Perfil sociodemográfico e saúde mental em cuidadores informais de idosos no município de São Paulo-Brasil: desafios para as políticas públicas

RESUMO: INTRODUÇÃO: O rápido envelhecimento populacional, o aumento da prevalência de transtornos neuropsiquiátricos, o aumento das taxas de morbilidade clínica e incapacidade entre idosos de países em desenvolvimento têm trazido preocupações sobre a saúde mental e sobrecarga de cuidadores informais. Está bem estabelecida a elevada prevalência de transtornos mentais comuns (TMC) associada à adversidade socioeconômica, baixo nível educacional, estresse e gênero. Idosos e cuidadores vivendo em comunidade compartilham fatores de risco para morbilidade física e psiquiátrica. Adicionalmente, os cuidadores tem uma tripla carga, sendo simultaneamente familiares, trabalhadores leigos em saúde sem suporte dos serviços de saúde e assistência social e um paciente com necessidades não atendidas. O cuidador informal é o principal provedor de cuidado em todos os países. OBJETIVOS: Acessar perfil sociodemográfico, níveis de transtorno mental comum (TMC) e sobrecarga em cuidadores, características do cuidado e prevalência de demência e depressão no idosos, numa área carente da região oeste de São Paulo –Brasil. MÉTODO: Esta pesquisa transversal deriva do São Paulo Ageing and Health Study (SPAH) que incluiu idosos com 65 anos ou mais e seus respectivos cuidadores. Os participantes foram identificados por arrolamento domiciliar e entrevistadas em suas casas com protocolo padronizado de pesquisa. O instrumento utilizado para acessar os transtornos mentais comuns, foi o Self Rating Questionnaire SRQ-20.A sobrecarga foi quantificada pelo Zarit Caregiver Burden Scale. Diagnósticos psicogeriátricos foram mensurados através do SRQ-20 e critérios do CID-10 e do DSM-IV. 8 RESULTADOS: 588 cuidadores e respectivos idosos foram incluídos. Nos idosos, a prevalência de demência foi 15,9%, de depressão pelo CiD-10 9.9% e de TMC 39,25% Nos cuidadores, a prevalência de TMC foi de 55,1% e 32,8% dos cuidadores apresentaram sobrecarga elevada. O perfil do cuidador foi filha,com idade em torno dos 49 anos, casada e com baixo nível educacional.------------------ABSTRACT: BACKGROUND: With the fast population aging, growing prevalence of neuropsychiatric disorders, clinical morbidity and disability among the elderly particularly in low income countries (LAMIC), has brought concerns about informal caregiver Mental Health and Burden. It is well established the high prevalence of Common Mental Disorders (CMD) associated to socioeconomic adversity, low educational attainment, stress and gender. Community-dwelling elders and caregivers share risk factors for physical and psychiatric morbidity. In addition, caregivers have a triple strain, being simultaneously, family members, lay health workers with lack of support from health and social work services and a hidden patient with unmet needs. The world main source of caregiving relies on informal caregiver. AIMS: To assess 1) the sociodemographic profile, levels of CMD and burden among caregivers, and 2) the characteristics of care and prevalence of dementia and depression in elderly in a socioeconomic underprivileged area in western region of Sao Paulo – Brazil. METHOD: The present investigation is a cross-sectional part of Sao Paulo Ageing and Health Study (SPAH) which included participants aged 65 or older and their respective caregivers. Participants were identified by household enrollment and interviewed in their homes using a standardized research protocol. The assessment of common mental disorders was performed with the Self Rating Questionnaire – 20 (SRQ-20), used to establish psychiatric caseness. The assessment of burden was performed with Zarit Caregiver Burden Scale. Dementia and psychogeriatric diagnosis were reached through ICD-10, SRQ-20 and DSM-IV criteria. 10 RESULTS: 588 caregivers and respective elderly relatives were included. Prevalence of dementia was 15.9%, ICD-10 depression 9.9% and CMD 39.3% among the elderlys. Common mental disorder prevalence in caregivers was 55.1% and high burden was reached in 32.8% of the caregiver sample. Most of the caregivers were married and co-resident daughters with a mean age of 49 years (CI 95% - 48.7 to 51).

Vulnerabilidade em pessoas idosas residentes na comunidade : estudo exploratório em utentes da Santa Casa da Misericórdia de Lisboa

RESUMO: Objectivo: O presente estudo tem como principal objectivo a caracterização da vulnerabilidade individual em pessoas idosas residentes na comunidade. Metodologia: Trata-se de um estudo não experimental, exploratório, quantitativo, e transversal numa amostra probabilística de aleatorização simples (n=213). A vulnerabilidade individual foi avaliada com recurso ao instrumento Vulnerable Elders Survey 13 e as restantes variáveis sócio-demográficas por questionário, ambas por via telefónica. Resultados: A amostra era predominantemente feminina, com uma maior prevalência das pessoas com 75 ou mais anos, viúvas, sem escolaridade, maioritariamente a viverem sós e mais de com um rendimento mensal igual ou inferior a 485€. Relativamente à vulnerabilidade, numa amostra aleatorizada de 213 pessoas, apenas 15 não apresentavam vulnerabilidade, avaliada pelo Vulnerable Elders Survey-13 (VES-13). Das 198 pessoas vulneráveis, correspondendo a 93% da amostra, 164, ou seja, 77% deste grupo, tinham uma pontuação total igual ou superior a 7 em 10, revelando um grau elevado de vulnerabilidade. Conclusão: As variáveis preditoras da vulnerabilidade são a idade, quanto maior a idade maior a vulnerabilidade, e o ser-se viúvo. As variáveis preditoras da dificuldade na realização das actividades físicas (AF) são a idade e pessoa isolada em alojamento colectivo. Para as actividades de vida diária (AVD), as variáveis que demostram ser preditoras são a idade, pessoa isolada em alojamento colectivo e residir em agregado familiar de casal de idosos.----------------------- ABSTRACT:Objective: The present study has as its principal objective the characterization of individual vulnerability in community-dwelling older people. Methodology: This is a non-experimental study, exploratory, qualitative, quantitative, and cross-sectional in a probabilistic sample of simple randomization (n=213). Individual vulnerability was assessed using the instrument Vulnerable Elders Survey 13 and the other socio-demographic variables by questionnaire, both by telephone. Results: the sample was predominantly female, with a higher prevalence of persons with 75 or more years, widows, without education, mostly living alone and most of all with less than or equal to 485€ per month. Concerning vulnerability, in a random sample of 213 people, only 15 doesn´t present vulnerability, evaluated by the Vulnerable Elders Survey-13 (VES-13). Of the 198 people vulnerable, accounting for 93% of the sample, 164, i.e. 77% of this group, had a total score equal to or greater than 7 in 10, revealing a high degree of vulnerability. Conclusion: The predictors of vulnerability are the age, where higher the age means greater vulnerability as well as being a widow. The predictors of the difficulty in physical activities are old age and isolated persons in collective accommodation. For the activities of daily life, the variables that demonstrate as being predictors are old age, isolated persons in collective accommodation and living in elderly couple.

Collaborative environment to support a professional community

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Electrotécnica e de Computadores

THE MAKING OF THE IMMIGRANT IDENTITY IN THE PRESS: Constructing the Immigrant Imagined Community

A dissertation submitted in partial fulfilment of the requirements for the degree of Master in Arts

BIWiki - Using a Business Intelligence Wiki to Form a Virtual Community of Practice for Portuguese Master's Students

Web 2.0 software in general and wikis in particular have been receiving growing attention as they constitute new and powerful tools, capable of supporting information sharing, creation of knowledge and a wide range of collaborative processes and learning activities. This paper introduces briefly some of the new opportunities made possible by Web 2.0 or the social Internet, focusing on those offered by the use of wikis as learning spaces. A wiki allows documents to be created, edited and shared on a group basis; it has a very easy and efficient markup language, using a simple Web browser. One of the most important characteristics of wiki technology is the ease with which pages are created and edited. The facility for wiki content to be edited by its users means that its pages and structure form a dynamic entity, in permanent evolution, where users can insert new ideas, supplement previously existing information and correct errors and typos in a document at any time, up to the agreed final version. This paper explores wikis as a collaborative learning and knowledge-building space and its potential for supporting Virtual Communities of Practice (VCoPs). In the academic years (2007/8 and 2008/9), students of the Business Intelligence module at the Master's programme of studies on Knowledge Management and Business Intelligence at Instituto Superior de Estatistica e Gestao de Informacao of the Universidade Nova de Lisboa, Portugal, have been actively involved in the creation of BIWiki - a wiki for Business Intelligence in the Portuguese language. Based on usage patterns and feedback from students participating in this experience, some conclusions are drawn regarding the potential of this technology to support the emergence of VCoPs; some provisional suggestions will be made regarding the use of wikis to support information sharing, knowledge creation and transfer and collaborative learning in Higher Education.

Spatial analysis and investigation of fire events occurrences in the Valencian Community, Spain

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Environmental Decision-making utilizing a Web GIS to Monitor Hazardous Industrial Emissions in the Valencian community of Spain

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Public Participation geographic information systems in developing countries: lessons from Uganda on the impacts of interactive screens PPGIS and community perceptions of space

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Studying the impact of co-authorship with external researchers:the case of research community in Portugal using social network analysis.

Project work presented as a partial requirement to obtain a Master Degree in Information Management

Pro poor tourism for community development on Atauro Island, Timor-Leste

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

A CSR communication strategy for Continente: Improving brand image and reinforcing local community bonds

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

The impact of online brand community on electronic word-of-mouth communications

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

The impact of Ireland’s current Mental Health Policy on the profile of community mental Health Services

RESUMO: Em 2006, foi aprovada uma nova política governamental para a saúde mental intitulada “Uma Visão para a Mudança”, a qual está neste momento no sétimo ano de implementação. A política descreve um enquadramento para o desenvolvimento e promoção da saúde mental positiva para toda a Comunidade e para a prestação de serviços acessíveis, baseados na comunidade, serviços especializados para pessoas com doença mental. A implementação da política e o tornar a “Vision for Change” uma realidade têm sido problemáticos, com críticas consideráveis por parte dos intervenientes, relativas à lenta e desconexa implementação. Este estudo fornece informação sobre as características dos serviços de três importantes tipos de instituições de saúde mental comunitária a nível nacional, nomeadamente Hospitais de Dia, Centros de Dia e residências comunitárias operantes 24 horas. A pesquisa analisa objetivos e funções, perfis dos pacientes, atividades terapêuticas, a eficácia das redes de comunicação e beneficia da perspectiva dos funcionários sobre o que mudou no terreno ao longo dos últimos sete anos. As questões identificadas a partir das características dos três serviços dizem respeito a todos. Os participantes indicaram que o ethos da recuperação parece ter alcançado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princípios de recuperação na prática clínica se mantém presente. Parece ser reconhecida a importância da planificação do cuidado individual nos serviços comunitários e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usuário do serviço. Há diferenças entre os „pontos de vista do pessoal‟ e os „pontos de vista dos representantes‟ sobre uma série de aspetos da prestação de serviços. Este é o primeiro estudo irlandês deste género a examinar a prestação de serviços das três principais instituições comunitárias de saúde mental num só estudo. Estes serviços representam um enorme investimento em recursos, quer a nível monetário, quer humano. O estudo examinou os desafios e as questões fundamentais que lhe são aplicáveis e que têm impacto nestes três tipos de prestação de serviços. Também forneceu informações sobre os elementos de mudança positiva, os quais se começam a focar lentamente na prestação do serviço, assim como na importância da centralidade do utilizador do serviço e na promoção de um ethos da recuperação.----------ABSTRACT: In 2006, a new Government policy for mental health “A Vision for Change” was endorsed and is currently in the seventh year of implementation. The policy describes a comprehensive framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. The implementation of the policy and turning “Vision for Change” into reality has been problematic with considerable criticism from stakeholders concerning slow and disjointed implementation. This study provides information on three key community mental health service settings, namely Day Hospitals, Day Centres and 24 Hour Community Residences at a national level. The research looks at aims and functions, patient profiles, therapeutic activities, effectiveness of key communication networks and gains an insight from staff on what has changed on the ground over the past seven years. Issues identified from the three service settings pertain to all. Participants indicated that the recovery ethos appears to have moved to a more central role in patient care in the community but acknowledged that the challenge of integrating recovery principles in clinical practice remains present. The importance of individual care planning appears to be recognised in community services and respondents indicated that efforts are being made to ensure service user involvement. There were differences between „staff views‟ and „advocate views‟ on a number of aspects of service provision. This is the first Irish study of its kind to examine service provision across the three main community mental health settings in one study. These services represent a huge investment in resources both on a monetary and human level. This study has examined the challenges and key issues which are applicable and impacting on all three types of service provision. It has also provided information on the elements of positive change, which are slowly embedding themselves in service provision such as the importance of the centricity of the service user and the promotion of a recovery ethos.

Enrichment of a PHA producing microbial community in a continuous bioreactor setup

Polyhydroxyalkanoates (PHAs) are biosynthetic polyesters, biodegradable and biocompatible making them of great interest for industrial purposes. The use of low value substrates with mixed microbial communities (MMC) is a strategy currently used to decrease the elevated PHA production costs. PHA production process requires an important step for selection and enrichment of PHA-storing microorganisms which is usually carried out in a Sequencing Batch Reactor (SBR). The aim of this study was to optimize the PHA accumulating culture selection stage using a 2-stage Continuous Stirrer Tank Reactor (CSTR) system. The system was composed by two separate feast and famine bioreactors operated continuously, mimicking the feast and famine phases in a SBR system. Acetate was used as carbon source and biomass seed was highly enriched in Plasticicumulans acidivorans obtained from activated sludge. The system was operated under two different sets of conditions (setup 1 and 2), maintaining a system total retention time of 12 hours and an OLR of 2.25 Cmmol/L.h-1. An average PHB-content of 3.3 % wt was obtained in setup 1 and 4.8% wt in setup 2. Several other experiments were performed in order to better understand the continuous system behaviour, using biomass from the continuous system. With the fed-batch experiment a maximum of 8.1% PHB was stored and the maximum substrate uptake and specific growth rates obtained in the growth experiment (1.15 Cmol Cmol-1.h-1 and 0.53 Cmol Cmol-1.h-1) were close to the ones from continuous system (1.12 Cmol Cmol-1.h-1 and 0.59 Cmol Cmol-1.h-1). The microbial community was characterized trough microscopic visualization, Denaturing Gradient Gel Electrophoresis (DGGE) analysis and Fluorescent in situ hybridization (FISH). The last studied performed mimicked the continuous system by building up a SBR system with all the same operational conditions while adding an extra acetate dosage during the 12 h cycle, simulating the substrate passing from the feast to the famine reactors under continuous operation. It was shown that possibly the continuous system was not able to efficiently select for PHB storing organisms under the operational conditions imposed, although the selected culture was capable of consuming the substrate and grow fast. This main conclusion might have resulted from two major factors affecting the system performance: the ammonium concentration in the Feast reactor and the amount of substrate leaching from the Feast to the Famine reactor.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Portugal:

Methicillin-resistant Staphylococcus aureus (MRSA), a human pathogen confined to hospitals (HAMRSA) for over 30 years have been emerging worldwide in the last two decades as a leading cause of severe infections in healthy individuals in the community (CA-MRSA). Despite its clinical significance, in the beginning of our studies no information existed on the prevalence, and population structure of CA-MRSA in Portugal. Moreover, it remained to be clarified how CA-MRSA emerged in our country. In particular, it was not known if CA-MRSA emerged locally by acquisition of the staphylococcal cassette chromosome mec (SCCmec) by established methicillin-susceptible S. aureus (MSSA) in the community, if they were imported from abroad or have escaped from the hospital.(...)