RESUMO
Peripheral arterial disease (PAD) increases with age and ankle-brachial index (ABI) ≤ 0.9 is a noninvasive marker of PAD. The purpose of this study was to identify risk factors related to a low ABI in the elderly using two different methods of ABI calculation (traditional and modified definition using lower instead of higher ankle pressure). A cross-sectional study was carried out with 65 hypertensive patients aged 65 years or older. PAD was present in 18% of individuals by current ABI definition and in 32% by modified method. Diabetes, cardiovascular diseases, metabolic syndrome, higher levels of systolic blood pressure and pulse pressure, elevated risk by Framingham Risk Score (FRS), and a higher number of total and antihypertensive drugs in use were associated with low ABI by both definitions. Smoking and LDL-cholesterol were associated with low ABI only by the modified definition. Low ABI by the modified definition detected 9 new cases of PAD but cardiovascular risk had not been considered high in 3 patients when calculated by FRS. In conclusion, given that a simple modification of ABI calculation would be able to identify more patients at high risk, it should be considered for cardiovascular risk prediction in all elderly hypertensive outpatients.
RESUMO
Partindo do pressuposto de que o conteúdo do prontuário pode refletir diretamente a qualidade e as características da atenção oferecida - podendo ser utilizados como instrumento de avaliação desta - buscou-se, neste estudo, avaliar a percepção de profissionais de saúde de um serviço de atenção primária, quanto à importância, adequação e disponibilidade de dados nos prontuários dos pacientes,além de verificar suas concepções quanto às informações que julgam necessário estarem contidas no prontuário para um adequado acompanhamento dos mesmos. A percepção geral captada através deste estudo deflagra que, apesar de os profissionais valorizarem aspectos de ordem social e psicológica, há preponderância de achados biológicos nos registros de saúde, mesmo em um serviço em Atenção Primária. Sugere-se, assim, a necessidade de um novo olhar sobre o processo de registros de informações em saúde que considere o paradigma biopsicosocial. Desta forma, os registros poderiam refletir abordagens e práticas mais abrangentes e integrais de cuidado, em especial no nível primário de atenção, onde estas questões têm especial relevância. São feitas algumas reflexões que podem colaborar para a definição de estratégias e ações que tenham estes objetivos.
Because the content of medical files may directly affect the quality of care, this study investigated the perceptions of primary health care professionals concerning the importance, adequation, availability and prioritization of data to be included in medical records so that patientcare may be optimized. Even though many professionals take into account social and psychological aspects in their practice, biological findings are predominant in medical records, a finding that takes place even in primary care.There should be a different focus on the processes used to record patients? information in the health system. Health professionals should take into account the biopsychosocial paradigm. Thus, medical records could reflect more comprehensive and complete approaches and practices,especially in relation to primary care, where these matters are of the essence. Some reflections have been made in order to help and boost the creation of strategies and policies toward this purpose.