993 resultados para Physicians, Family
Resumo:
OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.
Resumo:
The synthesis of two new inherently chiral calix[4]arenes (ICCs, 1 and 2), endowed with electron-rich concave surfaces, has been achieved through the desymmetrization of a lower rim distal-bridged oxacyclophane (OCP) macrocycle. The new highly emissive ICCs were resolved by chiral HPLC, and the enantiomeric nature of the isolated antipodes proved by electronic circular dichroism (CD). Using time-dependent density functional calculations of CD spectra, their absolute configurations were established. NMR studies with (S)-Pirkle's alcohol unequivocally showed that the host-guest interactions occur in the chiral pocket comprehending the calix-OCP exo cavities and the carbazole moieties.
Resumo:
Dissertao apresentada para a obteno do Grau de Mestre em Gentica Molecular e Biomedicina, pela Universidade Nova de Lisboa, Faculdade de Cincias e Tecnologia
Resumo:
This research, still at an early stage, and then presented in a poster format, intended to explain the management of organizational performance of a family business in the succession process using the case study method. The scripts for semi-structured interviews that will apply to managers, owners and other workers who are deemed suitable for the investigation, which include relatives of the owners of the company are being developed. For this work the model of organizational performance management developed by David Otley in 1999 [1], consisting of five questions that seek to explain the existing performance management in any organization is utilized.
Resumo:
RESUMO: Na parte inicial incluem-se algumas notas sucintas com base no panorama cientfico,histrico e cultural da viso considerada segundo trs abordagens - o olho (o olho humano na especificidade da sua posio filogentica, elemento antomo-funcional bsico do sistema visual ao qual o crebro pertence), os olhos (unidades gmeas essenciais do rosto na sua actividade consensual e conjugada da binocularidade), o olhar (carregado de expresso psicolgica e o seu efeito sobre o observador, sinal para o comportamento e criador de sentimentos, sedimentado em obras de arte e em formas de superstio dos povos). Segue-se a apresentao de um estudo descritivo transversal, como contribuio para o conhecimento do estado de sade visual da populao infantil da regio de Lisboa e determinar factores que o influenciam. Entre Outubro de 2005 e Agosto de 2006 examinaram-se 649 crianas com idade inferior a 10 anos da Consulta de Oftalmologia Peditrica dos Servios de Assistncia Mdico-Social do Sindicato dos Bancrios do Sul e Ilhas (SAMS). Colheram-se dados respeitantes a mais de 250 variveis primrias que cobriram a maior parte dos itens do exame oftalmolgico habitual. Na anlise dos dados teve-se especialmente em conta a idade, com um papel decisivo nas principais fases de desenvolvimento do sistema visual. No caso das crianas de 6 a 7 anos de idade pem-se lado a lado resultados dos SAMS e das Escolas. A profuso de dados numricos ditou a necessidade da determinao frequente da significncia estatstica dos resultados de subgrupos. Alguns resultados do estudo, na sua maioria do grupo SAMS: Crianas de 6-7 anos, 71,1% (SAMS) e 91,5% (Escolas) no tinham sido examinadas com menos de 4 anos. Frequncia global de alteraes mipicas 9,4%, de alteraes hipermetrpicas 25,3%, umas e outras com variaes acentuadas com a idade. Estrabismo convergente 3,9%. Ambliopia 2,6% (13/491 crianas >=4 anos de idade), mais frequente no sexo feminino, naquelas que tiveram a sua 1 observao depois dos 4 anos e em que os pais no aderiam teraputica prescrita. Objectivos especficos ocuparam-se da acuidade visual e da refraco ocular. O estudo comparativo da refractometria automtica sem e com cicloplegia permitiu evidenciar que o teste da acuidade visual insuficiente, por si s, para fazer o diagnstico correcto. A anlise dos antecedentes familiares oftalmolgicos demonstrou a importncia do seu conhecimento e ps em evidncia, entre outras, as seguintes relaes: 10 pag1.qxp 27-11-2001 18:28 Page 10 ndice Geral 11 Crianas com antecedentes de alteraes mipicas tm maior frequncia de diagnstico de alteraes mipicas e de refraco negativa, uma taxa mais elevada de correspondncia quantitativa diagnstico/refraco nas alteraes mipicas. Estas crianas tambm tm, em geral, caractersticas inversas no que diz respeito a alteraes hipermetrpicas. Crianas com antecedentes de alteraes hipermetrpicas tm maior frequncia de diagnstico de alteraes hipermetrpicas. Crianas com antecedentes de estrabismo tm maior frequncia de diagnstico de estrabismo convergente manifesto e de esodesvios no seu todo. Crianas com antecedentes familiares de astigmatismo tm maior frequncia de diagnstico de astigmatismo. Traam-se alguns perfis oftalmolgicos infantis que permitem apreciar de forma sinptica um conjunto de parmetros da sade da viso. Os dados colhidos sobre a aderncia dos pais teraputica prescrita e sobre a atitude em relao ao uso de culos assim como os dados sobre o comportamento da criana na sala de aula e dificuldades de aprendizagem foram em geral escassos para permitirem tirar concluses, embora mostrem indcios a investigar futuramente. Paralelamente ortoptistas e enfermeiras efectuaram um rastreio escolar da acuidade visual <0,8 e de alteraes da motilidade ocular extrnseca que abrangeu 520 alunos do 1 ano do 1 ciclo do ensino bsico (2005/2006) das escolas pblicas da cidade de Lisboa. 101 destas crianas foram observadas no consultrio da autora, umas referidas a partir do rastreio, outras como controlo deste. Quanto acuidade visual o valor preditivo do teste negativo foi de 91% mas o do teste positivo de apenas 67% (33% de falsos positivos, consequentemente uma alta taxa de sobrerreferenciao). A qualidade do rastreio efectuado por ortoptistas foi inferior do efectuado por enfermeiras. O rastreio no teve qualidade aceitvel. Foi feito um inqurito a mdicos e enfermeiros de centros de sade sobre conhecimentos, atitudes e prticas em relao com os cuidados de oftalmologia peditrica. Discutem-se os resultados, tiram-se concluses e fazem-se recomendaes susceptveis de contribuir para uma melhor sade visual das crianas. ABSTRACT: Firstly some brief remarks are made based on the scientific, historical and cultural panorama of the human vision with regard to three approaches: the eye (the human eye in its specific filogenetic place, fundamental anatomofunctional element of the visual system in interaction with the brain), the eyes (essential twin units of the face with their consensual and conjugated binocular activity), the gaze (psychologicaly overloaded, a means to express oneself and to influence the observer, a guide to other persons' behaviour, consolidated in works of art and in people's traditional superstitious believes and ways of thinking). A report is made on a cross-sectional descriptive study whose goal is to contribute to the knowledge of the level of visual health of children in the Lisbon Region and to identify factors which determine it. Between October 2005 and August 2006 649 children under 10 years were observed at the pediatric ophthalmologic consultation in the SAMS (Servios de Assistncia Mdico-Social do Sindicato dos Bancrios do Sul e Ilhas). Data were collected concerning more than 250 primary variables covering most itens of the usual ophthalmological examination. Special attention was paid to children's age since it plays a crucial role in main stages of visual system development. In the case of children age 6 to 7 SAMS and school results are often put side by side. On account of the great number of numerical data it was often necessary to look at the degree of statistical significancy of differencies between subgroups. Some of the study's results (mostly SAMS): Children age 6 to 7 - 71,1% (SAMS) and 91,5% (Schools) had not an ophthalmologic examination before 4 years old. Total frequency of myopic disorders 9,4%, of hypermetropic disorders 25,3%, both showing great differences between age groups; convergent strabismus 3,9%; amblyopia 2,6% (13/491 children over 3 years old), more frequent among little girls, in those with 1st examination after 4 years old and in those whose parents didnt complied to the therapy ordered for the child. Specific objectives dealt with visual acuity and ocular refraction. The comparison of automatic refractometry without and with cycloplegy showed that visual acuity testing is often not enough for a correct diagnosis. Eye disorders in the family history proved to be a very important information. Analysis of corresponding data disclosed a lot of relationships among others: 12 pag1.qxp 27-11-2001 18:28 Page 12 ndice Geral 13 Children with a family history of myopic disorders have more frequently a diagnosis of myopic disorders and a negative refraction, a higher rate of quantitative diagnosis/refraction matching concerning myopic disorders. Those children have in general inverse characteristics regarding hypermetropic disorders. Children with a family history of hypermetropic disorders have more frequently a diagnosis of hypermetropic disorders. Children with a family history of strabismus have more frequently a diagnosis of manifest convergent strabismus and all forms of esodeviations. Children with a family history of astigmatism have more frequently a diagnosis of astigmatism. Ophthalmologic profiles are drawn allowing to take into account in a synoptic way a set of visual health parameters. Data on parents' compliance with therapy ordered for the child, and attitudes regarding child's glass wearing, as well as data on child's behaviour in the classroom and learning difficulties were as a rule too few to allow conclusions but still need more studies in the future. Orthoptists and nurses performed in the same study period a screening of visual acuity <0,8 and of ocular motility disorders addressed to children of 1srt degree of public schools (term 2005/2006) in the town of Lisbon. 520 of such children were screened. 101 of them were examined by the author in her medical office; some were refered, the others taken as a control. Regarding visual acuity the predictive value of a negative test was 91% but the predictive value of a positive test was only 67% (33% of false positive results, consequently a too high rate of overreferal). Performed by orthoptists screening quality was inferior in comparison with screening done by nurses. On the whole this screening had not the required quality. A survey on physicians' and nurses' knowledge, attitudes and practices related to pediatric ophthalmologic care was carried out in health centers. Results are discussed, conclusions drawn. Some suggestions are made aiming at a better children's visual health.
Resumo:
In Portugal, feminine activity rate of working mother is high but remains structural asymmetries of responsibilities between women and men in familiar spheres. Based on quantitative and qualitative data results are presented that show that, in spite of a global feminization rate of 58,6%, women workers in State Administration remains with major responsibilities in familiar/private lives than men. Women in technical and leadership functions have the same patterns of familiar and domestic responsibilities but different patterns of work-time. Women in technical functions tend to have a strategy of work-family time balance, despite less career opportunities, while women in leadership functions adopt a supremacy of wok-time, just as men. Nevertheless, both women, in technical and leadership functions, feel a permanent conflict between career and family responsibilities, which is not felt by men. Gender roles define dominant models of work and family organisation which conduct to different professional strategies and career opportunities.
Resumo:
Dissertation presented to obtain a PhD degree in Biochemistry at the Instituto de Tecnologia Qumica e Biolgica, Universidade Nova de Lisboa
Resumo:
The studied family showed the presence of four different types of hemoglobin. The family member who gave rise to this study (=propositus) presented Hb C and the hybrid Hb CG-phila. The propositus has three children, all of which have Hb AC; none of the family members showed any clinical symptoms. The investigation of the hemoglobin arose from the finding of target red cells in a blood test done during the pre-operatory examination for lower limb varicose vein stripping. The hybrid Hb CG-phila is due to two gene pairs, each of which with individual expression, determining the synthesis and the particular type subunits. The hybrid Hb CG-phila is formed by the combination velocity of the subunits alpha2G-philabeta2; therefore the proportion of the hybrid Hb CG-phila is lower than Hb G-phila and Hb C. The identification and molecular characterization of Hb G-phila showed the position alpha268 Asn->Lys beta2 and Hb C showed alpha2beta26 Glu->Lys.
Resumo:
RESUMO:A depresso clnica uma patologia do humor, dimensional e de natureza crnica, evoluindo por episdios heterogneos remitentes e recorrentes, de gravidade varivel, correspondendo a categorias nosolgicas porventura artificiais mas clinicamente teis, de elevada prevalncia e responsvel por morbilidade importante e custos sociais crescentes, calculando-se que em 2020 os episdios de depresso major constituiro, em todo o mundo, a segunda causa de anos de vida com sade perdidos. Como desejvel, na maioria dos pases os cuidados de sade primrios so a porta de entrada para o acesso recepo de cuidados de sade. Cerca de 50% de todas as pessoas sofrendo de depresso acedem aos cuidados de sade primrios mas apenas uma pequena proporo correctamente diagnosticada e tratada pelos mdicos prestadores de cuidados primrios apesar dos tratamentos disponveis serem muito efectivos e de fcil aplicabilidade. A existncia de dificuldades e barreiras a vrios nveis doena, doentes, mdicos, organizaes de sade, cultura e sociedade contribuem para esta generalizada ineficincia de que resulta uma manuteno do peso da depresso que no tem sido possvel reduzir atravs das estratgias tradicionais de organizao de servios. A equipa comunitria de sade mental e a psiquiatria de ligao so duas estratgias de interveno com desenvolvimento conceptual e organizacional respectivamente na Psiquiatria Social e na Psicossomtica. A primeira tem demonstrado sucesso na abordagem clnica das doenas mentais graves na comunidade e a segunda na abordagem das patologias no psicticas no hospital geral. Todavia, a efectividade destas estratgias no se tem revelado transfervel para o tratamento das perturbaes depressivas e outras patologias mentais comuns nos cuidados de sade primrios. Novos modelos de ligao e de trabalho em equipa multidisciplinar tm sido demonstrados como mais eficazes e custo-efectivos na reduo do peso da depresso, ao nvel da prestao dos cuidados de sade primrios, quando so atinentes com os seguintes princpios estratgicos e organizacionais: deteco sistemtica e abordagem da depresso segundo o modelo mdico, gesto integrada de doena crnica incluindo a continuidade de cuidados mediante colaborao e partilha de responsabilidades intersectorial, e a aposta na melhoria contnua da qualidade. Em Portugal, no existem dados fiveis sobre a frequncia da depresso, seu reconhecimento e a adequao do tratamento ao nvel dos cuidados de sade primrios nem se encontra validada uma metodologia de diagnstico simples e fivel passvel de implementao generalizada. Foi realizado um estudo descritivo transversal com os objectivos de estabelecer a prevalncia pontual de depresso entre os utentes dos cuidados de sade primrios e as taxas de reconhecimento e tratamento pelos mdicos de famlia e testar metodologias de despiste, com base num questionrio de preenchimento rpido o WHO-5 associado a uma breve entrevista estruturada o IED. Foram seleccionados aleatoriamente 31 mdicos de famlia e avaliados 544 utentes consecutivos, dos 16 aos 90 anos, em quatro regies de sade e oito centros de sade dotados com 219 clnicos gerais. Os doentes foram entrevistados por psiquiatras, utilizando um mtodo padronizado, o SCAN, para diagnstico de perturbao depressiva segundo os critrios da 10 edio da Classificao Internacional de Doenas. Apurou-se que 24.8% dos utentes apresentava depresso. No melhor dos cenrios, menos de metade destes doentes, 43%, foi correctamente identificada como deprimida pelo seu mdico de famlia e menos de 13% dos doentes com depresso estavam bem medicados com antidepressivo em dose adequada. A aplicao seriada dos dois instrumentos no revelou dificuldades tendo permitido a identificao de pelo menos 8 em cada 10 doentes deprimidos e a excluso de 9 em cada 10 doentes no deprimidos. Confirma-se a elevada prevalncia da patologia depressiva ao nvel dos cuidados primrios em Portugal e a necessidade de melhorar a capacidade diagnstica e teraputica dos mdicos de famlia. A interveno de despiste, que foi validada, parece adequada para ser aplicada de modo sistemtico em Centros de Sade que disponham de recursos tcnicos e organizacionais para o tratamento efectivo dos doentes com depresso. A obteno da linha de base de indicadores de prevalncia, reconhecimento e tratamento das perturbaes depressivas nos cuidados de sade primrios, bem como a validao de instrumentos de uso clnico, viabiliza a capacitao do sistema para a produo de uma campanha nacional de educao de grande amplitude como a proposta no Plano Nacional de Sade 2004-2010.------- ABSTRACT: Clinical depression is a dimensional and chronic affective disorder, evolving through remitting and recurring heterogeneous episodes with variable severity corresponding to clinically useful artificial diagnostic categories, highly prevalent and producing vast morbidity and growing social costs, being estimated that in 2020 unipolar major depression will be the second cause of healthy life years lost all over the world. In most countries, primary care are the entry point for access to health care. About 50% of all individuals suffering from depression within the community reach primary health care but a smaller proportion is correctly diagnosed and treated by primary care physicians though available treatments are effective and easily manageable. Barriers at various levels pertaining to the illness itself, to patients, doctors, health care organizations, culture and society contribute to the inefficiency of depression management and pervasiveness of depression burden, which has not been possible to reduce through classical service strategies. Community mental health teams and consultation-liaison psychiatry, two conceptual and organizational intervention strategies originating respectively within social psychiatry and psychosomatics, have succeeded in treating severe mental illness in community and managing non-psychotic disorders in the general hospital. However, these strategies effectiveness has not been replicated and transferable for the primary health care setting treatment of depressive disorders and other common mental pathology. New modified liaison and multidisciplinary team work models have been shown as more efficacious and cost-effective reducing depression burden at the primary care level namely when in agreement with principles such as: systematic detection of depression and approach accordingly to the medical model, chronic llness comprehensive management including continuity of care through collaboration and shared responsibilities between primary and specialized care, and continuous quality improvement. There are no well-founded data available in Portugal for depression prevalence, recognition and treatment adequacy in the primary care setting neither is validated a simple, teachable and implementable recognition and diagnostic methodology for primary care. With these objectives in mind, a cross-sectional descriptive study was performed involving 544 consecutive patients, aged 16-90 years, recruited from the ambulatory of 31 family doctors randomized within the 219 physicians working in eight health centres from four health regions. Screening strategies were tested based on the WHO-5 questionnaire in association with a short structured interview based on ICD-10 criteria. Depression ICD-10 diagnosis was reached according to the gold standard SCAN interview performed by trained psychiatrists. Any depressive disorder ICD-10 diagnosis was present in 24.8% of patients. Through the use of favourable recognition criteria, 43% of the patients were correctly identified as depressed by their family doctor and about 13% of the depressed patients were prescribed antidepressants at an adequate dosage. The serial administration of both instruments WHO-5 and short structured interview was feasible, allowing the detection of eight in ten positive cases and the exclusion of nine in ten non-cases. In Portugal, at the primary care level, high depressive disorder prevalence is confirmed as well as the need to improve depression diagnostic and treatment competencies of family doctors. A two-stage screening strategy has been validated and seems adequate for systematic use in health centres where technical and organizational resources for the effective management of depression are made available. These results can be viewed as primary care depressive disorders baseline indicators of prevalence, detection and treatment and, along with clinical useful instruments, the health system is more capacitated for the establishment of a national level large education campaign on depression such as proposed in the National Health Plan 2004-2010.
Resumo:
Dissertation presented to obtain a Doctoral Degree in Biology by Instituto de Tecnologia Qumica e Biolgica, Universidade Nova de Lisboa
Resumo:
The authors observed an injury caused by the sting of a false tocandira ant in the hand of an amateur fisherman and they describe the clinical findings and the evolution of the envenoming, which presented an acute and violent pain, cold sweating, nausea, a vomiting episode, malaise, tachycardia and left axillary's lymphadenopathy. About three hours after the accident, still feeling intense pain in the place of the sting, he presented an episode of great amount of blood in the feces with no history of digestive, hematological or vascular problems. The intense pain decreased after eight hours, but the place stayed moderately painful for about 24 hours. In that moment, he presented small grade of local edema and erythema. The authors still present the folkloric, pharmacological and clinical aspects related to the tocandiras stings, a very interesting family of ants, which presents the largest and more venomous ants of the world.
Resumo:
Presented at Embed with Linux Workshop (EWiLi 2015). 4 to 9, Oct, 2015. Amsterdam, Netherlands.
Resumo:
We describe slipped capital femoral epiphysis in 4 members of a black, obese family, who were all first-degree relatives. The aetiology of slipped capital femoral epiphysis is unknown, although it is thought to be multifactorial. Genetic predisposition and environmental factors have been associated with the condition. A familial incidence with at least two cases in the same family has been reported. In epidemiological studies, this incidence ranges from 3% to 35%. Our cases were investigated in an attempt to find a possible aetiological genetic factor. A genetic predisposition with an autosomal dominant pattern of transmission is suggested, although environmental variables must be considered as provocative factors.
Resumo:
Objectives: The aim of this article is to analyze the factors associated with HIV testing among 767 sexually active women. Methods: Participants were administered several self-report questionnaires that assessed behavioral and psychosocial measures. Results: Overall, 59.8% of the participants reported ever having tested for HIV. Results show that higher levels of education, being pregnant or having been pregnant, concern about AIDS, AIDS knowledge, self-efficacy in condom negotiation and perception of no risk in partner significantly predicted the likelihood of testing among women. Attending the mass was negatively associated with HIV testing. Conclusions: These findings provide information that can be used in the development of a focused gender sensitive HIV prevention program to increase HIV testing.
Resumo:
Women account for 30% of all AIDS cases reported to the Health Ministry in Portugal and most infections are acquired through unprotected heterosexual sex with infected partners. This study analyzed socio-demographic and psychosocial predictors of consistent condom use and the role of education as a moderator variable among Portuguese women attending family planning clinics. A cross-sectional study using interviewer-administered fully structured questionnaires was conducted among 767 sexually active women (ages 1865). Logistic regression analyses were used to explore the association between consistent condom use and the predictor variables. Overall, 78.7% of the women were inconsistent condom users. The results showed that consistent condom use was predicted by marital status (being not married), having greater perceptions of condom negotiation self-efficacy, having preparatory safer sexual behaviors, and not using condoms only when practicing abstinence. Living with a partner and having lack of risk perception significantly predicted inconsistent condom use. Less educated women were less likely to use condoms even when they perceive being at risk. The full model explained 53% of the variance in consistent condom use. This study emphasizes the need for implementing effective prevention interventions in this population showing the importance of taking education into consideration.
