Effect of Chronic Ankle Sprain on Pain, Range of Motion, Proprioception, and Balance among Athletes.

Background: Ankle sprains are common among physically active individuals, especially among athletes. Majority of those who suffer ankle sprains have residual symptoms including pain, episodes of giving way, compromised proprioception and neuromuscular control, and re-injury leading to chronic ankle instability. The aim of this study was to see the effect of chronic ankle sprain on pain, range of motion, proprioception, and, static and dynamic balance among athletes. Methods: A total of 80 athletes, aged 18 to 25 years, involved in track-and-field sports were invited to participate in this study. They were divided in two groups. Athletes with history of grade 1 or 2 ankle sprain on either side requiring medical care who reported at least three episodes of ankle giving way in past 12 months were included in group A. An equal number of healthy athletes without any history of ankle sprain or injury in the lower limbs in the past one year matched by sex, age, height, weight, and limb dominance, were included in group B (control). Outcome measures: Participant's pain, range of motion, proprioception and balance (static and dynamic) was measured using visual analog scale, half circle goniometer, degree of foot position sense, single leg stance time and Y-balance test respectively. Results: Although there were no differences in the active ankle joint range of motion (p > 0.05) in comparison to the control group, athletes with chronic ankle sprain reported mild pain and statistically significant (p < 0.05) deficits in foot proprioception, static and dynamic balance. Conclusions: Deficits in foot proprioception, static and dynamic balance even one year after the ankle sprain could be the reason for limitations in the dynamic defense system of the joint that predisposes to recurrent injury and instability. It is essential to understand the normal clinical course and risk factors for athletes who sustain sprain before devising a long term comprehensive rehabilitation program that focuses on mechanical and functional insufficiencies in order to improve their functional performance and prevent the risk of recurrent sprain.

A incorporação da saúde ambiental pela atenção básica no município de Volta Redonda, Estado do Rio de Janeiro / The incorporation of environmental health for primary care in the municipality of Volta Redonda, Rio de Janeiro

O objetivo desse estudo em uma perspectiva qualitativa é o de analisar como está ocorrendo o processo de incorporação da saúde ambiental pela atenção básica, através da atuação da Estratégia de Saúde da Família no município de Volta Redonda, estado do Rio de Janeiro. A estrutura conceitual abordou os temas: Saúde ambiental e seu respectivo desenvolvimento dentro do sistema saúde brasileiro; o conceito de território e sua a aplicação prática na saúde; a Estratégia de Saúde da Família como veículo de operacionalização. A metodologia do Discurso do Sujeito Coletivo foi utilizada para a confecção do roteiro de entrevista e a tabulação dos dados, permitindo a identificação das idéias centrais e expressões-chaves presentes nos discursos dos gestores e das equipes. A análise foi pelos preceitos da Teoria das Representações Sociais. Os resultados das entrevistas apontam para uma dicotomia entre a visão dos gestores, influenciada pelas concepções teóricas contidas nas políticas públicas de saúde, e a visão da equipes, influenciada pela a estrutura organizacional do SUS. O que influencia na relação saúde e ambiente.

The objective of this study was in a qualitative perspective to analyze as theprocess of incorporation of the ambient health for the basic attention is occurring, through the performance of the Strategy of Health of the Family in the city in of Volta Redonda, state of Rio de Janeiro. The conceptual structure approached the subjects: Ambient health and its respective development inside of the Brazilian system health; the concept of territory and its practical application in the health, the Strategy of Health of the Family as operationalizes vehicle. The methodology of the Speech of the Collective Citizen was used for theconfection of the interview script and the tab of the data, having allowed theidentification of the ideas central offices and expression-keys gifts in the speeches of the managers and the teams. The analysis was for the rules of the Theory of the Social Representations. The results of the interviews point with respect to a dichotomy between the vision of the managers influenced by the contained theoretical conceptions in the publicpolitics of health, and the vision of the teams influenced by the a organizationalstructure of the SUS. What it influences in the relation health and environment.

Implementación de la Resolución 412 Una experiencia en la Ips Confamiliares / Implementation of Resolution 412: An experience of the health care provider Confamiliares

El presente artículo hace referencia a los aspectos fundamentales tenidos en cuenta para el desarrollo de las acciones de protección específica y detección temprana, y la atención de enfermedades de interés en salud pública establecidas en la Resolución 412 de diciembre de2000, en la institución prestadora de servicios de salud IPS Confamiliares de la ciudad de Manizales, y algunos de los resultados obtenidos tanto para la institución como para los usuarios que son atendidos en la misma. Se resaltan como aspectos fundamentales la voluntad política institucional, la competencia del personal, el sistema de información y el enfoque de procesos.

The present article makes reference to the fundamental aspects kept in mind for the development of the actions of specific protection and early detection and the attention of illnesses of interest in public health, settled down in the resolution 412 of December of 2000, in the IPS Confamiliares of the city of Manizales, and some of the obtained results as much for the institution as for the users that are assisted in the same one. It is stood out as fundamental aspects the institucional political will, the personnel's competition, the system of information and the focus of processes.

La promoción de la salud en el trabajo: aspectos conceptuales y de reflexión / Health promotion at the workplace: conceptual and reflection aspects

El artículo tiene el propósito de conceptuar y reflexionar sobre una de las temáticas vigentes relacionada con la promoción de la salud en los lugares de trabajo, desde los desarrollos teóricos de los procesos salud enfermedad, la categoría trabajo, pasando por la estrecha relación entre el trabajo y la salud en los contextos económicos, sociales y políticos actuales. Se destaca el papel que desempeñan las condiciones de trabajo, los estilos de vida, el compromiso directivo, mandos medios y trabajadores en la generación de actitudes y conocimientos promotores de la salud y prácticas de trabajo seguras y saludables. La naturaleza cambiante del trabajo tiene un impacto notable sobre la fuerza laboral y su salud; las nuevas tecnologías han contribuido al desarrollo económico, pero al mismo tiempo generan nuevos riesgos para la salud del trabajador, es por eso, que se reflexiona sobre esta problemática, a la vez que se hace énfasis en la promoción de la salud en el trabajo como el esfuerzo tendiente a gestar y promover procesos y toma de decisiones para que empleadores, trabajadores y demás actores incidan en el trabajo, en cuanto a la consolidación de formas de organización que produzcan comodidad, bienestar físico, social y mental, además de satisfacción laboral.

The article has the purpose of to consider and to meditate on one of the thematic ones effective related with the promotion of the health in the working places, from the theoretical developments of the processes health-illness, the category work, going by the narrow relationship between the work and the health in the current economic, social and political contexts. It stands out in the paper that they carry out the working conditions, the lifestyles, the directive commitment, controls means and workers in the generation of attitudes and knowledge promoters of the health and practical working sure and healthy. The changing nature of the work has a remarkable impact about the work force and its health; the new technologies have contributed to the economic development, but at the same time they generate new risks for the worker's health, it is for that reason that one meditates on this problem, at the same time that one makes emphasis in the promotion of the health in the work like the effort to gestate and to promote processes and taking of decisions so that employers, workers and other actors impact in the work, as for the consolidation in organization ways that you/they produce comfort, physical, social and mental well-being, besides labour satisfaction

El Autocuidado una habilidad para vivir / Self care: and ability for living

El autocuidado tiene que ver con aquellos cuidados que se proporciona la persona para tener una mejor calidad de vida, autocuidado individual, o los que son brindados en grupo, familia, o comunidad, autocuidado colectivo El autocuidado está determinado por aspectos propios de la persona y aspectos externos que no dependen de ella; estos determinantes se relacionan con los factores protectores para la salud, tanto como con los factores de riesgo, que generan, según el caso, prácticas favorables o riesgo para la salud. El personal de salud es el responsable del fomento del autocuidado en las personas, tanto con su testimonio de vida sana como con la educación, como herramienta, para que las personas puedan optar por prácticas favorables a la salud.

The self care of your health is related with those cares provided to the person to have a better quality of life, individual self care, or those that are offered in group family, comunity whit the same purpose. Self care is determined by own factors of the person and external factors that do not depend on him or her; these determinants are related to the protective factors for the health, as much as the factors of risk, that they generate according to the case, favorable practices or practices of risk for the health. The health personnel is in charge of the promotion of the self care in people, as much with its testimony of healthy life like with the education as tool, so that people can decide on favorable health practices.

A consulta de enfermagem centrada na promoção à saúde do diabético: uma abordagem psicossocial / Consultation of nursing centred in the promotion to the health of the diabetic adult: a psychosocial approach

O modelo clínico de atenção ao adulto diabético vêm demonstrando que os investimentos no controle das descompensações e nos programas educativos, apesar de melhorarem o índice de conhecimento dos doentes, pouco tem influenciado no sentido de gerar mudanças efetivas para um estilo de vida mais saudável, evidenciando um distanciamento entre os investimentos na atenção e os resultados obtidos. É nesse contexto que a atenção ao adulto diabético merece reconsiderações e novos investimentos no sentido de ampliar as bases teórico-metodológicas de projetos de intervenção aptos a promover expressões monos doentias de vida. Uma consulta de enfermagem revitalizada foi escolhida como instrumento apto a validar um modelo ampliado de atenção ao adulto diabético - o modelo psicossocial. Diante disso este estudo teve por objetivos analisar tanto a implementação da consulta de enfermagem formalizada segundo os referenciais do estudo quanto o nível de satisfação do cliente e do profissional frente ao empreendimento conjunto. Metodologicamente esta pesquisa teve um caráter exploratório-descritivo, nuima abordagem qualitativa e formulada numa perspectiva psicossocial. Foram estudados 12 adultos diabéticos em acompanhamento no ambulatório de clínica médica do Hospital Universitário da USP, durante os meses de maio a agosto de 2003, que mantinham a capacidade cognitiva preservada e que se dispuseram a participar. O instrumento utilizado foi adaptado do elaborado por Ide, Chaves (2001) -----------------------|a às peculiaridades do diabético. Como resultados obtivemos uma consulta e um atendimento reestruturados, que possibilitaram a elaboração de um diagnóstico clínico e psicossocial e um contrato terapêutico personalizado. Evidenciamos, na perspectiva psicossocial uma estrutura ensimesmada, dependente, insatisfeita e limitada, com uma vida pautada em rotinas, quase sem nenhum lazer e com uma imobilidade em lidar com essas situações. Na perspectiva clínica ) encontramos um grupo de indivíduos predispostos às complicações, com comorbidades associadas, com hábitos de vida distorcidos, com auto-cuidado limitado e com queixas polivalentes, evidenciando sofrimento e desprazer. O contrato terapêutico, tarefa mais árdua da pesquisa, buscou investir na pessoa e naquilo que para ele fizesse sentido, considerando os limites inerentes tanto à sua situação clínica, quanto a um método em validação. A consulta em questão mostrou-se, na perspectiva do cliente, mobilizadora de emoções, conceitos e ações no percurso do realinhamento de pensamentos, expressões e espaços na busca pela melhor saúde possível. No âmbito profissional a consulta mobilizou satisfação e contentamento na medida em que tornou real um modelo teórico, avançando na proposição. Assim sendo, ao término da pesquisa concluímos que fez sentido ampliar a perspectiva assistencial agregando princípios integralizadores. Assim sendo, reiteramos nossa certeza de que a proposta em questão é de notável valia, sobretudo para aqueles que ainda consideram possível qualificar a vida, promover a saúde até mesmo quando o adoecimento já se fez cronicamente presente

The clinical model of attention to the diabetic adult comes demonstrating that the investiments in the control of the descompensation and the educative programs, although to improve the index of kowledge of the sick people, it little has influenced in the direction to generate effective changes for a lifestyle more healthful, evidencing a distance among the investiments in the attention and the obtained Results. It is in this context that the attention to the diabetic adult deserves reconsiderations and new investiments aiming to increase the theoretical-methodological bases of intervention projects apt to ptomote life expressions less unhealthy. A revitalized nursing consultation was chosen as apt instrument to validate an extended model of attention to the diabetic adult - the psychosocial model. In face of that situation this study had for objectives analyseas much way the implemmentation of the legalized nursing consultation according to references of the study as the level of patient and the profesional satisfaction front to the joint entreprise. Methodologically this research had a exploratory-descriptive character, in a qualitative and formulated apporach in a psychosocial perspective. 12 diabetic adults had been studied in accompaniment in the ambulatory of medical clinic of the University Hospital of USP, from May to august of 2003, that they kept the preserved cognitive capacity and that they had been made use to participate. The used instrument was adopted from the elaborated one for IDE, CHAVES (2001) to the diabetic patient' peculiarities. As result we obtained a reorganized consultation and an attendance, taht make possible the elaboration of a clinical and psychosocial diagnosis and a personalized therapeutical contract. We evidence, in apsychosocial perspective a structure of being become absorbed in thought, dependent, unsatisfied and limited, with a life based in routines, almost without no leisure and with and immobility in dealing with these situations. In the clinical perspective we find a group of predisposed individuals to the complications, with associates other illness, distorted habits of life, an limited self-care as multipurpose complaints, evidencing suffering and displeasure. The therapeutical contract, more arduous task of the research, aimed to invest in the person and in whom it made sense to he/she, considering the inherent limits as much to his/her clinical situation as to a method in validation. The consultation in question revealed, in the perspective of the patient, mobilizing of emotions, concepts and action in the course of the realignment of thoughts, expressions and spaces in the search for the best possbile health. In the professional scope the consultation mobiled satisfaction and contentment in the measure that a theoretical model became real, advancing in the proposal. Thus, to the ending of the research we conclude that it made sense to extend the assistencial perspective adding combined principles. Therefore, we reiterate our certainty that the proposal in question is of notable valid, specially for that still they consider possible to characterize the life, to promote the health even though when the disease already became chronically present

Promoção da saúde em cuidados intensivos: atenção de enfermagem ao cliente com TVP: revisão da literatura de enfermagem / Promotion of health in intensive care: nursing intervention to client with TVP: review of nursing literature

O presente estudo, que relata uma revisão da bibliografia profissional de enfermagem, partiu da falta de conhecimento quanto à literatura existente abordando a promoção da saúde em cuidados intensivos, na atenção de enfermagem ao cliente com Trombose Venosa Profunda (TVP). Utilizou-se como metodologia a pesquisa exploratória com levantamento bibliográfico por busca manual e computadorizada de 1997 a 2002. A TVP é uma freqüente complicação dos clientes acamados, como no caso dos internados na Unidade de Tratamento Intensivo (UTI). Com início silencioso e complicações fatais, o estudo proporcionou o conhecimento da importância da atenção de enfermagem em todos os estágios da TVP, desde a profilaxia até a terapia anticoagulante. Tanto a produção brasileira, como a internacional convergem para relevância da atenção de enfermagem na promoção da saúde destes clientes, apontando cuidados profiláticos, para a TVP ou suas complicações e de sua terapêutica.

The present study, that relates a revision nursing professional bibliography, begun of the knowledge lack about the existent literature approaching the promotion of the health in intensive cares, in the nursing attention to the client with Deep Vein Thrombosis (DVT). It was used as methodology the exploratory research with bibliographical rising for manual and computerized search from 1997's to 2002's. TVP is a frequent complication of the fallen ill clients, as in the case of the interned in the Unit of Intensive Treatment (UCI). With silent beginning and fatal complications, the study provided the knowledge of the importance of the nursing attention in all the apprenticeships of DVP since the prophylaxis to the anticoagulant therapy. So much the Brazilian production, as the international converges the relevance of the nursing attention in the promotion of these clients' health, poiting preventives care, for TVP or its complications and of its therapeutics.