Perceção do apoio familiar do idoso institucionalizado com dependência funcional / Perception on the family support given to institutionalized aged in a state of functional dependency / Percepción del apoyo familiar del adulto mayor institucionalizado con dependencia funcional

Introdução: Os cuidados formais, prestados aos idosos dependentes, não podem ser desligados do apoio que os familiares proporcionam. Neste aspeto, os cuidados prestados por profissionais de saúde concorrem, lado a lado, com os cuidados informais prestados pelos familiares, para um apoio holístico ao idoso. Por conseguinte, o maior conhecimento do grau de dependência do idoso e do tipo de apoio prestado pela família poderá contribuir para uma melhor adequação dos cuidados ao idoso. Objetivos: Avaliar o apoio prestado pela família a idosos com dependência institucionalizados; descrever o grau de dependência dos idosos. Método: Foi realizado um estudo descritivo exploratório de corte, com idosos dependentes e institucionalizados, de uma região do Norte de Portugal; recorreu-se a uma amostra não probabilística racional (n=111). Foi utilizado um questionário organizado em três grupos: grupo I - caracterização sociodemográfica; grupo II- índice de Barthel; grupo III- Inventário da Perceção de Suporte Familiar. Resultados: Evidenciou-se que a maior parte dos idosos recebem sempre, ou quase sempre, apoio das suas famílias e esse apoio salientou-se na dimensão adaptação familiar. O perfil dos participantes caracteriza-se pela predominância de mulheres com grau grave ou moderado de dependência. Conclusões: Idosos dependentes institucionalizados têm apoio das suas famílias. Salientou-se a continuidade de laços afetivos com os idosos mesmo não coabitando com as suas famílias.

Introduction: Formal care offered to dependent old adults cannot be unlinked from the support which family members provide. In this sense, the care provided by health professionals converges with the informal care provided by family members, creating a holistic support to the old adult. Therefore, a greater knowledge on the degree of dependence of the old adult and on the characteristics of the informal care provided by the family members can contribute to a better care for these adults. Objectives: To assess the support provided by the family members of institutionalized old adults in a state of dependency, and describe the degree of this dependency. Methods: This is a descriptive and cut-exploratory study on institutionalized old adults in a state of dependency, from a region of northern Portugal. The sample was non-random rational (n = 111). The used questionnaire-instrument was organized in three areas: group I included the demographic characterization; the group II included the Barthel index, and the group III included the Family Support Perception Inventory. Results: It was evidenced that the majority of old adults always, or almost always, receive support from their families, which highlighted the dimension of Family Adaptation. The profile of the participants is characterized by a predominance of women with a severe or moderate degree of dependency. Conclusions: Institutionalized old adults in a state of dependency have support from their families. Though living separately, the continuity of affective links between these adults and their families was highlighted.

Introducción: Los cuidados formales ofrecidos a los adultos mayores dependientes, no se pueden desligar del apoyo que los familiares proporcionan. En este aspecto, los cuidados ofrecidos por profesionales de la salud convergen, lado a lado, con los cuidados informales prestados por los familiares, para un apoyo holístico al adulto mayor. Por consiguiente, el mayor conocimiento sobre el grado de dependencia del adulto mayor y del tipo de apoyo dado por la familia, podrá contribuir para una mejor adecuación de los cuidados del adulto mayor. Objetivos: Evaluar el apoyo prestado por la familia a los adultos mayores con dependencia institucionalizados; describir el grado de dependencia de los adultos mayores. Métodos: Se realizó un estudio descriptivo exploratorio de corte, con adultos mayores dependientes institucionalizados, de una región del norte de Portugal, se recurrió a una muestra no probabilística racional (n=111). Fue utilizado un cuestionario organizado en tres grupos: grupo I caracterización demográfica; grupo II índice de Barthel; grupo III Inventario de Percepción de Apoyo Familiar. Resultados: Se evidenció que la mayor parte de los adultos mayores siempre reciben, o casi siempre, apoyo de sus familias y ese tipo de apoyo sobresalió en la dimensión de adaptación familiar. El perfil de los participantes se caracteriza por la predominancia de mujeres con un grado grave o moderado de dependencia. Conclusiones: Los Adultos mayores dependientes institucionalizados tienen apoyo de sus familias. Se destacó la continuidad de los lazos afectivos con los adultos mayores, a pesar de no cohabitar con sus familias.

Prevalence of inflammatory bowel disease in an insured population in Puerto Rico during 1996

OBJECTIVES: Limited data exists about Inflammatory Bowel Disease (IBD) in Hispanic populations. The aims of the present study were to estimate overall and specific prevalence of IBD (Crohn's disease and ulcerative colitis) and to describe the characteristics of a group of patients from the University of Puerto Rico's IBD Registry. METHODS: To estimate the prevalence of IBD, computerized records of all physician billing and hospital discharges from a major health insurer in Puerto Rico and classified with ICD-9-CM codes 555.0-555.9 (Crohn's disease) and 556.0-556.9 (ulcerative colitis) during 1996 were searched. Prevalence was estimated by age group, sex, and type of insurance. To describe demographic and selected clinical information from patients with IBD, data gathered in the University of Puerto Rico's IBD Registry from 1995 through 2000 was analyzed. RESULTS: Out of 802,726 insured individuals, 332 had a diagnosis of Crohn's disease, 499 of ulcerative colitis and 21 had both diagnoses. The estimated prevalence per 100,000 was 41.4 for Crohn's disease, 62.2 for ulcerative colitis, and 106.1 cases per 100,000 for IBD. Peak prevalence of Crohn's disease occurred among the age groups 50-59 years and > or = 60 years, and the overall female:male prevalence ratio of Crohn's disease was 1.13 (95 per cent CI: 0.91-1.42). Ulcerative colitis was most prevalent among insured individuals aged 50-59 years and 40-49 years. The prevalence of ulcerative colitis was significantly higher among females than among males, with an overall prevalence ratio of 1.42 (95 per cent CI: 1.18-1.71). Of 342 patients participating in the IBD Registry, 155 (45.3 per cent) had Crohn's disease and 187 (54.7 per cent) had ulcerative colitis. Among patients diagnosed with Crohn's disease, 51.6 per cent were females, the mean age was 35.2 +/- 18.3 years, and 18.1 per cent had a family history of IBD. More than half (57.8 per cent) of patients with ulcerative colitis were females, the mean age was 42.6 +/- 17 years, and 17.1 per cent had a family history of IBD. CONCLUSIONS: The estimated prevalence of IBD in this insured population in Puerto Rico places it among the middle-range of that reported for other countries. Additional studies must be conducted in Puerto Rico in order to confirm the observed findings. Population-based epidemiologic studies aimed at estimating the burden of IBD in Hispanic populations in the United States and Latin America are essential for health care planning.

Deficiencia de vitamina A y estado nutricional antropométrico en niños marginales urbanos y rurales en el Estado Zulia, Venezuela / Vitamin A deficiency and the anthropometric nutritional status of urban and rural marginalized children in the state of Zulia, Venezuela

The present transversal study was carried out to estimate the prevalence of both vitamin A deficiency (VAD) and protein-energy malnutrition among children (24 to 85 months) from three urban slums (n = 173) in Maracaibo city, Zulia State, Venezuela and a rural slum area (n = 34), vieinal to Maracaibo, by measuring serum retinol and z score of anthropometric indices Height//Age (H//AZ); Weight//Age (W//AZ) and Weight//Height (W//HZ), compared to NCHS-WHO reference values. The Graffar's methodology adapted to Venezuela by MÚndez Castellano (1986) confirmed the underprivileged socio-economic condition of the children population. For serum retinol analysis, peripheral venous blood was drawn and serum was treated according to the Bieri et al. (1979) technique and HPLC procedure. Values were recorded in microgram/dL. Statistical analysis was done by using Epi Info 2000, release 1.0 and SAS release 6.0 (1996) computer programs. The prevalence of VAD (serum retinol < 20 micrograms/dL) in the total children population (n = 207) was 22.2, being higher in urban children than in rural children (22.5 vs 20.5). No clinical signs of VAD were detected in the children. The nutritional status analysed by Z score of anthropometric indices revealed that 27.4 of children suffered from undernutrition (Z score = -2 to > -3 SD), being 15.4 stunted, 9.6 wasted and 2.6 with acute protein-energy malnutrition. Neither severe malnutrition nor overweight were detected. According with the H//AZ index, 54.6 of children had adequate nutrition. However 23 of them suffered from VAD. In children at risk of developing undernutrition (Z score = -1 to > -2 SD), 20.9 had VAD and of the stunted children, 21.9 presented VAD. With W//AZ, 60.3, 29.9 and 9.1 of children were with adequate nutrition, at risk, or wasted respectively; of each group, 25.6, 17.7 and 15, respectively had serum retinol values below 20 micrograms/dL. The Z score of W//HZ indicator revealed that 87.4, 10.4 and 2.4 of children were in good nutrition, at risk, or with acute protein-energy malnutrition, respectively. In the three groups 22.1, 23.8 and 20, respectively were affected by VAD. These results indicate that VAD coexists indistinctly in healthy, adequately nourished children, as in those malnourished ones. Our VAD prevalence results and others from Venezuela, are higher than the criteria laid down by WHO and PAHO which warrant wide community intervention. This public health problem becomes mor

Por que a letalidade hospitalar do infarto agudo do miocárdio é maior nas mulheres? / Why is the in-hospital case-fatality rate of acute myocardial infarction higher in women?

OBJETIVO - Avaliar a influência da idade, da gravidade da doença e das intervençöes terapêuticas na maior letalidade hospitalar do infarto agudo do miocárdio (IAM) em mulheres. MÉTODOS - Estudo de coorte retrospectivo, envolvendo 388 pacientes com IAM (50 óbitos). Foram avaliadas, como possíveis explicaçöes para a associaçäo entre sexo e letalidade hospitalar do IAM, as variáveis: idade (menor que 60 vs menor ou igual 60 anos), duraçäo de sintomas, classe Killip, tipo de IAM (com ou sem ondas Q), comorbidades, história de acidente vascular cerebral e intervençöes terapêuticas para o IAM (ácido acetil-salicílico, betabloqueadores e agentes trombolíticos). Modelos de regressäo logística foram usados para avaliar a influência de potenciais variáveis confundidoras na associaçäo entre sexo e letalidade hospitalar do IAM. RESULTADOS - A letalidade hospitalar do IAM foi mais alta em mulheres (19,5 'por cento' vs 9,4 'por cento') do que em homens (odds ratio (OR)=2,34;IC 95 'por cento'=1,12-4,47). Embora as mulheres fossem significativamente (p menor que 0,01) mais idosas, a associaçäo entre sexo e morte reduziu-se em apenas 15 'por cento' após ajuste para idade (OR=1,99;IC 95 'por cento'=1,07-3,67). Esta associaçäo tornou-se mais fraca ao se considerar a gravidade da doença na admissäo (OR=1,84;IC 95 'por cento'=0,90-3,74) e intervençöes terapêuticas para o IAM (OR=1,50;IC=0,67-3,38). CONCLUSÄO - Diferenças de idade näo podem explicar completamente a maior letalidade do IAM em mulheres. A gravidade da doença na admissäo e diferenças de abordagen terapêutica devem desempenhar importante papel na maior letalidade hospitalar do IAM em mulheres.