O direito da pessoa idosa ao acompanhante, refletido na compreensão de profissionais da Saúde: uma contribuição ao debate / The elderly person's right to a companion, reflected in the understanding of health professionals: a contribution to the debate / El derecho de las personas mayores a un compañero, reflejado en la comprensión de los profesionales de la salud: una contribución al debate

Identificar a compreensão dos profissionais de saúde, no Brasil, sobre o direito de acompanhante, garantido ao idoso internado em instituições hospitalares, é o principal objetivo deste escrito. A metodologia consiste em uma pesquisa explicativa, com abordagem qualitativa, utilizando-se a revisão integrativa de estudos publicados na Biblioteca Virtual em Saúde. Como resultado principal, observamos que são delegadas aos acompanhantes as mesmas atribuições do cuidador, o que contribui para a designação máxima da responsabilidade do cuidado à família.

Identifying the understanding of health professionals in Brazil about the right to accompanying elderly people hospitalized in hospital institutions is the main objective of this paper. The methodology consists of an explanatory research, with a qualitative approach, using the integrative review of studies published in the Virtual Health Library. As a main result, it was observed that the same responsibilities of the caregiver are delegated to the companion, which contributes to the maximum designation of responsibility for caring for the family.

Identificar la comprensión de los profesionales de la salud, en Brasil, sobre el derecho de un compañero, garantizado a los ancianos hospitalizados en los hospitales, es el objetivo principal de este documento. La metodología consiste en una investigación explicativa, con un enfoque cualitativo, utilizando la revisión integradora de los estudios publicados en la Biblioteca Virtual en Salud. Como resultado principal, observamos que las mismas funciones del cuidador se delegan a los compañeros, lo que contribuye a la designación máxima responsabilidad del cuidado familiar.

Produção de conhecimento no serviço social sobre as lutas e proteção social à velhice dos trabalhadores / Knowledge production in social work about the struggles and social protection to the elderly workers

A história da proteção social aos velhos trabalhadores contempla modelos que antecedem a concepção liberal de "Direito do Cidadão" e indica uma trajetória de lutas e conquistas, respostas às expressões da "Questão Social". A velhice "trágica" compõe o rol dessas expressões, encaminhadas cotidianamente à profissão do Serviço Social. Este estudo tem como objetivo provocar a reflexão em torno das lutas sociais e da proteção social ao segmento idoso, a partir da produção de conhecimento do Serviço Social. Caracteriza-se como uma pesquisa explicativa, de cunho teórico-bibliográfico e fundamenta-se na concepção teórico-metodológica dialética de análise. Por fim, apontam-se cinco tendências observadas na atual produção de conhecimento do Serviço Social brasileiro, no campo da Gerontologia Social, sendo que uma delas permite a reflexão acerca da velhice na perspectiva da totalidade social, um desafio à profissão.

The history of social protection for elderly workers include models that precede the liberal conception of "Citizen's Law" and indicates a path of struggles and achievements, responses to expressions of "Social Issues". The "tragic" old age make up the list of these expressions, observed daily in profession of Social Work. This study aims to provoke reflection on the social struggles and social protection to the elderly segment, from the production of knowledge of Social Work. Characterized as an explanatory research, of theoretical and bibliographic nature and based on the theoretical, methodological and dialectic of analysis. We can identify five trends in Brazilian Social Service current production of knowledge, in the field of social gerontology, and one of them allows the reflection on old age in the context of social totality, a challenge to the profession.

A velhice vítima de negligência: omissão do Estado e rebatimentos ao Serviço Social / The old age victim of the violence:State’s omission and repercussions to Social Service

A violência, vista sob a ótica da totalidade social, é reveladora de particularidades. Na intenção de ir ao cerne desse fenômeno, o presente estudo tem por objetivo analisá-la como tendência da omissão do Estado no conteúdo das Políticas Sociais. Através da fundamentação teórica e crítica do Serviço Social e da interpretação dos dados demográficos e epidemiológicos, inferiu-se que a omissão do Estado, via políticas sociais, constitui uma negligência à velhice da classe trabalhadora, reservando contraditórias demandas ao Serviço Social.(AU)

The violence, seen from the perspective of social totality, is revealer of particularities. On intend to go to this problem's centre, the current study has as objective to analyze the violence like a tendency of State's omission in the content of Social Policies. Through the Social Service's theoretical and critical grounding and the interpretation of demographic and epidemiological information, it concludes that State's omission, by means of Social Policies, consist in a negligence to old age of worker class causing contradictory demands to Social Service.(AU)

A velhice vítima de negligência: omissão do Estado e rebatimentos ao Serviço Social / The old age victim of the violence:State’s omission and repercussions to Social Service

A violência, vista sob a ótica da totalidade social, é reveladora de particularidades. Na intenção de ir ao cerne desse fenômeno, o presente estudo tem por objetivo analisá-la como tendência da omissão do Estado no conteúdo das Políticas Sociais. Através da fundamentação teórica e crítica do Serviço Social e da interpretação dos dados demográficos e epidemiológicos, inferiu-se que a omissão do Estado, via políticas sociais, constitui uma negligência à velhice da classe trabalhadora, reservando contraditórias demandas ao Serviço Social.

The violence, seen from the perspective of social totality, is revealer of particularities. On intend to go to this problem's centre, the current study has as objective to analyze the violence like a tendency of State's omission in the content of Social Policies. Through the Social Service's theoretical and critical grounding and the interpretation of demographic and epidemiological information, it concludes that State's omission, by means of Social Policies, consist in a negligence to old age of worker class causing contradictory demands to Social Service.

Suicídio em idosos no Recife (PE): Um estudo sobre mortalidade por causas externas / Suicide in the elderly of Recife (PE): A study about mortality from external causes

O suicídio é um problema de saúde pública. Entre os idosos, esse tema não tem sido estudado com a devida importância. A doença mais frequentemente relacionada ao suicídio entre idosos é a depressão. Este estudo descreve características das mortes por suicídios entre idosos necropsiados no IML da cidade de Recife (PE), Brasil, em 2009. Os dados foram coletados do livro de registro de mortes do necrotério, dos laudos tanatoscópicos e das declarações de óbito. Das 352 necropsias, 25 foram por suicídio, sendo 13 homens e 12 mulheres, havendo maior incidência na idade entre 60 e 69 anos de idade.(AU)

Suicide is a public health problem. In regard the elderly, hadn't been studied with the importance it has. The disease that is mostly related to suicide in the elderly is depression. This study describes the deaths characteristics by suicide among the elderly autopsied at the Forensic Institute in Recife (PE),Brazil, in 2009. Data were collected from the death record book at the morgue, the autopsy reports and death certificates. Of 352 autopsies from external causes in 2009, 25 were suicides, 13 men and 12 women, and age group with the highest incidence was that between 60 and 69 years old.(AU)

Suicídio em idosos no Recife (PE): um estudo sobre mortalidade por causas externas / Suicide in the elderly of Recife (PE): a study about mortality from external causes

O suicídio é um problema de saúde pública. Entre os idosos, esse tema não tem sido estudado com a devida importância. A doença mais frequentemente relacionada ao suicídio entre idosos é a depressão. Este estudo descreve características das mortes por suicídios entre idosos necropsiados no IML da cidade de Recife (PE), Brasil, em 2009. Os dados foram coletados do livro de registro de mortes do necrotério, dos laudos tanatoscópicos e das declarações de óbito. Das 352 necropsias, 25 foram por suicídio, sendo 13 homens e 12 mulheres, havendo maior incidência na idade entre 60 e 69 anos de idade.

Suicide is a public health problem. In regard the elderly, hadn't been studied with the importance it has. The disease that is mostly related to suicide in the elderly is depression. This study describes the deaths characteristics by suicide among the elderly autopsied at the Forensic Institute in Recife (PE),Brazil, in 2009. Data were collected from the death record book at the morgue, the autopsy reports and death certificates. Of 352 autopsies from external causes in 2009, 25 were suicides, 13 men and 12 women, and age group with the highest incidence was that between 60 and 69 years old.

Prognostic value of changes in lean and fat mass in alcoholics.

BACKGROUND & AIMS: The prognostic value of nutritional status and/or lean and fat mass assessed by dual-energy X-ray absorptiometry (DEXA) has been widely analyzed, in both alcoholics and non-alcoholics. However, the prognostic value of changes in fat and lean mass over time in alcoholics has scarcely been studied, nor has the effect of alcohol abstinence on these changes. METHODS: From an initial cohort of 113 alcoholic patients, 70 prospectively underwent two DEXA assessments six months apart. One hundred and five patients (including 66 of those who underwent two DEXA assessments) were followed up for 34.9 ± 36.4 months (median = 18 months, interquartile range = 7.25-53.75 months). During this follow-up period, 33 died (including 20 of those who had undergone a second DEXA assessment). RESULTS: Forty-two of the 70 patients undergoing a second DEXA assessment had abstained from alcohol. Of these, 69.04% (29) gained left arm lean mass, compared with only 35.71% (10 of 28) of those who had continued drinking (χ² = 7.46; p = 0.006). Similar results were observed regarding right arm lean mass (χ² = 4.68; p = 0.03) and right leg lean mass (χ² = 7.88; p = 0.005). However, no associations were found between alcohol abstinence and changes in fat parameters. Analysis by means of Kaplan-Meier curves showed that loss of total lean mass, right leg lean mass, left leg lean mass and total fat mass were all significantly associated with reduced survival. However, within 30 months of the second evaluation, significant associations were observed between changes of all parameters related to lean mass, and mortality, but no association between changes in fat parameters and mortality. CONCLUSIONS: Loss of lean mass over a period of six months after a first assessment is associated with worse prognosis in alcoholics, irrespective of whether they stop drinking during this period or not. Continued drinking is associated with greater loss of lean mass, but not with changes in fat mass.

A mortalidade de idosos no Recife: quando o morrer revela desigualdades / Mortality among elderly people in Recife, State of Pernambuco, Brazil: when death reveals inequalities

Objetivo: caracterizar a mortalidade dos idosos segundo estratos de condição de vida (CV) em residentes do Recife, no triênio 2004-2006. Metodologia: estudo ecológico exploratório utilizando-se de informações do Sistema de Informações sobre Mortalidade(SIM) e da fundação Instituto Brasileiro de Geografia e Estatística (IBGE), e a classificação de Guimarães para definir estratos. Resultados: os maiores riscos foram encontrados nos estratos de baixa CV, comparados com os de intermediária e elevada CV, independentemente do sexo, faixa etária, causa básica e local de ocorrência; mulheres e idosos (60-69) apresentaram riscos maiores nos estratos de baixa CV, em relação ao de elevada; na comparação de estratos, os riscos para cardiovasculares, respiratórias e neoplasias foram de 1,55, 1,58 e 1,13 respectivamente. Conclusão: a partir dos indicadores observados, o estudo aponta a necessidade de intervenção na fase adulta, mediante a responsabilização do poder público em promover melhores condições de vida e, consequentemente, o direito de envelhecer com dignidade.

Objective: the aim of the study was to characterize mortality among elderly people living in the City of Recife, State of Pernambuco, Brazil over the three-year period 2004-2006. Methodology: exploratory ecological study using data from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE) foundation, and the Guimaraes classification to define strata. Results: the higher risks were found among individuals who suffer from poor living conditions, as compared to those with better and good living conditions, regardless of sex, age group, underlying cause or place of occurrence; women and elderly people (60-69) also presented greater or lower risks, according to their living conditions;comparing different population groups, the risk for cardiovascular, respiratory and neoplastic disease was of 1.55,1.58 and 1.13 respectively. Conclusion: considering the observed indicators, this study points out the need of interventions by public authorities focused on adults, in order to promote better living conditions and consequently to enable the general population to grow older with dignity.

Tetraparesia fláccida y desconexión del medio tras neumonía bilateral en un paciente alcohólico / Flaccid tetraparesia and disconnection in an alcoholic patient affected by pneumonia

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Prognostic value of nutritional status in alcoholics, assessed by double-energy X-ray absorptiometry.

OBJECTIVES: This study was performed in order to assess nutritional status of 77 alcoholic patients. METHODS: Patients underwent a total body double-energy X-ray absorptiometry (DEXA) analysis, with estimation of lean and fat mass at different parts of the body. RESULTS: Lean mass, but not fat mass, was significantly reduced among alcoholics, compared to 31 age-matched controls, especially at right arm, legs, and total body. Lean mass at both arms was significantly related to liver function parameters (albumin, prothrombin activity, bilirubin) and, inversely, with ethanol consumption. The 24 patients who died during a follow-up period of 88 months showed less lean mass at both arms, trunk, and left leg, and also less fat at the left arm, than survivors. When right and left arm lean mass were classified in quartiles, Kaplan-Meier curves showed significant differences between dead and survivors. Left arm lean mass was the parameter which was independently related to mortality when encephalopathy was not included in a stepwise Cox regression analysis, but was displaced by this last parameter when it was also introduced in the analysis. CONCLUSION: Lean mass is reduced in alcoholics, is related to liver function derangement and ethanol consumption, and is related to mortality.

A velhice não contemplada: invisibilidade das demandas sociais na pessoa idosa em Fernando de Noronha - Nordeste do Brasil / The invisibility of the social demands of the elderly in Fernando de Noronha - Northeast of Brazil

O objetivo deste trabalho é apresentar informações epidemiológicas e reflexões sobre os padrões e as desigualdades no processo de envelhecimento. Os resultados da pesquisa sobre o perfil socioeconômico e epidemiológico da população idosa do Distrito Estadual de Fernando de Noronha (DEFN), PE, e uma leitura crítica analisando o IDH, a prevalência de déficit cognitivo, as taxas de invisibilidade e negligência das demandas sociais do segmento mais velho da população no conteúdo das políticas públicas do país. AU

The main overall aim of this study is to present epidemiological information and reflections on patterns of aging and inequalities relating to this process. The State of Pernambuco has the tenth best human development index (HDI) in Brazil, according to the ranking of cities in the country. The results of research on the “socioeconomic and epidemiological profile” of the elderly population of the State District of Fernando de Noronha (DEFN) – PE’, together with a critical reading that analyses the HDI, the Prevalence of Cognitive Deficit, the Rates of Aging and the living conditions found on the island, corroborate the invisibility and negligence regarding the social needs of the elderly sector of the population in the public policy of the State of Pernambuco.AU

A velhice não contemplada: invisibilidade das demandas sociais na pessoa idosa em Fernando de Noronha - Nordeste do Brasil / The invisibility of the social demands of the elderly in Fernando de Noronha - Northeast of Brazil

O objetivo deste trabalho é apresentar informações epidemiológicas e reflexões sobre os padrões e as desigualdades no processo de envelhecimento. Os resultados da pesquisa sobre o perfil socioeconômico e epidemiológico da população idosa do Distrito Estadual de Fernando de Noronha (DEFN), PE, e uma leitura crítica analisando o IDH, a prevalência de déficit cognitivo, as taxas de invisibilidade e negligência das demandas sociais do segmento mais velho da população no conteúdo das políticas públicas do país.

The main overall aim of this study is to present epidemiological information and reflections on patterns of aging and inequalities relating to this process. The State of Pernambuco has the tenth best human development index (HDI) in Brazil, according to the ranking of cities in the country. The results of research on the “socioeconomic and epidemiological profile” of the elderly population of the State District of Fernando de Noronha (DEFN) – PE’, together with a critical reading that analyses the HDI, the Prevalence of Cognitive Deficit, the Rates of Aging and the living conditions found on the island, corroborate the invisibility and negligence regarding the social needs of the elderly sector of the population in the public policy of the State of Pernambuco.

Relación entre homocisteína y masa ósea en pacientes alcohólicos / Relationship between homocysteine and bone mass in alcoholic patients

Introducción. En el paciente alcohólico se observa la presencia de osteopatía. La homocisteína puede interferir con la formación del colágeno, la mineralización ósea y aumentar el riesgo de fracturas osteoporóticas. Algunos autores han encontrado relación entre la homocisteína y las fracturas óseas pero no se ha estudiado en pacientes alcohólicos. Pacientes y métodos. Estudiar en 43 pacientes alcohólicos la relación entre la densidad mineral ósea, hormonas, osteocalcina, N-Telopéptido terminal y la homocisteína. Grupo control de 63 individuos. Resultados. Los niveles séricos de homocisteína estaban ligeramente más elevados en los pacientes respecto a los controles (más en cirróticos que en no cirróticos) pero no de forma significativa. Un 38,5% de los pacientes presentaba osteoporosis. Aunque en los pacientes con osteoporosis los niveles de homocisteína estaban más aumentados no hallamos relación entre la homocisteína y la densidad mineral ósea en ninguna de las localizaciones analizadas ni en los valores hormonales ni en los marcadores óseos. Conclusiones. No hemos encontrado relación entre el aumento de la homocisteína y la osteoporosis de los pacientes alcohólicos

Introduction. Alcoholism leads to osteoporosis. Homocysteine (tHcys) may weaken bone by interfering with collagen cross-linking. Some authors hve found a relation between tHcys and bone fracture in clinical settings differents from alcoholism. Methods. We studied the relationship between bone mineral density, hormones, bone metabolism markers and homocysteine in 43 alcoholics patients. Data were compared with those obtained on 63 controls. Results. Serum homocysteine were slightly non-significantly higher among patients than controls and among cirrhotic than non-cirrhotic patients. A total of 38.5% patients had osteoporosis. Although homocysteine levels were slightly highly in patients with osteoporosis, no relationships were observed between homocysteine and bone mineral density at any of the bone sites analyzed or in hormones or serum markers of bone metabolism. Conclusion. We found no relationship between the number of homocysteine and osteoporosis of alcoholic patients

Hypophosphatemia in postoperative patients with total parenteral nutrition: influence of nutritional support teams.

UNLABELLED: PURPOSE, SETTING AND SUBJECTS: We conducted a prospective, descriptive study of postoperative patients under total parenteral nutrition controlled by a Multidisciplinary Nutritional Support Team in a tertiary care hospital. Between january 2002 and november 2003. Data of nutritional status, nutritional support, hypophosphatemia, electrolyte and metabolic complications were reviewed. RESULTS: 215 postoperative patients (63.3% male, 68 +/- 13.9 years old, 47.4% neoplasia). were included. Nutritional support according nutritional needs was made during fasting 14.2 +/- 18.4 days. Mild-moderate initial malnutrition was present in 58% of patients. 18.1% developed postoperative hypophosphatemia 96 hours after starting total parenteral nutrition containing phosphate. 37.7% patients showed moderated and 6.5% severe hypophosphatemia. Nutritional intervention corrected hypophosphatemia (p < 0.001). Factors related to hypophosphatemia were hypokalemia, hypomagnesemia, hypercalcemia, female sex, neoplasia, 96-hour postoperative period and duration of nutrition. CONCLUSIONS: Prevalence of hypophosphatemia in postoperative patients with total parenteral nutrition is high and needs timely monitoring. The intervention of Multidisciplinary Nutritional Support Team is effective detecting and correcting postoperative hypophosphatemia.

Hypophosphatemia in postoperative patients with total parenteral nutrition: influence of nutritional support teams / Hipofosfatemia en pacientes posoperados con nutrición parenteral total: influencia de los equipos de soporte nutricional

Purpose, setting and subjects: We conducted a prospective, descriptive study of postoperative patients under total parenteral nutrition controlled by a Multidisciplinary Nutritional Support Team in a tertiary care hospital. Between January 2002 and November 2003. Data of nutritional status, nutritional support, hypophosphatemia, electrolyte and metabolic complications were reviewed. Results: 215 postoperative patients (63.3% male, 68 ± 13.9 years old, 47.4% neoplasia). were included. Nutritional support according nutritional needs was made during fasting 14.2 ± 18.4 days. Mild-moderate initial malnutrition was present in 58% of patients. 18.1% developed postoperative hypophosphatemia 96 hours after starting total parenteral nutrition containing phosphate. 37.7% patients showed moderated and 6.5% severe hypophosphatemia. Nutritional intervention corrected hypophosphatemia (p < 0.001). Factors related to hypophosphatemia were hypokalemia, hypomagnesemia, hypercalcemia, female sex, neoplasia, 96-hour postoperative period and duration of nutrition. Conclusions: Prevalence of hypophosphatemia in postoperative patients with total parenteral nutrition is high and needs timely monitoring. The intervention of Multidisciplinary Nutritional Support Team is effective detecting and correcting postoperative hypophosphatemia (AU)

Propósito, contexto y sujetos: Realizamos un estudio descriptivo, prospectivo, en pacientes con nutrición parenteral total controlados por un Equipo Multidisciplinar de Soporte Nutricional de un hospital terciario, entre enero de 2002 y noviembre de 2003. Se revisaron los datos de estado nutritivo, soporte nutricional, hipofosfatemia, y de complicaciones electrolíticas y metabólicas. Resultados: Se incluyó a 215 pacientes postoperados (63,3% varones, edad 68 ± 13,9 años, 47,4% de neoplasias). Se realizó un soporte nutricional de acuerdo con las necesidades nutritivas durante un periodo de ayuno de 14,2 ± 18,4 días. Había malnutrición de base en un 58% de los pacientes. El 18,1% de los pacientes desarrolló hipofosfatemia postoperatoria 96 horas después de iniciar la nutrición parenteral total que contenía fosfato. El 37,7% de los pacientes tuvo hipofosfatemia moderada y 6,5% grave. La intervención nutricional corrigió la hipofosfatemia (p < 0,001). Los factores relacionados con la hipofosfatemia fueron hipopotasemia, hipomagnesemia, hipercalcemia, sexo femenino, neoplasia, periodo post-operatorio de 96 horas y duración de la nutrición. Conclusiones: La prevalencia de hipofosfatemia en pacientes posoperados con nutrición parenteral total es alta y requiere una vigilancia estrecha. La intervención del Equipo Multidisciplinar de Soporte Nutricional es eficaz para la detección y corrección de la hipofosfatemia postoperatoria (AU)

Effect of zinc supplementation on ethanol-mediated bone alterations.

Ethanol consumption leads to bone alterations, mainly osteoporosis. Ethanol itself may directly alter bone synthesis, but other factors, such as accompanying protein malnutrition--frequently observed in alcoholics, chronic alcoholic myopathy with muscle atrophy, alcohol induced hypogonadism or hypercortisolism, or liver damage, may all contribute to altered bone metabolism. Some data suggest that zinc may exert beneficial effects on bone growth. Based on these facts, we analyzed the relative and combined effects of ethanol, protein malnutrition and treatment with zinc, 227 mg/l in the form of zinc sulphate, on bone histology, biochemical markers of bone formation (osteocalcin) and resorption (urinary hydroxyproline excretion), and hormones involved in bone homeostasis (insulin growth factor 1 (IGF-1), vitamin D, parathormone (PTH), free testosterone and corticosterone), as well as the association between these parameters and muscle fiber area and liver fibrosis, in eight groups of adult Sprague Dawley rats fed following the Lieber de Carli model during 5 weeks. Ethanol showed an independent effect on TBV (F=14.5, p<0.001), causing it to decrease, whereas a low protein diet caused a reduction in osteoid area (F=8.9, p<0.001). Treatment with zinc increased osteoid area (F=11.2, p<0.001) and serum vitamin D levels (F=3.74, p=0.057). Both ethanol (F=45, p<0.001) and low protein diet (F=46.8, p<0.01) decreased serum osteocalcin levels. Ethanol was the only factor independently related with serum IGF-1 (F=130.24, p<0.001), and also showed a synergistic interaction with protein deficiency (p=0.027). In contrast, no change was observed in hydroxyproline excretion and serum PTH levels. No correlation was found between TBM and muscle atrophy, liver fibrosis, corticosterone, or free testosterone levels, but a significant relationship was observed between type II-b muscle fiber area and osteoid area (rho=0.34, p<0.01). Osteoporosis is, therefore, present in alcohol treated rats. Both alcohol and protein deficiency lead to reduced bone formation. Muscle atrophy is related to osteoid area, suggesting a role for chronic alcoholic myopathy in decreased bone mass. Treatment with zinc increases osteoid area, but has no effect on TBV.

Perfil socioeconômico e epidemiológico da população idosa do Distrito Estadual de Fernando de Noronha - PE / Profile socioeconomic and epidemiologic of the elderly population of the State District of Fernando of Noronha - PE

Conhecer o perfil socioeconômico e epidemiológico do idoso ilhéu, identificando a atual situação de saúde e apresentando peculiaridades da vida cotidiana dapopulação insular, minoritária, vivendo em situação de isolamento geográfico, no Distrito Estadual de Fernando de Noronha - PE, é o principal objetivo destetrabalho. O desenho censitário do estudo caracteriza-se pela realização de uma abordagem epidemiológica descritiva de tipo corte transversal em populaçãoespecial. Foram entrevistados 80 idosos residentes na Ilha do universo de 88. O instrumento utilizado para coleta de dados foi o Brazil Old Age Schedule (BOAS),questionário multidimensional para estudos comunitários em população idosa. Basicamente, o referencial teórico está fundamentado no conteúdo de disciplinasrelacionadas ao processo de envelhecimento humano e da saúde coletiva. Em Fernando e Noronha, a Taxa de 4,3por cento não caracteriza a existência de uma população envelhecida e não ocorre o processo de feminização da velhice,contrastando com a realidade observada no Brasil, de forma geral. Os indicadores socioeconômicos, analisados isoladamente, revelam o perfil de umapopulação diferenciada, quando comparada a outras do Continente. No entanto, apesar da boa qualidade de vida, onde o IDH é considerado um dos melhores do Brasil, o elevado custo de vida na Ilha chega a superar os padrões observados em Pernambuco e na capital Recife. Do ponto de vista gerontológico, os indicadores de autonomia e independência apontam para o perfil de uma população saudável, porém, apesar da boa capacidade funcional, foramencontradas elevadas taxas de prevalência de Diabetes Mellitus e Hipertensão Arterial

El reumatólogo consultor: enlace entre la medicina primaria y la hospitalaria. Organización de la Unidad Consultora de Reumatología-Atención Primaria (UCRAP). Experiencia del primer año de funcionamiento / The rheumatology consultant: a link between hospital and primary care. Organization of a rheumatology unit in primary care. First year experience

Fundamento: Comunicamos la creación de una unidad consultora de reumatología para atención primaria y analizamos la experiencia del primer año de funcionamiento, así como la valoración que de ella hacen los médicos de atención primaria y los pacientes atendidos. Material y método: Hemos registrado los datos de cada paciente y la actividad generada a través de una hoja de registro. La valoración por médicos y pacientes se ha realizado mediante cuestionarios diseñados para tal fin. Resultados: Se ha atendido a 17.602 consultas ordinarias y 45 consultas urgentes. La demanda ha sido creciente. Se han recibido 532 llamadas telefónicas y 36 correos electrónicos. Se han realizado 269 artrocentesis y 1.993 infiltraciones. El 3,2 por ciento de los pacientes se remitió al servicio hospitalario de reumatología. La artrosis, los reumatismos de partes blandas y las raquialgias encabezan los diagnósticos más frecuentes. Se han diagnosticado 52 nuevos casos de enfermedad inflamatoria. Todos los aspectos de la actividad del reumatólogo consultor fueron evaluados muy positivamente por los médicos de asistencia primaria. La evaluación de los pacientes es también muy satisfactoria. Discusión: La atención combinada en el hospital y en la asistencia primaria por el mismo especialista supone una posibilidad óptima de acercar a la atención primaria una especialidad hasta ahora exclusivamente hospitalaria. La experiencia es considerada muy positiva por reumatólogos, médicos de atención primaria y pacientes. (AU)