Medication regimen complexity in institutionalized elderly people in an aging society

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist’s intervention to reduce it as part as the medication review routine in all the patients.

Cante alentejano: entre o quotidiano e a patrimonialização de uma prática cultural.(O caso de Santo Aleixo da Restauração)

A presente dissertação pretende contribuir para a compreensão dos processos de patrimonialização. Especificamente, exploram-se contextos quotidianos associados à prática do Cante Alentejano, delineando as suas reconfigurações e manifestações contemporâneas. A pesquisa é ancorada metodologicamente em investigação etnográfica na localidade de Santo Aleixo da Restauração (Moura). Neste contexto empírico, caracterizam-se os espaços sociais onde é desenvolvido o quotidiano do Cante Alentejano, de forma a perceber o dualismo entre a sua prática quotidiana e aquilo que é a sua patrimonialização, tal como é percepcionada pelos atores sociais locais; Abstract: This dissertation aims to contribute to the understanding of processes of heritagization. Specifically, we explore contexts of daily practice of Cante Alentejano and identify the current manifestations and reconfigurations of this practice. Methodologically, research is based in an ethnography conducted in the locality of Santo Aleixo da Restauração (Moura). In this empirical context, we analyse daily social spaces where Cante Alentejano has been developed, with the purpose of understanding the dualism between this daily practice and the process of patrimonialization, as i tis perceived by local social actors.

Clinical utility of the personal questionnaire

The demand to implement routine outcome assessment in mental health care services calls for measures with clinical utility, i. e, feasible to therapists, acceptable to clients and generalizable to settings. This research aims to explore the clinical utility of a patient-generated measure, the Personal Questionnaire (PQ). An on-line survey was designed (study I) and administered to an international sample of 25 therapists with experience using the PQ (study II). Results suggest that the PQ is perceived as a clinically significant and fairly practical measure, useful not only in assessing outcome but also in various clinical tasks. Furthermore, it is relatively well accepted by clients and it is extremely generalizable to different clients, clinical approaches and settings. Specific suggestions to increase the PQ’s clinical utility are provided. Exploring therapists’ perspectives and practices will improve the appropriateness of measures to real-world clinical settings; A utilidade clínica do Personal Questionnaire RESUMO: O movimento para implementar a avaliação rotineira de resultados nos serviços de saúde mental pede medidas com utilidade clínica, i. e, práticas para terapeutas, aceitáveis para clientes e generalizáveis para contextos clínicos. Este estudo tem como objetivo explorar a utilidade clínica de uma medida gerada pelo cliente, o Personal Questionnaire (PQ). Um questionário on-line foi desenvolvido (estudo I) e administrado a uma amostra internacional de 25 terapeutas com experiência de uso do PQ (estudo II). Os resultados sugerem que o PQ é considerado um instrumento valioso para a prática clínica, relativamente prático, útil como indicador de resultado e também como ferramenta clínica. Adicionalmente, é bem aceite pelos clientes e bastante generalizável para diferentes clientes, abordagens terapêuticas e contextos clínicos. Sugestões específicas para melhorar a utilidade clínica do PQ são fornecidas. Explorar as perspetivas e práticas dos terapeutas face a medidas de resultado possibilita uma melhor adequação à prática clínica.

Creative Practices Around the Production of Cork

Cork, as a natural product provided by the bark of the cork oak tree, is an important staple of the Portuguese economy and important to Portuguese culture. It is a sustainable product with a positive ecological footprint, from harvesting to industrial production, with the advantage of creating a local economic model through regional labour activity and distribution. Within the balance between nature-human-economy to create a sustainable system, cork production in Portugal represents a human and social dimension. By focusing on that dimension and by creating an awareness of the cultural and social impact of the activity and by re-appraising the meaning of the material within the culture, the study reframes a consideration of the actual place of labour and production. The human, geophysical, historical, social, economic, ecological and cultural aspects of the place are observed as regards their relation to work or labour in that physical space. A pilot study is being developed in the village of Azaruja in the district of Évora, Portugal. In this small locality, cork is very important in terms of the relationships between the physical subsistence of their residents and the local natural resources, because it structures the place in its cultural, social and economical dimensions. This paper outlines the theoretical foundations, the process and the outcomes of the participatory ecodesign project titled Creative Practices Around the Production of Cork which was initiated by a Portuguese artist/design researcher and developed further through the collaboration with the other two authors, one a Portuguese visual artist/researcher and the other a Turkish fashion designer/theorist. The investigation focuses on questions that expand the notion of place for artists and designers, filtered through the lenses of manual labourers in order to understand their physical, social, cultural and economic relationship with the environment. To create the process of interaction with the place and the people, a creative collaborative dynamic is developed between the authors with their range of artistic sensibilities and the local population. To adopt a holistic notion of sustainability and cultural identity a process of investigation is designated to: (1) analyse, test and interpret - through the dissemination of life stories, visual representation of the place and the creation of cork objects - the importance of culture related to the labour activity of a local natural resource that determines and structures the region; (2) to give public recognition to those involved, taking into account their sense of belonging to the place and in order to show the value of their sustainable labour activities related to local natural resources; (3) to contribute to the knowledge of the place and to its dynamism through an aesthetic approach to labour activities. With reference to fields of knowledge such as anthropology, the social arts and sustainable design, a practice-based research is conducted with collaborative and participatory design methods to create an open model of interaction which involves local people in the realization of the project. Outcomes of this research will be presented in the paper as a survey analysis with theoretical conclusions.