RESUMO
El cuidado humanitario es un acto del ser, susceptible de evolucionar y conformar una unidad de cuidado a la salud con calidad para todos y requiere también de cuidado para no perder su valor de sentido positivo. Conciliar teoría y práctica no es simple, sino complejo. En este artículo se propone atender la relación Agente de SaludPaciente por ser universal y congruente con el cambio. El enfoque epistemológico puntualiza lo positivo, lo acumulado en la historia no puede desaparecer del presente. La respuesta es integración, hacer coincidir las ciencias formales, con las sociales, humanas y la tecnología. El apoyo cultural es vital, la educación es sólo parte y convoca a construir el nuevo paradigma; al invocarlo se superan las acciones ineficaces. El acto preventivo es a todos los niveles, sea del hospital, la escuela, la comunidad el hogar y la comunidad entera. La Enfermería del futuro, con su desarrollo teórico, contribuye al cambio, del cuidado reduccionista al integral y humanitario. Se propone reforzar la atención al desempeño del Agente de Salud y orientarlo con la disposición Humanitaria. El tema profundiza en el conocimiento del cuidado y le concierne a todo profesional de la salud.
The humanitarian care is an act, the being who may evolve and transformed into a quality unit for everybody's health care. Requires attention, good care, and not to lose the sense of positive value. Must reconcile theory and practice which is not so simple, it is rather complex. We propose to address the Relationship of Health Agent - Patient to a universal approach consistent with the changing nature. The epistemological approach points out the positive sense. The history accumulated knowledge cannot fail at the present time. The answer is integration, to combine formal sciences with social and human, as well as technology. The cultural support is vital for education and is part of it, calls for the build the new paradigm. To invoke it is sufficient to avoid ineffectiveness. The preventive act is at all levels, whether in hospital, school, community, home and the entire community. The future nursing, with the care models, should contribute to shift from the reductionist care to the humanitarian care. Let us reinforce the Health Agent performance and guide it towards a Humanitarian Care. The issue analyzes the care knowledge and is of every health server concern.
Assuntos
Humanos , Masculino , Feminino , História do Século XX , Conhecimento , Cuidados de Enfermagem , Filosofia em EnfermagemRESUMO
In the XVIII century, the English naturalist Stephen Hales started to apply blood sphygmomanometry in animals. Direct recording of the blood pressure was first applied, in the XIX century, by AE Chauveau and JLM Poiseuille. However, it was not until 1856 that it was possible to perform a direct determination of blood pressure in humans by means of a device designed by Faivre. The first sphygmomanometer appeared at the end of the XIX century. The physician Samuel K. von Basch, native of Prague and who lived a few years in Mexico, fabricated successively three models of sphygmomanometers. The first (1881), with a mercury column, proved to be the most practical and useful. This instrument inspired the sphygmomanometer of the Italian physician Scipione Riva-Rocci who presented it in 1896. His sphygmomanometer, supported on the Vierordt principle, could measure manometrically the force needed to stop the pulse wave. Thanks to the research of Russian physician N. Korotkoff, the auscultatory method was added to sphygmomanometry. During the XX century other instruments to measure blood pressure were fabricated: the Pachon's and Plesch's oscillometers, as well as the aneroid manometer. On the other side, the use of direct tensional recordings has subsisted which has allowed to document the wide oscillations of arterial pressure levels during the day. Anyway, the sphygmomanometer with a mercury column has persisted until the present and will still be used for a long time. A new evolving methodology is the continuous ambulatory sphygmomanometry.
Assuntos
Humanos , Animais , História do Século XVIII , História do Século XIX , História do Século XX , Esfigmomanômetros , Conhecimento , Retrato , Determinação da Pressão Arterial/históriaRESUMO
From january 1980 to december 1992 a total of 400 valvulopathies were subjected to conservative mitral procedures: 364 had rheumatic heart disease, 33 were congenital abnormalities and 3 probably myxomatous. Functional class and the cardiomegaly, were in grade III and IV in most cases. Different procedures were done; the most common one was commisurotomy, also subvalvular apparatus opening, annuloplasty ring and a newly designed procedure called "Tension Stitch". The results were satisfactory, with a reoperation rate of 9.2%, mostly caused by fibrosis which in turn caused dysfunction. A second cause were technical problems. The mortality rate was 2%, and was not caused by the procedure itself but because of bad clinical status of the patients. The follow up period was 13 years and showed an actuarial survival curve of 98%, with 90.8% free of reoperation and a very good post-op quality of life. We present this analysis in a effort to bring this procedure to the attention of cardiac surgeons, considering it as an alternative to prosthesis placement.
Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Procedimentos de Cirurgia Plástica , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Fibrose/etiologia , Fibrose/patologia , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/patologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Procedimentos de Cirurgia Plástica/mortalidade , Reoperação , Espanha/epidemiologia , Análise de SobrevidaRESUMO
To evaluate the information about prevalence of hypertension at a national level, several articles published either within or outside Mexico from 1933 to 1995 were reviewed. Variables about criteria and methodology were considered: the BP readings, method used, cutting points to define hypertension, year for screen. There were 30 papers out of 7 states, 16 reporting the Federal District of Mexico, 3 from Jalisco, 3 from Yucatán and 2 from Tamaulipas, there was only one referring to the State of Mexico, one to Veracruz, one to Michoacán and another referring to Mexicans in USA; as whole population there were two, one by the Instituto Mexicano del Seguro Social and another by Secretaría de Salud. A wide variation in prevalence was found (0.47 to 30.9%) mainly attributed to different sampling, measurements and reporting methodology. Few information was disclosed regarding female and elderly populations. The trend is slightly increasing, as expected accordingly to other information sources, but the problem might actually be masked by bias interference. Most of the studies performed have contributed so far to explore the gross prevalence, but may not reach scientific evidence to base evaluations of preventive interventions. The problem may not just be happening in this country. Variability may be partially controlled following the international recommendations to record arterial blood pressure, but still, there is a lack of recommendations to uniform epidemiological reports. Otherwise the values of hypertension prevalence may not be useful for hypertension surveillance.
Assuntos
Hipertensão/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Morbidade/tendências , PrevalênciaRESUMO
An electrocardiographic recording method with an associated reading guide, designed for epidemiological studies on Chagas' disease, was tested to assess its diagnostic reproducibility. Six cardiologists from five countries each read 100 electrocardiographic (ECG) tracings, including 30 from chronic chagasic patients, then reread them after an interval of 6 months. The readings were blind, with the tracings numbered randomly for the first reading and renumbered randomly for the second reading. The physicians, all experienced in interpreting ECGs from chagasic patients, followed printed instructions for reading the tracings. Reproducibility of the readings was evaluated using the kappa (kappa) index for concordance. The results showed a high degree of interobserver concordance with respect to the diagnosis of normal vs. abnormal tracings (kappa = 0.66; SE 0.02). While the interpretations of some categories of ECG abnormalities were highly reproducible, others, especially those having a low prevalence, showed lower levels of concordance. Intraobserver concordance was uniformly higher than interobserver concordance. The findings of this study justify the use by specialists of the recording of readings method proposed for epidemiological studies on Chagas' disease, but warrant caution in the interpretation of some categories of electrocardiographic alterations.
Assuntos
Doença de Chagas/diagnóstico , Eletrocardiografia , Argentina/epidemiologia , Doença de Chagas/epidemiologia , Métodos Epidemiológicos , Estudos de Avaliação como Assunto , HumanosRESUMO
This paper is about the effort to measure the assistance load at the first level of attention given by arterial hypertension and care risk factors. It is been worked as a demonstration project to initiate activities within the setting of a Health Center. The risk factors are explored from the proportions of patients with the problems of obesity, smoking, hyperlipidemia, diabetes mellitus and alcoholism. The information was obtained from 395 consecutive cases out of 1100 persons who came to the center in a month period. They were 325 women (82.2%) and 70 men (17.2%) with a range of 18 to 85 years, average 40 +/- 17 and a median of 36. Obesity was encountered in 35.7% in men and 48.8% in women. Diabetes was found in 9.1% both sexes. Hypercholesterolemia > 200 mg/dl in 30.4% and > 240 mg/dl in 19.6%. Alcohol abuse was encountered in 14%, 9.2% in women and 37.7% in men. Smoking was present in 22.3% of them, 16.3% in women and 50% in men. High blood pressure > 140/90 mm Hg or hypertension history was present in 21% of the cases. Controlled cases were 6.6%. In the whole group 34% showed at least one risk factor, 57% showed two factors and 66% showed three factors. Therefore, the best estimate of assistance load, on the fight of risk factors associated to hypertension should not consider less than 70% among the regular subjects coming to this health center.
Assuntos
Doença das Coronárias/epidemiologia , Hipertensão/epidemiologia , Atenção Primária à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco , Distribuição por SexoRESUMO
The main aim was to assess the role of anticoagulant therapy (AT) in reducing the mortality for patients with acute myocardial infarction (AMI). A pair-matched case-control study was designed according to three confounding factors: gender, age (+/- 5 years), and hospitalization date (+/- 13 months). Cases were defined as patients with AMI who died during hospitalization and controls were those patients with AMI who survived. Excluded from the study were patients with strong indications or contraindications for use of AT, and also those with early death (less than 12 hr). The study undertaken at the National Institute of Cardiology "Ignacio Chávez" of Mexico City and all necessary information was obtained from clinical charts of patients discharged between the period from January 1, 1975 to December 31, 1985. Complete information was accomplished for 212 pairs of cases and controls. A protective odds ratio (favoring use of AT) = 12.1 (p less than 0.0001, 95% CI 4.2-34.9) was obtained by means of a multiple logistic regression analysis by conditional method. Other variables that entered into the logistic model were: antithrombotic therapy, severity measured by Killip scale and by Norris index. Such findings support the favorable therapeutic role of AT in patients with AMI.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estatística como AssuntoRESUMO
Four groups from a urban population of Morelia were inquired, to determine frequency of high blood pressure and provide basic information of arterial hypertension in relation with other variables; 2638 persons were checked. Age ranged from 10 to 90 years, (771 men, 1867 women). Age, sex, weight and height were also measured. Evaluations were performed in the morning with mercury sphygmomanometer registering first and fifth korotkoff's sounds in orthostatic position with a second selective evaluation in sitting position. Availability of medical services and knowledge about presence of arterial hypertension were also evaluated. Blood pressure and prevalence of hypertension had similar behavior with regard to age: pressure recordings were higher in men before 40 years. After this age were higher in women. In general, 14% had high blood pressure, in the second evaluation this value dropped to 7%. For 11% of the studied population, high blood pressure had been previously recorded 7 out of 10 cases of hypertension did not have any control. Three of them had not information about this illness. We found a positive correlation between weight and blood pressure (p less than 0.001) specially among women.
Assuntos
Pressão Sanguínea/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , México , Pessoa de Meia-Idade , Ocupações , Valores de Referência , População UrbanaRESUMO
In order to investigate the frequency of corneal micro-deposits of amiodarone and its relationship to age, sex, dose and treatment duration, we studied one-hundred-fifty consecutive patients from 1982 to 1986. The average age was 33.8 +/- 17.5 years for eighty woman and seventy men. The mean weekly dose was of 1.1 +/- 0.3 g and the duration was 23.7 +/- 15.3 months. A complete eye examination was performed in all cases. The corneal micro-deposits were classified in three levels according to their density. In one-hundred-fourteen cases there were corneal micro-deposits; sixty-nine had grade I, thirty grade II and fifteen grade III. None had visual disturbances. There was only a direct statistical correlation between age and micro-deposit levels. Nine cases had also deposits of pigment in the lens. Two cases presented atypical keratopathy which by their involution after withdrawal of the drug was considered to be amiodarone-related. Fifteen cases presented chronic blepharitis, and ten, chronic non-secreting conjunctivitis. Therefore, age is a determinant factor for corneal accumulation of amiodarone micro-deposits.
Assuntos
Amiodarona/efeitos adversos , Doenças da Córnea/induzido quimicamente , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
In carrying out blood pressure epidemiologic studies there may be different factors that can affect internal and external validity and thus eliminate the inferential process. As part of the Hypertension and Risk Factors Associated Study conducted in March 1987 in Cuajimalpa de Morelos, Mexico City, 23 nursing students were standardized on the blood pressure auscultatory method using a sound picture and measuring intraobserver and interobserver agreement through intraclass correlation coefficient. Even though initial standardization sessions showed difficulties in the use of instruments and in the reading of blood pressure levels, final K (kappa) values measuring interobserver agreement increased from 0.25 to 0.86. Omega values measuring intraobserver agreement fluctuated between 0.86 and 0.98. This epidemiologic technique is proposed in order to improve internal and external validity of blood pressure studies.
Assuntos
Pressão Sanguínea , Erros de Diagnóstico , Hipertensão/diagnóstico , Reprodutibilidade dos Testes , Determinação da Pressão Arterial/métodos , Humanos , Hipertensão/epidemiologia , Estudantes de EnfermagemRESUMO
There are few studies on the behavior of the diastolic blood pressure during the stress test. The purpose of this report is to present a simple, noninvasive technique of measuring the mean diastolic arterial blood pressure at rest, during maximal exercise testing and in the first minute of recovery (X delta DAP). We studied 132 patients with exercise testing (E/T) and coronariography (C). Of these, 116 had coronary artery disease and 16 did not. The following data were analyzed: Age (A) X delta DAP, X2, p value, sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-). As we analyzed our patients with coronary arterial disease, we found that in 75% of the cases, the X delta DAP increased more than 15 mmHg, immediately after maximal effort, and 86% of these cases had poor myocardial contratility by angiocardiogram. We conclude that the increase of X delta DAP has a significant value in a ischemic heart disease.
Assuntos
Pressão Sanguínea , Doença das Coronárias/diagnóstico , Teste de Esforço , Angiografia Coronária , Doença das Coronárias/fisiopatologia , Diástole , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contração MiocárdicaRESUMO
This paper presents a model of care of the patient with the problem of systemic arterial hypertension, from the point of view of the organization of community service. The development of such a service should be closely linked with the existing community health services, specially those dealing with preventive medicine, but also with other resources and their particular needs. The paper gives, general recomendations considering the main needs brought by arterial hypertension as a pathologic process. The organization should be integrated by a multidisciplinary group and pointed out their objectives and goals. The task program should be made accordingly to the peculiar conditions of the community. Such type of community service has worked years ago in developed countries. Since the problem of hypertension in our environment is already a public health problem, it is becomming necessary to achive some experience in this type of organization, as well as having preliminary results with the community response to this service.
Assuntos
Serviços de Saúde Comunitária/organização & administração , Hipertensão/prevenção & controle , Educação Médica , Humanos , MéxicoRESUMO
It scarcely has a glimpse about the knowledge of aterosclerosis nature. About preventive recommendations, it has not yet surpassed hypothetic level, but problem is in force and requires to prove hypothetic and theoretical models that have been proposed. Everything that has been said as preventive recommendations has arisen all kind of opinions that constitute the existent controversy. Discussion is composed by the diametrically adverse points of view, in spite of that they are refered to the same data. Positive aspect that can remain is to centralize the knowledge and to comprehend best the problem nature. Controversy is a part of the collective thinking process about the theme. Obviously no one researcher has the complete solution, neither it is a lonely person work. There are exposed at the work some details of the subjacent process implicit into the term of risk factors. In order to comprehend the controversy, it is necessary to take on account the process that has been followed for the concepts formation, by no one manner it can be taken with frivolity and less to under-value it. Most part of researches on the subject agree that infancy and youthfulness are the best ages to make intervene primary prevention. There are revised these concept's bases and it is concluded that it is necessary at our ambient to acquire own experience about the theme, but we have to be very cautious at the best resources' utilization that are to our disposition.
Assuntos
Arteriosclerose/prevenção & controle , Fatores Etários , HumanosAssuntos
Doenças Cardiovasculares/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Doença das Coronárias/mortalidade , Feminino , Humanos , Hipertensão/mortalidade , Lactente , Masculino , México , Pessoa de Meia-Idade , Cardiopatia Reumática/mortalidade , Fatores Sexuais , Organização Mundial da SaúdeRESUMO
The present article summarises statistical information about the problem of hypertension in this country making reference to international and national epidemiological works, with the purpose of evaluating the problem in community. Includes information about the clino-pathologic experience acheived at the National Institute of Cardiology of Mexico. The data is analyzed and commented from the point of view of how worth might be to study hypertension in Mexico.
Assuntos
Hipertensão , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Feminino , História da Medicina , Humanos , Hipertensão/epidemiologia , Hipertensão/história , Masculino , México , Pessoa de Meia-Idade , Fatores Sexuais , Organização Mundial da SaúdeRESUMO
Spironolactone is a diuretic, selective aldosterone, antagonist with its own antihypertensive action which prevents body loss of potassium. Its clinical use has been documented on the treatment of essential arterial hypertension; however, there does not seem to be enough information to form a solid chemical criterion. This work is a clinical evaluation of the antihypertensive effect of the drug using double-blind technic with 41 patients with essential arterial hypertension, all external patients from the Instituto de Cardiología. They were divided in two groups, selected at random, to be able to observe their tensional range with spironolactone every two weeks, during 16 weeks; and using a placebo for the next 16 weeks. On group following this order; and the other one viceversa. After 32 weeks, the results observed show the effect of placebo, as well as spironolactone on arterial pressure and the statistic comparison, states the real antihypertensive effect of the drug on this group of patients. Every day doses were from 300 to 450 mg., and with it there was a rise in seric potassium of an average of 1 mEq/l. The authors suggest that this drug is useful in cases of essential hypertension although its pathway isn't deeply known. Apparently, the antihypertensive effect of spironolactone is not solely on patients with hypertension due to primary aldosteronism. The intervention on various hipertensinogenous factors in relation to its effect are discussed.