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Mortalidade por doenças do aparelho circulatório no município de Ribeirão Preto - SP, de 1980 a 2004 Mortalidad por enfermedades del aparato circulatorio en el municipio de Ribeirão Preto-SP, del 1980 a 2004 Mortality rates due to diseases of the circulatory system (DCS) in Ribeirão Preto - SP, from 1980 to 2004FUNDAMENTO: No âmbito da transição epidemiológica, estudos de tendência secular podem subsidiar a formulação de hipóteses para o gerenciamento em Saúde. OBJETIVO: Identificar o padrão de mortalidade por doenças do aparelho circulatório (DAC) no município de Ribeirão Preto, SP, no período de 1980 a 2004. MÉTODOS: Os óbitos por DAC foram obtidos do Sistema de Informações sobre Mortalidade (SIM). As estimativas populacionais para o município, segundo sexo, faixa etária e anos-calendário, foram obtidas do Instituto Brasileiro de Geografia e Estatística (IBGE). Os coeficientes específicos de mortalidade foram calculados, anualmente, segundo sexo e faixa etária classificada em intervalos de 10 anos, a partir dos 30 anos de idade. O estudo de tendência foi realizado por meio da construção de modelos de regressão polinomial para séries históricas, adotando-se nível de significância < 0,05. RESULTADOS: Os coeficientes específicos de mortalidade por DAC aumentaram com a idade, em ambos os sexos, sendo mais elevados no sexo masculino até a faixa etária de 40 a 49 anos, quando ocorreu aproximação em magnitude, sendo que, na faixa etária de 80 anos ou mais, esses indicadores, no sexo feminino e em alguns anos da série, ultrapassaram os do sexo masculino. Ao longo do período estudado, em ambos os sexos e em todas as faixas etárias, ocorreu declínio significante das taxas de mortalidade por esse grupo de causas (p<0,001). CONCLUSÕES: O padrão de mortalidade por DAC no município de Ribeirão Preto foi similar ao encontrado em regiões desenvolvidas, permitindo a formulação de hipóteses sobre possíveis fatores de proteção que podem explicar o declínio observado.<br>FUNDAMENTO: En el ámbito de la transición epidemiológica, estudios de tendencia secular pueden proveer argumentos a la formulación de hipótesis para el gerenciamiento en la Salud. OBJETIVO: Identificar el estándar de mortalidad por enfermedades del aparato circultorio (EAC) en el municipio de Ribeirão Preto, SP, en el periodo del 1980 a 2004. MÉTODOS: Se obtuvieron los óbitos EAC en el Sistema de Informaciones sobre Mortalidad (SIM). Se obtuvieron las estimaciones poblacionales para el municipio, según el sexo, el grupo de edad y los años calendarios en el Instituto Brasileiro de Geografia e Estatística (IBGE). Se calcularon anulamente los coeficientes específicos de mortalidad según el sexo y el grupo de edad, clasificados en intervalos de 10 años, a partir de los 30 años de edad. Se realizó un estudio de tendencia a través de la construcción de modelos de regresión polinomial para series históricas, adoptándose el nivel de significancia <0,05. RESULTADOS: Los coeficientes específicos de mortalidad por EAC aumentaron con la edad, en ambos sexos, siendo más elevados en el sexo masculino hasta el grupo de edad de 40 a 49 años, cuando ocorrió aproximación en magnitud, siendo que en el grupo de edad de 80 años y más, esos indicadores, en el sexo femenino y en algunos años de la serie, rebasaron los del sexo masculino. A lo largo del periodo estudiado, en ambos sexos y en todos los grupos de edad, ocurrió una reducción significante de las tasas de mortalidad por ese grupo de causas (p<0,001). CONCLUSIONES: El estándar de mortalidad por EAC en el municipio de Ribeirão Preto fue similar al encontrado en regiones desarrolladas, permitiendo la formulación de las hipótesis sobre posibles factores de protección que pueden explicar la reducción observada.<br>INTRODUCTION: In terms of epidemiologic transition, century-long trend studies may act as subsidies for health management hypotheses. OBJECTIVE: Identify mortality rate pattern for diseases of the circulatory system (DCS) in Ribeirão Preto, SP (RP-SP), in the period between 1980 and 2004. METHODS: The number of deaths due to DCS were obtained from the Mortality Information System (SIM). Populational estimates for RP-SP - taking gender, age group, and calendar years into account - were obtained from the Brazilian Institute of Geography and Statistics (IBGE). Specific mortality rates were calculated on yearly basis according to gender and age group in 10-year intervals starting at 30 years of age. The trend analysis was conducted through polynomial regression models for time series. Significance level was < 0.05. RESULTS: Specific mortality rates due to DCS increased with age both among males and females, being higher among males in the 40 to 49-year-old range. After that, figures were comparable, although at 80-year-old age groups data for females showed to be higher than that for males in some years of the series. Along the study period, significant reduction was observed for mortality rates among both males and females, and for all age ranges from those causes (p<0.001). CONCLUSIONS: Mortality rate pattern due to DCS in RP-SP was similar to that found in developed areas, which helped formulate hypotheses on the likely protection factors that may explain the observed decline.
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Estrategia educativa novedosa en la prevención de factores de riesgo cardiovascular gracias a la alianza de programas estatales y la iniciativa universitaria Innovative education strategy in prevention of cardiovascular risk factors thanks to an alliance between state programs and university initiativeEl fracaso de las estrategias tradicionales que se basan en el manejo de guías y educación mediante charlas en las unidades de salud, es evidente en diferentes estudios, en especial en los EUROASPIRE. Por ello, surge la necesidad de crear nuevas tácticas que sean efectivas para cambiar los estilos de vida no saludables de las personas y las comunidades, y disminuir la prevalencia de los factores de riesgo modificables para aterosclerosis y bajar la incidencia de eventos cardiovasculares. Aquí se presenta una experiencia que si bien no mide aún el impacto sobre estos aspectos, fue bien recibida por la comunidad e involucró aspectos novedosos. Se demostró la posibilidad de unir esfuerzos entre las políticas y recursos estatales y los medios académicos universitarios. De este modo, se probó la utilidad del trabajo interdisciplinario entre académicos de diferentes formaciones y creativos de medios audiovisuales y de la comunicación así como una estrategia lúdico-educativa masiva que parece ofrecer grandes posibilidades como didáctica moderna eficiente en la búsqueda de cambios hacia estilos de vida saludable.<br>Failure in traditional strategies based on guidelines and educational management through lectures in health units is evident in different studies in particular in those of EUROASPIRE. Therefore, there is a need for creating new effective tactics for the change of non-healthy life-styles in subjects and communities and lower the prevalence of modifiable risk factors for atherosclerosis and for lowering the incidence of cardiovascular events. We present an experience that even though does not measure the impact on these aspects, was well received by the community and involved innovative aspects. The possibility to unite efforts between politics and state resources with university academic media was shown. Usefulness of interdisciplinary task between different academic disciplines and audiovisual media as well as a massive amusement- education strategy was proven and it appears to offer great possibilities as a modern and efficient didactis in the search of changes towards healthy lifestyles.
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Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)<p>Abstract</p> <p>Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described.</p> <p>Obtaining competence in ICU echocardiography may be achieved in different ways – either through completion of an appropriate fellowship/training scheme, or, where not available, via a staged approach designed to train the practitioner to a level at which they can achieve accreditation. Here, peri-resuscitation focused echocardiography represents the entry level – obtainable through established courses followed by mentored practice. Next, a competence-based modular training programme is proposed: theoretical elements delivered through blended-learning and practical elements acquired in parallel through proctored practice. These all linked with existing national/international echocardiography courses. When completed, it is anticipated that the practitioner will have performed the prerequisite number of studies, and achieved the competency to undertake accreditation (leading to Level 2 competence) via a recognized National or European examination and provide the appropriate required evidence of competency (logbook). Thus, even where appropriate fellowships are not available, with support from the relevant echocardiography bodies, training and subsequently accreditation in ICU echocardiography becomes achievable within the existing framework of current critical care and cardiological practice, and is adaptable to each countrie's needs.</p>