Interface entre cuidado à saúde da criança e a formação profissional: estudo original / Interface between child health care and vocation training: original study / Interfaz entre atención médica infantil y formación profesional: estudio original

OBJETIVO: Compreender a efetivação da linha de cuidado integral à saúde da criança na Estratégia Saúde da Família e suas interfaces entre a prática e a formação. MÉTODO: Pesquisa qualitativa, descritiva e exploratória, do tipo estudo de caso, realizada com observação e entrevistas com profissionais médicos e enfermeiros. Analisaram-se os dados a partir de análise temática de conteúdo. RESULTADOS: Três categorias foram geradas: Fragilidade da formação acadêmica frente a temática saúde da criança na Estratégia Saúde da Família; Desconexão entre teoria e prática frente ao cuidado à saúde da criança; Entre muitos limites e algumas possibilidades na efetivação de práticas integrais. CONCLUSÃO: Tornam-se necessárias ações de educação permanente para qualificação das práticas, assim como a ampliação das discussões sobre o tema na formação acadêmica.

OBJETIVO: Comprender la efectividad de la línea de atención integral a la salud infantil en la Estrategia Salud de la Familia y sus interfaces entre práctica y formación. MÉTODO: Investigación cualitativa, descriptiva y exploratoria, del tipo estudio de caso, realizada con observación y entrevistas a profesionales médicos y enfermeros. Los datos se analizaron con base en el análisis de contenido temático. RESULTADOS: Se generaron tres categorías: Fragilidad de la formación académica ante la salud infantil en la Estrategia Salud de la Familia; Desconexión entre teoría y práctica en relación con la atención de la salud infantil; Entre muchos límites y algunas posibilidades en la implementación de prácticas integrales. CONCLUSIÓN: Las acciones de educación permanente son necesarias para calificar las prácticas, así como la ampliación de las discusiones sobre el tema en la formación académica.

OBJECTIVE: To understand the implementation of the comprehensive care for children's health in the Family Health Strategy and its interfaces between practice and training. METHOD: Qualitative, descriptive and exploratory case study, conducted with observation and interviews with medical professionals and nurses. Data were analyzed using thematic content analysis. RESULTS: Three categories were formed: Fragility of academic education in relation to child health area in the Family Health Strategy; Disconnection between theory and practice in relation to child health care; Among the many limitations and some possibilities in the implementation of comprehensive practices. CONCLUSION: Permanent education actions are necessary to qualify practices, as well as the expansion of discussions on the subject in academic education.

Práticas profissionais de saúde diante da linha cuidado à criança / Professional health practices regarding child care

Objetivo: identificar as práticas de profissionais da Estratégia Saúde da Família frente à linha de cuidado da atenção integral à saúde da criança. Método: trata-se de estudo de bibliográfico, tipo revisão integrativa, com artigos publicados em português, inglês e espanhol, entre 2012 e 2017, nas bases de dados LILACS, MEDLINE, BDENF e na biblioteca virtual SciELO. Utilizou-se os seguintes Descritores em Ciências da Saúde (DeCS): saúde da criança e Estratégia Saúde da Família, utilizando-se o operador booleano AND e seus respectivos termos em inglês e espanhol. Apresentaram-se os resultados em forma de figura. Resultados: compôs-se o corpus de análise por 26 artigos que atenderam aos critérios de inclusão. Evidenciaram-se duas categorias: "A dispersão de práticas profissionais frente ao cuidado à saúde da criança" e "Os entraves que tornam complexa a prática de profissionais de saúde no cuidado à saúde da criança". Conclusão: reconstroem-se, pelos profissionais que atuam frente à linha de cuidado integral à saúde da criança, práticas centradas no modelo biomédico, com necessidade de superação deste modus operandi.(AU)

Objective: to identify the practices of Family Health Strategy professionals regarding the care line of comprehensive child health care. Method: this is a bibliographic study, integrative review type, with articles published in Portuguese, English and Spanish, between 2012 and 2017, in the LILACS, MEDLINE, BDENF and SciELO virtual library. The following Health Sciences Descriptors (DeCS) were used: child health and Family Health Strategy, using the Boolean operator AND and its respective English and Spanish terms. The results are presented in figure form. Results: the corpus of analysis was composed by 26 articles that met the inclusion criteria. Two categories were highlighted: "The dispersion of professional practices in relation to child health care" and "The barriers that make the practice of health professionals in child health care complex". Conclusion: the professionals who work in front of the integral line of child health care reconstruct practices centered on the biomedical model, with the need to overcome this modus operandi.(AU)

Objetivo: identificar las prácticas de profesionales de la Estrategia Salud Familiar con respecto a la línea de cuidado de la atención integral a la salud infantil. Método: se trata de un estudio bibliográfico, tipo revisión integradora, con artículos publicados en portugués, inglés y español, entre 2012 y 2017, en la base de datos LILACS, MEDLINE, BDENF y en la biblioteca virtual SciELO. Se utilizaron los siguientes descriptores en Ciencias de la Salud (DeCS): Salud infantil y Estrategia de Salud Familiar, utilizando el operador booleano AND y sus respectivos términos en inglés y español. Los resultados se presentaron en forma de figura. Resultados: el corpus de análisis estuvo compuesto por 26 artículos que cumplieron con los criterios de inclusión. Se destacaron dos categorías: "La dispersión de las prácticas profesionales en relación con la atención de la salud infantil" y "Las barreras que hacen que la práctica de los profesionales de la salud en la atención de la salud infantil sea compleja". Conclusión: los profesionales que trabajan hacia la línea integral de atención de salud infantil reconstruyen prácticas centradas en el modelo biomédico, con la necesidad de superar este modus operandi.(AU)

Prática e formação de profissionais da Estratégia Saúde da Família: desafio do cuidado à criança / Practice and training of the family health care strategy: child care challenge

Objetivo: compreender aspectos da prática de cuidado e sua correlação com a formação do profissional de saúde que atua na efetivação da linha de cuidado à saúde da criança na ESF; identificar diretrizes relacionadas à formação dos profissionais no que se refere à linha de cuidado à criança; analisar potencialidades e limitações das práticas de cuidado de profissionais de saúde perante a linha de cuidado à saúde da criança. Método: estudo qualitativo, descritivo, exploratório. Serão realizadas entrevistas e observação não participante com enfermeiros e médicos da ESF. A análise dos dados se fará por meio da técnica de Análise de Conteúdo na modalidade Análise temática. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal Fluminense, número CAAE 62136016.7.0000.5243.Resultados esperados: oportunizar reflexões sobre os processos de formação e sobre as práticas na linha de cuidado à saúde da criança na ESF; e indicar a necessidade de incorporação desta temática específica na formação e nas ações de educação permanente.

A prática e a formação de profissionais da estratégia saúde da Família: o desafio do cuidado integral à saúde da criança / The professionals practice and training of the family health strategy: the challenge of integral care to the child's health

Este trabalho trata-se de uma pesquisa qualitativa descritiva que problematiza a prática do profissional da Estratégia Saúde da Família (ESF), diante da linha de cuidado integral à saúde da criança, e a correlação dessa prática com a formação acadêmica. Objetivos: Compreender aspectos da prática profissional e a sua correlação com a formação, para efetivar a linha de cuidado integral à saúde da criança na ESF. Identificar aspectos da formação profissional relacionados com a linha de cuidado integral à saúde da criança. Analisar se as práticas profissionais contemplam a singularidade do cuidado integral à saúde da criança. Descrever potencialidades e limitações das práticas profissionais, frente à singularidade da linha de cuidado integral à saúde da criança nas unidades de ESF. Indicar estratégias para reorientações da prática profissional perante a linha de cuidado integral à saúde da criança. Metodologia: Este trabalhou foi realizado em 2017 por meio de uma pesquisa de campo em uma unidade de ESF no município do Rio de Janeiro. A abordagem foi de natureza qualitativa, descritiva e exploratória, do tipo estudo de caso. Após aprovado pelo Comitê de Ética em Pesquisa, realizou-se trabalho de campo com observação não participante e entrevistas com profissionais atuantes na ESF (médicos e enfermeiros), diretamente ligados à linha de cuidado integral à saúde da criança. Analisaram-se os dados a partir da análise temática. Resultados: Foram geradas três categorias: Fragilidade da formação acadêmica referente à temática saúde da criança na Atenção Primária à Saúde; Desconexão entre teoria e prática frente ao cuidado integral à saúde da criança; Entre muitos limites e algumas possibilidades na efetivação de práticas resolutivas. Conclusão: Considera-se que há um frágil preparo dos profissionais de saúde da ESF para efetivar a linha de cuidado integral à saúde da criança. Portanto, indicam-se ações de educação permanente aos profissionais para a qualificação das práticas, assim como a ampliação das discussões sobre o tema na formação acadêmica, o que poderá garantir à população infantil uma assistência resolutiva, integral e universal. Também foi construído um produto tendo por base as demandas do local, ou seja, uma proposta de complementações no prontuário eletrônico (PE) com um "guia" orientador às ações desempenhas pelos profissionais diante da linha de cuidado integral à saúde da criança

It is a descriptive qualitative research that problematizes the practice of the Family Health Strategy (ESF) professional, considering the line of integral care to the child's health and the correlation with his academic formation. Objectives: To understand aspects of the professional practice and its correlation with the training to carry out the line of integral health care of the child in the FHS. Identify aspects of professional training related to the line of comprehensive child health care; To analyze if the professional practices contemplate the singularity of the integral health care of the child; Describe the potential and limitations of professional practices in relation to the uniqueness of the line of comprehensive child health care in FHS units; Indicate strategies for reorientation of professional practice towards the line of integral health care for the child. Methodology: Conducted in 2017 through a field work in an ESF unit in the city of Rio de Janeiro. The approach was qualitative, descriptive and exploratory, of the case study type. After approval by the Research Ethics Committee, fieldwork was carried out with non-participant observation and interviews with professionals working at the FHS (Physicians and Nurses), directly linked to the child's comprehensive health care line. Data analyzed from the thematic analysis. Results: Three categories were generated: Fragility of the academic formation related to the health issue of the child in the Primary Attention in Health; Disconnection between theory and practice regarding integral child health care; Among many limits and some possibilities in the implementation of resolutive practices. Conclusion: It is considered that there is a fragile preparation of the health professionals of the FHT to carry out the line of integral health care of the child. Therefore, permanent education actions are indicated to the professionals to qualify the practices, as well as the expansion of the discussions on the subject in the academic formation, which can guarantee to the child population a complete, universal and resolute assistance. A product was also built based on the demands of the place, that is, a proposal of complements in the electronic medical record (PE) with a "guide" guiding the actions performed by the professionals in front of the line of integral health care of the child

Moving in an environment of induced sensorimotor incongruence does not influence pain sensitivity in healthy volunteers: a randomised within-subject experiment.

OBJECTIVES: It has been proposed that in the same way that conflict between vestibular and visual inputs leads to motion sickness, conflict between motor commands and sensory information associated with these commands may contribute to some chronic pain states. Attempts to test this hypothesis by artificially inducing a state of sensorimotor incongruence and assessing self-reported pain have yielded equivocal results. To help clarify the effect sensorimotor incongruence has on pain we investigated the effect of moving in an environment of induced incongruence on pressure pain thresholds (PPT) and the pain experienced immediately on completion of PPT testing. METHODS: Thirty-five healthy subjects performed synchronous and asynchronous upper-limb movements with and without mirror visual feedback in random order. We measured PPT over the elbow and the pain evoked by testing. Generalised linear mixed-models were performed for each outcome. Condition (four levels) and baseline values for each outcome were within-subject factors. RESULTS: There was no effect of condition on PPT (p = 0.887) or pressure-evoked pain (p = 0.771). A sensitivity analysis using only the first PPT measure after each condition confirmed the result (p = 0.867). DISCUSSION: Inducing a state of movement related sensorimotor incongruence in the upper-limb of healthy volunteers does not influence PPT, nor the pain evoked by testing. We found no evidence that sensorimotor incongruence upregulates the nociceptive system in healthy volunteers.

Assessing self-perception in patients with chronic low back pain: development of a back-specific body-perception questionnaire.

BACKGROUND: There is considerable interest in the role that disturbance of body-perception may play in long standing pain problems such as chronic low back pain (CLBP), both as a contributor to the clinical condition and as a potential target for treatment. In some chronic pain conditions body-perception has been investigated using self-report questionnaires. There is currently no questionnaire for assessing body-perception in people with CLBP. OBJECTIVE: To describe the development of a back-specific body-perception questionnaire and examine the psychometrics of this new scale. METHODS: Based on available evidence a back-specific body-perception questionnaire was developed. Fifty-one people with CLBP and an equal number of healthy controls completed the questionnaire; a subset of the patient population completed the questionnaire again one-week later. Scale-consistency and test-retest reliability were investigated on the patient sample. Validity was investigated by comparing responses between patients and controls as well as exploring the relationship between the questionnaire and important clinical characteristics. RESULTS: All but one of the patients endorsed items on the questionnaire, which suggests that distorted body-perception may exist in this population. The internal-consistency and test-retest reliability of the scale appear acceptable. The discriminative validity of the questionnaire is supported by the marked differences in the questionnaire responses between patients and healthy controls and the construct validity by the significant association between the questionnaire score and important clinical variables. CONCLUSION: Symptoms of body-perception distortion were endorsed by most CLBP patients, while these symptoms are very infrequent amongst healthy controls. Our results suggest the questionnaire has reasonable psychometric properties.

Illusory touch temporarily improves sensation in areas of chronic numbness: a brief communication.

BACKGROUND: Creating the visual illusion of touch can improve tactile perception in healthy subjects. OBJECTIVE: We were interested in seeing if creating the illusion of touch in an insensate area could improve sensation in that area. METHODS: Fourteen people with chronic numbness participated in a randomized crossover experiment. The 4 conditions were the following: (a) stimulation over the unaffected limb with mirror visual feedback (experimental condition), (b) stimulation over the affected limb with mirror visual feedback, (c) stimulation over the unaffected limb without mirror visual feedback, and (d) stimulation over the affected limb without mirror visual feedback. Participants were assessed before and after each condition using the Ten-Test and mechanical detection thresholds. Data were analyzed using linear mixed models. RESULT: Only the experimental condition produced a change in the Ten-Test (mean difference = -1.1; 95% confidence interval = -1.8 to -0.4; P = .003), corresponding to a 24% improvement in sensation. No differences were observed for any condition in mechanical detection thresholds. CONCLUSION: Creating the illusion of touch may improve sensory function in areas of chronic numbness. This preliminary finding adds to the growing body of evidence supporting the use of techniques that directly target cortical function in people with peripheral nerve injury.

Mislocalization of sensory information in people with chronic low back pain: a preliminary investigation.

OBJECTIVES: The purpose of this study was to establish if people with chronic low back pain (CLBP) demonstrate impairments in the ability to localize sensory information delivered to the back more than pain-free controls and determine whether any sensory abnormalities are related to pain-related variables. METHODS: Vision was occluded and participants were stimulated using light touch or pinprick over a number of body areas in random order. To assess for mislocalizations participants were asked to nominate the location of each stimulus in reference to a marked body chart. To assess referred sensations participants who were asked whether they experienced any sensations elsewhere during stimulation. If referred sensations were reported, testing was repeated with visualization of the stimulated area. RESULTS: Although a small number of CLBP patients demonstrated referral of sensations, this was not statistically different from what was observed in a pain-free control group (P=0.381). In contrast, mislocalizations were very common in the patient sample and statistically more common than we found in controls (P=0.034). No statistically significant associations were detected between sensory function and the measured pain-related variables (all P>0.05). DISCUSSION: These data add to a growing body of evidence suggesting that disturbed self-perception is a feature of CLBP. It is plausible that altered self-perception is maladaptive and contributes to the maintenance of the problem and may represent a target of treatment for CLBP.

Seeing it helps: movement-related back pain is reduced by visualization of the back during movement.

OBJECTIVES: The aim of this study was to determine whether visualization of the back influenced parameters of movement-related pain in people with chronic nonspecific low back pain. METHODS: We used a randomized cross-over experiment in which 25 participants performed repeated lumbar spine movements under 2 conditions. In the visual feedback condition, patients were able to visualize their back as it moved by the use of mirrors. In the control condition, the mirror was covered so no visualization of the back was possible. RESULTS: The average postmovement pain intensity after participants had moved with visual feedback was less (35.5 ± 22.8 mm) than when they moved without visual feedback (44.7 ± 26.0 mm). This difference was statistically significant (mean difference=9.3, 95% confidence interval: 2.8-15.7 F(1,22)=8.82, P=0.007). The average time to ease after participants had moved with visual feedback was shorter (44.5 s ± 53.8) than when they moved without visual feedback (94.4 s ± 80.7). This difference was also statistically significantly (mean difference=49.9, 95% confidence interval: 19.3-80.6, F(1,22)=8.82, P=0.003). DISCUSSION: Patients with chronic nonspecific low back pain reported less increase in pain and faster resolution of pain when moving in an environment that enabled them to visualize their back. This is consistent with emerging research on the use of mirror visual feedback in other long-standing pain problems and suggests that similar lines of inquiry may be worth pursuing in the chronic nonspecific low back pain population.

Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation.

OBJECTIVES: To investigate impairments in sensory function in chronic non-specific low back pain patients, and the relationship between any impairment and the clinical features of the condition. DESIGN: A cross-sectional case-control study. SETTING: Laboratory-based study. PARTICIPANTS: Nineteen chronic non-specific low back pain patients and 19 healthy controls. MAIN OUTCOME MEASURES: Tactile threshold, two-point discrimination distance and accuracy at a task involving recognising letters drawn over the skin of the lower back (graphaesthesia) were assessed over the lumbar spine in both groups. Pain duration, pain intensity, physical function, anxiety and depression were assessed by questionnaire in the back pain group. RESULTS: No difference was found in tactile threshold between the two groups [median difference 0.0mg, 95% confidence interval (CI) -0.04 to 0.04]. There was a significant difference between controls and back pain patients for two-point discrimination (mean difference 17.9mm, 95% CI 5.9 to 29.8) and graphaesthesia accuracy (mean difference 6.1, 95% CI 1.3 to 11.0). Low back pain patients had a larger lumbar two-point discrimination distance threshold and a greater letter recognition error rate. In the back pain group, no relationship was found between clinical profile and sensory function, and no relationship was found between the sensory tests. CONCLUSIONS: These data support existing findings of perceptual abnormalities in chronic non-specific low back pain patients, and are suggestive of cortical rather than peripheral sensory dysfunction. Amelioration of these abnormalities may present a target for therapeutic intervention.

[Neonatal screening - the challenge of an universal and effective coverage]. / Triagem neonatal - o desafio de uma cobertura universal e efetiva.

Newborn screening programs (NSP) aim to detect carriers of several congenital diseases among asymptomatic infants in order to warrant effective intervention. Specimen collection is the first step of a process that should be done in an universal and timely manner. A review of coverage and time of collection was done in NSP of several countries. The search was made in various sources, from 1998 to 2008, with "neonatal screening" and "coverage" as key words. The lack of a typical study design did not allow to the rigor required for a systematic review. Data were grouped in macro-regions. Canada had coverage of 71% in 2006 while the European coverage was of 69% in 2004, with data of 38 countries. In Asia and Pacific region, there were data of 19 countries. In Middle East and North Africa, there were data of 4 countries. In Latin America, the coverage was 49% in 2005, with data of 14 countries. In Brazil, coverage was 80%. Twelve reports had information about timeliness. The conclusion is that epidemiological transition has contributed to NSP success. Developed regions had more universal and timelier collection. In Brazil, government initiative increased access to the NSP, but late collections lead to the need of educational actions and participation of professional organizations in developing specific guidelines definition.

Triagem neonatal: o desafio de uma cobertura universal e efetiva / Neonatal screening: the challenge of an universal and effective coverage

Programas de triagem neonatal (PTN) visam detectar portadores de várias doenças congênitas em recém-natos assintomáticos para uma intervenção efetiva. A coleta do teste é a primeira etapa do processo, devendo ser universal e precoce. Foi feita revisão sobre cobertura e momento de coleta em PTN de diversos países. A busca foi realizada em fontes diversas, de 1998 e 2008, com descritores "triagem neonatal" e "cobertura". A falta de desenho de estudo típico impediu o rigor necessário a uma revisão sistemática. Os dados foram agrupados em macrorregiões. O Canadá teve cobertura de 71 por cento em 2006. A Europa teve cobertura de 69 por cento em 2004, com dados de 38 países. Na Ásia e Pacífico, houve dados de dezenove países. No Oriente Médio e Norte da África, houve dados de quatro países. Na América Latina, a cobertura foi de 49 por cento em 2005, com dados de catorze países. No Brasil, a cobertura foi de 80 por cento em 2005. Sobre o momento da coleta, houve doze relatos. A transição epidemiológica contribuiu para o êxito dos PTN. Regiões mais desenvolvidas têm coberturas e momento de coleta mais adequados. No Brasil, a iniciativa do governo ampliou o acesso ao teste, mas coletas tardias indicam a necessidade de ações educativas e de organizações profissionais na definição de diretrizes específicas.

Newborn screening programs (NSP) aim to detect carriers of several congenital diseases among asymptomatic infants in order to warrant effective intervention. Specimen collection is the first step of a process that should be done in an universal and timely manner. A review of coverage and time of collection was done in NSP of several countries. The search was made in various sources, from 1998 to 2008, with "neonatal screening" and "coverage" as key words. The lack of a typical study design did not allow to the rigor required for a systematic review. Data were grouped in macro-regions. Canada had coverage of 71 percent in 2006 while the European coverage was of 69 percent in 2004, with data of 38 countries. In Asia and Pacific region, there were data of 19 countries. In Middle East and North Africa, there were data of 4 countries. In Latin America, the coverage was 49 percent in 2005, with data of 14 countries. In Brazil, coverage was 80 percent. Twelve reports had information about timeliness. The conclusion is that epidemiological transition has contributed to NSP success. Developed regions had more universal and timelier collection. In Brazil, government initiative increased access to the NSP, but late collections lead to the need of educational actions and participation of professional organizations in developing specific guidelines definition.

Vasculopathy in the Diabetic Foot

This paper attempts to distil some of the results of vasculopathy studies performed on Jamaican diabetic clinic attendees. Doppler measurements of ankle/brachial pressure index (A/BI) revealed that 23 percent of the diabetics have peripheral occlusive arterial disease (POAD) which was mostly asymptomatic. Plethysmorgraphic blood flow studies revealed a profound reduction in the vasodilatory response to increased flow demand. Prevalence of POAD determined by Doppler testing of A/BI reported by other researchers ranged from 13 percent in a large community study, one-third of whom were diabetic, to 47 percent in patiens who had been diabetic for 20 years. Isolated posterior tibial disease has been reported to carry a three-fold risk of all cause mortality and a four-fold risk of coronary heart disease mortality. This underscores the need for regular Doppler A/BI testing in order to improve the recognition, and treatment of POAD, and prevent further cardiovascular morbidity and mortality.(Au)

Some clinical factors contributing to the development of the diabetic foot

Clinical neurological studies, blood pressure measurements and some haematological investigations were performed on a random sample of forty-four patients, at the Diabetes Out-Patient Clinic of the University Hospital of the West Indies (UHWI), to examine some of the factors that predispose to the development of the diabetic foot. Our results revealed that 86 percent of the patients had elevated glycosylated haemoglobin (HbA > 9.0 percent), 82 percent had clinical signs of peripheral sensory neuropathy. 29 percent had signs of autonomic neuropathy in addition to peripheral sensory neuropathy. Sixty-one percent (61 percent) of the patients had ankle/arm systolic blood pressure ration less than 1.0 and were diagnosed as having peripheral vascular disease (PVD). The group with neuropathy was found to have a significantly lower diastolic blood pressure (p < 0.0005) than the group without neuropathy. We believe that hyperglycaemia-induced vasodilation (indicated by a lower diastolic blood pressure) in a significant number of diabetics resulted in compensatory shunting of blood from the deeper tissues, including nerves, to periphery. The resulting endoneural hypoxia could be responsible for the unusually high incidence of peripheral sensory neuropathy detected in this sample of diabetic patients. Metabolic factors may also play a role.(AU)

Peripheral occlusive arterial disease in diabetic clinic attendees

Peripheral occlusive arterial disease occurs with a greater frequency in the diabetic population than in the general population. It can have debilitating effects and so early detection and intervention are important. The aim of this study was to investigate the prevalence of peripheral occlusive arterial disease (POAD) among a sample of diabetic patients attending the out-patient clinic at the University Hospital of the West Indies (UHWI), Mona. A sphygmomanometer was used to measure arm and ankle blood pressures in 80 diabetic patients, and the ankle-brachial systolic pressure index (ABI) was determined. The presence or absence of peripheral pulses was detected with the Multi-dopplex (model 1). POAD was defined by the absence of one or more peripheral pulses and/or an ABI < 0.09. Of the 80 diabetic patients examined, 18 (22.5 percent) were found to have POAD. Seventy-eight percent of diabetics with POAD had the disease in both legs. Intermittent claudication was diagnosed in 27.7 percent of patients with POAD. A significantly larger proportion of diabetics with POAD were hypertensive and/or neuropathic (p < 0.05). The results suggest that serious attention should be given to the quantitative screening for POAD in the diabetic patients attending the clinic at the UHWI (AU)

The effect of glycaemic control on peripheral blood flow in diabetics -Poster presentation

Many studies have shown that persistent uncontrolled blood glucose predisposes to several diabetic complications. The aim of this study was to determine the influence of blood glycated haemoglobin levels on plasma fibrinogen concentration - (PFC), relative plasma viscosity (RPV) and ankle blood flow (Qak) in a group of diabetic patients with vascular complications compared with non-diabetic control (C). Qak was measured by the technique of venous occlusion plethysmography. PFC was determined by a clot-weight method. RPV was determined by capillary viscometry. Glycaemic control was determined by measuring glycated haemoglobin levels (GHb). Patients were divided into three categories of glycaemic control, namely good (GHb 4 - 8 percent), moderate (GHb > 8 - 12 percent) and poor (GHb > 12 percent). Qak, PFC and RPV were compared among diabetics with and without peripheral occlusive arterial disease (POAD) and/or neuropathy of various categories of glycaemic control. Qak in diabetics without peripheral occlusive arterial disease (POAD) with good glycaemic control was significantly higher (p <0.05) than that of non-diabetic (C). Qak differed significantly (p < 0.05) between non-neuropathic diabetics (without POAD) (D) with good and poor or good and moderate glycaemic control. PFC was significantly higher (p < 0.05) in all diabetics with POAD, in D with moderate glycaemic control and in neuropathic diabetes (without POAD) (ND) with poor control than in C. RPV was significantly higher (p < 0.05) in D with moderate control and poorly controlled neuropathic diabetics with POAD than in C. RPV differed significantly (p < 0.05) between D with moderate and poor control. The results suggest that in the absence of POAD, an initial vasodilatation occurs in diabetics. The decrease in arterial flow as metabolic control worsens, may be a consequence of the simultaneous increase in plasma viscosity.(AU)

Venous function study in diabetics with neuropathy: a preliminary study

In a previous study, we found a significantly impaired vasodilatory reserve, a reflection of abnormal vasodilation in the feet of diabetics with neuropathy. No study has been done to establish whether our diabetics have abnormal venous function. The present study was designed to examine venodynamic variables in order to determine whether venous impairment was present in our diabetic patients. Venous circulation in the leg was examined in 27 diabetic patients with neuropathy (ND) and compared with 35 non-neuropathic diabetics (NND) and 19 non-diabetic controls (C). Patients and controls were free from signs and symptoms of peripheral occlusive arterial disease. Glycaemic control in the patients was assessed by the measurement of glycated haemoglobin.(AU)

Impaired vasodilatory reserve in diabetes with and without neuropathy - abstract

Several studies have shown that resting blood flow is increased in the diabetic neuropathic foot, It has been proposed that the mechanism involved is the loss of sympathetic tone which occurs when nervesto peripheral blood vessels are damaged resulting in blood vessels being constantly dilated. The extent to which further dilatation can be achieved when interrupted flow is resumed we termed vasodilatory reserve (VDR). This has not previously been investigated. We, therefore, attempted to assess the VDR in diabetes' blood vessels by measuring reactive hyperaemia at the ankle. The VDR was determined in 23 neuropathic (ND), and 16 non-neuropathic diabetic (D) patients and compared with 16 non-diabetic control subjects (C). Patients and controls were free from signs and symptoms of peripheral occlusive arterial disease. Glycaemic control are assessed by glycosylated haemoglobin levels. Ankle blood flow (Q) was measured by venous occlusion plethsmography. Reactive hyperaemia was induced by occlusion of the ankle at 200 mm Hg for 4 minutes. Blood flow was then measured at 1 minutes deflation of the occlusive cuff to 60 Hg. The VDR is expressed as the precentage change in blood flow from the resting value 1 minute after reactive hyperaemia. VDR was 14.49 percent, 20.8 percent and 114.75 percent in the ND, D and C groups respectively. Our present finding indicated and impaired vasodilatory reserve in the ankle of neuropathic and non-neuropathic diabetes pointing to their inability to adequately increase blood supply to the feet after interrupted flow(AU)

Haemorrheological changes in diabetic neuropathies - abstract

Chronic hyperglycaemia leads to disturbances in metabolic pathways in nerves. However, the underlying mechanisms are still not fully understood. One of the theories of diabetic neuropathy has implicated a vascular factor, which we believe may be associated with abnormal haemorrheological changes. Persistent hyperglycaemia creates a "stressful" conditions which triggers increased production of the acute-phase-reactant protein, fibrinogen, causing the development of a hyperfibrinogenaemic state. Apart from the red cell concentration, fibrinogen is the next most important determinant of whole blood viscosity. Therefore, an hyper-viscosity syndrome is commonly seen in diabetic patients. The increased viscosity could be an important factor in the development of endothelial damage in the vaso nervorum, hence contributing to the pathogenesis of diabetic neuropathy. The present study examined changes in haemorrheological parameters, with particular emphasis on plasma fibrinogen concentration in diabetics with and without peripheral neuropathy. Forty-seven (47) diabetics, 39 females and 8 males, were selected randomly during routine attendance at the Diabetic Clinic at the Unversity Hospital of the West Indies. Patients underwent a comprehensive medical check and were screened for peripheral neuropathy. Twenty-one patients were classified as insulin-treated and 26 as non-insulin-treated. For the diabetic patients, the mean (ñ SD): Age = 53.71 ñ 15.22 years, duration of diabetes mellitus = 12.96 ñ 7.97 years, B.M.I. = 30.00 ñ 10.00, blood pressue = 162.58 ñ 33.91/91.78 ñ 11.65 mm Hg; HbA1 = 13.99 ñ 4.83 percent. Only 2 (4.35) of the patients smoked or drank alcohol. A sex and age-matched non-diabetic control group consisting of 30 subjects were also studied. Venous blood was analysed for plasma fibrinogen concentration (PFC), packed-cell volume (PCV), haemoglobin concentration (HB) and glycosylated haemoglobin (HbA1) levels. The prevalence of peripheral neuropathy in the diabetic patients was 73.87 percent. PFC was significantly (p < 0.001) elevated in diabetic group, 5.06 ñ 1.26 g/l, compared with non diabetic groups, 3.19 ñ 0.65 g/l. However there was no significant difference in PFC betwen diabetics with (4.19 ñ 1.36 g/l) and without (5.14 ñ 1.14 g/l) neuropathy. Both PCV and Hb values were significantly less (p<0.05) in diabetics than in non-diabetics. Neither PCV nor Hb showed any significant variation between deabetics with and without neuropathy (AU)