Tid, rum och självbestämmande : Möjligheter och hinder i vardagen för äldre personer med intellektuell funktionsnedsättning på gruppboende

People with intellectual disability are living longer, which creates new demands for the support and care of this target group. Participation and autonomy at all ages, regardless of functional capacity, are cited in legislation and among the key objectives of disability policy. As a group, older people with intellectual disability have previously been almost invisible in both policy documents and research. Information regarding this group is thus limited, and more systematic knowledge is needed about older people with intellectual disability, their daily lives, and especially their opportunities for autonomy. The purpose of this thesis is to learn more about the role of influence and autonomy in everyday life from the perspective of older people with intellectual disability living in group homes. This will be achieved by studying situations in which opportunities and obstacles arise for these residents to exercise their autonomy in daily life, and identifying and analysing how autonomy is expressed in the meeting between residents and staff. The study applies an ethnographic approach, using methods including field studies with observations and videotaped meetings between residents and staff. The sample consists of residents aged 65 and over and staff at three group homes for people with intellectual disability. One resident at each group home is followed in greater depth. The analysis uses the time-geographic concepts of project, activity and restrictions in order to clarify where and when different projects are carried out, as well as who has the power to determine what is to be carried out. Interaction analysis is used to analyse the videotaped meetings between residents and staff. The analysis is based on Goffman’s interaction order and interaction rituals, theories about turntaking, both verbal and non-verbal, and theories about power and counter-power. In accordance with Goffman’s framework concept, the starting point is the concrete framework that reflects spatiality, which in turn becomes a way to place the more abstract framework of the situation into a specific context. Two major projects were identified: Sleep and Rest and Meals. The analysis reveals projects that are governed by the resident’s own preferences (individual projects) and projects that are governed to a greater degree by the staff’s objectives and opportunities (institutional projects). Some guidance also derives from municipal decisions and guidelines (organizational projects). Many projects were carried out based on staff decisions and objectives, but in actual practice many projects failed to get off the ground. Some projects were at risk of failure until something happened or someone intervened and thereby rescued the project so that it could be implemented. The interactional analysis perspective shows how autonomy is constructed in the meeting. Autonomy is situation-bound, and shifts more on the basis of context than in relation to specific individuals. The study includes decision situations mainly between autonomy and its opposite, paternalism, which are viewed as extremes on a continuum. However, certain factors lead to stronger autonomy in certain situations. When a resident can define the situation, they also have greater power to determine the outcome. In situations characterized by paternalism, the staff have a preferential right of interpretation and the power to decide, both on the basis of their knowledge and because of the asymmetrical interdependence that characterizes the resident-professional relationship. Such situations are also governed by the rules and procedures of the group home to a greater degree than those situations in which the resident exercises autonomy. The thesis discusses strategies that could increase the residents’ opportunities for autonomy. Greater communication skills among staff can be viewed as a step on the path toward greater autonomy for the residents. Staff have the potential to eliminate obstacles, to strengthen inadequate skills or create new ones by providing choices and assistive devices, and to exercise an affirmative approach.

El concepto y la práctica de la actividad física y su relación con calidad de vida en los modelos teóricos de la salud

Los estudios acerca del concepto actividad física (AF) son diversos, presentando diferentes concepciones; su relación con calidad de vida suele estar generada dentro del discurso médico, que propende por la ejecución de la Actividad Física desde una mirada netamente biológica. Si bien esta disertación es importante, se debe tener en cuenta que los estudios relacionados con calidad de vida y la AF se basan en la condición de bienestar y percepción frente al estado de salud; dichos estudios no se han realizado desde las condiciones de vida y del contexto social. Si bien es cierto que la mirada médica y lo estudios objetivos son relevantes, ya que arrojan estadísticas que permiten abordar recomendaciones en cuanto a la actividad física, en este documento se elaboró una investigación de tipo cualitativo por medio de la revisión documental del concepto de actividad física, sus prácticas y su relación con calidad de vida, que abordan diferentes autores. Para ello se elige la base de datos PubMed por su énfasis en las publicaciones de salud; se seleccionan artículos publicados del 2004 y 2014, que estudien el concepto de actividad física, sus prácticas y relaciones con calidad de vida, para finalmente hacer un análisis desde los modelos de determinación y determinantes sociales. De esta forma se analiza la posición de los autores con respecto al concepto, sus prácticas y las relaciones que puede llegar a surgir con la calidad de vida. En esta investigación se obtuvo como resultados tendencias biológicas, psicológicas, sociales y culturales, en los cuales los autores dejan clara la posición médica ya que en la mayoría de investigaciones centran sus relaciones en la funcionalidad, y es a través de la visión terapéutica donde buscan el bienestar, la satisfacción de los pacientes que padecen cualquier enfermedad. Además, aparecen categorías emergentes como: cuerpo como medio de publicidad, cibernética que avanza vertiginosamente y el papel del poder en la actividad física que pueden ser contempladas para otros estudios.

Envelhecimento e Diabetes Mellitus Tipo 2: estudo dos efeitos do exercício físico no comportamento postural e capacidade funcional de pacientes com Diabetes Mellitus Tipo 2

A Diabetes Mellitus é uma patologia fortemente associada ao processo de envelhecimento, afectando cada vez mais pessoas em todo o mundo. Uma das maiores complicações observadas nesta população prende-se com a diminuição do controlo postural e da capacidade funcional relacionada com a locomoção. O exercício físico tem sido apontado como uma das formas de prevenção e tratamento deste problema, no entanto existe ainda uma lacuna no conhecimento sobre o modo mais indicado de exercício. O presente pretende avaliar os efeitos de um programa de exercício físico aeróbio sobre o controlo postural e a capacidade funcional de pacientes portadores de Diabetes Mellitus Tipo 2. A amostra do estudo foi composta por 30 sujeitos de ambos os sexos, distribuídos por um grupo experimental (n=16) a quem foi aplicado o programa de exercício físico, e por um grupo de controlo (n=14), o qual não usufruiu de qualquer programa de exercício físico. O programa teve a duração de 12 semanas de treino, e uma frequência de 3 vezes por semana. Os participantes mantiveram-se em movimento constante durante as sessões tendo os exercícios realizados possuído uma forte componente dinâmica. Foi avaliado o controlo postural através de uma plataforma de forças e a capacidade funcional através de um conjunto de cinco testes funcionais. Os resultados obtidos revelam não terem existido diferenças estatisticamente significativas (p>0,05) na interacção entre grupos e momentos de avaliação nas variáveis analisadas, com excepção para a performance no Timed Get Up & Go Test, a qual melhorou significativamente (p<0,05) no grupo experimental. Estes dados sugerem que a especificidade tanto estática como dinâmica dos exercícios e a intensidade a que são realizados são factores fundamentais a ter em consideração no planeamento de programas de exercício físico, com vista à melhoria quer do controlo postural quer da capacidade funcional em portadores de Diabetes Mellius Tipo 2. ABSTRACT: Diabetes Mellitus is a disease associated with aging, affecting a growing number of people all over the world. One of the major concerns in this population relates to the decline of postural control and functional capacity. Exercise has been suggested as one way of preventing and treating this problem, however little is known about the most appropriate mode of exercise. This study evaluates the effect of an aerobic exercise program on postural control and functional capacity of patients with Type 2 Diabetes Mellitus. The sample consisted of 30 subjects, over an experimental group (n = 16) applied to an exercise program, and a control group (n = 14), that received no treatment. The program lasted 12 weeks, three times a week. Participants remained in constant motion during the sessions and the exercises performed had a strong dynamic component. Postural control was assessed using a force platform and functional capacity through a set of five functional tests. The results show that there were no statistically significant differences (p>O, O5) in group/moment interaction in the variables analyzed, except for the Timed Get Up & Go Test, which improved significantly (p <0,05) in the experimental group. These data suggest that both static and dynamic specificity and intensity of exercises are key factors in exercises programs planning, targeted to improve both postural control and functional capacity in patients with Type 2 Diabetes Mellius.

An Efficient Protocol For The Generation Of Monocyte Derived Dendritic Cells Using Serum-free Media For Clinical Applications In Post Remission Aml Patients.

Protocols for the generation of dendritic cells (DCs) using serum as a supplementation of culture media leads to reactions due to animal proteins and disease transmissions. Several types of serum-free media (SFM), based on good manufacture practices (GMP), have recently been used and seem to be a viable option. The aim of this study was to evaluate the results of the differentiation, maturation, and function of DCs from Acute Myeloid Leukemia patients (AML), generated in SFM and medium supplemented with autologous serum (AS). DCs were analyzed by phenotype characteristics, viability, and functionality. The results showed the possibility of generating viable DCs in all the conditions tested. In patients, the X-VIVO 15 medium was more efficient than the other media tested in the generation of DCs producing IL-12p70 (p=0.05). Moreover, the presence of AS led to a significant increase of IL-10 by DCs as compared with CellGro (p=0.05) and X-Vivo15 (p=0.05) media, both in patients and donors. We concluded that SFM was efficient in the production of DCs for immunotherapy in AML patients. However, the use of AS appears to interfere with the functional capacity of the generated DCs.

[gait Speed, Grip Strength And Self-rated Health Among The Elderly: Data From The Fibra Campinas Network, São Paulo, Brazil].

The article seeks to investigate patterns of performance and relationships between grip strength, gait speed and self-rated health, and investigate the relationships between them, considering the variables of gender, age and family income. This was conducted in a probabilistic sample of community-dwelling elderly aged 65 and over, members of a population study on frailty. A total of 689 elderly people without cognitive deficit suggestive of dementia underwent tests of gait speed and grip strength. Comparisons between groups were based on low, medium and high speed and strength. Self-related health was assessed using a 5-point scale. The males and the younger elderly individuals scored significantly higher on grip strength and gait speed than the female and oldest did; the richest scored higher than the poorest on grip strength and gait speed; females and men aged over 80 had weaker grip strength and lower gait speed; slow gait speed and low income arose as risk factors for a worse health evaluation. Lower muscular strength affects the self-rated assessment of health because it results in a reduction in functional capacity, especially in the presence of poverty and a lack of compensatory factors.

Prevalence Of Urinary Incontinence And Its Association With Multimorbidity In Women Aged 50 Years Or Older: A Population-based Study.

To evaluate the prevalence and associated risk factors for urinary incontinence, as well as its association with multimorbidity among Brazilian women aged 50 or over. This was a secondary analysis of a cross-sectional population-based study including 622 women 50 years or older, conducted in the city of Campinas-SP-Brazil. The dependent variable was Urinary Incontinence (UI), defined as any complaint of urine loss. The independent variables were sociodemographic data, health-related habits, self-perception of health and functional capacity evaluation. Statistical analysis was carried out using the Chi-square test and Poisson regression. The mean age of the women was 64. UI was prevalent in 52.3% of these women: Mixed UI (26.6%), Urge UI (13.2%) and Stress UI (12.4%). Factors associated with a higher prevalence of UI were hypertension (OR 1.21, CI 1:01-1:47, P = 0.004), osteoarthritis (OR 1.24, CI 1:03-1:50, P = 0.022), physical activity ≥3 days/week (OR 1.21, CI 1:01-1:44, P = 0.039), BMI ≥ 25 at the time of the interview (OR 1.25, CI 1:04-1:49, P = 0.018), negative self-perception of health (OR 1.23, CI 1:06-1:44 P = 0.007) and limitations in daily living activities (PR 1:56 CI 1:16-2:10, P = 0.004). The prevalence of UI was high. Mixed incontinence was the most frequent type of UI. Many associated factors can be prevented or improved. Thus, health policies targeted at these combined factors could reduce their prevalence rate and possibly decrease the prevalence of UI. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.

Artificial Gait In Complete Spinal Cord Injured Subjects: How To Assess Clinical Performance.

Objective Adapt the 6 minutes walking test (6MWT) to artificial gait in complete spinal cord injured (SCI) patients aided by neuromuscular electrical stimulation. Method Nine male individuals with paraplegia (AIS A) participated in this study. Lesion levels varied between T4 and T12 and time post injured from 4 to 13 years. Patients performed 6MWT 1 and 6MWT 2. They used neuromuscular electrical stimulation, and were aided by a walker. The differences between two 6MWT were assessed by using a paired t test. Multiple r-squared was also calculated. Results The 6MWT 1 and 6MWT 2 were not statistically different for heart rate, distance, mean speed and blood pressure. Multiple r-squared (r2 = 0.96) explained 96% of the variation in the distance walked. Conclusion The use of 6MWT in artificial gait towards assessing exercise walking capacity is reproducible and easy to apply. It can be used to assess SCI artificial gait clinical performance.

Saude fisica, indicadores antropometricos, desempenho fisico e bem-estar subjetivo em idosos atendidos no ambulatorio de geriatria do HC/UNICAMP

Universidade Estadual de Campinas . Faculdade de Educação Física

Qualidade de vida e fatores associados em idosos dependentes em uma cidade do interior do Nordeste

OBJETIVO: Este estudo tem por objetivo verificar a influência de fatores sociodemográficos, condições de saúde, capacidade funcional e dinâmica familiar na qualidade de vida de idosos dependentes residentes em domicílio em uma cidade do interior da região do Nordeste. MÉTODOS: Trata-se de uma pesquisa de caráter analítico com delineamento transversal. A amostra deste estudo foi composta por 117 idosos dependentes, cadastrados nas Unidades de Saúde da Família da área de abrangência do bairro do Jequiezinho, no município de Jequié, BA. Os instrumentos de coleta de dados utilizados foram o WHOQOL-OLD, o Índice de Barthel, o Apgar de Família e o levantamento de dados sociodemográficos e condições de saúde. RESULTADOS: Com a aplicação do Teste do qui-quadrado (x²) encontrou-se diferença estatística entre comprometimento da qualidade de vida e da dinâmica familiar, com exceção do domínio autonomia (p = 0,061) da qualidade de vida. CONCLUSÕES: Apenas o comprometimento da dinâmica familiar influencia de maneira negativa a qualidade de vida dos idosos dependentes, uma vez que, quanto mais prejudicada a funcionalidade familiar, pior a qualidade de vida desses.

Fatores associados à qualidade de vida de cuidadores de idosos em assistência domiciliária

O objetivo do presente estudo foi investigar se o comportamento da qualidade de vida (QV) de cuidadores de idosos em assistência domiciliária pode ser influenciado por características sociodemográficas, pela rede de suporte oferecida ao cuidador e por variáveis relacionadas ao ato de cuidar. Foram entrevistados 40 cuidadores de idosos de um Programa de Assistência Domiciliária da cidade de São Paulo. A QV foi mensurada utilizando-se a versão brasileira do Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36). Características sociodemográficas, as variáveis relacionadas à rede de suporte oferecida ao cuidador e ao ato de cuidar foram obtidas por meio de questionário complementar. A análise de regressão linear mostrou relação independente entre três domínios do SF-36 e o maior número de horas dedicadas ao cuidado: domínios capacidade funcional, aspecto físico e aspecto emocional. Possuir mais de oito anos de escolaridade implicou em melhor pontuação no domínio estado geral de saúde e pior pontuação no domínio aspecto social. Os cuidadores com mais de 60 anos de idade apresentaram pior pontuação no domínio aspecto físico e as mulheres pior pontuação no domínio dor. Os filhos ou cônjuges que prestam cuidado aos seus pais ou parceiros apresentaram pior pontuação no domínio aspecto emocional. Os cuidadores que modificaram sua rotina para prestar os cuidados apresentaram pior pontuação no domínio saúde mental. Tanto fatores sociodemográficos como a rede de suporte oferecida ao cuidador e os fatores relacionados à dinâmica do cuidado são capazes de influenciar negativamente a QV de cuidadores principais de idosos em atendimento domiciliário.

LATENT RANK CHANGE DETECTION FOR ANALYSIS OF SPLICE-JUNCTION MICROARRAYS WITH NONLINEAR EFFECTS

Alternative splicing of gene transcripts greatly expands the functional capacity of the genome, and certain splice isoforms may indicate specific disease states such as cancer. Splice junction microarrays interrogate thousands of splice junctions, but data analysis is difficult and error prone because of the increased complexity compared to differential gene expression analysis. We present Rank Change Detection (RCD) as a method to identify differential splicing events based upon a straightforward probabilistic model comparing the over-or underrepresentation of two or more competing isoforms. RCD has advantages over commonly used methods because it is robust to false positive errors due to nonlinear trends in microarray measurements. Further, RCD does not depend on prior knowledge of splice isoforms, yet it takes advantage of the inherent structure of mutually exclusive junctions, and it is conceptually generalizable to other types of splicing arrays or RNA-Seq. RCD specifically identifies the biologically important cases when a splice junction becomes more or less prevalent compared to other mutually exclusive junctions. The example data is from different cell lines of glioblastoma tumors assayed with Agilent microarrays.

The contribution of self-efficacy and depression to disability and work status in chronic pain patients: A comparison between Australian and Brazilian samples

There is evidence that cognitions (beliefs) and mood contribute to physical disability and work status in people with chronic pain. However, most of the current evidence comes from North America and Europe. This study examined the contribution of demographic, pain and psychosocial factors to disability and work status in chronic pain patients in two matched samples from quite different countries (Australia and Brazil). Data were collected from 311 chronic pain patients in each country. The results suggest that although demographic and pain variables (especially pain levels) contribute disability, self-efficacy beliefs made a significant contribution to disability in both samples. Age and educational level also contributed to unemployment in both samples. But there were some differences, with self-efficacy and physical disability contributing to work status only in the Brazilian sample. In contrast, depression was the only psychological risk factor for unemployment in the Australian sample. Catastrophising and pain acceptance did not contribute to disability or unemployment in either sample. These findings confirm key aspects of biopsychosocial models of pain in two culturally and linguistically different chronic pain samples from different countries. They suggest that different chronic pain populations may share more similarities than differences. (C) 2008 European Federation of Chapters of the International Association for the Study of Pain. Published

Sexuality and quality of life of breast cancer patients post mastectomy

Aim: To evaluate the sexual functioning of breast cancer patients post mastectomy and its association with their quality of life, the personal characteristics of women and their partners, breast reconstruction, cancer staging and adjuvant therapies. Methods: A cross-sectional study was carried out in a University hospital located in the SouthEast of Brazil. A total of 100 women were included in the study. The parameters evaluated were sexual functioning, which was assessed based on the Sexual Quotient Female Version (SQ-F), quality of life (QoL), evaluated by the Medical Outcomes Study 36-item Short Form (SF-36), cancer staging, breast reconstruction, adjuvant therapies and the personal characteristics of patients (age, years of study and years of marriage) and their partners (age, years of study). Results: The majority (40.48%) of women had an unfavorable to regular SQ-F score. A significant positive correlation (p < 0.05) was found between the SQ-F score and years of education (p = 0.03), and the following SF-36 domains: functional capacity (p = 0.03), vitality (p = 0.06), emotional limitations (p = 0.00) and mental health (p = 0.03). A significant negative correlation was found between SQ-F score and the age of the partners (p = 0.03). SQ-F mean value was significantly higher (p = 0.04) among women who underwent breast reconstruction. Conclusions: Women with low educational level, who have older partners, and who did not have a breast reconstruction should receive special attention with respect to their sexuality, and the effects of mastectomy on the sexuality of patients should be assessed. Oncology nurses are best qualified to recognize issues related to sexuality and quality of life, and can offer specific and meaningful support for breast cancer patients. (C) 2010 Elsevier Ltd. All rights reserved.

Possible Relationship Between Performance and Oxidative Stress in Endurance Horses

The purpose of this study was to evaluate oxidative stress, antioxidant biomarkers, and performance during a multiday 210-km endurance race. Nine endurance athlete horses participated in this study. Samples were always taken at the same times of day, before the beginning of the race and after every day of competition. Analytic measurements included glutathione reductase (GR) and catalase activity, thiobarbituric acid-reactive substances (TBARs), and reactive carbonylated derivatives. Competition intensity was low, with an average speed of 12.56 +/- 0.9 km/h. Four horses were unable to finish the race because of metabolic problems or fatigue. GR activity increased progressively (P < .001) throughout the competition, and TBARs showed a significant rise compared with baseline values (P < .01) but remained at the same levels throughout the 3 days of competition. Catalase and reactive carbonylated derivatives did not show any significant alterations in any time period. The best performance was obtained from horses who demonstrated higher GR capacity and/or lower TBAR concentration. In conclusion, redox. status seems to modulate horses` performance in endurance races, but further Studies are needed to better determine the adequate oxidant/antioxidant ratio to acquire optimal performance.

Metabolic syndrome features small, apolipoprotein A-I-poor, triglyceride-rich HDL3 particles with defective anti-apoptotic activity

The metabolic syndrome (MetS) phenotype is typically characterized by visceral obesity, insulin resistance, atherogenic dyslipidemia involving hypertriglyceridemia and subnormal levels of high density lipoprotein-cholesterol (HDL-C), oxidative stress and elevated cardiovascular risk. The potent antioxidative activity of small HDL3 is defective in MetS [Hansel B, et al. J Clin Endocrinol Metab 2004;89:4963-71]. We evaluated the functional capacity of small HDL3 particles from MetS subjects to protect endothelial cells from apoptosis induced by mildly oxidized low-density lipoprotein (oxLDL). MetS subjects presented an insulin-resistant obese phenotype, with hypertriglyceridemia, elevated apolipoprotein B and insulin levels, but subnormal HDL-C concentrations and chronic low grade inflammation (threefold elevation of C-reactive protein). When human microvascular endothelial cells (HMEC-1) were incubated with oxLDL (200 jig apolipoprotein B/ml) in the presence or absence of control HDL subfiractions (25 mu g protein/ml), small, dense HDL3b and 3c significantly inhibited cellular annexin V binding and intracellular generation of reactive oxygen species. The potent anti-apoptotic activity of small HDL3c particles was reduced (-35%; p < 0.05) in MetS subjects (n = 16) relative to normolipidemic controls (n = 7). The attenuated anti-apoptotic activity of HDL3c correlated with abdominal obesity, atherogenic dyslipidemia and systemic oxidative stress (p < 0.05), and was intimately associated with altered physicochemical properties of apolipoprotein A-I (apoA-I-poor HDL3c, involving core cholesteryl ester depletion and triglyceride enrichment. We conclude that in MetS, apoA-I-poor, small, dense HDL3c exert defective protection of endothelial cells from oxLDL-induced apoptosis, potentially reflecting functional anomalies intimately associated with abnormal neutral lipid core content. (c) 2007 Elsevier Ireland Ltd. All rights reserved.