Medication regimen complexity in institutionalized elderly people in an aging society

Background: Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective: To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting: Five nursing homes in mainland Portugal. Methods: A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure: Medication regimen complexity index. Results: The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion: Medication regimen complexity proved to be high. There is certainly potential for the pharmacist's intervention to reduce it as part as the medication review routine in all the patients.

Transient Spaces: unsettling boundaries and norms at the cultural event Noc Noc, Guimarães, Portugal

Cities are increasingly expected to be creative, inventive and to exhibit intense expressivity. In the past decades many cities have experienced growing pressure to produce and stage cultural events of different sorts and to develop new strategies that optimize competitive advantages, in order to promote themselves and to boost and sell their image. Often these actions have relied on heavy public investment and major private corporation sponsoring, but it is not always clear or measured how successful and reproductive these investments have been. In the context of strained public finances and profound economic crisis of European peripheral countries, events that emerge from local communities and have low budgets, which manage to create significant fluxes of visitors and visibility, assume an increased interest. In order to reflect and sketch possible answers, we look to an emerging body of literature concerning creative cities, and we focus on the organisation of a particular cultural event and its impact and assimilation into a medium size Portuguese city. This paper looks at the two editions (2011 and 2012) of one of such events – Noc Noc – organized by a local association in the city of Guimarães, Portugal. Inspired by similar events, Noc Noc is based on creating transient spaces of culture which are explored by artists and audiences, by transforming numerous homes into ephemeral convivial and playful social ‘public’ environments. The event is based on a number of cultural venues/homes scattered around the old and newer city, which allows for an informal urban exploration and an autonomous rambling and getting lost along streets. This strategy not only disrupts the cleavages between public and private space permitting for various transgressions, but it also disorders normative urban experiences and unsettles the dominant role of the city council as the culture patron of the large majority of events. Guimarães, an UNESCO World Heritage City was the European Capital of Culture in 2012, with a public investment of roughly 73 million euro. By interviewing a sample of people who have hosted these transitory art performances and exhibitions, sometimes doubling as artists, the events’ organizers and by experience both editions of the event, this paper illustrates how urban citizens’ engagement and motivations in a low budget cultural event can strengthen community ties. Furthermore, it also questions the advantages of large scale high budget events, and how this event may be seen as unconscious counter movement against a commodification of cultural events and everyday urban experience at large, engaging with the concepts of staging and authenticity.

Perspectives of the Internal Public in a Cultural Event: the Case of Noc Noc, Guimarães - Portugal

Given the significant impact that cultural events may have in local communities and the inherent organization complexity, it is important to understand their specificities. Most of the times cultural events disregard marketing and often marketing is distant from art. Thus an analysis of an inside perspective might bring significant returns to the organization of such an event. This paper considers the three editions (2011, 2012 and 2013) of a cultural event – Noc Noc – organized by a local association in the city of Guimarães, Portugal. Its format is based in analogous events, as Noc Noc intends to convert everyday spaces (homes, commercial outlets and a number of other buildings) into cultural spaces, processed and transformed by artists, hosts and audiences. By interviewing a sample of people (20) who have hosted this cultural event, sometimes doubling as artists, and by experiencing the three editions of the event, this paper illustrates how the internal public understands this particular cultural event, analyzing specifically their motivations, ways of acting and participating, as well as their relationship with the public, with the organization of the event and with art in general. Results support that artists and hosts motivations must be identified in a timely and appropriate moment, as well as their views of this particular cultural event, in order to keep them participating, since low budget cultural events such as this one may have a key role in small scale cities.

Levels and risks of particulate-bound PAHs in indoor air influenced by tobacco smoke: a field measurement

Considering tobacco smoke as one of the most health-relevant indoor sources, the aim of this work was to further understand its negative impacts on human health. The specific objectives of this work were to evaluate the levels of particulate-bound PAHs in smoking and non-smoking homes and to assess the risks associated with inhalation exposure to these compounds. The developed work concerned the application of the toxicity equivalency factors approach (including the estimation of the lifetime lung cancer risks, WHO) and the methodology established by USEPA (considering three different age categories) to 18 PAHs detected in inhalable (PM10) and fine (PM2.5) particles at two homes. The total concentrations of 18 PAHs (ΣPAHs) was 17.1 and 16.6 ng m−3 in PM10 and PM2.5 at smoking home and 7.60 and 7.16 ng m−3 in PM10 and PM2.5 at non-smoking one. Compounds with five and six rings composed the majority of the particulate PAHs content (i.e., 73 and 78 % of ΣPAHs at the smoking and non-smoking home, respectively). Target carcinogenic risks exceeded USEPA health-based guideline at smoking home for 2 different age categories. Estimated values of lifetime lung cancer risks largely exceeded (68–200 times) the health-based guideline levels at both homes thus demonstrating that long-term exposure to PAHs at the respective levels would eventually cause risk of developing cancer. The high determined values of cancer risks in the absence of smoking were probably caused by contribution of PAHs from outdoor sources.

Estudo do impacte da institucionalização em lares na satisfação das necessidades humanas fundamentais : perspectiva dos idosos residentes

RESUMO O envelhecimento populacional, nos países ditos “desenvolvidos”, tem sido largamente discutido a nível internacional pelas suas implicações económicas, sociais e de saúde. Uma das prioridades de intervenção face a este fenómeno é promover o aumento de pessoas idosas autónomas inseridas no seu contexto social e familiar habitual. No entanto, nem sempre esse objectivo é atingido e a muitas pessoas idosas restam os lares, ou preferem-nos, como opção de alojamento e de satisfação das necessidades humanas fundamentais. O principal objectivo deste estudo foi procurar saber se a institucionalização no lar teve impacte na satisfação habitual das necessidades humanas fundamentais das pessoas idosas. Como objectivos secundários pretendeu-se complementar esta informação com alguns aspectos relacionados com o processo de institucionalização e perceber se existem diferenças significativas no que respeita ao sexo, grupo etário ou tempo de internamento. Foram incluídas no estudo 125 pessoas com 65 ou mais anos, residentes em 15 lares com alvará de iniciativa privada, pertencentes à Região de Lisboa e Vale do Tejo, no distrito de Setúbal. Os dados foram obtidos através de um questionário construído para o efeito pela autora. As principais conclusões do estudo apontaram para um impacte negativo da institucionalização na satisfação habitual de algumas necessidades que se enquadram no plano social, nomeadamente ocupar-se para se sentir útil, recrear-se e comunicar com os semelhantes. Nas diferentes necessidades, de uma forma geral, a institucionalização teve um impacte negativo no que respeita às dimensões relacionadas com privacidade e preferência individual. Por outro lado, a institucionalização parece ter tido um impacte positivo nas dimensões relacionadas com a segurança e a acessibilidade. Não foram encontradas diferenças significativas no que respeita ao número médio de respostas favoráveis ao lar ou à casa entre os grupos etários ou quanto ao tempo de internamento. Apesar disso, encontraram-se diferenças no que respeita ao grau de satisfação em residir num lar, sendo que o nível de satisfação com a institucionalização foi maior nas pessoas que residiam no lar há mais de um ano, comparativamente às que residiam no lar há um ano ou menos.-------------------------------------------- ABSTRACT: The ageing of the population of the more developed countries has been largely discussed internationally because of its economic, social and health implications. One of the priorities of intervention facing the ageing phenomenon is to promote the increase of autonomous elderly, within their usual social and familiar environment. Not always this goal is achieved and many elderly have nursing homes as option, or voluntary choose them, for lodgement and fundamental human needs satisfaction. The main goal of this study was to search whether the nursing home institutionalization had impact in the satisfaction of fundamental human needs. As secondary goals it was established to complement this information with some aspects of the institutionalization process, as well as to analyse if there were significant differences as far as sex, age groups or institutionalization time. The study sample included 125 individuals aged 65 years or more, living in 15 private nursing homes with approved legal certification, belonging to the Lisboa and Tagus Valley Region, in the district of Setúbal. Data were collected through a questionnaire designed for this study by the author. The main conclusions of this study pointed at a negative impact of institutionalization on the usual satisfaction of some human needs included at the social field, namely occupation, recreation and communication. At another level of needs, in a general way, institutionalization had negative impact concerning privacy and individual preferences dimensions. On the other hand, institutionalization appeared to have a positive impact in safety and accessibility dimensions. It was not found significant differences between age groups or institutionalization time as far as the average positive answers in favour to nursing home or house. Notwithstanding, there were differences relating to satisfaction in living at the nursing home being the satisfaction higher in residents who lived at the nursing home for more than a year, comparatively to those that lived at the nursing home for a year or less.

Identification of factors and groups at risk of infection with Schistosoma mansoni: a strategy for the implementation of control measures?

A fourteen year schistosomiasis control program in Peri-Peri (Capim Branco, MG) reduced prevalence from 43.5 to 4.4%; incidence from 19.0 to 2.9%, the geometric mean of the number of eggs from 281 to 87 and the level of the hepatoesplenic form cases from 5.9 to 0.0%. In 1991, three years after the interruption of the program, the prevalence had risen to 19.6%. The district consists of Barbosa (a rural area) and Peri-Peri itself (an urban area). In 1991, the prevalence in the two areas was 28.4% and 16.0% respectively. A multivariate analysis of risk factors for schistosomiasis indicated the domestic agricultural activity with population attributive risk (PAR) of 29.82%, the distance (< 10 m) from home to water source (PAR = 25.93%) and weekly fishing (PAR = 17.21%) as being responsible for infections in the rural area. The recommended control measures for this area are non-manual irrigation and removal of homes to more than ten meters from irrigation ditches. In the urban area, it was observed that swimming at weekly intervals (PAR = 20.71%), daily domestic agricultural activity (PAR = 4.07%) and the absence of drinking water in the home (PAR=4.29%) were responsible for infections. Thus, in the urban area the recommended control measures are the substitution of manual irrigation with an irrigation method that avoids contact with water, the creation of leisure options of the population and the provision of a domestic water supply. The authors call attention to the need for the efficacy of multivariate analysis of risk factors to be evaluated for schistosomiasis prior to its large scale use as a indicator of the control measures to be implemented.

Plataforma de gestão de guias de programação de TV digital

Com o consumismo de mais variedade e qualidade de informação, assim como, produtos interativos, surgiu a necessidade de apresentar mais conteúdos, para além da programação de televisão comum. Com os avanços tecnológicos ligados à indústria da televisão e sua distribuição nos lares portugueses pelos operadores de TV, a quantidade de oferta de canais deixou de ser um foco, passando a ser prioritário a melhoria da experiência do cliente. Com a introdução de novas funcionalidades nas caixas recetoras de sinais de transmissão de canais, como por exemplo, a capacidade de apresentar informações adicionais sobre os programas, desde da sua apresentação em modo trailer até ao elenco detalhado que o compõe, os clientes podem ter uma nova experiência de interação com os serviços de TV. A funcionalidade de gravação agendada de programas levou ao próximo ponto de melhoria de experiência do cliente. As gravações que resultavam em programas indevidamente cortados, quer no seu início quer no seu fim, foi um dos motivos que levou os operadores de TV a procurarem um melhor serviço de gestão de guias de programação digitais. A InfoPortugal, entidade detentora do seguinte projeto e EPG Provider de algumas operadoras de TV nacionais, viu-se obrigada a atualizar os seu sistemas de distribuição de conteúdos, para responder à evolução dos requisitos dos seus clientes.

SCADA House Intelligent Management for Energy Efficiency Analysis in Domestic Consumers

The implementation of smart homes allows the domestic consumer to be an active player in the context of the Smart Grid (SG). This paper presents an intelligent house management system that is being developed by the authors to manage, in real time, the power consumption, the micro generation system, the charge and discharge of the electric or plug-in hybrid vehicles, and the participation in Demand Response (DR) programs. The paper proposes a method for the energy efficiency analysis of a domestic consumer using the SCADA House Intelligent Management (SHIM) system. The main goal of the present paper is to demonstrate the economic benefits of the implemented method. The case study considers the consumption data of some real cases of Portuguese house consumption over 30 days of June of 2012, the Portuguese real energy price, the implementation of the power limits at different times of the day and the economic benefits analysis.

Sistema de Informação no auxílio à comunicação Escola-Família

Mestrado em Engenharia Informática

Percepção do estado de saúde da pessoa idosa institucionalizada

RESUMO: O envelhecimento da população portuguesa é um facto. Esta alteração da estrutura demográfica exige o investimento no conhecimento científico para que se conheçam as consequências a nível, económico, social, cultural, biológico, físico e, principalmente, a nível da saúde. Isto porque, é emergente que a sociedade tenha capacidade para responder às necessidades específicas das pessoas neste estádio de vida, tendo sempre por base o conceito de qualidade de vida. Este estudo teve como objectivo avaliar a percepção do estado de saúde da pessoa idosa institucionalizada. Foram nove as instituições participantes, denominadas por lares de idosos de residência permanente, onde se contou com uma amostra de 75 indivíduos entre os 66 e 100 anos, de ambos os sexos. Foram recolhidos dados através de uma caracterização sócio-demográfica, através do Mini Mental State e através do Questionário de auto-avaliação da saúde e do bem-estar físico (de Fonseca e Paúl, 1999). Os dados obtidos foram trabalhados numa perspectiva de estatística descritiva e estatística inferencial, nomeadamente com a análise do coeficiente de Spearman. A partir desta análise determinou-se que: a grande maioria da amostra designa como “aceitável” ou “fraca” a sua percepção da saúde, em geral; os dados sócio-demográficos, e a instituição a que cada indivíduo pertence não têm relação com a percepção do estado de saúde destas pessoas; existe relação significativa entre a percepção do estado de saúde das pessoas idosas institucionalizadas e a saúde dos seus pares, essencialmente quando se abordam itens relacionados com aspectos físicos; no que concerne aos hábitos de vida, não existe relação entre a percepção do estado de saúde das pessoas idosas e os hábitos tabágicos e os hábitos alcoólicos. Os dados obtidos nem sempre são os dados que se esperavam efectivamente, porém fazem sentido ao serem consolidados com a teoria.--------ABSTRACT: The aging of the Portuguese population is a reality. It is imperative that society has the capacity to face the specific necessities of those who are in this phase of their lives. Therefore, this change in the demographics requires investment in scientific knowledge in order to know the consequences at levels such as: the economic, social cultural, biological and physical, mainly related to health. The main purpose of this study has been to evaluate the perceptions of elderly people concerning their health conditions. There were nine institutions involved, which are referred to as nursing homes, and a sample of 75 people between 66 and 100 years-old, from both genders, cooperated. Data has been collected through social-demographic, Mini Mental State and also through the questionnaire of the self-evaluation of health and physical well-being (from Fonseca and Paúl, 1999). The obtained data was worked within a perspective of descriptive/ inference statistic. From this analysis, it was determined that the great majority of the sample describes their perception of health as “acceptable” or “weak”, in general; the social-demographic information and the institution to where each person belongs do not show a connection with their perception of their health condition; however, there seems to be a significant relation between an institutionalized elderly person´s perception of their health condition and their spouse’s health, mainly when related to physical issues. In as far as life styles are concerned, do not show a connection between elderly people’s perception of health and smoking habits and alcohol habits. The obtained data does not always match expectations; nevertheless they make sense when being complemented by the theory.

Os custos das fracturas de etiologia osteoporótica em mulheres : institucionalização na Rede Nacional de Cuidados Continuados (RNCCI) e lares de 3ª idade

RESUMO - Contexto: A osteoporose é uma doença sistémica associada à diminuição da resistência óssea que condiciona o aparecimento de fracturas por traumatismos de baixa energia as quais reduzem em muitos casos a esperança e a qualidade de vida, implicando um elevado número de horas de dedicação dos cuidadores e conduzindo, em muitos casos, à necessidade de institucionalização dos doentes. Em Portugal, ocorrem cerca de 40.000 fracturas anualmente, das quais 8.500 do fémur proximal, que se estima consumirem mais de 50 milhões de euros só em cuidados hospitalares1. Objectivo: Avaliar o impacto económico da institucionalização na Rede Nacional de Cuidados Continuados Integrados e Lares da 3ª idade por fractura de etiologia osteoporótica em mulheres no ano 2009, em Portugal. Métodos: O estudo começa por analisar sucintamente os aspectos clínicos, sociais e epidemiológicos da osteoporose, focando a perda de autonomia e qualidade de vida dos doentes vítimas deste episódio e a subsequente necessidade de institucionalização. Descrevem-se os custos associados à institucionalização na RNCCI, em Portugal, ano 2009, utilizando como fonte principal a base de dados da instituição “Gestcare CCI”, complementada com dados da literatura. Apuram-se os custos totais associados ao encaminhamento dos doentes para Lares de 3ª Idade em Portugal no ano 2009, utilizando-se informação proveniente de um painel de Delphi modificado e dados da literatura. A valorização dos recursos tem por base os preços em vigor no território nacional, expressos nos decretos-lei devidamente referenciados. Resultados: No ano 2009 em Portugal foram empregues cerca de 2,5 milhões de euros no internamento das mulheres na RNCCI, na perspectiva da sociedade, sendo cerca de 2,2 milhões atribuíveis à osteoporose (90%). Cerca de 91% dos custos totais são alocados à fractura osteoporótica da anca (2 milhões €). Para a fractura vertebral, úmero e punho os custos foram mais baixos - 7,1%, 1,3% e 1% dos custos totais da osteoporose, respectivamente. Nos Lares de 3ª idade, estimou-se a admissão de aproximadamente 14.372 doentes com fractura osteoporótica em diferentes localizações, em 2009, Portugal, com um custo que oscilou entre os 19 e os 21,6 milhões de euros. A fractura osteoporótica da anca foi a mais incidente e a que representou custos mais elevados para a Segurança Social – entre 17,5 e 19,7 milhões de euros. Considerando como referência os 52 milhões de euros gastos em 2006 no tratamento hospitalar da fractura da anca (DGS, 2006), o encaminhamento das mulheres para a RNCCI e Lares da 3ª Idade corresponde a 42% do bolo total. Assim, os resultados nacionais enquadram-se no que se encontra descrito na literatura internacional - os custos atribuíveis à hospitalização oscilaram entre 17%50 e 63%29 da despesa total da doença e das institucionalizações entre os 16%58 e os 59%51. Conclusões: Em Portugal o impacto económico da institucionalização por fractura osteoporótica, sobretudo por fractura da anca, não é desprezável e mostra que existiriam poupanças significativas se fosse possível reduzir a prevalência da doença em Portugal. Face às alterações demográficas associadas ao envelhecimento da população, é expectável que a incidência e custos com o tratamento das fracturas do colo do fémur, mais associadas à osteoporose, venham a subir nos próximos anos, pelo que o combate à doença deve ser considerada uma prioridade nacional. A decisão pela opção por determinados programas de prevenção da doença ou da comparticipação ou não de determinada terapêutica necessita contudo de ser complementada com a medição da dimensão dos benefícios terapêuticos. --- ABSTRACT - Background: Osteoporosis is a systemic disease associated with the loss off the bone strength and it is one of the major causes of low energy fractures, which in many cases reduce life hope and quality. This happens because it has associated extensive treatments and it usually carries loss of independence, implying many hours of caregivers dedication and leading, in many cases, to the institutionalization of the patients. In Portugal, about 40,000 fractures occur annually, which 8,500 are proximal femur, and that are estimated to consume over 50 million euros only in hospital care. Objective: Evaluate the economic impact of institutionalization on the Integrated Continued Care National Network (RNCCI) and Care Homes associated to osteoporotic fractures in women, in the year 2009 in Portugal. Methods: The study begins by reviewing briefly the clinical, social, and epidemiological studies of osteoporosis and osteoporotic fractures, focusing on the patient autonomy loss and life quality. The total and average costs per episode associated with the institutionalization in RNCCI are described, in Portugal, year 2009, using as main data source the application "Gestcare CCI", complemented with literature data. The total costs associated with the patients referral for the Care Homes in Portugal in 2009 is also calculated, using information from a modified Delphi panel and some literature data. The resources valuation is based on prices prevailing in Portugal. Results: In 2009, women relocation in RNCCI consumed approximately 2.5 million euros, which 2.2 million are attributable to osteoporosis (90%). About 91% of the total costs are allocated to osteoporotic hip fracture (€ 2 million). For vertebral, humerus, and wrist fracture, the associated costs were lower, 7.1%, 1.3%, and 1% of total costs of osteoporosis treatment, respectively. In Care Homes, an intake of approximately 14 372 patients with osteoporotic fracture was estimated, at a cost that is between 19 and 21.6 million euros. The osteoporotic hip fracture was the most frequent and represented higher costs for Social Security - between 17.5 and 19.7 million euros. Taking as reference the 52 million spent in 2006 with hospital treatment of hip fracture (DGS, 2006), referring women to RNCCI and Care Homes represents 42% of the total costs. The results are in accordance with the international literature - costs attributable to hospitalization ranged between 17% and 63% of total expenditure of illness and institutionalization between 16% and 59%. Conclusions: In Portugal, the economic impact of institutionalization for osteoporotic fracture, particularly for hip fracture, is not negligible. It was shown that there would be significant savings if it were possible to reduce the prevalence of the disease in Portugal. Femoral fractures were the second most frequent diagnosis in RNCCI in 2008 and 2009 (16% of all episodes recorded). The execution of RNCCI in 2008 was 75 million euros, and 2.7% consumed by hip fracture and 0.3% by wrist, humerus, and spine fractures. The average cost per episode in 2009, from the perspective of society, for hip fracture, vertebral, humerus, and wrist (or non-osteoporotic) was € 5,195, € 5,160, € 5,030, and € 4,854 respectively. Thus, considering an average cost per episode in RNCCI from January to March of 3230€, the expense related to the treatment of these patients in RNCCI in 2009 was higher. For the Care Homes, an intake of approximately 14 372 patients with osteoporotic fracture in 2009 was estimated, at a cost to Social Security that ranged from 19 to 21.6 million €. The osteoporotic hip fracture was the most frequent and it was shown to absorve higher resources from Social Security - between 17.5 and 19.7 million €. This was followed by the analysis of vertebral and humerus fracture and the results showed that these fractures have a low incidence and low proportion of institutionalization, with a significantly lower cost - only about 4.7% and 3.3% of total expenditure, respectively. With demographic changes associated to ageing, it is expected that the incidence and treatment cost of the femoral neck fractures, more commonly associated with osteoporosis, will climb in coming years, so the fight against the disease should be considered a national priority. The decision to choose a certain disease prevention program or to reimburse a certain drug not should only account about the costs, but also the benefits of it. In fact, the size and impact of this problem, makes it necessary to focus all interventions in the prevention of these episodes either by using an appropriate therapy, either through real programs for disease prevention. Once the problem is installed, we must measure the health gains associated with the patient institutionalization by conducting additional research.

Enterococcus and biocides: mechanisms of tolerance and selection for vancomycin resistance

Dissertation presented to obtain a Doctoral degree in Biology, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa.

O ensino de cuidados continuados: proposta de modelo multimédia sobre o tema

As alterações demográficas verificadas nos últimos anos, com um peso cada vez maior da população idosa, a par da alteração do tecido social provocada pela ausência do domicílio da mulher, cuidadora tradicional, levaram à necessidade de encontrar respostas para apoio de pessoas em situação de dependência. Reabilitar e reinserir, a par de políticas de envelhecimento ativo, são alguns dos desafios no momento, a nível global. A Rede Nacional de Cuidados Continuados Integrados (RNCCI), criada pelo Decreto-Lei n.º 101/2006, de 6 de junho, tem por missão prestar os cuidados adequados, de saúde e apoio social, a todas as pessoas que, independentemente da idade, se encontrem em situação de dependência. A Prestação de Cuidados na RNCCI significa fornecer os melhores cuidados possíveis disponíveis a um indivíduo e ou família/cuidador com uma necessidade, num contexto específico. O âmbito de intervenção na RNCCI fundamenta-se no princípio dos 3 R’s – Reabilitação, Readaptação e Reinserção. Tradicionalmente, verifica-se uma boa preparação dos profissionais de saúde que acompanham o paciente mas tem-se verificado que estes cuidados se devem prolongar para além dos apenas prestados em ambiente hospitalar e/ou familiar. De facto, constata-se a necessidade de este tipo de cuidados ser mais abrangente, podendo vir a envolver outras pessoas (familiares, amigos, ou outros cuidadores), verificando-se, porém, que na maioria dos casos não dispõem de conhecimentos ou técnicas necessárias para o acompanhamento dos mesmos pelo facto de não terem uma formação efetiva relacionada com este problema. Neste sentido, e com o auxílio das tecnologias de informação emergentes e cada vez mais poderosas é atualmente possível desenvolver soluções de apoio aos cuidadores deste tipo de cuidados. Pretendemos com o presente estudo investigar essa possibilidade, contribuindo para soluções capazes de proporcionar de forma simples e intuitiva um conhecimento adicional em prol de um apoio mais eficaz nestas situações. Para o efeito, foi desenvolvido um protótipo com essa finalidade que foi posto em prática e para o qual se apresentam os resultados obtidos.

Bringing Context Awareness to IoT-Based Wireless Sensor Networks

IEEE International Conference on Pervasive Computing and Communications (PerCom). 23 to 26, Mar, 2015, PhD Forum. Saint Louis, U.S.A..

A terapia ocupacional como recurso para idosos institucionalizados: um estudo de avaliação das necessidades ocupacionais

RESUMO: O envelhecimento populacional está associado a necessidades de saúde, incluindo aspectos ligados à realização das actividades quotidianas e à vertente ocupacional em geral.O presente estudo procurou identificar as necessidades ocupacionais de uma amostra de idosos institucionalizados e avaliar alterações no desempenho ocupacional e na satisfação após participação num programa de actividades terapêuticas. A amostra foi constituída por 20 indivíduos, com uma média de idades de 86,2 anos (DP=6,0), maioritariamente do sexo feminino e viúvos, com níveis de escolaridade diversos, sem défice cognitivo grave, provenientes de duas instituições para idosos em Lisboa. Os instrumentos utilizados foram entrevista de caracterização sócio-demográfica. Mini- Mental State Examination. Índice de Katz e Medida Canadiana de Desempenho Ocupacional. Após a participação no programa de actividades, oito indivíduos mantiveram as notas de desempenho e de satisfação na Medida Canadiana; cinco apresentaram aumento em ambas as notas; para dois, o desempenho permaneceu inalterado e o grau de satisfação diminuiu; finalmente, três deixaram de ter pelo menos um problema no desempenho, destacando-se um indivíduo que deixou de ter problemas para se alimentar, tornando-se independente nesta área. Comparando as avaliações iniciais e as reavaliações pósintervenção, não se registaram diferenças significativas nas pontuações de desempenho nem de satisfação da Medida Canadiana. Em conclusão, muitos dos participantes do estudo referiram um desempenho deficiente em muitas actividades ocupacionais que valorizavam, assim como um grau elevado de insatisfação em relação a esse desempenho. Apesar de ter tido algum impacto nas necessidades ocupacionais dos participantes, o programa de actividades não pareceu trazer benefícios generalizados nesta pequena amostra.------------ABSTRACT:The aging process in institutionalized populations has implications that encompass various issues related to health, including occupational development and the performance of daily activities. It was this study’s objective to identify the occupational needs of a sample of institutionalized elderly and to identify the existence of changes in occupational performance and satisfaction after participation in a program of therapeutic activities. The sample consisted of 20 individuals (mostly female and widowed) from two nursing homes in Lisbon, having various levels of education and an average age of 86,2 years (SD=6,0) as well as the ability of verbal expression without severe cognitive deficit. The instruments used were a structured interview for socio-demographic characterization, the Mini Mental State Examination, the Katz Index and the Canadian Occupational Performance Measure. We found that older respondents claimed that the performance of daily activities constituted a problem. They stated that the activities of self-care and leisure were the most problematic, that they had negative self-perceptions regarding their own performance, and that they were dissatisfied with this performance of their daily activities. After participating in program activities, eight respondents experienced no change in their respective grades of performance and satisfaction, five showed increases in both grades and, for two respondents, the performance remained unchanged while the satisfaction level showed a decline. Three stopped having at least one problem in performance, and one participant even stopped referring feeding problems, having become independent in this area. Regarding the evolution of the Canadian Measure performance and satisfaction scores (before versus after the intervention), we found no significant differences. In conclusion, most participants stated that they were performing badly in what concerned the occupational activities they valued the most. The same applies to low levels of satisfaction regarding that performance. In this small sample, and despite some benefits, the program of therapeutic activities did not prove to be significantly effective.