Health-related And Socio-demographic Factors Associated With Frailty In The Elderly: A Systematic Literature Review.

Frailty is a syndrome that leads to practical harm in the lives of elders, since it is related to increased risk of dependency, falls, hospitalization, institutionalization, and death. The objective of this systematic review was to identify the socio-demographic, psycho-behavioral, health-related, nutritional, and lifestyle factors associated with frailty in the elderly. A total of 4,183 studies published from 2001 to 2013 were detected in the databases, and 182 complete articles were selected. After a comprehensive reading and application of selection criteria, 35 eligible articles remained for analysis. The main factors associated with frailty were: age, female gender, black race/color, schooling, income, cardiovascular diseases, number of comorbidities/diseases, functional incapacity, poor self-rated health, depressive symptoms, cognitive function, body mass index, smoking, and alcohol use. Knowledge of the complexity of determinants of frailty can assist the formulation of measures for prevention and early intervention, thereby contributing to better quality of life for the elderly.

Boys In White: A Classic Of Qualitative Research Turns 50.

This article analyzes Boys in white: student culture in medical schoolby Howard S. Becker, Blanche Geer, Everett C. Hughes and Anselm Strauss, considered a model of qualitative research in sociology. The analysis investigates the trajectories of the authors, the book, qualitative analysis, and the medical students, emphasizing their importance in the origins of medical sociology and the sociology of medical education. In the trajectory of the authors, bibliographical information is given. The trajectory of qualitative research focuses on how this methodology influences the construction of the field. The investigation of the students' trajectory shows how they progress through their first years at medical school to build their own student culture.

A visita domiciliária realizada pelo agente comunitário de saúde sob a ótica de adultos e idosos

A visita domiciliária constitui o principal instrumento de trabalho dos agentes comunitários na Estratégia Saúde da Família. O objetivo deste estudo foi descrever a percepção de adultos e idosos em relação à visita domiciliária realizada pelo agente comunitário de saúde. Como referencial metodológico foi utilizada a abordagem qualitativa embasada em algumas figuras metodológicas do Discurso do Sujeito Coletivo. Os dados foram coletados em maio de 2007, em uma Unidade de Saúde da Família de Botucatu-SP, por meio de formulário sociodemografico e entrevista semiestruturada aplicada a 14 usuários. A análise dos dados permitiu identificar dois temas: "Sentimentos e percepções em relação à visita e ao agente comunitário" e "O reconhecimento das ações do agente comunitário". Apesar de os entrevistados sentirem-se satisfeitos e gratos diante da visita, o fato de perceberem a frequência mensal como insuficiente e de alegarem desconhecer o conteúdo das anotações realizadas pelo agente no momento da visita sinalizam a necessidade de o enfermeiro investir de maneira mais intensa em atividades educativas junto a esses profissionais, priorizando questões que envolvem os processos de comunicação. Acredita-se que com essa medida será possível otimizar, qualitativamente, a realização da atividade.

Qualitative Analysis of the Interdisciplinary Interaction between Data Analysis Specialists and Novice Clinical Researchers

Background: The inherent complexity of statistical methods and clinical phenomena compel researchers with diverse domains of expertise to work in interdisciplinary teams, where none of them have a complete knowledge in their counterpart's field. As a result, knowledge exchange may often be characterized by miscommunication leading to misinterpretation, ultimately resulting in errors in research and even clinical practice. Though communication has a central role in interdisciplinary collaboration and since miscommunication can have a negative impact on research processes, to the best of our knowledge, no study has yet explored how data analysis specialists and clinical researchers communicate over time. Methods/Principal Findings: We conducted qualitative analysis of encounters between clinical researchers and data analysis specialists (epidemiologist, clinical epidemiologist, and data mining specialist). These encounters were recorded and systematically analyzed using a grounded theory methodology for extraction of emerging themes, followed by data triangulation and analysis of negative cases for validation. A policy analysis was then performed using a system dynamics methodology looking for potential interventions to improve this process. Four major emerging themes were found. Definitions using lay language were frequently employed as a way to bridge the language gap between the specialties. Thought experiments presented a series of ""what if'' situations that helped clarify how the method or information from the other field would behave, if exposed to alternative situations, ultimately aiding in explaining their main objective. Metaphors and analogies were used to translate concepts across fields, from the unfamiliar to the familiar. Prolepsis was used to anticipate study outcomes, thus helping specialists understand the current context based on an understanding of their final goal. Conclusion/Significance: The communication between clinical researchers and data analysis specialists presents multiple challenges that can lead to errors.

Denoising swallowing sound to improve the evaluator`s qualitative analysis

Swallowing dynamics involves the coordination and interaction of several muscles and nerves which allow correct food transport from mouth to stomach without laryngotracheal penetration or aspiration. Clinical swallowing assessment depends on the evaluator`s knowledge of anatomic structures and of neurophysiological processes involved in swallowing. Any alteration in those steps is denominated oropharyngeal dysphagia, which may have many causes, such as neurological or mechanical disorders. Videofluoroscopy of swallowing is presently considered to be the best exam to objectively assess the dynamics of swallowing, but the exam needs to be conducted under certain restrictions, due to patient`s exposure to radiation, which limits periodical repetition for monitoring swallowing therapy. Another method, called cervical auscultation, is a promising new diagnostic tool for the assessment of swallowing disorders. The potential to diagnose dysphagia in a noninvasive manner by assessing the sounds of swallowing is a highly attractive option for the dysphagia clinician. Even so, the captured sound has an amount of noise, which can hamper the evaluator`s decision. In that way, the present paper proposes the use of a filter to improve the quality of audible sound and facilitate the perception of examination. The wavelet denoising approach is used to decompose the noisy signal. The signal to noise ratio was evaluated to demonstrate the quantitative results of the proposed methodology. (C) 2007 Elsevier Ltd. All rights reserved.

Causes of communication problems at work: A qualitative analysis of supervisor-subordinate differences

This study provided information about how individual workers perceive, describe and interpret episodes of problematic communication. Sixteen full-time workers (5 males, 11 females) were interviewed in depth about specific incidents of problematic communication within their workplace. Their descriptions of the attributed causes of the incidents were coded using a categorisation scheme developed from Coupland, Wieman, and Giles' (1991) model of sources of problematic communication. Communication problems were most commonly attributed to individual deficiency and group membership, although there were differences depending on the direction of communication. The most negative attributions (to personality flaws, to lack of skills, and to negative stereotypes of the outgroup) were most commonly applied by individuals to their supervisors, whilst attributions applied to co-workers and subordinates tended to be less negative, or even positive in some instances (where individuals attributed the fault to themselves). Overall, results highlighted distinctions between the perceptions of communication problems with supervisors and with subordinates, and are interpreted with reference to social identity theory.

Integrating technology to improve the efficiency of qualitative data analysis - A note on methods

Qualitative data analysis (QDA) is often a time-consuming and laborious process usually involving the management of large quantities of textual data. Recently developed computer programs offer great advances in the efficiency of the processes of QDA. In this paper we report on an innovative use of a combination of extant computer software technologies to further enhance and simplify QDA. Used in appropriate circumstances, we believe that this innovation greatly enhances the speed with which theoretical and descriptive ideas can be abstracted from rich, complex, and chaotic qualitative data. © 2001 Human Sciences Press, Inc.

Cognitive intervention protocol for age-related memory impairments

With the number of elderly people increasing tremendously worldwide, comes the need for effective methods to maintain or improve older adults' cognitive performance. Using continuous neurofeedback, through the use of EEG techniques, people can learn how to train and alter their brain electrical activity. A software platform that puts together the proposed rehabilitation methodology has been developed: a digital game protocol that supports neurofeedback training of alpha and theta rhythms, by reading the EEG activity and presenting it back to the subject, interleaved with neurocognitive tasks such as n-Back and Corsi Block-Tapping. This tool will be used as a potential rehabilitative platform for age-related memory impairments.

As autarquias e a educação. Centro e periferia na construção das políticas educativas (1998-2008)

RESUMO: Com o actual quadro de descentralização de atribuições e competências da administração central para as autarquias locais, na área da educação, os municípios passam a investir cada vez mais na acção educativa ao liderarem e planearem políticas educativas locais mais ou menos explícitas, e, nalguns casos, tentando superar carências que o sistema educativo apresenta. Esta pesquisa tem como problemática compreender o papel do Estado na (re)configuração das políticas de educação, quando a tendência para a mudança, de um Estado-educador para um Estado-regulador, tem por pressuposto o discurso neoliberal de que com ‗menos‘ Estado mas maior accountability se obtêm melhores resultados. Este processo origina uma redefinição no papel e funções do Estado no plano social e económico, provocando constrangimentos e conflitos de poder no que respeita ao seu controlo político, com a redistribuição de poderes entre o Estado e a comunidade, entre o central e o local. É neste contexto de mudança que a presente investigação, que se situa no âmbito da análise das políticas educativas, procura averiguar como e com que meios as autarquias locais concretizam as suas competências na área da educação. A estratégia de investigação concentra-se em uma metodologia qualitativa, com a utilização de um estudo exploratório, em três municípios da Região de Lisboa e Vale do Tejo. As actuais políticas educativas derivam da nova visão na gestão da coisa pública – res publica –, como resultado da nova concepção para o próprio Estado, e dos processos de elaboração das decisões político-educativas. Nesta perspectiva, a descentralização passa a ser um instrumento do poder local que favorece o aumento da autoridade democrática dos actores. Todavia, a governação – governance – supõe uma dinâmica de negociação, até mesmo de regulação entre o Estado, a região, o local, a escola e o mercado, feita para atender à construção do interesse geral, que já não é totalmente definido pelo Estado, mas construído em conjunto com as diversas forças políticas, económicas, educativas e sociais. O estudo permitiu evidenciar que a descentralização é posta em causa pelo Estado central, quando este ‗recentraliza‘ decisões e condiciona o poder local, com o fecho da maioria das escolas do primeiro ciclo e a verticalização dos agrupamentos escolares. Por sua vez, algumas políticas educativas como a ‗Escola a Tempo Inteiro‘ fomentam a desregulação dos vínculos laborais, forçando os municípios a aumentar os seus meios técnicos e humanos e a construírem novas infra-estruturas educativas. As políticas educativas passaram a ser concebidas segundo uma matriz híbrida, que visam a municipalização da educação – do pré-escolar e de todo o ensino básico –, por um lado; e fomentam a situação de ‗quase-mercado‘ com a privatização de sectores e o financiamento de várias instituições – que fornecem serviços na área da educação –, por outro lado. ABSTRACT: With the current framework of decentralization of functions and powers from central government to local authorities, in education, the municipalities are investing each more in educational work in leading educational policies and planning places more or less explicit and in some cases, trying to overcome shortcomings that education system. This research aims to understand the role of the state in the (re) configuration of education policies, when the tendency for the change in a State-Educator for a State-regulator, is the assumption that neo-liberal speech that with 'less' State but with more accountability we achieve better results. This process leads to a redefinition of the role and State functions in socio-economic constraints, resulting in power struggles with regard to its political control, with the redistribution of powers between the state and community, between the central and local. It is in this changing context that the present investigation, which lies in the examination of education policy addresses the question how and by what means the local, materialized their skills in education. The strategy focuses on a qualitative methodology, with the use of an exploratory study in three municipalities of Lisbon and Tagus Valley. The current education policies come from the new vision in the management of public affairs - res publica - as a result of the new design for the State itself, and the process of preparation of educational policy decisions. In this perspective, decentralization becomes an instrument of local government that favours the increase of democratic authority of the actors. However, the governance assumes a dynamic negotiation, even in regulation between the State, region, local authorities, school and market, made to suit the construction of general interest, which is not anymore fully defined by the State, but constructed together with the various political, economic, educational and social forces. The study indicates that decentralization is undermined by the central government when it ‗re-centralize‘ decisions and the local conditions, with the closure of most primary schools and with vertical groupings of schools. In turn, some educational policies such as 'Full Time School' forced the municipalities to increase their technical and human resources, to build new educational infrastructure. The educative policies began to be designed according to a hybrid matrix, which aims the decentralization of education - from pre-school and all the primary school - on one hand, and promote the situation of 'quasi-market' with privatization of sectors and the financing of several institutions - that provide services in education -, on the other hand. RÉSUMÉ: Avec le cadre actuel de décentralisation des fonctions et pouvoirs du gouvernement central aux autorités locales, dans l'éducation, les municipalités investissent de plus en plus dans le travail éducatif dans la conduite des politiques éducatives en mener et en faisant la planification des lieux plus ou moins explicites et, dans certains cas, essayer de remédier aux lacunes que présente l'éducation. Donc, nous voulons avec cette recherche comprendre le rôle de l'Etat dans la (re) configuration des politiques d'éducation, alors que la tendance au changement d‘un État-éducateur pour un État-régulateur, a comme l'hypothèse le discours néo-libéral de que avec «moins» État, mais plus d‘accountability on a des meilleurs résultats. Ce processus conduit à une redéfinition du rôle et des fonctions de l'Etat au plan social et économique, en donnant lieu à des luttes de pouvoir à l'égard de son contrôle politique, avec la redistribution des compétences entre l'État et la collectivité, entre les niveaux central et local. C‘est dans ce contexte changeant que la présente enquête, qui réside dans l‘examen de la politique de l‘éducation aborde la question de savoir comment et par quels moyens le local matérialisé leurs compétences dans l‘éducation. La stratégie est axée sur une méthodologie qualitative, avec l'utilisation d'une étude exploratoire dans trois municipalités de Lisbonne et Vallée du Tage. Les politiques actuelles d'éducation sont tirées de la nouvelle vision dans la gestion des affaires publiques - res publica – à la suite de la nouvelle conception de l'État lui-même, et le processus de préparation des décisions politique-éducatives. Dans cette perspective, la décentralisation devient un instrument de gouvernement local qui favorise l'augmentation de l'autorité démocratique des acteurs. Toutefois, la gouvernance assume une dynamique de négociation, même en matière de réglementation entre l'État, la région, le local, l'école et le marché, faite pour répondre à la construction d'intérêt général, qui n'est pas plus entièrement défini par l'Etat, mais construit en ensemble avec les divers forces politiques, économiques, éducatives et sociales. L‘étude indique que la décentralisation est minée par le gouvernement central quand il ‗re-centralise‘ les décisions et les conditions locales, avec la fermeture de la plupart des écoles du premier cycle et avec des groupements verticaux d‘écoles. À leur tour, certaines politiques éducatives telles que ‗l'école à temps plein‘ forcé les municipalités à accroître leurs ressources techniques et humaines, de construire de nouvelles infrastructures éducatives. Les politiques éducatives ont commencé à être conçues selon une matrice hybride, qui vise à la municipalisation de l'éducation - de l'école maternelle et de toute l'école basique - d'une part ; et de promouvoir la situation de «quasi-marché» avec la privatisation de secteurs et le financement de plusieurs institutions - qui offrent des services dans l'éducation -, d‘autre part.

Modelo de avaliação do programa comunitário de intervenção precoce da CERCI Lisboa

Mestrado em Intervenção Socio-Organizacional na Saúde - Área de especialização: Políticas de Administração e Gestão de Serviços de Saúde.