Primary health care services utilization and satisfaction among the elderly in Asir region, Saudi Arabia.

Use of primary health care (PHC) services and satisfaction among elderly people (60 + years) in Asir was studied in 26 PHC centres. They visited PHC centres significantly less often than younger adults but they were referred significantly more often to secondary and tertiary care and for more laboratory tests. A random sample of 253 elderly people attending the centres was interviewed about accessibility, continuity, humaneness, informativeness and thoroughness of care. Overall, 79.0% were satisfied with the services provided. The leading 3 items of dissatisfaction were: not enough audiovisual means for health education (65.1%), long time spent in the centre (46.4%), and not enough specialty clinics (42.5%).

[Silent ischemia after an uncomplicated myocardial infarct. A study in asymptomatic patients]. / Isquemia silenciosa após infarto do miocárdio não complicado. Estudo em pacientes assintomáticos.

PURPOSE: To verify the prognostic value of silent myocardial ischemia (SMI) after an uncomplicated myocardial infarction (MI). METHODS: Forty asymptomatic patients were studied after a first uncomplicated MI. They were submitted to 48 hour ambulatory electrocardiographic monitoring and exercise-testing, during the 2nd and 8th weeks after the acute event. Thirty-nine patients were submitted to cardiac catheterization and coronary arteriography; one patient was submitted to necropsy. The electrocardiographic study identified 11 (27.5%) individuals with SMI (group A); the other 29 patients were considered group B. RESULTS: Groups A and B were similar in relation to clinical characteristics, infarct site and ventricular function. Group A had significantly more extensive coronary artery disease when compared to group B. After a two-year follow-up, patients from group A had significantly more coronary events (36.3%) when compared to group B (3.4%). Kaplan-Meier analysis demonstrated a significantly higher cumulative probability of not experiencing a new coronary event for the group B patients. CONCLUSION: SMI may have a prognostic value after uncomplicated MI, as in other clinical manifestations of coronary artery disease.

Propedêutica cinecoronariográfica e cineventriculográfica em pacientes com idade superior a 70 anos / Coronary cineangiographic and cineventriculographic propedeutics in patients over 70 years old

Foi estudada a cinecoronarioventriculografia de 167 pacientes com idade superior a 70 anos de portadores de angina instavel, sendo 131 do sexo masculino. Registrou-se a localizacao o numero e grau das lesoes obstrutivas das arterias coronarias, a presenca de circulacao colateral e a alteracao da contracao do ventriculo esquerdo. Os pacientes foram divididos em: grupo A - portadores de arterias coronarias normais ou com obstrucao ate 50% (27); grupo B - portadores de lesao uniarterial com obstrucao superior a 50% (36); grupo C - portadores de lesao biarterial com obstrucao superior a 50% (52) e grupo D - portadores de lesao triarterial com obstrucao superior a 50% (52). Observou-se que em 11,4% dos casos, as arterias coronarias eram normais. Entre os pacientes com menor comprometimento coronario (grupos A e B), a frequencia de mulheres foi significativamente maior que entre os doentes com comprometimento mais acentuado (grupo C e D). A descendente anterior foi a arteria mais frequentemente alterada. A presenca de circulacao colateral acompanhou a gravidade do comprometimento coronario. O comprometimento ventricular esquerdo foi concordante com a intensidade das alteracoes coronarias