In spite of the economic difficulties, very important efforts have been made to treat ESRD patients and gross mortality statistics in some countries are similar to those reported by other regional registries.
ResumoObjetivo: a informática hoje participa em vários aspectos de nossa vida cotidiana. Os autores, através deste artigo de revisão, analisam e discutem sua inserção nos consultórios médicos assistenciais e/ou de ensino. Fontes de dados:foram utilizadas informações obtidas através de revisão bibliográfica, não sistemática, abrangendo artigos, normas oficiais, capítulos de livros e anais, realizada, também, por busca direta e de bancos eletrônicos nas bases de dados Medline e Lilacs.Síntese dos dados: o artigo foi estruturado em tópicos, apresentando, inicialmente, uma discussão sobre o prontuário eletrônico, sua história, funções, custos e benefícios, aspectos éticos e legais e suas vantagens e desvantagens. Avalia-se, também, os sistemas de apoio à decisão em medicina frente à quantidade enorme de informações que surgem, a cada ano, na área da saúde. Foi analisado o impacto do uso da Internet na universalização e na democratização do conhecimento e avaliada a telemedicina, que cria novos desafios à prática médica, bem como levanta aspectos éticos importantes como os da "consulta virtual" e, finalizando, descreve-se uma experiência prática de modernização de um ambulatório de ensino em Pediatria, com a introdução das ferramentas de informática e telecomunicação.Conclusões: a área de informática médica hoje dispõe de ferramentas e instrumentos que podem apoiar a organização administrativa da consulta médica, a captura, o armazenamento e o processamento das informações do paciente, a geração do diagnós-tico, a orientação terapêutica e o acesso às informações, visando a melhora do conhecimento médico e a disponibilidade deste conhecimento onde e quando ele for necessário, para uma adequada tomada da decisão.J Pediatr (Rio J) 2003;79(Supl.1):S3-S12: sistemas computadorizados de registros médicos, aplicação de informática médica. AbstractObjective: currently, information technology is part of several aspects of our daily life. The objective of this paper is to analyze and discuss the use of information technology in both medical education and/or medical practice. Sources of data:information was gathered through nonsystematic bibliographic review, including articles, official regulations, book chapters and annals. Direct search and search of electronic databanks in Medline and Lilacs databases were also performed. Summary of the findings: this paper was structured in topics.First, there is a discussion on the electronic medical record. The following aspects are presented: history, functions, costs, benefits, ethical and legal issues, and positive and negative characteristics. Medical decision-support systems are also evaluated in view of the huge amount of information produced every year regarding healthcare. The impact of the Internet on the production and diffusion of knowledge is also analyzed. Telemedicine is assessed, since it presents new challenges to medical practice, and raises important ethical issues such as "virtual medical consultation". Finally, a practical experience of modernization of a pediatric out...
SUMMARY A study of the prevalence of hypertension was undertaken among workers in 10 subsectors of the economy in Sao Paulo, a major urban-industrial area of Brazil. Included in the study were 5500 subjects 15-65 years of age, employed in 57 randomly selected firms. Hypertension rates (DBP ^ 90 mm Hg) were higher among males up to 44 years of age. There was a decreasing gradient from mild to moderate and severe forms in all groups. Severity tended to increase with age in all groups. Black males showed higher rates than whites (29.2% vs 16.7%, p < 0.05), the excess being partially accounted for by moderate and severe forms (40% vs 20%). Subjects who overworked showed a trend toward higher hypertension rates. Higher rates in four subsectors (metallurgy, finance, transport, and journalism), aside from the distribution of known risk factors and job selection, may reflect a variety of work-related stressors. 1 " 4 In most developed countries hypertension and associated diseases have been acknowledged as major public health concerns. In underdeveloped countries, however, the issue is much less clear. For a long time, health and disease patterns in underdeveloped countries have been considered to be altogether different from those prevailing in developed societies. Evidence has accumulated in recent years, however, that shows at least in some areas of the so-called "third world" a mixed pattern of disease characterized by disorders considered more prevalent among urban industrial populations than in "traditional" societies.'The transition from traditional to industrial societies is a complex process involving profound social and economic changes that, in turn influence health and disease patterns of the members of society. In urban industrial societies, entry into the job market, qualitative aspects of work (time pressured, hierarchically controlled, competitive) as well as the quantity of work, have been argued to be critical events regarding hypertension. 6 The objectives of the present study were to: 1) estimate the prevalence of hypertension among workers in selected economic activities of a highly urbanized area of the third world, the Metropolitan area of Sao Paulo; 2) provide descriptive data on the epidemiology of hypertension in that population; and 3) set up baseline data for testing hypotheses relating to work-related factors associated with hypertension. MethodologySubjects from 10 subsectors of the economy were studied. In the secondary sector (industry), the following subsectors were selected: textile, metallurgy, housing, and automobile construction. In the tertiary sector (trade and services) the selected subsectors were the following: trade (wholesale, retail), insurance, loans and finance, transportation, advertising and journalism, teaching, liberal arts professionals.In Brazil, a federal law, known as the "Law of the Two Thirds," makes it mandatory for each firm to report annually to the Ministry of Labour the number
In the evaluation of exercise intolerance of patients with respiratory diseases the American Medical Association (AMA) and the American Thoracic Society (ATS) have proposed similar classifications for rating aerobic impairment using maximum oxygen uptake (VO 2 max) normalized for total body weight (ml min -1 kg -1 ). However, subjects with the same VO 2 max weight-corrected values may have considerably different losses of aerobic performance (VO 2 max expressed as % predicted). We have proposed a new, specific method for rating loss of aerobic capacity (VO 2 max, % predicted) and we have compared the two classifications in a prospective study involving 75 silicotic claimants. Logistic regression analysis showed that the disagreement between rating systems (higher dysfunction by the AMA/ATS classification) was associated with age >50 years (P<0.005) and overweight (P = 0.04). Interestingly, clinical (dyspnea score) and spirometric (FEV 1 ) normality were only associated with the VO 2 max, % predicted, normal values (P<0.01); therefore, in older and obese subjects the AMA/ATS classification tended to overestimate the aerobic dysfunction. We conclude that in the evaluation of aerobic impairment in patients with respiratory diseases, the loss of aerobic capacity (VO 2 max, % predicted) should be used instead of the traditional method (remaining aerobic ability, VO 2 max, in ml min -1 kg -1 ).
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