory diseases the most important were the pneumonias caused by not specified microorganisms, and within the infectious diseases the most important was the diarrhea of presumably infectious origin. The mortality rate in this Institute was 9.4%. The "Instituto de Ortopedia e Traumatologia" left 3,825 patients 61.7% males, and 46.9% of them were aged between 20 and 49 years. The greatest number of cases (57.1%) belonged to the Chapter "Injury and Poisoning" followed by that of "Diseases of the Muscoleskeletal System" and Connective Tissue Diseases (23.5%). In this Institute the mortality rate was 1.2%. From the "Instituto do Coração" 7,194 patients were discharged; 65% of them were males, varying their age between 50 and 69 years. The diseases of the circulatory system were mostly ischemic heart disease, miocardiopathies and rheumatic heart diseases. Mortality rate in this Institute was 10.8%. The "Instituto Central" was responsible for 65.6% of all the patients discharged from the "Hospital das Clínicas" (26,015 cases). As to the diagnostic categories the predominant chapter was that of "Injury and Poisoning" (12.8% of cases) followed by the "Diseases of the Digestive System" (10.9%) "Neoplasms" (10.8%) and the "Diseases of Circulatory System" (9.2%). The mortality rate in the "Instituto Central" was 7.2%.

[Analysis of health and life status of a urban population of Botucatu, São Paulo (Brazil). IV. Morbidity reported in domiciliary interviews, 1983-1984]. / Análise das condições de saúde e de vida da população urbana de Botucatu, São Paulo (Brasil). IV--Morbidade referida em entrevistas domiciliárias, 1983-1984.

The objective of the study was to analyse the referred morbidity of the urban population resident in the city of Botucatu, S. Paulo State, Brazil for the period 1983-1984 was analysed. Data was obtained from a sample population of 7,075 persons (12 per cent of the population) by means of household interviews using two pre-codified questionnaires applied by trained lay interviews under supervision. The recall period of the events was fixed at three weeks. The variables studied were: sex, age, schooling, "per capita" income, and referred morbidity (complaints, symptoms, common accidents, and diagnoses). The results showed that 56 percent reported episodes of illness to a total of 6,649. Women of 50 or more years old presented the highest frequency of complaints. There was no variation of occurrence of episodes in terms of "per capita" income. The prevalence of illness episodes was 939 per thousand persons. There was a predominance of complaints relating to the respiratory system (20 per cent of complaints), mainly acute respiratory infections; on a second level was signs, symptoms and ill-defined conditions (19 per cent), followed by diseases of the musculoskeletal system, of the nervous system and of the circulatory system (about 9%) and, finally, diseases of the digestive system and lesions and poisoning (8%). Specific rates of prevalence according to groups of diseases (ICD) and to the variables of study were estimated. The difficulties of comparing these results with those given by other works, because of the lack of homogeneity in the criteria adopted for obtaining information, are commented on.(ABSTRACT TRUNCATED AT 250 WORDS)