Letramento funcional em saúde nos portadores de doenças cardiovasculares crônicas / Functional Health Literacy in chronic cardiovascular patients

Resumo Letramento Funcional em Saúde (LFS) é a capacidade de obter, processar e compreender informações de forma a tomar decisões apropriadas quanto ao autocuidado, definido pela Organização Mundial de Saúde como um determinante social da saúde. Sua avaliação tem importância especial em portadores de Doenças Crônicas não Transmissíveis, pela necessidade de cuidados permanentes em saúde. Os objetivos são avaliar o LFS em portadores de doenças cardiovasculares crônicas e possíveis implicações no entendimento da doença e orientações médicas e na adesão a medidas propostas por profissionais de saúde. Pesquisa transversal e quantitativa aplicando-se o instrumento S-TOFHLA e um questionário estruturado em 345 pacientes de um ambulatório de doenças cardiovasculares em Juiz de Fora. Menos da metade (49,3%) da amostra apresentou LFS adequado. O LFS satisfatório associou-se a menor idade e maior escolaridade. O baixo LFS mostrou influenciar o déficit de compreensão da doença e de orientações médicas e o hábito menor de questionar os profissionais. Houve alta prevalência de LFS inadequado na amostra, associado a prejuízo no entendimento da doença e de instruções médicas, expondo a necessidade de otimizar a comunicação médica nesse grupo.

Abstract Functional Health Literacy (FHL) is the ability to retrieve, process and understand information in order to make appropriate decisions regarding self-care, defined by the World Health Organization as a social determinant of health. Its evaluation is important especially between patients with noncommunicable chronic diseases, given the need of permanent health care. This paper aims to evaluate the FHL in patients with chronic cardiovascular diseases and possible implications to the understanding of the disease and medical instructions and adherence to the measures proposed by health professionals. This is a cross-sectional and quantitative study with the application of tool S-TOFHLA and a structured questionnaire on 345 patients of a cardiovascular disease outpatient service in Juiz de Fora. Less than a half (49.3%) of the sample showed adequate FHL. Satisfactory FHL was associated with lower ageand higher schooling. Lower FHL evidenced that it can influence the impaired comprehension of the disease and medical instructions and the rare habit to question professionals. A high prevalence of inadequate FHL was identified in our sample and was associated with the impaired understanding of the disease and medical instructions, showing the need to streamline medical communication in this group.

Structural and ecophysiological alterations of the water hyacinth [Eichhornia crassipes (Mart.) Solms] due to anthropogenic stress in Brazilian rivers

In this work, the structural and ecophysiological alterations (chlorophyll a fluorescence and photosynthetic pigments), and quantification of Cr, Pb and Zn in the leaf limb, petiole and younger and older roots of water hyacinth from the lower, medium and upper Paraíba do Sul river (PSR) and Imbé river were evaluated. The plants from the medium and upper PSR (more industrialized and populated regions) exhibited lower turgid cell in the root cortex, less root hairs and leaf epidermis, chloroplasts with plastoglobules and increased stroma volume. Higher concentrations of metals were observed in the younger and older roots from the medium PSR plants. The results suggested that the plants from more anthropized regions were able to maintain the maximum quantum yield (Fv/Fm) which was a result from the metabolic fitting, increasing the non-photochemical quenching, reducing total chlorophyll/carotenoids and leading to the structural modifications.

Camurati-Engelmann disease: typical manifestations of a rare disease / Doença de Camurati-Engelmann: manifestações típicas de uma doença rara

A displasia diafisária progressiva ou doença de Camurati-Engelmann é uma doença rara, caracterizada por dor e fraqueza muscular dos membros afetados e espessamento progressivo da cortical diafisária dos ossos longos. Os autores descrevem o caso clínico de um doente com manifestações iniciais da doença na infância, mas cujo diagnóstico só foi estabelecido durante a idade adulta, depois de evoluída a doença e após surgirem as mesmas manifestações em um dos filhos. Salienta-se a dificuldade no diagnóstico e a relevância do diagnóstico diferencial com outras doenças que cursam com osteoesclerose e/ou hiperostose. Na literatura é rara a descrição da sua evolução ao longo dos anos.

Camurati-Engelmann Disease or progressive diaphyseal dysplasia is a rare disease, characterized by limb pain and muscular weakness, and cortical thickening of the diaphyses of long bones. The authors report a case of a male patient with manifestations since his childhood, whose diagnosis was established later on, when he was an adult, with the disease already progressed, and when the same manifestations began in one of his sons. The importance of the differential diagnosis regarding other diseases concurrent with osteosclerotic and/or hyperostotic changes is emphasized here. Description of its evolution along the years is rarely found in the literature.