Prevenção em saúde na prática médica:: da primária à quaternária

Na Grécia antiga, berço da civilização ocidental, a prática médica baseava-se na promoção de estilos de vida saudáveis, particularmente da “dietética”, e considerava-se que os estados patológicos resultavam do desequilíbrio entre as causas das doenças e das forças curativas da natureza. A partir de então, com os avanços no campo da microbiologia, a possibilidade de interferir no curso das doenças transmissíveis consolidaram ao longo dos anos a doença como principal óbice médico, não o doente. Foi somente entre 1920 e 1950, nos EUA e no Canadá, que surgiu a Medicina Preventiva como reação à Medicina Curativa. PropoÌ‚s-se a transformação do ensino médico de modo que a prática deste profissional tivesse uma nova atitude nas relações com os órgãos de atenção à saúde. Foi o nascimento da epidemiologia dos fatores de risco, que usava a estatística para estabelecer relação de causalidade com as patologias. A medicina preventiva, uma vez objetivando melhorar - por vezes a qualquer custo - a saúde dos indivíduos, tem contribuído com a “epidemia de risco” (risk epidemic) e, consequentemente, com cascatas clínicas de cuidados excessivos em saúde, incluindo a exagerada medicalização e a aumentos da morbimortalidade das populações. Objetivos: revisão acerca dos conceitos de prevenção, da primária à quaternária, na literatura em saúde em língua portuguesa, suas motivações, definições, importância, abrangência e consequências. Métodos: revisão expositiva da produção bibliográfica em português acerca dos unitermos “conceito de prevenção em saúde”, “conceito de prevenção primária”, “conceito de prevenção secundária”, “conceito de prevenção terciária” e “conceito de prevenção quaternária” entre 1990 e 2013, na BIREME (Biblioteca Virtual da Saúde) estando nela compreendidas a LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e SCIELO (Scientific Eletronic Library online-Brasil) e no Google Acadêmico. Conclusão: O fundamento da proposta preventivista pretendeu que o atuar médico fosse imbuído de novas atitudes, de uma relação mais próxima às comunidades, aos serviços de saúde, à promoção e a proteção da saúde do indivíduo e de sua família. Nos países desenvolvidos (mas também, provavelmente, naqueles em desenvolvimento), haverá no século 21 as populações mais saudáveis e longevas da história da humanidade, entretanto insatisfeitas pela contradição entre a oferta de atividades sanitárias e as demandas por saúde. As intervenções sanitárias “quase febris” causarão elevada morbimortalidade, no entanto com benefícios sanitários mínimos. &nbsp

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

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation