No abstract
O artigo pretende analisar à luz do princípio da dignidade da pessoa humana, autonomia e do Estatuto do idoso a adoção da desospitalização, na rede privada, em pacientes idosos crônicos com indicação médica para hospital de transição ou home care, como medida de humanização e acolhimento desse enfermo. Por outro lado, o trabalho abordará acerca dos benefícios e os malefícios na internação desse grupo de pessoas. Além disso, outro ponto que será brevemente apontado toca aos impasses encontrados quando essa proposta é levada à família, na qual há recusa injustificada de adesão da indicação médica, sob alegação da ausência de autonomia do idoso em razão da idade avançada. Tal argumento esbarra no princípio da autonomia e na tutela jurídica conferida aos anciãos. Outro fator que revela-se presente na negativa do familiar acerca da indicação de desospitalização, envolve a natureza contratual que está relacionada ao custeio da manutenção do paciente na UTI e a participação do familiar na recepção do paciente. Por fim, a pesquisa apontará a legislação vigente que respalda a desospitalização na rede privada, incluindo, possíveis abandonos de pacientes de longa permanência nos hospitais e os benefícios esperados com a prática da desospitalização como ferramenta da humanização do cuidado em saúde.
RESUMOO artigo pretende analisar à luz do princípio da dignidade da pessoa humana, autonomia e do Estatuto do idoso a adoção da desospitalização, na rede privada, em pacientes idosos crônicos com indicação médica para hospital de transição ou home care, como medida de humanização e acolhimento desse enfermo. Por outro lado, o trabalho abordará acerca dos benefícios e os malefícios na internação desse grupo de pessoas. Além disso, outro ponto que será brevemente apontado toca aos impasses encontrados quando essa proposta é levada à família, na qual há recusa injustificada de adesão da indicação médica, sob alegação da ausência de autonomia do idoso em razão da idade avançada. Tal argumento
Background The association of cardiovascular (CV) diseases and their risk factors with socioeconomic status has been well described, but its influence is often underestimated in epidemiological studies in Brazil. Objective To evaluate the relationship between the main CV risk factors and socioeconomic indicators in a population of adults registered in a Family Health Care (FHC) unit in a great urban center - Rio de Janeiro, Brazil. Methods Cross-sectional population study that included adults aged between 20 and 50 years living in the area covered by the FHC unit in Rio de Janeiro. Demographic data (gender and age), socioeconomic data (education level, profession, employment), CV risk factors (smoking, sedentary lifestyle, obesity, hypertension, diabetes, dyslipidemia) were recorded. The metabolic profile is evaluated through laboratory tests. Those who studied up to high school were considered poorly educated. Results 604 individuals were enrolled [39% male, mean age: 38.8 ± 8,9 years] The median of schooling was 12 years. 288 individuals had high schooling, 44.5% were male. A total of 130 individuals did not study or work. Women with low education had a higher risk of smoking, obesity and hypertension with no difference regarding labor or study activities. Otherwise, men with low education had a higher risk of sedentary lifestyle and hypertension. Among men, not working or studying increased the risk of smoking and hypertension. Conclusions We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Women are more affected by low schooling, while men are more affected by their working occupation. The study suggests that socioeconomic factors influence the CV risk, affecting men and women differently, pointing to the need for more comprehensive public health policies that effectively reverse this situation. Key messages We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Socioeconomic factors influence cardiovascular risk differently according to gender.
Preservation of the facial nerve (FN) and vestibulocochlear nerve is essential to keep the quality of life of patients during surgery for the treatment of vestibular schwannoma (VS). One of the great challenges for neurosurgeons is to make a good surgical planning, to identify a tumor location, as well as its relationship with anatomical and nervous structures to facilitate the surgeon’s work and avoid inappropriate conducts. Currently, many studies have reported the effectiveness of the diffusion tensor and tractography imaging (DTI) technique. We conducted a systematic review of studies that report the use of this technique.The PubMed and Embase databases were used to search, according to pre-established inclusion and exclusion criteria. Twelve articles were selected for this study, with a total of 255 patients who underwent a DTI preoperatively. The location and path of the facial nerve were verified intraoperatively, and 226 (89%) correlated the DTI result with the intraoperative finding, which met our inclusion criteria. The results of this research pointed to the excellent result of the DTI to predict the location of the FN in the preoperative period, allowing greater surgical planning and improvement in the outcome of the facial nerve function.
Background Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease. Objective To evaluate the prevalence and CV risk factors associated with MHO in a young population assisted by a Family Health Care unit in a large urban center in Brazil. Methods A cross-sectional population study for CV risk assessment in adults aged 20–50 years old from a FHC unit in Brazil. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a BMI ≥30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥200 mg/dL, HDL<40 mg/dL (men) and 50 mg/dL (women), triglycerides>150 mg/dL and increased waist circumference. Results A total of 632 individuals were evaluated (60% female; mean age 37±9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO. Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p=0.03), hypertension (44% vs 19%, p<0.001), dyslipidemia (50% vs 36%, p=0.002) and diabetes (7% vs 2%, p=0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p=0.02) and abdominal circumference (102 vs 110 cm, p=0.03), with lower diastolic BP. Conclusion MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention FUNDunding Acknowledgement Type of funding sources: None.
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