ABSTRACT
INTRODUCTION: Microalbuminuria, as determined by the urinary albumin to creatinine (AC) ratio, is a marker of target organ damage (TOD) in hypertensive patients. Pulse pressure (PP) predicts arterial elasticity and the ankle-brachial index (ABI) is a marker of cardiovascular morbidity. TOD reduction should be achieved through improvements in these indices. OBJECTIVE: To determine whether ABI, calculated as the ratio between mean PP in the upper and lower limbs, is associated with a reduction in renal damage, as measured by the AC ratio. METHODS: This was a prospective interventional study based on an intention-to-treat analysis in an opportunity sample of patients treated by three specialists in family medicine, with three-monthly follow-up over a total of six months. Blood pressure was measured in arms and ankles, and PP was calculated and used to determine right and left ABI and mean overall ABI. The AC ratio was determined by urine dipstick test. Descriptive and inferential statistical analysis was performed. RESULTS: A sample of 75 patients were studied (42.4% women), of whom(42.4% women), of whom 27.6% were diabetic, 46.7% overweight/obese and 49.3% dyslipidemic. overweight/obese and 49 dyslipidemic. There were statistical differences for right ABI (as determined by PP) and for mean overall ABI (as determined by mean PP in lower and upper limbs). Bivariate correlation analysis showed that in the group with improved PP between the first and the third observations, n=23 (40%), there was a statistically significant reduction in AC ratio (r = -0.924, two-tailed p < 0.001); the opposite was observed in the group with reduced PP, in which the AC ratio increased. DISCUSSION: ABI determined by systolic blood pressure is an excellent predictor of hemodynamic alterations. Increased ABI, based on PP, was accompanied by improved urinary AC ratio. These results are in line with the international literature. CONCLUSIONS: An improvement in urinary AC ratio--a predictor of TOD--is observed when an improvement in the ankle PP/brachial PP ratio is achieved.
Subject(s)
Albuminuria/complications , Albuminuria/physiopathology , Ankle Brachial Index , Hypertension/complications , Hypertension/physiopathology , Blood Pressure , Family Practice , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
OBJECTIVE: To ascertain the opinion about anxiety, depression and the medicines to treat them by gender, labour activity and age. MATERIAL AND METHODS: validated questionnaire; patients attending a Central Portugal Health Centre; doctors and nurses that proposed the questionnaire to all attending patients. Cross sectional observational study, by anonymous and secret self-fulfilment, in a convenience sample drawn from a population composed by all those attending the Health Centre between the 22nd June and the 3rd July (both inclusive) 2009. Descriptive and inferential statistics were performed by means of a SPSS 11.0 statistical package. Age groups were defined as: < 36 years, 36-55 years, =56 years and professional activity groups as non-actives (students, retired and unemployed) and actives (housewives, and workers in primary, secondary and tertiary sectors). RESULTS: A n = 281 sample was studied age distribution of < 36 years = 47,7%, 36-55 years = 36,7% and = 56 years = 15,6%, mostly active (69,4% actives) and predominantly female (71,6% women). Age distribution is normal (Kolmogorov-Smirnov Z = 1,644 2 tailed p = 0,009). As results of agreement vs disagreement, showing the significant differences, 'In general medicines for anxiety and for depression are capable of making me feel well' (71,4% vs 15,2%, p = 0,035 by age group), 'In general medicines can relieve the unpleasant sensations caused by day by day stress of actual society' (67,7% vs 22,6%, ns), 'If necessary medicines can relieve my anxiety or depression problems' (52,0% vs 34,1%, p = 0,000 by gender) and 'Anxiety and depression problems are displays of body illnesses' (42,8% vs 33,2%, ns). There is a majority of disagreement for 'In general medicines can, by themselves cure depression or anxiety' (72,5% vs 20,7%, p = 0,013 by sex), 'In general medicines for anxiety or depression can help change the way one sees the problems' (49,4% vs 43,4%, p = 0,041 by age group, p = 0,004 by sex, p = 0,002 by group of professional activity), 'I can feel good just by taking medicines' (71,4% vs 19,8%, p =0,008 by sex, p = 0,006 by professional activity group) and 'Medicines can bring more joy to my life' (58,5% vs 23,9%, p = 0,008 by sex, p = 0,006 by professional activity group). Anxiety problems and depression problems are demonstrations of body diseases, 42,8% vs 33,2%, ns). CONCLUSIONS: The pharmacological treatment for anxiety or depression must be individualised by sex, gender, age and activity of patients. In general medicines are judged capable of curing anxiety and depression problems but in the particular own case their activity is considered. Anxiety problems and depression problems are considered as manifestations of the body's disease.
Subject(s)
Anxiety/drug therapy , Depression/drug therapy , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
A valorização da atividade médica em Medicina Geral e Familiar (MGF), conhecida no Brasil como Medicina de Família e Comunidade, depende, entre outros fatores, do resultado de um encontro médico/doente. O especialista em MGF, ao ter de gerir a sua atividade com base nos pilares fundamentais do contexto, da ciência e da atitude, deve ponderar que a qualidade é algo que depende também da interface que ele contata. Objetivos: verificar a satisfação dos pacientes com a consulta médica de Clínica Geral. Averiguar a capacidade de os médicos avaliarem corretamente a satisfação dos pacientes na consulta. Foi feito um estudo observacional, transversal, com intenção analítica. O material utilizado consistiu em: três médicos de Medicina Geral e Familiar de um Centro de Saúde, questionário validado e usuários da consulta em dois dias distintos de trabalho. Métodos: em dois dias de atividade, apenas sabidos no início de período laboral, foram entregues pelos médicos o questionário com 11 afirmações. No final da cada consulta os médicos preenchiam questionário sobre os mesmos pontos, mas, na sua óptica e após a saída do paciente. Critérios de inclusão: maiores de 16 anos, capacidade de leitura e escrita e aceitação para participar. Análise estatística descritiva e inferencial ( 2 e t de student). Análise de diferenças na resposta às afirmações do questionário, por um modelo de correlação bi-variada com o coeficiente tau-b de Kendall com sensibilidade a 5%. Resultados: recebidos 43 (64,2%) dos questionários entregues. Idade média de 42,7±16,8 anos, sendo majoritariamente do sexo feminino (72,1%). Para 51,3% da amostra não terá havido possibilidade de falar sobre as preocupações de saúde e para 50% não parecem ter sido recebidas instruções acerca de estilos de vida saudáveis para a doença, e para 56,1% o tempo de duração da consulta não terá sido suficiente. Sem diferenças com significado as respostas por sexo, grupo etário e formação. Apenas na questão de o médico querer advogar a saúde do doente, as respostas são consonantes entre doentes e médicos. Conclusões: boa avaliação da consulta nos 11 fatores estudados. Os médicos revelam baixa capacidade de avaliação correta da satisfação dos pacientes na consulta, apenas estando médico e doente de acordo quanto à disponibilidade do médico para advogar a saúde do paciente.
One of the criteria for evaluating medical activity in the field of Family and General Practice, in Brazil known as Family and Community Practice, is the satisfaction obtained in the doctor-patient encounter. The general practitioner, while performing his activity based on the fundamental pillars context, science and attitude, has to consider that quality is something that has to be seen from the viewpoint of the patient as well. Objectives: verify the degree of satisfaction of patients with the general practice consultation and the capacity of the practitioners to correctly predict the satisfaction of their patients with the consultation. An observational transverse study was carried out with the intent to analyze this question. The subjects ans material used in the study consisted of: three general practitioners from a Primary Care Unit, a validated questionnaire and users of consultations on two distinct workdays. Method: during two specific days, only revealed in the beginning of each work shift, the doctors asked the patients to answer a questionnaire containing 11 statements. In the end of each consultation, after the patient had left, the doctors answered the same questionnaire from their own perspective. Criteria for inclusion in the study: over 16 years of age, ability to read and write and consensual participation. Data were submitted to descriptive and inferential statistical analysis (chi square and students t test). The differences in the answers to the statements contained in the questionnaire were analyzed with a bivariable correlation model using Kendalls tau-b coefficient with sensibility of 5%. Results: Forty three (64,2%) of the distributed questionnaires were returned. The age mean of responders was 42,7±16,8 years, most of them of feminine sex (72,1 %). 51,3% of the sample claimed that they were not given the chance to speak about their health concerns, 50% seem not to have received instructions about healthier life styles in relation to their disease and in the opinion of 56,1% the consultation was too short. The answers showed no significant differences in relation to sex, age group and educational level of the responders. The only question in which doctors and patients agreed was that the doctors were ready to care for the health of the patients. Conclusions: the consultations were considered good with regard to the 11 factors studied. The doctors reveal low capacity for correctly predicting the satisfaction of their patients with the consultation. Doctors and patients only agree with respect to the doctors readiness to care for the patients health.
