Impacto del nivel socioeconómico en el conocimiento del ictus de la población general: un gradiente de desigualdad social / Effect of socioeconomic level on knowledge of stroke in the general population: A social inequality gradient

Objetivos: El nivel socioeconómico es un factor que condiciona el comportamiento individual ante la salud y las condiciones de salud de la población. Se evalúa la asociación entre factores socio-demográficos y el conocimiento del ictus en la población general. Método: Estudio transversal. Los sujetos fueron seleccionados por un sistema de asignación al azar doble. Se administró un cuestionario estructurado con preguntas abiertas y cerradas mediante entrevistas cara a cara. El «conocimiento adecuado» fue definido previamente. Se utilizaron el test de Mantel-Haenszel y la regresión logística con modelos ajustados para evaluar la asociación entre el conocimiento del ictus y las variables estudiadas. Resultados: Entrevistas, 2.411; 59,9% mujeres; edad media ± desviación estándar, 49,0 ± 17,3 años. El 74% residente en área urbana. Un 24,7% tenía estudios universitarios, el 15,2% un nivel de escolarización bajo. Solo el 2,1% declaraba ganar mas de 40.000 euros/año y un 29,9% menos de 10.000. Casi el 74% declaró tener un excelente o buen nivel de salud. El desempleo fue del 17,0%. La prevalencia de «conocimiento adecuado» fue del 39,7%(IC del 95%, 37,7%-41,6%). El análisis de tendencias mostró una asociación entre conocimiento y nivel económico (z = 10,14; p < 0,0001); nivel de estudios (z = 15,95; p < 0,0001), estado de salud (z = 7,92; p < 0,0001) y situación laboral (z = 8,98; p < 0,0001). Conclusiones: El nivel de estudios y renta, disponer de trabajo y gozar de salud son factores independientes de un «conocimiento adecuado» del ictus. Las campañas educativas deberían realizarse con un lenguaje sencillo y dirigirse con especial interés a las clases sociales mas desfavorecidas

Objectives: Socioeconomic status is a factor that influences health-related behaviour in individuals as well as health conditions in entire populations. The objective of the present study was to analyse the sociodemographic factors that may influence knowledge of stroke. Method: Cross-sectional study. A representative sample was selected by double randomisation. Face-to-face interviews were carried out by previously trained medical students using a structured questionnaire with open- and closed-ended questions. Adequate knowledge was previously defined. The Mantel-Haenszel test and adjusted logistic regression analysis were used to assess the association between knowledge of stroke and the study variables. Results: 2411 subjects were interviewed (59.9% women; mean age 49.0 [SD 17.3] years) Seventy-three per cent were residents of urban areas, 24.7% had a university education, and 15.2% had a low level of schooling. Only 2.1% reported earning more than 40 000 euros/year, with 29.9% earning less than 10 000. Nearly 74% reported having an excellent or good state of health. The unemployment rate was 17.0%. Prevalence of 'adequate knowledge' was 39.7% (95% CI: 37.7%-41.6%). Trend analysis showed an association between knowledge of stroke and income (z = 10.14, P < 0.0001); educational level (z = 15.95, P < 0.0001); state of health (z = 7.92, P < 0.0001); and employment status (z = 8.98,P < 0.0001). Conclusions: Educational level, income, employment status, and state of health are independent factors for adequate knowledge of stroke. Public awareness campaigns should present material using simple language and efforts should be directed toward the most disadvantaged social strata in particular

Acerca de las interconsultas a los neurólogos formuladas desde urgencias. Respuesta del autor / Regarding emergency department consultations with neurologists. Author's reply

No disponible

Perfil e prevalência de uso de plantas medicinais em uma unidade básica de saúde da família em Campina Grande, Paraíba, Brasil / Profile and prevalence of the use of medicinal plants in a local Public Health Service Family Clinic in Campina Grande, Paraíba, Brazil

Através desta pesquisa, objetivamos avaliar aspectos relacionados ao uso de plantas medicinais por usuários da Unidade Básica de Saúde da Família (UBSF), Malvinas V, em Campina Grande, PB. Para desenvolver essa avaliação, foram aplicados questionários semiestruturados com 420 usuários da referida unidade. Os resultados revelaram que 79% dos entrevistados faziam uso de plantas medicinais, sendo a mais prevalente o boldo (Peumus boldus), com uma porcentagem de 21,02%. A grande maioria dos entrevistados (97%) não recebeu qualquer orientação sobre fitoterapia de profissionais da UBSF, sendo que 84% mencionaram que o conhecimento sobre a utilização de plantas medicinais foi adquirido com parentes. Mais da metade (51%) dos entrevistados pensam que as plantas medicinais não causam dano à saúde, tanto que, 43% das pessoas reconheceram a automedicação com plantas medicinais. Esses dados nos permitem concluir que o consumo e a automedicação com plantas medicinais é uma realidade social também em Campina Grande e, que, os profissionais de saúde da rede pública precisam rever sua atuação enquanto responsáveis pela promoção de uma fitoterapia racional, conforme previsto pelo Programa Nacional de Plantas Medicinais e Fitoterápicos.

The aim of this enquiry was to assess the use ofmedicinal plants by patients of the Family HealthCenter (UBSF) for the district of Malvinas V, inCampina Grande city, Paraíba, Brazil. We issued semistructuredquestionnaires to 420 users of the healthcenter. The results revealed that 79% of respondentswere using medicinal plants, the most prevalent beingboldo (Peumus boldus) (21.02%). The vast majorityof respondents (97%) did not receive any informationabout the use of herbal medicine from the professionalsworking at the UBSF Malvinas V, 84% of themmentioning that their knowledge of medicinal plantswas acquired from relatives. More than half (51%)of the respondents thought medicinal plants werenot harmful to health, so much so that 43% of thepeople admitted self-medication with medicinal plantsand 52% reported the use of herbal in associationwith allopathic medicine. These data show that selfmedicationwith herbs is a social reality in CampinaGrande and that public health professionals need toreview their performance in the promotion of rationalherbal medicine, as foreseen in the National Program ofplant medicines and herbal remedies.

Evolución temporal de las interconsultas hospitalarias dirigidas a Neurología en un hospital terciario. Una actividad asistencial en crecimiento / Longitudinal Study of In-Hospital Consultations with Neurology in a Tertiary Hospital. A health care activity on the increase

Objetivo: Las interconsultas hospitalarias (ICh) constituyen un servicio que se ofrece de unas especialidades médicas a otras con la función de ayudar a resolver las complicaciones de los pacientes ingresados en las distintas unidades del hospital. El objetivo de este trabajo es analizar descriptivamente y con carácter temporal las ICh recibidas en nuestro servicio durante el último quinquenio. Método: Estudio retrospectivo de las ICh realizadas. Periodo: 2005-2009. Los datos analizados son: servicio de origen de la interconsulta, motivo de consulta, fecha, prioridad en la atención, diagnóstico definitivo, necesidad de seguimiento, necesidad de traslado y datos demográficos de los pacientes. Resultados: n=1458 ICh. Edad media 58,2±19,10. Varones: 837 (57,6%). Por año el número de ICh fue: 2005: 263; 2006: 226; 2007: 239; 2007: 239, 2008: 329 y 2009: 401. El 86,8% tenían prioridad normal, 8,5% preferente y 4,7% urgentes. Urgencias (12%), Cardiología (10,9%), Medicina Interna (9,8%) y Psiquiatría (8,9%) fueron los servicios con mayor demanda. Los motivos de consulta más frecuente fueron: pérdidas de conciencia y crisis epilépticas (24,6%), patología vascular cerebral (21,1%) y cuadros confusionales y deterioro cognitivo (13,4%). El 36,8% se resolvieron en la primera consulta y el resto (63,8%) precisaron de seguimiento. Precisaron traslado a Neurología el 8,4% de los casos valorados. Conclusiones: La ICh es una actividad compleja que no se resuelve en una única visita. Provoca una carga asistencial que crece cada año. La creciente complejidad diagnóstica de la neurología y los tratamientos cada vez más específicos son los factores que condicionan este aumento de la demanda(AU)

Objective: In-hospital consultation (IHC) is a service that some medical specialties provide to others with the aim of resolving complications in patients admitted to different hospital units. The aim of this study is to perform a descriptive analysis and longitudinal study of IHCs received in our department during the last 5 years. Method: A retrospective study was conducted on the IHCs made within the period 2005-2009. The data analysed were as follows: department of origin of the IHC, reason for consult, date, priority of care, definitive diagnosis, need for follow-up, need for transfer, and the demographic data of the patients. Results: There were a total of 1458 IHCs in the period studied. The mean age of the patients was 58.2±19.10 years, and 837 (57.6%) were males. The number of IHCs per year was: 2005: 263; 2006: 226; 2007: 239; 2007: 239, 2008: 329 and 2009: 401. The majority (86.8%) had normal priority, 8.5% high priority, and 4.7% were urgent. The Emergency Department (12%), Cardiology (10.9%), General Medicine (9.8%) and Psychiatry (8.9%) were the services with the highest demand. The most frequent reasons for consulting were loss of consciousness and epileptic seizures (24.6%), cerebral vascular disease (21.1%), and confusional states and cognitive impairment (13.4%). Over one third (36.8%) were resolved in the first consultation, and the remainder (63.8%) required follow up. Of all the cases assessed, 8.4% required transfer to Neurology. Conclusions: IHC is a complex activity that may not resolve all questions in a single visit. It involves a health care burden which is increasing annually. The increasing diagnostic complexity of the neurology, as well as the increasingly more specific treatments are the factors that lead to this higher demand(AU)

Síndrome de hiperperfusión cerebral tras endarterectomía carotídea / Cerebral hyperperfusion syndrome following a carotid endarterectomy

No disponible

Evaluación clínica y videofluoroscópica de la deglución en pacientes con parálisis cerebral tetraparésica espástica y atetósica / Clinical and videofluoroscopic evaluation of swallowing in patients with spastic tetraparetic cerebral palsy and athetosic cerebral palsy

Objetivo. Evaluar y comparar los hallazgos de la fase oral y faríngea de la deglución de niños con parálisis cerebral tetraparésica espástica (PCT) y atetósica (PCA). Pacientes y métodos. Se evaluaron 11 niños, con edades comprendidas entre 10 meses y 8años, mediante la evaluación clínica y la videofluoroscopia. Resultados. Los niños con PCT se mostraron más afectados en los aspectos neurológicos, clínicos y fonoaudiológicos. En la fase oral, todos los niños presentaron alguna afectación. En la fase faríngea, se identificaron síntomas clínicos de aspiración en 10 niños. Se observaron aspiraciones en el 80% de los niños con PCT y en el 67% con PCA. Las alteraciones de la deglución fueron semejantes en los dos grupos de parálisis cerebral, pero la ejecución de la misma en los niños con PCT fue inferior. Conclusión. La videofluoroscopia ha constituido un importante instrumento de diagnóstico, ya que ha posibilitado la verificación de las aspiraciones, ayudándonos en la programación terapéutica de estos niños (AU)

Aim. To evaluate and to compare the findings of oral and pharyngeal phases of swallowing in children with bothspastic tetraparetic cerebral palsy (STCP) and with athetosic cerebral palsy (ACP). Patients and methods. 11 children were evaluated, with their ages ranging from 10 months to 8 years old, through both clinical assessment and videofluoroscopic evaluation. Results. The children with STCP were more involved at the neurologic, clinical and speech-language and hearing aspects. At the oral phases all the children had presented some involvement. At the pharyngeal phases the clinical signs of aspiration were identified in 10 children. It was observed aspirations in 80% of children with STCP and in 67% with ACP. The changes on swallowing were similar in both cerebral palsy groups, but the performance of the children with STCP was inferior. Conclusion. The videofluoroscopy was an important method which makes possible the verification of aspirations, helping the professionals at the therapeutical program for these children (AU)

Multimídia e conectividade entre os conselhos de saúde: a plenária virtual permanente

Aborda a formação de uma rede de conexões através do uso das novas tecnologias da informação e da comunicação por parte dos conselhos de saúde e as perspectivas que a prática aponta. A partir das concepções de políticas de acúmulo de capital social, de exclusão digital e de governança eletrônica, realizou-se um trabalho de campo para determinar o uso da Internet entre os conselhos de saúde do Estado do Rio de Janeiro. Tendo por base este diagnóstico, concebeu-se uma ferramenta para amplificar a interlocução entre os conselhos municipais e estadual de saúde do Rio de Janeiro, utilizando vídeo e áudio em redes digitais, com a perspectiva de implantação num sistema de TV digital. Arquivo disponível para leitura e/ou download nos ícones ao lado.