Rehabilitación pulmonar en pacientes con diagnóstico de fibrosis quística / Pulmonary rehabilitation in patients diagnosed with cystic fibrosis

La fibrosis quística (FQ) es una enfermedad genética que se hereda de forma autosómica recesiva, tiene características multiorgánicas y se presenta con mayor frecuencia en población caucásica. La disfunción respiratoria es la causa de muerte en cerca del 95% de los pacientes con FQ y una causa importante de morbilidad. Los programas de rehabilitación pulmonar en casos de FQ deben centrarse en las necesidades específicas de cada paciente, mejorar su tolerancia al ejercicio y su movilización de secreciones, disminuir el riesgo de complicaciones e impactar en su calidad de vida.

Cystic fibrosis (CF) is a genetic disease inherited in an autosomal recessive manner; it has multi-organ characteristics and occurs more frequently in the Caucasian population. Respiratory dysfunction is the cause of death in about 95% of CF patients and a major cause of morbidity. Pulmonary rehabilitation programs in CF cases should focus on each patient's specific needs, improve their exercise tolerance and mobilization of secretions, decrease the risk of complications, and impact their quality of life.

Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country.

Objective: To investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country. Methods: Dementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben's advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness. Results: PwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis. Conclusion: Results reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

Gerontological training: the challenge of integrating different professional categories / Formação gerontológica: o desafio da integração das diversas categorias profissionais

Gerontological training must be present on the discussion agenda of several training and professional qualification entities. Despite the expressive increase in life expectancy in Brazil, the number of qualified professionals to adequately meet the demands of the aging population is below what is necessary in the country. While many countries are already organizing themselves to elaborate standards and guidelines for gerontological education, Brazil still moves slowly in the definition of professional competencies at different levels of education, hiding the visibility of the identity of professionals working in gerontology. This article aims to shed light on the topic of gerontological training based on joint efforts of scientific societies, professional councils, professional associations, and educational institutions.

A formação gerontológica deve fazer-se presente na pauta das discussões das diversas entidades de capacitação e habilitação profissional. Apesar do aumento expressivo da expectativa de vida, o número de profissionais qualificados para atender adequadamente às demandas da população que envelhece se encontra aquém do necessário. Enquanto vários países já se organizam para elaborar normas e diretrizes para a educação gerontológica, o Brasil ainda caminha lentamente na definição das competências profissionais nos diversos níveis de formação, encobrindo a visibilidade da identidade dos profissionais que atuam na gerontologia. O presente artigo tem como objetivo dar luz ao tema da formação gerontológica mediante a união de esforços das sociedades científicas, conselhos profissionais, associações de classe e instituições de ensino.

Vigilancia Epidemiológica de la sífilis gestacional y congénita en el departamento de Córdoba, Colombia, 2012- 2016 / Monitoramento epidemiológico Da sífilis gestacional e congênita No departamento de Córdoba, Colômbia, 2012-2016 / Epidemiological surveillance of Congenital and gestational syphilis In the department of Córdoba, Colombia, 2012-2016

Introducción: la sífilis gestacional y congénita son consi-derados eventos de interés en salud pública, no solo por las implicaciones que tiene para la mujer en gestación, sino por las consecuencias y/o secuelas que estos eventos pueden generar en el feto y en el recién nacido. Metodo-logía: la presente investigación corresponde a un estudio epidemiológico, descriptivo de tipo retrospectivo. Obje-tivo: describir la vigilancia epidemiológica de la sífilis gestacional y congénita en el departamento de Córdoba a partir del tamizaje y el tratamiento de los casos diagnos-ticados y notificados durante la atención prenatal en el período 2012-2016. Resultados: el 66,6 % de gestantes diagnosticadas durante la atención prenatal residían en las cabeceras municipales, la mayoría de ellas (87,6 %) pertenecían al régimen subsidiado; el 50 % de los casos notificados iniciaron el tratamiento sobre las 36 semanas de gestación y solo el 35,9 % de las parejas sexuales de las gestantes tuvieron acceso al tratamiento. La mayoría de casos de sífilis congénita fue diagnósticada por nexepidemiológico, situación que refleja fallas en los esquemas terapéuticos ordenados, inclu-yendo el tratamiento a los contactos sexuales. En la cuenca del río Sinú y del San Jorge, se concentró el mayor número de casos de sífilis congénita en el departamento de Córdoba durante el período de estudio. Conclusiones: la falta de seguimiento a los casos de sífilis gestacional durante la atención prenatal y el tratamiento a los compañeros de las mujeres diagnosticadas con esta infección han sido las limitaciones más evidentes del cumplimien-to de las metas establecidas para el control de sífilis congénita en la región cordobesa

Introduction: Gestational and congenital syphilis are events of great interests in public health, not only because of the implications it has for the pregnant woman but also for the consequences and/or sequelae these events may cause in the fetus and the newborn. Method: This research is a descriptive, retrospective, epidemiological study. Objective: To describe epidemiological surveillance of gestational and congenital syphilis in the de-partment of Cordoba from the screening and treatment of the cases diagnosed and in-formed during prenatal care in the period 2012-2016. Results: 66.6% of pregnant women diagnosed in prenatal care lived in municipal capitals, most of them (87.6%) received a subsidy; 50% of the cases informed started treatment at around 36 weeks of pregnancy and only 35.9% of sexual partners had access to treatment. Most cases of congenital syphilis were diagnosed by epidemiological nexus, situation which reflects flaws in the requested therapeutic schemes, including treatment of sexual contacts. Most cases of congenital syphilis in the department of Cordoba during the study period were concentrated in the basin of Sinu and San Jorge rivers. Conclusions: lack of follow up of gestational syphilis cases during prenatal care and lack of treatment of sexual partners of women diagnosed with this infection have been the most evident limitations to reach the objectives set to control congenital syphilis in the region.

Introdução: A sífilis gestacional e congênita são consideradas eventos de interesse em saúde pública, não apenas pelas implicações que ela tem para a mulher em gestação, mas pelas consequências e / ou sequelas que esses eventos podem gerar no feto e no recém-nascido. Metodologia: Esta pesquisa corresponde a um estudo epidemiológico, descritivo do tipo retrospetivo. Objetivo: descrever a vigilância epidemiológica da sífilis gestacional e congênita no departamento de Córdoba com base na triagem e tratamento dos casos di-agnosticados e notificados durante o controle pré-natal no período 2012-2016. Resultados: 66,6% das gestantes diagnosticadas no controle pré-natal residiam em centros municipais, a maioria (87,6%) pertencia ao regime subsidiado; 50% dos casos relatados iniciaram o tratamento após 36 semanas de gestação e apenas 35,9% dos parceiros sexuais das ges-tantes tiveram acesso ao tratamento. A maioria dos casos de sífilis congênita foi diagnos-ticada por um elo epidemiológico, situação que reflete falhas nos esquemas terapêuticos ordenados, incluindo o tratamento de contatos sexuais. O maior número de casos de sífilis congênita no departamento de Córdoba durante o período do estudo concentrou-se nas bacias dos rios Sinú e San Jorge. Conclusões: a falta de acompanhamento dos casos de sífilis gestacional durante o controle pré-natal e o tratamento dos parceiros de mulheres diagnosticadas com esta infecção têm sido as limitações mais óbvias do cumprimento das metas estabelecidas para o controle da sífilis congênita na região de Córdoba.

The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country.

OBJECTIVE: Previous studies have indicated that dementia and depression have a considerable impact on the functional capacity of older adults, also influencing awareness about ability. The purpose of the current study was to investigate the impact of dementia, depression and awareness on activities of daily living (ADL) in a sample from a middle-income country. METHODS: The current study explored impairments in basic, instrumental and advanced ADL using a factorial design comparing four groups: people with dementia and depression, people with dementia without depression, older adults with depression but no dementia and healthy older adults. For each type of ADL, self-report and informant report was contrasted in order to investigate the issue of lack of awareness in relation to ADL. RESULTS: Results indicate that dementia is associated with impairments in all types of ADL. Advanced ADL were also reduced in depressed participants. In addition, in the case of instrumental and basic ADL, informant report indicated less preserved abilities than participant self-report, particularly in people with dementia. CONCLUSIONS: The findings highlight the importance of developing interventions and compensatory strategies to prevent loss of ADL in dementia, also suggesting that early intervention in older adults with depression should focus on advanced ADL to prevent social isolation and withdrawal. Finally, the findings indicate that self-information about ADL may be compromised in dementia, so clinicians exploring disability should consider fully different aspects of ADL in this group. Copyright © 2017 John Wiley & Sons, Ltd.

Re-assessing the dimensional structure of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): empirical evidence for a shortened Brazilian version.

BACKGROUND: The dimensional structure, effective number of item responses and item redundancies are controversial features of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) requiring more light. The aims of the present study are to revisit the dimensional structure and propose a shorter version of the instrument. METHODS: The sample comprised 652 elderly and their informants, either attending a geriatric service of a public university clinic or enrolled in a health care provider database in Rio de Janeiro, Brazil. A Confirmatory Factor Analysis (CFA) first tested the originally proposed one-dimensional structure comprised of 26 items. This was followed by sequential Exploratory Structural Equation Model (ESEM) to evaluate alternative models, in particular a bi-dimensional solution. The identification of residual correlations (RC) lead to a shortened 20-item model, which was tested further via CFA. RESULTS: The original model fitted poorly (RMSEA = 0.073; 90% CI: 0.069-0.077). Regarding the two-dimensional model, the exploratory procedure (ESEM) indicated several RCs and a lack of factor-based discriminant validity. The ensuing CFA on the one-dimensional model with freely estimated RCs showed an adequate fit (RMSEA = 0.051; 90% CI: 0.047-0.055). Addressing the identified RCs, the CFA on the abridged 20-item version also showed an adequate fit (RMSEA = 0.058; 90% CI: 0.053-0.064) and no further RCs. CONCLUSION: A one-factor dimensional structure and a reduced version with 20 locally independent items were the most tenable solution. However, although promising, this simpler structure requires further examination before it may be fully supported and recommended.

Accuracy of the Brazilian version of the informant questionnaire on cognitive decline in the elderly at screening for dementia in community-dwelling elderly participants: findings from FIBRA-RJ study.

OBJECTIVES: To determine the accuracy of the Brazilian version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-BR) for screening for dementia and to analyze the association of sociodemographic variables of the elderly participants and informant, as well as the mental health of the informant, in the scores of the questionnaire. METHODS: A cross-sectional study was carried out with 417 elderly participants and their informants from the sample of the Frailty in the Brazilian Elderly Study, Rio de Janeiro, Brazil. The older individuals were assessed by clinical, functional, and neurocognitive evaluation, and the diagnosis of dementia was established according to Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition) criteria. The informants were evaluated by Mini-Mental State Examination (MMSE), Center of Epidemiologic Studies--Depression Scale, and Burden Interview Scale. The Cambridge Cognitive Examination Test--Revised (CAMCOG-R) was used for convergent validity analysis. The association between IQCODE-BR and the study variables was determined by multivariate logistic regression analysis. RESULTS: The best cutoff point was 3.26; the sensitivity, specificity, and area under the receiver-operating characteristic curve were 89%, 72%, and 0.88 (95% confidence interval: 0.837-0.917), respectively. The CAMCOG-R and the MMSE showed a moderate and negative association with IQCODE-BR. CONCLUSION: The IQCODE-BR is an instrument with good accuracy for the detection of dementia syndrome in Brazilian older person.

Screening for dementia: Brazilian version of the Informant Questionnaire on Cognitive Decline on the Elderly and its psychometric properties.

AIM: To assess the criterion validity of the Brazilian version of the Informant Questionnaire on Cognitive Decline on the Elderly (IQCODE-BR), and analyze the influence of educational level and age of both the elderly and the informants on the questionnaire scores. METHOD: The study design was a cross-sectional study with a convenience sample. Convergent validity was assessed using the Mini-Mental State Examination, and the accuracy of the IQCODE-BR was evaluated by receiver operating characteristic curve analysis. Multivariate logistic regression analysis was carried out to determine the influence of sociodemographic characteristics on IQCODE-BR scores. RESULTS: A total of 169 elderly individuals participated in the study, of which 35.5% were diagnosed with dementia. There was no statistically significant association between the IQCODE-BR scores, and the age and educational level of both the elderly and the informants. The cut-off point for greater accuracy was 3.52, with sensitivity of 83.3% and specificity of 80.7%. The area under the receiver operating characteristic curve was 0.83 (95% CI 0.766-0.893). There was a negative and moderate correlation between IQCODE-BR and the Mini-Mental State Examination scores (P<0.01). CONCLUSION: This study suggests that the IQCODE-BR is a valid tool for screening of dementia and that IQCODE-BR scores do not seem to be influenced by age, educational level and other factors associated with the informants. However, further studies are required to evaluate informant characteristics, such as anxiety states, depression and burden level.

Cross-cultural adaptation of the Functional Activities Questionnaire - FAQ for use in Brazil / Adaptação transcultural do Functional Activities Questionnaire - FAQ para uso no Brasil

Objective: The aim of this paper was to present the results of the first stage of cross-cultural adaptation of the Functional Activities Questionnaire (FAQ). Methods: The tool was subjected to translation and re-translation, and the test-retest reliability of a proposed version for use in Brazil was analyzed. Results: Of the 548 questionnaire respondents, a convenience sample of 68 informants was selected for retesting. Internal consistency was measured by Cronbach's alpha (0.95) while test-retest reliability was assessed using intra-class correlation (0.97). The findings have shown that FAQ is brief - averaging seven minutes to apply, easily understood and has good intra-rater test-retest reliability. Conclusion: Our results suggest this adapted version of the FAQ is a reliable and stable tool which may be useful for assessing function in Brazilian elderly. Notwithstanding, the version should be subjected to further analysis with the aim of reaching functional equivalence.

Objetivo: Este trabalho tem como objetivo apresentar os resultados da primeira fase da adaptação transcultural do Questionário de Atividades Funcionais (FAQ). Métodos: O instrumento foi submetido à tradução e retro tradução, e a confiabilidade teste-reteste de uma versão de proposta para uso no Brasil foi analisada. Resultados: Dos 548 que responderam ao questionário, uma amostra de conveniência de 68 informantes foi selecionada para o reteste. A consistência interna e confiabilidade teste-reteste foram medidas pelo alfa de Cronbach (0,95), a correlação intra-classe (0,97). Os achados mostram que o FAQ é breve - uma média de sete minutos, de fácil compreensão e teve boa confiabilidade intra-observador no teste-reteste. Conclusão: Nossos resultados sugerem que esta versão adaptada do FAQ é um instrumento confiável e estável, e pode ser útil na avaliação de funcionalidade de idosos brasileiros; não obstante, ele deve ser submetido a uma análise mais aprofundada com o objectivo de alcançar a equivalência funcional.

Cross-cultural Adaptation of the "Functional Activities Questionnaire - FAQ" for use in Brazil.

OBJECTIVE: The aim of this paper was to present the results of the first stage of cross-cultural adaptation of the Functional Activities Questionnaire (FAQ). METHODS: The tool was subjected to translation and re-translation, and the test-retest reliability of a proposed version for use in Brazil was analyzed. RESULTS: Of the 548 questionnaire respondents, a convenience sample of 68 informants was selected for retesting. Internal consistency was measured by Cronbach's alpha (0.95) while test-retest reliability was assessed using intra-class correlation (0.97). The findings have shown that FAQ is brief - averaging seven minutes to apply, easily understood and has good intra-rater test-retest reliability. CONCLUSION: Our results suggest this adapted version of the FAQ is a reliable and stable tool which may be useful for assessing function in Brazilian elderly. Notwithstanding, the version should be subjected to further analysis with the aim of reaching functional equivalence.

OBJETIVO: Este trabalho tem como objetivo apresentar os resultados da primeira fase da adaptação transcultural do Questionário de Atividades Funcionais (FAQ). MÉTODOS: O instrumento foi submetido à tradução e retro tradução, e a confiabilidade teste-reteste de uma versão de proposta para uso no Brasil foi analisada. RESULTADOS: Dos 548 que responderam ao questionário, uma amostra de conveniência de 68 informantes foi selecionada para o reteste. A consistência interna e confiabilidade teste-reteste foram medidas pelo alfa de Cronbach (0,95), a correlação intra-classe (0,97). Os achados mostram que o FAQ é breve - uma média de sete minutos, de fácil compreensão e teve boa confiabilidade intra-observador no teste-reteste. CONCLUSÃO: Nossos resultados sugerem que esta versão adaptada do FAQ é um instrumento confiável e estável, e pode ser útil na avaliação de funcionalidade de idosos brasileiros; não obstante, ele deve ser submetido a uma análise mais aprofundada com o objectivo de alcançar a equivalência funcional.

[Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): cross-cultural adaptation for use in Brazil]. / Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): adaptação transcultural para uso no Brasil.

This article presents the results of the translation and cross-cultural adaptation of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the test-retest reliability of a version to be used in Brazil. An instrument review committee analyzed the conceptual and item equivalence. In order to analyze semantic equivalences, three translations and three back-translations were performed; a summary version was devised and pre-tested, and a test version elaborated. The Cronbach's +/- coefficient and intraclass correlation coefficient (ICC) were used to measure the internal consistency and test-retest reliability, respectively. Of the 169 informants assessed, 97 were retested. A Cronbach's +/- of 0.94 and an ICC of 0.92 were found. The reliability levels lead to the conclusion that the IQCODE-BR version is easy to comprehend. Satisfactory equivalence to the original version was observed.

Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): adaptação transcultural para uso no Brasil / Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): cross-cultural adaptation for use in Brazil

O presente trabalho tem como objetivo apresentar os resultados do processo de tradução e adaptação transcultural do Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) e da confiabilidade teste-reteste de uma versão para uso no Brasil. Um comitê para revisão do instrumento analisou a equivalência conceitual e de itens. Para análise de equivalência semântica, foram realizadas três traduções e três retrotraduções; elaboração de uma versão síntese; pré-teste e elaboração de uma versão teste. A consistência interna e a confiabilidade teste-reteste foram mensuradas pelo coeficiente ± de Cronbach e o coeficiente de correlação intraclasse (CCI), respectivamente. Dos 169 informantes avaliados, 97 foram retestados. O ± de Cronbach foi 0,94 e o CCI foi de 0,92. Os níveis de confiabilidade obtidos permitem concluir que a versão do IQCODE-BR se mostrou de fácil compreensão, sendo observada uma boa equivalência com a versão original.

This article presents the results of the translation and cross-cultural adaptation of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the test-retest reliability of a version to be used in Brazil. An instrument review committee analyzed the conceptual and item equivalence. In order to analyze semantic equivalences, three translations and three back-translations were performed; a summary version was devised and pre-tested, and a test version elaborated. The Cronbach's ± coefficient and intraclass correlation coefficient (ICC) were used to measure the internal consistency and test-retest reliability, respectively. Of the 169 informants assessed, 97 were retested. A Cronbach's ± of 0.94 and an ICC of 0.92 were found. The reliability levels lead to the conclusion that the IQCODE-BR version is easy to comprehend. Satisfactory equivalence to the original version was observed.

A entrevista social no processo de avaliação geriátrica ampla / The social interview in the comprehensive geriatric assessment process

As novas diretrizes do pacto de gestão fortalecem as ações de atenção à saúde do idoso a partir do momento em que se torna uma das prioridades do Ministério da Saúde. Além disso, a Política Nacional de Saúde da Pessoa Idosa preconiza uma atenção integral e integrada com ênfase em abordagens multidimensionais que buscam resgatar ou preservar a autonomia e independência do sujeito que envelhece. Um novo paradigma na atenção emerge trazendo a avaliação geriátrica ampla, realizada por uma equipe multidisciplinar, como uma prática essencial no rastreamento e identificação dos variados problemas que acometem o indivíduo idoso. Nesta modalidade de avaliação é fundamental um olhar direcionado aos problemas sociais que podem influenciar no restabelecimento da saúde ou no aparecimento de novas doenças. A entrevista social é um instrumento técnico que fornecerá ao profissional subsídios para realizar uma avaliação que possa gerar uma intervenção adequada a partir do conhecimento das possibilidades e limitações dos usuários que buscam atenção em unidades geriátricas. O objetivo deste trabalho é tecer algumas considerações acerca da avaliação social no processo de avaliação geriátrica ampla. É também um esforço preliminar de contribuir com o fazer profissional do assistente social, visto que as produções teóricas neste campo são escassas e as questões sociais se constituem em elementos essenciais para o estabelecimento de condutas terapêuticas eficazes.

The new guidelines of the pledge management strengthen actions towards the elderly care now that it has become one of the Health Ministery's priorities. Furthermore, the National Policy of Elderly prescribes a thorough and integrated care with emphasis on the multidimensional approaches that aim at rescuing or preserving both the autonomy and independence of the aging subject. A new paragon in the care appears bringing the comprehensive geriatric assessment, which is accomplished by a multidisciplinary team, as an essential praxis of both tracking and identifying the numerous illnesses to which the elderly is susceptible to. In this kind of assessment, it is fundamental to look into the social issues that might either retard the elderly's recuperation or bring about new maladies. The social interview is a technical instrument that will provide the professional with resources for an assessment that will entail an adequate intervention from the knowledge of the possibilities and limitations of the patients coming to geriatric facilities. This work aims at taking under consideration the social assessment withing the range of the comprehensive geriatric assessment. It is also an effort to contribute to the praxis of the social worker, given that theory in this is rare and social issues are central to the establishment of efficient therapeutic procedures.

[Geriatric outpatient healthcare: hierarchical demand structuring]. / Assistência ambulatorial geriátrica: hierarquização da demanda.

In Brazil, the rapid growth of the elderly population has been causing a great impact on the healthcare system, with increased costs and service utilization. The inefficiency of traditional models for geriatric healthcare has made it essential to change the healthcare concepts for this population. This can take place through the development of new healthcare models that include the means to identify, assess and treat elderly patients with a variety of morbid and functional conditions, and which can be applied diverse healthcare scenarios. An outpatient model is proposed, with two stages that differ in the depth and coverage of their actions. These stages are organized as increasing levels of complexity and are capable of selecting subgroups of individuals that, because of their risk characteristics, should follow different paths through the healthcare structure. This paper discusses the first stage of this model, which involves risk identification among large groups of elderly people, by means of structuring a hierarchical flow of actions and using assessment tools of adequate sensitivity and specificity. Individuals aged 65 years or over who are detected through walk-in outpatient consultation, home visits or telephone interview are classified using a rapid screening risk evaluation instrument composed of eight items. Depending upon the level of risk presented, the individual will either be referred to another level of functional evaluation (medium-high and high risk levels), or to normal clinical care and old people's community centers (low and medium risk levels). The second stage will be the subject of a subsequent paper.

Assistência ambulatorial geriátrica: hierarquização da demanda / Geriatric outpatient healthcare: hierarchical demand structuring

No Brasil, o rápido crescimento da população de idosos vem produzindo grande impacto no sistema de saúde, com elevação dos custos e da utilização dos serviços. A ineficiência dos modelos tradicionais de assistência ao idoso torna imprescindível a mudança no paradigma de atenção à saúde dessa população, por meio do desenvolvimento de novos modelos de atenção que incorporem a identificação, a avaliação e o tratamento de idosos com perfis mórbidos e funcionais variados, passíveis de serem aplicados nas diversas modalidades assistenciais. Propõe-se um modelo ambulatorial, em duas etapas, que se diferencia pela profundidade e abrangência das ações, organizadas em níveis crescentes de complexidade e capazes de selecionar subgrupos de indivíduos que, por suas características de risco, devem progredir, diferenciadamente, na estrutura de atenção. Descreve-se a primeira etapa, que pressupõe a captação e identificação de risco de grandes grupos de idosos, por meio de um fluxo hierarquizado de ações e o uso de instrumentos de avaliação com sensibilidades e especificidades adequadas. O indivíduo com 65 anos ou mais, captado por demanda espontânea ambulatorial, captação domiciliar ou busca telefônica, é classificado segundo avaliação de risco, denominada Triagem Rápida, composta de oito itens. Dependendo do risco encontrado, o indivíduo será encaminhado para acompanhamento clínico usual e atividades em centros de convivência de idosos (risco baixo e médio) ou para outra etapa da avaliação funcional (riscos médio-alto e alto). A segunda etapa será tema de artigo posterior.

Novos paradigmas do modelo assistencial no setor saúde: conseqüência da explosäo populacional dos idosos no Brasil / New paradigms of the assistential model in the health sector: consequence of aging population growth in Brazil

O processo de envelhecimento da populaçäo mundial tem as suas origens enraizadas nas transformações econômico-sociais vividas pelas nações desenvolvidas no século passado e que, no entanto, só produziram modificações significativas nas suas variáveis demográficas na virada do século XX

A dependência e suas implicaçöes para a perda de autonomia: estudos das representaçöes para idosos de uma unidade ambulatorial geriátrica / Dependency and its implications to lost autonomy: study of the old age representations from a Geriatrics Ambulatory Unit

Este artigo é o resumo de uma pesquisa realizada no serviço de Cuidado Integral à Pessoa Idosa (CIPI) - UnATI-UERJ - cujo objetivo foi investigar representações de idosos sobre suas relações familiares. Foram entrevistados 11 idosos, na faixa de 65 a 82 anos, que apresentavam incapacidade funcional, causadora de dependência para a realização de atividades básicas de vida diária. Os pressupostos que nortearam o estudo preconizaram a possibilidade do exercício da autonomia de pensamento, de vontade e decisão mesmo em face de um comprometimento da autonomia de ação. Os resultados revelaram que a dependência compromete a autonomia total da pessoa, trazendo à tona a teia de relações familiares, permeadas de atitudes ambíguas revestidas de um misto de zelo paternalista com autoritarismo discriminatório, explicitado pela falta de negociação e de espaço vital ao idoso

A dependência e suas implicações para a perda de autonomia: estudo das representações para idosos de uma unidade ambulatorial geriátrica / The dependence and their engaged for the lost of autonomy: an study of the representations for old of a geriatric ambulatorial unit

Objetiva investigar representações de idosos sobre usas relações familiares. Pesquisa realizada com onze idosos, na faixa de 65 a 82 anos, que apresentavam incapacidade funcional, causadora de dependência para a realização das atividades básicas e instrumentais de vida diária e recebiam atendimento em unidade ambulatorial da UnATI/UERJ (Universidade Aberta da Terceira Idade da Universidade do Estado do Rio de Janeiro)