Fungal contamination assessment in Portuguese elderly care centers

Individuals spend 80-90% of their day indoors and elderly subjects are likely to spend even a greater amount of time indoors. Thus, indoor air pollutants such as bioaerosols may exert a significant impact on this age group. The aim of this study was to characterize fungal contamination within Portuguese elderly care centers. Fungi were measured using conventional as well as molecular methods in bedrooms, living rooms, canteens, storage areas, and outdoors. Bioaerosols were evaluated before and after the microenvironments' occupancy in order to understand the role played by occupancy in fungal contamination. Fungal load results varied from 32 colony-forming units CFU m(-3) in bedrooms to 228 CFU m(-3) in storage areas. Penicillium sp. was the most frequently isolated (38.1%), followed by Aspergillus sp. (16.3%) and Chrysonilia sp. (4.2%). With respect to Aspergillus genus, three different fungal species in indoor air were detected, with A. candidus (62.5%) the most prevalent. On surfaces, 40 different fungal species were isolated and the most frequent was Penicillium sp. (22.2%), followed by Aspergillus sp. (17.3%). Real-time polymerase chain reaction did not detect the presence of A. fumigatus complex. Species from Penicillium and Aspergillus genera were the most abundant in air and surfaces. The species A. fumigatus was present in 12.5% of all indoor microenvironments assessed. The living room was the indoor microenvironment with lowest fungal concentration and the storage area was highest.

Determination of airborne nanoparticles in elderly care centres

According to numerous studies, airborne nanoparticles have a potential to produce serious adverse human health effects when deposited into the respiratory tract. The most important parts of the lung are the alveolar regions with their enormous surface areas and potential to transfer nanoparticles into the blood stream. These effects may be potentiated in case of the elderly, since this population is more susceptible to air pollutants in general and more to nanoparticles than larger particles. The main goal of this investigation was to determine the exposure of institutionalized elders to nanoparticles using Nanoparticle Surface Area Monitor (NSAM) equipment to calculate the deposited surface area (DSA) of nanoparticles into elderly lungs. In total, 193 institutionalized individuals over 65 yr of age were examined in four elderly care centers (ECC). The occupancy daily pattern was achieved by applying a questionnaire, and it was concluded that these subjects spent most of their time indoors, including the bedroom and living room, the indoor microenvironments with higher prevalence of elderly occupancy. The deposited surface area ranged from 10 to 46 μm2/cm3. The living rooms presented significantly higher levels compared with bedrooms. Comparing PM10 concentrations with nanoparticles deposited surface area in elderly lungs, it is conceivable that living rooms presented the highest concentration of PM10 and were similar to the highest average DSA. The temporal distribution of DSA was also assessed. While data showed a quantitative fluctuation in values in bedrooms, high peaks were detected in living rooms.

Determination of airborne nanoparticles in elderly care centres

According to numerous studies, airborne nanoparticles have a potential to produce serious adverse human health effects when deposited into the respiratory tract. The most important parts of the lung are the alveolar regions with their enormous surface areas and potential to transfer nanoparticles into the blood stream. These effects may be potentiated in case of the elderly, since this population is more susceptible to air pollutants in general and more to nanoparticles than larger particles. The main goal of this investigation was to determine the exposure of institutionalized elders to nanoparticles using Nanoparticle Surface Area Monitor (NSAM) equipment to calculate the deposited surface area (DSA) of nanoparticles into elderly lungs. In total, 193 institutionalized individuals over 65 yr of age were examined in four elderly care centers (ECC). The occupancy daily pattern was achieved by applying a questionnaire, and it was concluded that these subjects spent most of their time indoors, including the bedroom and living room, the indoor microenvironments with higher prevalence of elderly occupancy. The deposited surface area ranged from 10 to 46 mu m(2)/cm(3). The living rooms presented significantly higher levels compared with bedrooms. Comparing PM10 concentrations with nanoparticles deposited surface area in elderly lungs, it is conceivable that living rooms presented the highest concentration of PM10 and were similar to the highest average DSA. The temporal distribution of DSA was also assessed. While data showed a quantitative fluctuation in values in bedrooms, high peaks were detected in living rooms.

Determination of pharmocotherapeutical complexity in institutionalized elderly

The phenomenon of aging is nowadays society as acquired the status of a social problem, with growing attention and concern, leading to an increase number of studies dedicated to the elderly. The lack of domestic, familiar or social support often lead elderly to nursing homes. Institutionalization is in many cases the only opportunity to have access to health care and life quality. Aging is also associated with a higher prevalence of chronic diseases that require long term medication sometimes for life. Frequently the onset of multiple pathologies at the same time require different therapies and the phenomenon of polypharmacy (five ou more drugs daily) can occur. Even more, the slow down of physiological and cognitives mechanisms associated with these chronic diseases can interphere, in one hand, with the pharmacocinetic of many medications and, on the other hand, with the facility to accomplish the therapeutical regimen. All of these realities contribute to an increase of pharmacotherapeutical complexity, decreasing the adherence and effectiveness of treatment. The pharmacotherapeutical complexity of an individual is characterized by the conciliator element of different characteristics of their drug therapy, such as: the number of medications used; dosage forms; dosing frequency and additional indications. It can be measured by the Medication Regimen Complexity Index (MRCI), originally validated in English.

Diagnostic performance of visual screening tests in the elderly

This study aimed to determine and evaluate the diagnostic accuracy of visual screening tests for detecting vision loss in elderly. This study is defined as study of diagnostic performance. The diagnostic accuracy of 5 visual tests -near convergence point, near accommodation point, stereopsis, contrast sensibility and amsler grid—was evaluated by means of the ROC method (receiver operating characteristics curves), sensitivity, specificity, positive and negative likelihood ratios (LR+/LR−). Visual acuity was used as the reference standard. A sample of 44 elderly aged 76.7 years (±9.32), who were institutionalized, was collected. The curves of contrast sensitivity and stereopsis are the most accurate (area under the curves were 0.814−p = 0.001, C.I.95%[0.653;0.975]— and 0.713−p = 0.027, C.I.95%[0,540;0,887], respectively). The scores with the best diagnostic validity for the stereopsis test were 0.605 (sensitivity 0.87, specificity 0.54; LR+ 1.89, LR−0.24) and 0.610 (sensitivity 0.81, specificity 0.54; LR+1.75, LR−0.36). The scores with higher diagnostic validity for the contrast sensibility test were 0.530 (sensitivity 0.94, specificity 0.69; LR+ 3.04, LR−0.09). The contrast sensitivity and stereopsis test's proved to be clinically useful in detecting vision loss in the elderly.

Gestão de empreendimentos de iniciativa municipal na área da educação

A requalificação e a modernização do parque escolar do 1º ciclo de ensino básico e do pré-escolar é uma competência atribuída aos municipios e implica a existência de um plano de intervenção e a construção de novos centros escolares, bem como a ampliação e requalificação dos edifícios existentes.Procura-se com esta dissertação e a partir de uma situação específica associada a empreendimentos escolares de iniciativa municipal, abordar a temática da gestão de projectos.A dissertação ora apresentada encontra-se estruturada em cinco partes essenciais: A primeira, corresponde ao estado actual, abordando as metodologias da gestão de projectos mais usadas. A segunda, parte do conceito de ciclo de vida de um projecto, descreve o modelo de fases sucessivas e integra-o no modelo de grupos de processos. A terceira, apresenta uma proposta de modelo de gestão de projectos gerado por distintos processos e inclui um guia de referência e de técnicas. A quarta, descreve os processos de gestão dos custos e determina com base num conjunto de projectos analisados: i) indicadores específicos, para uso em estimação de custos; ii) funções lineares, que relacionam características físicas de um edifício escolar com custo estimado de execução; iii) estrutura de custos, para obter informação valiosa do ponto de vista técnico-económico no domínio da promoção deste tipo de empreendimentos. Finalmente a última, reúne as conclusões e aponta orientações futuras de pesquisa.Propõe-se, portanto, uma forma diferente de observar a gestão de projectos no âmbito da Administração Local, considerando-se a implementação do modelo de processos uma via para a obtenção de resultados mais rigorosos e participativos e ao mesmo tempo aponta-se para uma nova orientação sobre qualidade em gestão de projectos.

Diagnostic performance of visual screening tests in the elderly

The aging of Portuguese population is characterized by an increase of individuals aged older than 65 years. Preventable visual loss in older persons is an important public health problem. Tests used for vision screening should have a high degree of diagnostic validity confirmed by means of clinical trials. The primary aim of a screening program is the early detection of visual diseases. Between 20% and 50% of older people in the UK have undetected reduced vision and in most cases is correctable. Elderly patients do not receive a systematic eye examination unless a problem arises with their glasses or suspicion vision loss. This study aimed to determine and evaluate the diagnostic accuracy of visual screening tests for detecting vision loss in elderly. Furthermore, it pretends to define the ability to find the subjects affected with vision loss as positive and the subjects not affected with the same disease as negative. The ideal vision screening method should have high sensitivity and specificity for early detection of risk factors. It should be also low cost and easy to implement in all geographic and socioeconomic regions. Sensitivity is the ability of an examination to identify the presence of a given disease and specificity is the ability of the examination to identify the absence of a given disease. It was not an aim of this study to detect abnormalities that affect visual acuity. The aim of this study was to find out what´s the best test for the identification of any vision loss.

A importância da fiscalização municipal na obras promovidas por particulares

O presente trabalho tem como objectivo ser um elemento de reflexão do exercício das competências de fiscalização dos Municípios, no actual contexto legal (Decreto-Lei nº 555/99 de 16 de Dezembro na redacção que lhe foi conferida pela Lei nº 60/2007 de 4 de Setembro). Este regime jurídico que visa aligeirar os procedimentos de controlo prévio das operações urbanísticas vem, numa linha inovadora, remeter para um controlo “a posteriori” o controlo administrativo das operações urbanísticas promovidas por particulares. Os limites de intervenção da Administração, num quadro em que os interesses dos particulares e o interesse público têm por vezes objectivos distintos, fazem com que a actividade de fiscalização se manifeste de alguma dificuldade. O universo deste documento abrange os municípios da Área Metropolitana de Lisboa, num total de dezoito, com uma população residente de 2.830.867 habitantes. Espera-se que as conclusões obtidas sejam dinamizadoras de melhoria futura.

Projecto de execução e remodelação da rede predial de abastecimento de água e da rede de drenagem de águas residuais domésticas do mercado municipal da Tapada das Mercês e da casa da Juventude

Este trabalho final de mestrado baseia-se no projecto de execução e remodelação de uma rede predial de abastecimento de água e de uma rede predial de drenagem de águas residuais domésticas de um edifício existente na localidade da Tapada das Mercês (freguesia de Algueirão - Mem Martins, Concelho de Sintra). Este prédio está dividido em dois pisos: o Mercado da Tapada das Mercês - Piso 0 - e a Casa da Juventude - Piso-1. Com este trabalho, respondeu-se a uma solicitação da Divisão de Projectos Municipais e da Divisão de Mercados da Câmara Municipal de Sintra e procurou-se: Melhorar o desempenho das redes existentes; Diminuir os custos de operação e manutenção dessas mesmas redes; Resolver o problema das infiltrações no tecto da Casa da Juventude, que está a afectar a rede de distribuição eléctrica perturbando o normal funcionamento desses serviços. Pretende-se também fornecer sugestões de melhoria do Regulamento -Decreto Regulamentar nº 23/95 e aumentar os meus conhecimentos nesta área, atendendo a que a minha formação base é em Vias de Comunicação e Transportes. A título de reflexão, propõe-se uma actualização em termos de materiais para o regulamento acima mencionado.

Acompanhamento dos trabalhos de reabilitação de espaços exteriores à Casa Museu dos Patudos e edifício de apoio: Câmara Municipal de Alpiarça

Relatório de Estágio para obtenção de grau de Mestre em Engenharia Civil Perfil de Edificações

Sobre a interpretação das batalhas ibéricas para órgão do século XVII: uma leitura da "Batalha famoza" do manuscrito MM 43 da Biblioteca Pública Municipal do Porto

A batalha é geralmente considerada como um dos géneros mais característicos da literatura organística ibérica do Barroco. Paradoxalmente é, de todas os géneros da música de órgão peninsular, aquele acerca do qual se possuem menos dados sobre a prática interpretativa. A informação que se pode obter a partir da generalidade dos textos seiscentistas sobre música de tecla, aplica-se sobretudo à interpretação das obras contrapontísticas, deixando em aberto muitas questões relacionadas com o carácter eminentemente descritivo das batalhas. Por outro lado, é também interessante verificar que algumas das mais convincentes interpretações de batalhas que actualmente escutamos são aquelas que resultam de uma leitura menos literal do texto musical e de uma intenção clara de sublinhar o seu carácter descritivo. A informação extraída da Batalha famoza (presente no manuscrito MM 43 da Biblioteca Pública Municipal do Porto) e apresentada ao longo deste texto parece pôr em evidência o apelo que a execução das batalhas fazia a um esforço interpretativo por parte do organista, não só através da utilização de recursos específicos do órgão ibérico, mas também mediante o emprego de uma ornamentação mais livre que pusesse em evidência o carácter descritivo daquele género musical.

Association between grip strength, anthropometric data and functional capacity

The hand is one of the most important instruments of the human body, mainly due to the possibility of grip movements. Grip strength has been described as an important predictor of functional capacity. There are several factors that may influence it, such as gender, age and anthropometric characteristics. Functional capacity refers to the ability to perform daily activities which allow the individual to self-care and to live with autonomy. Composite Physical Function (CPF) scale is an evaluation tool for functional capacity that includes daily activities, self-care, sports activities, upper limb function and gait capacity. In 2011, Portugal had 15% of young population (0-14years) and 19% of elderly population (over 65 years). Considering the double-ageing phenomen, it is important to understand the effect of the grip strength in elderly individuals, considering their characteristics, as the need to maintainin dependency as long as possible.

Plano de Negócios - Criação de uma empresa de apoio domiciliário

Mestrado em Gestão

A checklist for patient safety rounds at the care pathway level

Objective - To define a checklist that can be used to assess the performance of a department and evaluate the implementation of quality management (QM) activities across departments or pathways in acute care hospitals. Design - We developed and tested a checklist for the assessment of QM activities at department level in a cross-sectional study using on-site visits by trained external auditors. Setting and Participants - A sample of 292 hospital departments of 74 acute care hospitals across seven European countries. In every hospital, four departments for the conditions: acute myocardial infarction (AMI), stroke, hip fracture and deliveries participated. Main outcome measures - Four measures of QM activities were evaluated at care pathway level focusing on specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies and clinical review (CR). Results - Participating departments attained mean values on the various scales between 1.2 and 3.7. The theoretical range was 0-4. Three of the four QM measures are identical for the four conditions, whereas one scale (EBOP) has condition-specific items. Correlations showed that every factor was related, but also distinct, and added to the overall picture of QM at pathway level. Conclusion - The newly developed checklist can be used across various types of departments and pathways in acute care hospitals like AMI, deliveries, stroke and hip fracture. The anticipated users of the checklist are internal (e.g. peers within the hospital and hospital executive board) and external auditors (e.g. healthcare inspectorate, professional or patient organizations).

Does 6-minutes walk test predict functional capacity in elderly people?

Portugal has an accentuated aging tendency, presenting an elderly population (individuals with more than 65 years old) of 19.2%. The average life expectancy is 79.2 years. Thus, it’s important to maintain autonomy and independency as long as possible. Functional ability concept rises from the need to evaluate the capacity to conduct daily activities in an independent way. It can be estimated with the 6-minute walk test (6MWT) and other validated test. This test is simple, reliable, valid and consists in a daily activity (walk). The goals of this study was to verify associations between functional capacity measured with two different instruments (6MWT and Composite Physical Function (CPF) scale) and between those results and characterization variables.