ABSTRACT
BACKGROUND: Although dyspepsia is a highly prevalent complaint, only a small percentage of patients are found to have serious disease and to need full investigation. The selection of dyspeptic patients who really need upper gastrointestinal endoscopy (UGE) is crucial in order to avoid unnecessary costs and overload services. MATERIAL AND METHODS: 200 primary care patients (age range 16-76 years) with dyspepsia and without any evidence of organic disease were interviewed with a structured questionnaire, and afterwards they underwent UGE. Multiple logistic regression analysis identified variables that could discriminate individuals with abnormal UGE from individuals with normal UGE, as well as individuals with peptic ulcer from individuals with normal UGE. RESULTS: The variables to discriminate individuals with abnormal UGE from individuals with normal UGE were age 45 years or above, and male sex, whereas to discriminate individuals with peptic ulcer in UGE from individuals with normal UGE were age 45 years or above, male sex, smoking, fullness, and absenteeism. A practical model based on these variables was developed, showing sensitivity of 78,9%, specificity of 51,7%, positive predictive value (PPV) of 39,4 % and negative predictive value (NPV) of 86% for the detection of individuals with UGE abnormal; and sensitivity of 84%, specificity of 70%, PPV of 38% and NPV of 95% for the identification of individuals with UGE identifying peptic ulcer. CONCLUSIONS: A strategy based on a model containing clinical and social characteristics of dyspeptic patients could potentially decrease the number of unnecessary UGEs.
Subject(s)
Decision Support Techniques , Dyspepsia/diagnosis , Endoscopy, Digestive System/standards , Primary Health Care , Adolescent , Adult , Aged , Female , Humans , Logistic Models , Male , Middle Aged , Peptic Ulcer/diagnosis , ROC Curve , Sensitivity and SpecificityABSTRACT
OBJETIVO: Desenvolver uma estratégia capaz de otimizar a indicação de endoscopia digestiva alta (esofagogastroduodenoscopia-EGD) em pacientes com dispepsia e sem sinal de alarme para doença orgânica, baseada em variáveis clínicas e sociais com maior valor em discriminar indivíduos com EGD com alteração de indivíduos com EGD normal. CASUÍSTICA E MÉTODO: 200 pacientes (idade: 16-76 anos) com dispepsia e sem evidência de doença orgânica, atendidos em nível primário, foram entrevistados com um questionário estruturado e submetidos a EGD. Análise de regressão logística múltipla identificou variáveis com maior valor em discriminar indivíduos com EGD com alteração de indivíduos com EGD normal, bem como indivíduos com EGD com úlcera péptica daqueles com EGD normal. RESULTADOS: As variáveis com maior valor em discriminar indivíduos com EGD com alteração daqueles com EGD normal foram: idade igual ou superior a 45 anos e sexo masculino. Para discriminar indivíduos com EGD com úlcera péptica daqueles com EGD normal, as variáveis foram: idade igual ou superior a 45 anos; sexo masculino; tabagismo; empachamento e absenteísmo. Um modelo prático foi desenvolvido, visando a apoiar a decisão de indicar ou não EGD, apresentando sensibilidade de 78,9 por cento, especificidade de 51,7 por cento, valor preditivo positivo (VPP) de 39,4 por cento e preditivo negativo (VPN) de 86 por cento, para a identificação de indivíduos com EGD com alteração; e sensibilidade de 84 por cento, especificidade de 70 por cento, VPP de 38 por cento e VPN de 95 por cento, para a identificação de indivíduos com EGD com úlcera péptica. CONCLUSÃO: Uma estratégia baseada em variáveis clínicas e sociais de pacientes com dispepsia poderia potencialmente diminuir o número de EGD desnecessárias.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Primary Health Care , Endoscopy, Digestive System , Decision Support Techniques , Dyspepsia/diagnosis , Peptic Ulcer/diagnosis , Logistic Models , Predictive Value of Tests , ROC Curve , Sensitivity and Specificity , Ambulatory CareABSTRACT
Although the implementation of geriatric services is an emerging priority in Brazil, little emphasis has been put on the type of acute care that should be provided for elderly patients in the hospital setting. The objective was to review some models of acute hospital care for elderly people, focusing on the role of geriatric medicine and its relationship with other specialties. Medline database (1989-1999), textbooks of geriatrics and gerontology, and other health publications were consulted in an attempt to identify all relevant publications about hospital services providing acute care to elderly people. The features of each model were compiled and discussed taking into account their suitability to the Brazilian health system. Some examples of interventions, with their effectiveness demonstrated by systematic reviews, were also mentioned. The models more frequently described were: long-time traditional, age-defined, unspecialized and integrated care. Variants of such models were frequently reported. There is no evidence pointing to one as the best model, but models favoring the integration of geriatrics with general medicine seemed to be particularly suitable to the Brazilian setting. With the aging of the population, there is a need to restructure the health services to face the increasing demands of elderly people. Given that the design of hospital services is an important factor for the effectiveness of geriatric care, this issue should be studied as priority in Brazil.
Subject(s)
Health Services for the Aged/organization & administration , Hospital Departments/organization & administration , Models, Organizational , Acute Disease , Aged , Hospital Restructuring , Humans , Inpatients , Nursing Service, Hospital/organization & administrationABSTRACT
INTRODUCTION: The population of Brazil is ageing very rapidly, and the care of the elderly is an emerging priority. Up to this date, there is no comprehensive study addressing the profile of the elderly in Northeastern Brazil. The objective is to compile the multidimensional profile of the elderly residents in a metropolitan area of Northeastern Brazil. METHODS: Six hundred sixty-seven elderly (60 years and over), residents in the city of Fortaleza, Ceará, Brazil, constituting a multistage random sample stratified by socioeconomic status. The data was gathered by household survey using a multidimensional functional assessment questionnaire. RESULTS: The majority of the elderly were living in multigenerational households (75,3%). More than half (51,9%) lived without the spouse; 92,4% mentioned at least one disease; 26,4% were considered psychiatric cases; 47,7% showed loss of autonomy; 6,6% were hospitalized, and 61,4% used health services within the twelve and six months preceding the interview, respectively. The prevalence of multigenerational households, loss of autonomy and psychiatric morbidity were higher in the poorest areas. CONCLUSIONS: The elderly population in the city of Fortaleza lives mainly in multigenerational households, with physical and mental morbidity rates particularly high in poor areas, they represent special concern in terms of burden for the social and health services in the next decades
Subject(s)
Aged/statistics & numerical data , Aged, 80 and over , Brazil , Female , Geriatric Assessment , Health Status , Humans , Male , Marital Status , Middle Aged , Residence Characteristics , Socioeconomic Factors , Urban Population/statistics & numerical dataABSTRACT
The Ministry of Health launched the Family Health Program (FHP) with the aim of establishing comprehensive primary care for families and communities. The Public Health School of Ceará has been applying problem-based learning as the instructional method for the training of the family health teams. The importance of this method and the possibility of applying it in the implementation of a new and effective approach to the continuing education of Brazilian health professionals are emphasized.
