Experience in the combined utilization of the international classifications to describe health information

Dados de morbidade são comunicados por registro padronizado, conforme orientado na CID. Entretanto,potencialidades e deficiências não são totalmente descritas nesta classificação, sendo necessária a CIF, ainda pouco utilizada. O artigo apresenta experiência no uso combinado das classificações internacionais com objetivo de descrever e analisar registros em saúde para além do uso isolado da CID. Uma amostragem probabilística em estudo observacional com delineamento transversal foi aplicada para sujeitos em tratamento fisioterapêutico. O número de ocorrências codificadas foi usado para tabular a distribuição de frequência por capítulos e para calcular razões que indicariam relações entre doenças e incapacidades. Cerca de cinco ocorrências por sujeito foram registradas dentre as 70 ocorrências, em códigos distribuídos por oito dos 22 capítulos da CID. Na CIF, um total de 116 ocorrências por sujeito das 1.739 ocorrências distribuídas entre os capítulos por domínios da CIF foram registradas, perfazendo, aproximadamente, 25 ocorrências para cada ocorrência codificada pela CID. Conclui-se que a CIF ampliou em cinco vezes os aspectos relacionados à saúde, completando com maior detalhamento a descrição feita no atual sistema brasileiro de informação em saúde. _______________________________________________________________________________ ABSTRACTMorbidity data are communicated by standardized record as guided in the ICD. However, functioning and disabilities are not fully described in this classification, being necessary the creation of the ICF, yet little used. The paper presents experience in the combined use of International Classifications whose goal is to describe and analyze health record beyond the separate use of the ICD. Sampling procedures were applied to subjects during physical therapeutic treatment in a cross-sectional observational study. The number of events coded was used to tabulate the frequency distribution of ratings by chapter and to calculate the rate that would indicate links between diseases and disabilities. About 5 events per subject were recorded among the 70 events coded into codes distributed by 8 of the 22 chapters of the ICD. By the same analysis in the ICF, about 116events per subject of the 1739 events distributed among the domains per chapters of ICF were registered, accounting for approximately 25 events for each event coded by ICD. It is concluded that the ICF has expanded5 times the aspects related to health by supplementing with a more detailed description given in the current Brazilian system of health information

Morfologia e mecânica pulmonares no curso da infecção experimental induzida pelo Paracoccidioides brasiliensis em camundongos

Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, 2007.No presente trabalho, camundongos BALB/c foram infectados por via endovenosa com leveduras viáveis do P. brasiliensis e foram analisadas a morfologia e a mecânica pulmonares no curso da infecção experimental causada pelo fungo, em diferentes ocasiões (15, 30, 45 e 60 dias após a infecção). Os animais foram sedados, anestesiados e ventilados mecanicamente e foram mensuradas as elastâncias estática (Est), dinâmica (Edyn) e a diferença entre elas ( E), bem como as pressões resistivas ( P1), viscoelásticas/inomogêneas ( P2) e a variação total das pressões ( Ptot) dos pulmões, obtidas pelo método de oclusão ao final da inspiração. Foram coletadas amostras de sangue arterial para análise através da gasometria arterial dos parâmetros: potencial hidrogeniônico (pH), pressão parcial do oxigênio arterial (PaO2), pressão parcial do gás carbônico arterial (PaCO2), percentagem de hemoglobina saturada pelo oxigênio (SaO2), excesso de base (BE) e íon bicarbonato (HCO3). Após as coletas os animais foram sacrificados e os pulmões foram retirados e enviados para a análise histopatológica e para a dosagem de quimiocinas. A análise histopatológica revelou resposta inflamatória progressiva, de padrão granulomatoso, com aumento na quantidade de fungos e formação de tecido fibroso, graduais ao desenvolvimento da infecção, comprometendo o tecido pulmonar. A dosagem de quimiocinas detectou a presença de MIP-1?, RANTES, MIG e KC, com aumento significativo diretamente proporcional ao tempo de infecção. A presença de acidose mista seguida de acidose metabólica, com alterações mais acentuadas na fase aguda, foram observadas no sangue arterial. Na avaliação da mecânica respiratória evidenciou-se aumento das elastâncias estática e dinâmica, da pressão viscoelástica/inomogênea e da variação total das pressões pulmonares. Os resultados indicam que o comprometimento pulmonar é progressivo, com o estabelecimento de fibrose tecidual, determinando um padrão pulmonar provavelmente do tipo restritivo como conseqüência da redução da distensibilidade tecidual. _________________________________________________________________________________________ ABSTRACTIn the present work, mice BALB/c were infected intravenously with variable yeast cells of P. brasiliensis and were analyzed the morphology and pulmonary mechanics in the course of the experimental infection caused by the fungus, at different occasions (15, 30, 45 and 60 days after infection).Mice were sedated, anesthetized and mechanically ventilated and static (Est) and dynamic (Edyn) elastances, their differences (~E) and resistive (~P1) and viscoelastic/inhomogeneous (~P2) pressures and the total variation of pressures (~Ptot) of the lungs, were obtained by end-inflation occlusion method. Arterial blood samples were collected for arterial blood gas analysis of the parameters: hidrogenionic potential (pH), partial pressures of oxygen (Pa02), and carbon dioxide (PaC02), oxygen saturation (Sa02), base excess (BE) and bicarbonate (HC03). After the collecting data the animais were sacrificed and the lungs were removed and sent for histopathology and for the analysis of the concentration of chemokines.Histopathology revealed progressive inflammatory response, leading to granuloma formation, with increase in the fungus counts and formation of fibrosis, gradual to the development of infection, compromising the pulmonary tissue. The dosage of chemokines detected the presence of: MIP-1 a, RANTES, MIG and KC, demonstrating significant increase Directly proportional to the time of infection. The presence of mist acidosis followed by metabolic acidosis, indicating alterations more pronounced in the acute phase, were observed in the arterial blood. In the avaliation of pulmonary mechanics showed increases in static and dynamic elastances and increases in viscoelastic/inhomogeneous pressure and in the total variation of pressures of the lungs. Results indicate that the lung injury is progressive, with the establishment of tissue fibrosis, robably determining a restrictive functional pattern as a result of lower distensibility of lung tissue

Fear of falling and associated factors in community elderly with cataracts

ABSTRACT Objective: To investigate prevalence of the fear of falling of elderly with cataracts living in the community and the associated factors with high concern with falling occurrences. Methods: A cross-sectional, analytical and observational study. It was composed by 86 elderly diagnosed with bilateral cataracts. To quantify the fear of falling among elderly, the scale Falls Efficacy Scale-International-Brasil (FES-I-BRASIL) was used. Other variables were obtained through application of a structured questionnaire. Results: Between participants, 41.9% reported low concern of falling, while 58.1% reported high concern. From those last ones, 52% fell at least once on the past 12 months and, 30% of them are recurrent fallers. The activities "to walk in slippery surfaces", "to walk in irregular surfaces" and, "to walk up and down the stairs" represented higher concern for elderly. Conclusion: Cataracts or any other visual issue predispose falls due to difficulty in overcoming obstacles present in the environment. Fear of falling is especially associated with factors acquired after the first fall episode

Sarcopenia in sedentary elderly and relation with functionality and inflammatory markers (IL-6 and IL-10)

INTRODUCTION: Sarcopenia is progressive loss of skeletal muscle mass related to aging. A sedentary lifestyle is a major factor related to the imbalance between synthesis and protein degradation, especially in the elderly. OBJECTIVE: To investigate the prevalence of sarcopenia in a group of sedentary elderly and its relationship to physical strength and inflammatory markers. METHODS: were conducted in 53 elderly collection of anthropometric data, assessment of body composition, functional test (Timed Up and Go), test of strength (grip) and collecting blood sample for evaluation of inflammatory markers. RESULTS: The prevalence of sarcopenia in the sample was 50% men and 54% among women. The average age was 71.3 years old in sarcopenia group and 66.4 years in non sarcopenia group (p = 0.015). There was no statistically significant difference between the values found for IL-6 (p = 0.70) and IL-10 (p = 0.14). CONCLUSION: There was a high prevalence of sarcopenia in sedentary elderly and muscle mass loss was associated with loss of muscle strength in men and women. There was no association with inflammatory markers IL-6 and IL-10.</p

Acupuncture Treatment in Elderly People with Sarcopenia: Effects on the Strength and Inflammatory Mediators

Introduction. Sarcopenia is defined as the progressive loss of skeletal muscle mass, associated with aging. A multidisciplinary approach has been increasingly prioritized in elderly care. A technique that has been widely used by the seniors is acupuncture. Objectives. To analyse the effects of acupuncture in muscle strength and in inflammatory markers of older people with sarcopenia. Methods. The sample was composed by 53 elderly people, aged over 60 years. Inclusion criteria were as follows: male and female seniors, sedentary and who were not under acupuncture treatment during the survey period. Assessment of body composition, handgrip strength, and functional test and IL-6, IL-10, and TNF-α cytokines analyses were performed. After verification of the physical examination, the subjects were divided into two groups (sarcopenic and nonsarcopenic). The first group was then randomized (by drawing lot) to be further divided into two subgroups: G1, composed of sarcopenic elderly people who received acupuncture intervention, and G2, composed of sarcopenic elderly people who did not receive intervention. The nonsarcopenic elderly people composed the group 3 (G3) and did not receive acupuncture intervention. ANOVA Split Plot was performed for intergroup comparison. For intragroup evaluation, ANOVA was conducted for repeated measures. For the delta values, ANCOVA was performed with the pretest as covariant. A p<0.05 significance level was adopted. Results. 26 older people concluded the collections. There was no statistically significant difference between the G1 group and the other ones regarding the assessed variables (muscle mass, muscle strength, functionality, and inflammatory markers). Conclusion. The results allow us to infer that it is possible that the conducted intervention protocol has not produced any significant effects in the studied population. UTN number: RBR-8df2h4