28 resultados para Needs Assessment Program Development
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RESUMO: Os indivduos com doena mental grave, assim como os seus familiares, podem ser caracterizados como uma populao em que ocorre uma combinao complexa de necessidades mdicas e psicossociais, nomeadamente a nvel do diagnstico e do acesso aos servios de sade mental. A avaliao de necessidades pode fornecer informaes importantes para o desenvolvimento de intervenes eficazes, tanto a nvel da populao como a nvel individual. Este estudo teve como objetivo determinar as diferentes necessidades reportadas pelos pacientes com doena mental grave e seus familiares , assim como investigar as possveis relaes entre o estado de necessidades e as variveis scio-demogrficas e clnicas. Simultaneamente, o estudo teve como objetivo avaliar a sobrecarga familiar e a satisfao dos utentes com os servios de sade mental. Foi elaborado um estudo transversal, realizado numa amostra de convenincia de cinquenta dades de paciente/membro da famlia, seguidos em regime de ambulatrio no Centro Nacional de Sade Mental. Foram utilizados como instrumentos de avaliao um questionrio sociodemogrfico, a Escala Breve de Avaliao Psiquitrica (BPRS), o questionrio de Avaliao de Necessidades de Camberwell (CAN), o Questionrio de Avaliao do Envolvimento (IEQ) e a Escala de Verona de Satisfao com os Servios (VSSS). As mais frequentes necessidades no-satisfeitas foram o sofrimento psicolgico, as atividades sociais e os benefcios sociais. O estudo mostrou uma sobrecarga significativa nas famlias que cuidam de pessoas com doena mental grave, que se correlacionou com as suas opinies sobre as necessidades dos pacientes e teve um impacto negativo sobre o bem-estar psicolgico. Os trs mais importantes predictores de sofrimento psquico em familiares foram o sexo, a situao laboral e a relao com o paciente. A avaliao da satisfao com os servios revelou a existncia de um hiato significativo entre os servios prestados e os servios desejados, reportados pelos pacientes e seus familiares. A maioria dos participantes do estudo desejavam ter um trabalho protegido, ou receber ajuda para encontrar emprego. Os resultados deste estudo podero ser usados para fins de planeamento desenvolvimento e avaliao de servios de sade mental no Azerbeijo. Algumas recomendaes sobre a melhoria dos servios de sade mental para pacientes com doena mental grave e suas famlias so feitas na seco final do trabalho.----------ABSTRACT: Patients suffering from severe mental illness, in addition to their family members, may be characterized as a population with a complex combination of medical and psychosocial needs, which are under-recognized and under-addressed by mental health services. At the same time, needs assessment provides important information necessary for developing effective interventions at both population and individual level. The study was aimed to determine various needs perceived by patients with SMI and their family members, as well as to find out possible relations between the needs and socio-demographic and clinical variables. Similarly the study was intended to evaluate family burden and users satisfaction with services. This was a cross-sectional study conducted on a convenience sample. Fifty dyads of a patient and family member applying for out-patient services to the National Mental Health Centre participated in the study. Sociodemographic questionnaire, Brief Psychiatric Rating Scale, Camberwell Assessment of Need, Involvement Evaluation Questionnaire, and Verona Service Satisfaction Scale were used as assessment tools. The most prominent unmet needs reported by people with SMI and their relatives were psychological distress, social activities and welfare benefits. The study showed significant burden in families caring for people with SMI, which correlated with their views about patients needs and had a negative impact on the psychological well-being. The three most important predictors of psychological distress in family members were gender, employment status and relationship to patient. Evaluation of satisfaction with services pointed out the gap between provided and desired services reported by patients and their relatives. Most of study participants wished to have sheltered work, or receive help in finding employment. The results of this study may be used for the purposes of mental health service planning, development and evaluation in our country. Some recommendations on improvement of mental health services for patients with SMI and their families have been made in the conclusion.
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A foremost dispute that persists on the contemporary worlds agenda is change. The on-going social/technological/economic changes create a competitive and challenging environment for companies to endure. To benefit from these changes, world economies partially depend on emerging Small and Medium Enterprises (SMEs) and their adaptability skills, and subsequently the development of an integrated capability to innovate has become the prime strategy for most of SMEs to subsist and grow. However, innovation and change are always somewhat bonded to an inherent risk development, which subsequently brings on the necessity of a revision of risk management approaches in innovative processes, whose importance SMEs tend to disregard. Additionally, little efforts have been made to improve and create empirical models, metrics and tools to assist SMEs managing latent risks in their innovative projects. This work seeks to present and discuss a solution to support SMEs in engaging on systematic risk management practices, which consists on an integrated risk assessment and response support web-based tool - Spotrisk - designed for SMEs. On the other hand, an inherent subjectivity is linked with risk management and identification processes, due to uncertainty trait of its nature, for each individual perceives situations according to his own idiosyncrasy, which brings complications in normalizing risk profiles and procedures. This essay aims to bring insights concerning the support in decision-making processes under uncertainty, by addressing issues related with the risk behavior character among individuals. To address such issues, subjects of neuroscience or psychology are explored and models to identify such character are proposed, as well as models to improve presented tool. This work attempts to go beyond the restrictive aim of endeavoring on technical improvement dissertation, and in embraces an exploratory conceptualization concerning micro, small and medium businesses traits regarding risk characters and project risk assessment tools.
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RESUMO - A avaliao de necessidades de cuidados crucial no planeamento, monitorizao e avaliao de servios de psiquiatria e sade mental, bem como na investigao e na clnica. Este princpio obviamente aplicvel aos servios responsveis por populaes de pessoas mais velhas. O instrumento CANE Camberwell Assessment of Need for the Elderly possibilita uma avaliao consistente das necessidades de utentes idosos, nomeadamente em situaes de patologia neuropsiquitrica. Procede-se a uma avaliao cruzada, entrevistando a pessoa em questo, o seu cuidador informal e o tcnico responsvel. Esta avaliao multidimensional abrange domnios da esfera biolgica, psicolgica e social, sendo aplicvel na comunidade ou em internamento (regime parcial ou completo). A utilidade do CANE tem sido evidenciada em contextos clnicos, de investigao e de avaliao de servios. Existem mltiplas tradues a nvel internacional, a maioria das quais validada. Na rea da epidemiologia psiquitrica nem sempre esto disponveis os dados relativos qualidade das adaptaes de instrumentos, pelo que se apresenta o processo de desenvolvimento da verso portuguesa (de acordo com as regras para validao transcultural, no processo de traduo-retroverso). A aplicabilidade da verso portuguesa foi satisfatria neste estudo-piloto, representando a primeira fase de um trabalho multicntrico nacional. Nesta fase inicial, foram considerados casos de idosos com patologia neuropsiquitrica (maioritariamente demncia 71,4%), em dois centros (Lisboa e Porto) (n = 21). A mdia de idades foi 73,9 ( 6,3) anos, sendo 76,2% do sexo feminino. A maioria vivia em casa, apresentava co-morbilidade somtica e estava em contacto com um cuidador informal (em geral, familiares do sexo feminino). Os avaliadores identificaram necessidades, nem sempre cobertas, nas seguintes dimenses: cuidados com a casa, alimentao, actividades dirias, memria, sade fsica, sofrimento psicolgico, companhia e dinheiro/economias. Nem sempre a perspectiva de doentes, cuidadores, tcnicos e avaliadores foi inteiramente coincidente. Estes resultados preliminares da aplicao da verso portuguesa do CANE so consistentes quanto sua validade ecolgica, facial e de contedo, estando em curso contributos adicionais para a validao efectiva numa amostra de maior dimenso.
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Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno do grau de Mestre em Gesto e Sistemas Ambientais
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RESUMO: O desenvolvimento de servios locais adequados deve ser baseado numa avaliao sistemtica das necessidades e resultados obtidos nos cuidados a uma populao de indivduos identificados como apresentando uma doena mental na rea de referenciao do servio. Neste sentido foram utilizados os seguintes mtodos: dados epidemiolgicos acerca das necessidades locais e taxas de utilizao de servios a nvel nacional e local, este ltimo com base no case-register. Os diagnsticos de maior prevalncia em ambulatrio so as perturbaes de humor e as perturbaes neurticas de stress ou somatoformes, com uma preponderncia de doenas mentais comuns (depresso e ansiedade) em servios de psiquiatria. Constatam-se baixas taxas de abandono da consulta (12%). A idade, a doena e a escolaridade esto correlacionados com o risco de drop-out, mas utilizada a regresso logstica, a idade e a escolaridade perdem o seu significado estatstico. Encontram-se taxas reduzidas de drop-out dos indivduos com psicose ou perturbaes bipolares, em virtude da interveno activa da equipa. Os custos de transporte, a distncia ao local de consulta e o tempo de espera para a primeira consulta so barreiras no acesso aos cuidados a nvel local. Os cuidadores no se sentem apoiados pela rede de suporte social e queixam-se sobretudo da acessibilidade, mas exibem elevadas taxas de satisfao com os servios prestados. Decidiu-se apostar numa organizao do servio baseada na comunidade, com intervenes baseadas na evidncia, dando prioridade ao doente mental grave e qualidade dos cuidados.----------- ABSTRACT: The development of appropriate local services should be based on a systematic assessment of the needs and outcomes of the population of individuals identified as mentally ill within the services catchment area. A number of methods may be used as proxies in assessing local needs for services, such as service utilization rates found nationally and locally, by case-register. The most prevalent diagnoses in ambulatory care are mood disorders and neurotic, stress and somatoform disorders, with a majority of common mental disorders (depression and anxiety) in psychiatric services. Low dropout rates (12%) are found in ambulatory care. Age, disease and education are correlated with the risk of drop-out, but after using logistic regression, age and education lose their statistical significance. Low drop-out rates are found in individuals with psychosis or bipolar disorders, because the active intervention from the team. The costs of transportation, distance and the waiting time for the first consultation are barriers in access of care locally. Carers do not feel supported by the network of social support and complain primarily of accessibility, but exhibit high levels of satisfaction with the services provided. It was decided to invest in a service organization based in the community with evidence-based interventions, giving priority to severe mental illness and quality of care.
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Dissertao para obteno do Grau de Mestre em Engenharia e Gesto Industrial
Sade Mental em meio prisional : avaliao de necessidades de cuidados em reclusos com perturbao mental
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RESUMO: A populao prisional constituda por indivduos geralmente sujeitos a alguma forma de excluso social e que apresentam problemas de sade fsica e mental mais frequentes do que na populao em geral. A prevalncia mais elevada de perturbaes mentais e de suicdio nos reclusos, em relao populao civil, consensual e est demonstrada em numerosos estudos internacionais. O abuso/dependncia de substncias, a depresso, as psicoses e a perturbao anti-social de personalidade so as perturbaes mais comuns na populao prisional. As perturbaes mentais so importantes factores de risco de suicdio, de vitimizao, de reincidncia e de reentrada no sistema prisional. Assim sendo, o grupo de reclusos com perturbao mental constitui um grupo de risco relevante. A avaliao de necessidades de cuidados foi iniciada no Reino Unido como um mtodo para o planeamento, medio dos resultados e financiamento dos cuidados de sade. Para esta avaliao foram desenvolvidos instrumentos que avaliam as necessidades em diversos domnios (clnicos e sociais) para aplicao aos utentes, cuidadores e profissionais. At aos anos noventa, a avaliao de necessidades no contexto prisional incidia especialmente nas necessidades de segurana dos servios, segundo a perspectiva dos profissionais. Contudo, a partir do relatrio Reed (1992), sobre a situao dos reclusos com perturbao mental, verificou-se uma abordagem mais abrangente, que inclua a avaliao das necessidades de cuidados dos reclusos. Embora as necessidades dos reclusos com perturbao mental paream ser similares s dos doentes psiquitricos em geral, existem diferenas em determinados domnios como a comorbilidade do eixo II, o abuso de substncias e o risco de violncia. Por este motivo, as necessidades de cuidados de sade mental dos reclusos so elevadas e frequentemente no se encontram satisfeitas. De forma a incluir estas especificidades foi desenvolvida a verso forense do Camberwell Assessment of Need (CAN), designada por CAN - Forensic Version (CANFOR). Actualmente existe um consenso generalizado entre as instituies internacionais do dever de proporcionar aos reclusos cuidados de sade, de preveno e de tratamento, equivalentes aos cuidados disponveis para a populao civil - o princpio da equivalncia de cuidados. A presente investigao pretendeu caracterizar e avaliar as necessidades de cuidados dos reclusos acompanhados nos servios de psiquiatria prisionais na rea da Grande Lisboa (internamento no Servio de Psiquiatria do Hospital Prisional de S. Joo de Deus (HPSJD) e consultas nos Estabelecimentos Prisionais (EP) de Caxias e de Tires). De modo a estabelecer uma comparao com sujeitos civis foi seleccionada uma amostra de convenincia de pacientes acompanhados num departamento de psiquiatria da mesma regio, segundo um emparelhamento por sexo, escalo etrio, e por diagnstico, num perodo de 3 meses. Realizou-se um estudo de tipo observacional, transversal e comparativo. Aplicaram-se os seguintes instrumentos de avaliao: questionrio especfico, Brief Psychiatric Rating Scale 4.0, Mini International Neuropsychiatric Interview 5.0.0, Global Assessment Functioning, CAN-R e CANFOR-R. No perodo do estudo (12 meses) foram assistidos 149 reclusos, dos quais, 35 (23,5%) no cumpriram os critrios de incluso. A amostra final de reclusos (PRs) (n=114) foi constituda por 79 homens (69,3%) e 35 mulheres (30,7%), dos quais 77 eram condenados (67,5%) e 37 (32,5%) encontravam-se detidos preventivamente. A amostra final de participantes civis (PCs) foi constituda por 121 indivduos, dos quais 76 eram homens (62,8%) e 45 eram mulheres (37,2%).A amostra final de participantes civis (PCs) foi constituda por 121 indivduos, dos quais 76 eram homens (62,8%) e 45 eram mulheres (37,2%). Relativamente aos PRs, o diagnstico mais frequente foi a Perturbao Anti-social da Personalidade (57,9%), seguida pela Depresso Major (56,1%). A maioria (53,5%) apresentava trs ou mais categorias diagnsticas. Aproximadamente um tero dos PRs (30%) pontuou o nvel elevado de risco de suicdio. A probabilidade deste risco aumentava, significativamente, nos portadores de Depresso Major, de um maior nvel de psicopatologia e de uma condenao actual. Perto de metade dos PRs (47,4%) possua duas ou mais condenaes prvias e mais de metade estavam envolvidos em crimes contra pessoas (53,5%). A probabilidade de condenaes mltiplas foi significativamente superior nos portadores de Perturbao Antisocial da Personalidade e nos reclusos com maior nmero de necessidades totais. Entre os PRs dos dois sexos, as principais diferenas significativas residiram na maior frequncia de consumo de substncias e no maior nmero de necessidades de cuidados nosatisfeitas nos homens versus mulheres. A comparao entre os PRs, antes da deteno, e os PCs mostrou que os primeiros possuam menor escolaridade, menos medicao psiquitrica, mas mais emprego e mais consumos de substncias ilcitas. A Perturbao Anti-social da Personalidade (OR=26,4; IC95%: 10,7-64,9), a Perturbao Ps-stress Traumtico (OR=15,0; IC95%: 3,5-65,4), a Dependncia/Abuso de Substncias (OR=8,5; IC95%: 4,2-17,6) a Depresso Major (OR=2,6; IC95%: 1,5-4,4) e o Risco de Suicdio Elevado (OR=2,6; IC95%: 1,4-5,0) foram significativamente mais frequentes nos PRs versus PCs. Relativamente avaliao de necessidades de cuidados, os PRs mostraram maior nmero de necessidades no-satisfeitas e maior necessidade de ajuda profissional, em relao aos PCs. Embora diversas necessidades no-satisfeitas possam resultar da condio de recluso, outras, em domnios da sade fsica, da segurana do prprio e dos consumos txicos, podero indicar que os PRs recebem um nvel de cuidados inferior ao necessrio, em comparao com os PCs. Os PRs apresentaram patologia mental, predominantemente no-psictica e elevado risco de suicdio/auto-agresso, associado a depresso, necessidades de cuidados e uma pena de priso. Possuam, numa frequncia elevada, caractersticas, consistentemente, associadas reincidncia criminal (personalidade anti-social, consumos txicos, condenaes anteriores), pelo que se justifica um especial acompanhamento deste grupo, no perodo pr e ps-libertao. A comparao de necessidades de cuidados no contexto civil e prisional indica um maior nvel de necessidades e um menor nvel de cuidados recebidos pelos PRs, em relao aos PCs. O princpio da equivalncia de cuidados poder estar comprometido nos indivduos reclusos com perturbao mental. A utilizao do CANFOR foi fcil e poder contribuir para um melhor planeamento, oferta e avaliao de resultados ao nvel individual. Os PRs e PCs revelaram caractersticas clnicas e de necessidades muito diferentes entre si, pelo que, os reclusos com perturbao mental devero ser assistidos em servios de sade mental preparados para abordar as suas especificidades.---------------ABSTRACT: The prison population is generally made up of individuals who are usually subject to some sort of social exclusion and who show physical and mental problems more frequently than the general population. Various international studies have found higher rates of mental disturbances and suicide within the prison population. The most common mental disturbances found are substance abuse or dependency, depression, psychosis, and anti-social personality disturbance. Such mental disturbances are important factors in suicide, victimization, delinquency recurrence, and the risk of reentry into prison. As a result, prison inmates with mental disturbances are a relevant at risk group. Assessment of needs of care first started in the United Kingdom as a method of care planning, results measuring and finance health care. The method involved the development of certain measuring instruments to be used by patients, caregivers and professionals in order to evaluate needs in various domains (clinical and social). Until the nineties, the assessment of needs of care in a prison context focused mainly on the services security needs. However, after the Reed (1992) report on mentally disturbed inmates, a much wider approach was considered, which included evaluation of the inmates needs of care. However similar mentally disturbed prison inmates needs may appear to those of other psychiatric patients, there are some differences in particular domains, namely, co-morbidity of Axis II, substance abuse and the risk of violence. For this reason, inmates mental health care needs are high and very often not met. In order to include these specificities, a forensic version of the Camberwell assessment of need (CAN,) designated CAN Forensic version (CANFOR) was developed. There is now generalized consensus among international institutions of the duty under the equivalent health care principle to provide inmates with preventative health care and treatment, that are equivalent to the care available to the civil population. This investigation aims to characterize and assess the health care provision of prison inmates admitted to Lisbons Psychiatric Prison ward - the Psychiatric Ward of So Joo de Deus Hospital (HPSJD) - and inmates in the Caxias and Tires Prison Establishments (EP) undertaking outpatient treatment. In order to establish a comparison between prison and civilian patients, a convenience sample was selected from civilian patients being treated in a psychiatric ward in the same geographical area. This sample was paired by gender, age group and diagnosis during a three month period. The study was observational, transversal and comparative. The following measuring instruments were used: a purpose-built questionnaire, Brief Psychiatric Rating Scale 4.0, Mini International Neuropsychiatric Interview 5.0.0, Global Assessment Functioning Scale, CAN-R and CANFOR-R. During the research period (12 months), 149 inmates received care, of whom 35 (23.5%) did not comply with the prerequisite criteria of this study. The final sample of inmates (PRs) (n=114) comprised 79 men (69.3%) and 35 (30.7%) women, of whom 77 (67.5%) were convicted prisoners and 37 (32.5%) were in preventive custody. The final sample for Civilian Participants (PCs) was made up of 121 individuals, of whom 76 (62.8%) were men and 45 (37.2%) were women. The most common diagnosis among the PRs was Anti-Social Personality Disorder (57.9%), followed by Major Depression (56.1%). More than half of the subjects in the sample (53.5%) showed three or more diagnostic categories. Approximately one third (30%) of the PRs showed a high level of suicide risk. The probability of this risk was significantly higher among Major Depression patients, those showing a higher level of psychopathology and those with a current conviction. Almost half of the PRs (47.4%) had been given two or more prior convictions and more than half (53.5%) were involved in crimes against people. The probability of multiple convictions was significantly higher among inmates with Anti-Social Personality Disorder and in those with more total needs. With regard to gender, the main significant difference among the PRs was that men were found to have a higher frequency of substance use and a greater number of unsatisfied caring needs than women. Comparison between the PRs prior to detention and PCs revealed that the former held lower educational qualifications and received less psychiatric medication, but had higher levels of employment and showed greater consumption of illicit substances. In addition Anti-Social Personality Disorder (OR=26.4; IC 95%: 10.7-64.9), Post-Stress Traumatic Disturbance (OR=15.0; IC 95%: 3.5-65.4), Substance Dependency/Abuse (OR=8.5; IC 95%: 4.2-17.6), Major Depression (OR=2.6; IC 95%: 1.5-4.4), and High Suicide Risk (OR=2.6; IC 95%: 1.4-5.0) were significantly more frequent amongst PRs than PCs. The results for needs assessment revealed that the PRs showed higher levels of unmet needs and a greater need for professional help in comparison with the PCs. Although various unmet needs may result from the inmates condition, other needs - in particular those regarding physical health, personal security and toxic substance use - suggest that the care given to PRs may be inadequate in comparison with that given to PCs. This implies that the principle of equivalent health care for PRs with mental illnesses may not be upheld. Furthermore, the mental morbidity results of the PRs indicated that they suffer predominantly from non-psychotic and high suicide/self inflicted aggression risk associated with depression, caring needs and a prison sentence. They also often showed characteristics that are consistently associated with criminal recidivism (Anti-social Personality, use of toxic substances, prior convictions). This result justifies that there should be special follow-up for this group in the pre- and after release period. The use of CANFOR proved to be simple and the application delay was acceptable. No difficulties were encountered in the understanding of its categories by its users. As a result, itcould contribute towards better planning, supply and assessment of results at an individual level. Given that the PRs and PCs revealed different clinical and needs characteristics, it is recommended that inmates with mental disturbances should be assisted in mental health services that are adequately prepared to address their specificities.
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RESUMO - O envelhecimento demogrfico uma constatao e ao mesmo tempo uma oportunidade para viver de forma mais saudvel e autnoma o mais tempo possvel. A principal razo para a admisso de pessoas idosas em instituies e para o uso desproporcionado de servios de sade o declnio funcional que acompanha o envelhecimento. Os Cuidados de Sade Primrios apresentamse como contexto ideal para promover cuidados antecipatrios. A avaliao da autonomia funcional multidimensional permite a deteco de perturbaes incipientes. Os programas de rastreios facilitam o desencadear de recursos para a deteco precoce e tratamento. Os mdicos sentem diversas barreiras na aplicao dos rastreios, como a falta de familiaridade com os testes, bem como a falta de tempo ou recursos. O estudo aqui proposto visa conhecer, a ttulo exploratrio, as atitudes dos mdicos de famlia face aos rastreios de autonomia funcional multidimensional em pessoas idosas; avaliar o grau de conhecimento sobre esta abordagem multidimensional, no que diz respeito s reas e instrumentos a avaliar; caracterizar as prticas na prestao de cuidados preventivos s pessoas idosas e caracterizar as condies genricas necessrias para a aplicao destes rastreios no contexto dos cuidados de sade primrios. Para tal, ir basearse num questionrio autoadministrado aos mdicos de famlia dos 22 Agrupamentos de Centros de Sade, na Regio de Sade de Lisboa e Vale do Tejo. As suas concluses podero contribuir para uma uniformizao do conceito de autonomia funcional multidimensional e para a realizao de um levantamento de necessidades de formao sobre a abordagem multidimensional e interdisciplinar.
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Dissertation to obtain the Master degree in Electrical Engineering and Computer Science
Avaliao de necessidades das pessoas idosas em Medicina Geral e Familiar: um estudo de exequibilidade
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RESUMO: Os mdicos de famlia devem participar na deteco precoce dos factores de risco que favorecem o declnio funcional nas pessoas idosas. A avaliao estruturada das suas necessidades poder contribuir para identificar os problemas de sade que traduzam deteriorao funcional. O objectivo deste trabalho foi avaliar a exequibilidade da implementao de um processo de avaliao de necessidades de cuidados em sade das pessoas idosas na consulta de MGF.Seleccionou-se uma amostra no aleatria de pacientes com 65 ou mais anos de idade, na consulta mdica de uma Unidade de Sade Familiar da regio de Lisboa. A avaliao de necessidades foi realizada, pelos mdicos, com cinco itens da entrevista Camberwell Assessment of Need for the Elderly (CANE-5). Avaliou-se a percepo dos mdicos e dos pacientes sobre este processo de avaliao de necessidades mediante um questionrio escrito e entrevistas individuais, respectivamente. Identificaram-se necessidades em 38 (75%) dos 51 pacientes avaliados. Do total das 83 necessidades identificadas, 17 no estavam cobertas. O sofrimento psicolgico foi a necessidade no coberta mais frequente. A comparao das avaliaes do mdico com as do paciente mostrou concordncia razovel ou boa nas cinco reas avaliadas. Esta avaliao foi bem aceite e considerada til na perspectiva dos mdicos e dos pacientes. A principal dificuldade identificada pelos mdicos foi o tempo despendido na avaliao face durao da consulta. Este estudo aponta para a exequibilidade da utilizao da entrevista CANE-5 na prtica clnica de MGF. No entanto, ser importante alargar este estudo a amostras de maior dimenso e avaliar a utilidade da entrevista em intervenes sobre a funcionalidade dos pacientes idosos.----------ABSTRACT: General practitioners (GP) should participate in the early detection of risk factors for fuctional disability in elderly people. Structured needs assessments may contribute to a better identification of health problems that are linked to functional decline. The aim of this study was to assess the feasibility of a structured assessment of needs in the elderly, in the context of opportunistic screening in primary care. A convenience sample was selected of patients aged 65 years and over with scheduled appointments in one general practice in the Lisbon region. The assessment of needs was done by their GPs, using five items of the Camberwell Assessment of Need for the Elderly (CANE-5). Perceptions of GPs and patients about this process of needs assessment were ev+aluated by means of a written questionnaire and individual interviews, respectively. Needs were identified in 38 (75%) of 51 patients. Seventeen unmet needs were identified, out of a total number of 83 needs. Psychological distress was the most frequent unmet need. GPs and patients assessments showed moderate or good agreement in all five areas. This needs assessment process was well accepted and considered useful by both GPs and patients. The main difficulty, according to the views of GPs, was the time consumed in this process, given the length of consultation. This study suggests the feasibility of using the CANE-5 interview in clinical practice in primary care settings. However it is important to replicate this study in larger samples and to evaluate the usefulness of the interview regarding interventions related to functionality in elderly patients.
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The theme of this dissertation is the finite element method applied to mechanical structures. A new finite element program is developed that, besides executing different types of structural analysis, also allows the calculation of the derivatives of structural performances using the continuum method of design sensitivities analysis, with the purpose of allowing, in combination with the mathematical programming algorithms found in the commercial software MATLAB, to solve structural optimization problems. The program is called EFFECT Efficient Finite Element Code. The object-oriented programming paradigm and specifically the C ++ programming language are used for program development. The main objective of this dissertation is to design EFFECT so that it can constitute, in this stage of development, the foundation for a program with analysis capacities similar to other open source finite element programs. In this first stage, 6 elements are implemented for linear analysis: 2-dimensional truss (Truss2D), 3-dimensional truss (Truss3D), 2-dimensional beam (Beam2D), 3-dimensional beam (Beam3D), triangular shell element (Shell3Node) and quadrilateral shell element (Shell4Node). The shell elements combine two distinct elements, one for simulating the membrane behavior and the other to simulate the plate bending behavior. The non-linear analysis capability is also developed, combining the corotational formulation with the Newton-Raphson iterative method, but at this stage is only avaiable to solve problems modeled with Beam2D elements subject to large displacements and rotations, called nonlinear geometric problems. The design sensitivity analysis capability is implemented in two elements, Truss2D and Beam2D, where are included the procedures and the analytic expressions for calculating derivatives of displacements, stress and volume performances with respect to 5 different design variables types. Finally, a set of test examples were created to validate the accuracy and consistency of the result obtained from EFFECT, by comparing them with results published in the literature or obtained with the ANSYS commercial finite element code.
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Dissertao apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para a obteno do grau de Mestre em Engenharia do Ambiente, perfil Gesto de Sistemas Ambientais
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Thesis submitted to the Faculty of Sciences and Technology, New University of Lisbon, for the degree of Doctor of Philosophy in Environmental Sciences
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Text based on the paper presented at the Conference "Autonomous systems: inter-relations of technical and societal issues" held at Monte de Caparica (Portugal), Universidade Nova de Lisboa, November, 5th and 6th 2009 and organized by IET-Research Centre on Enterprise and Work Innovation
Resumo:
The post-graduation in the field of Technology Assessment (TA) is recent and that are several and different ways to be organised. Most experiences are related with the Masters diplom level (2nd cycle of graduation in high education). Just one in PhD level is explicit in the field of TA, and some other PhD courses include also TA topics in their programme structure. In this chapter we will analyse the problems related with the design of a post-graduation (MA, MSc or PhD) programme in the field of TA using as reference some international experiences. Hereby, the main conclusion seems to address labour market needs in the specialised knowledge of TA, of technology management or technology innovation. In this sense TA should be included as minor into post-graduation courses which may range from engineering disciplines to social sciences. As a graduation programme it can fill an expertise gap between technicians, engineers, scientists and the strategic decision makers or policy makers.
