Social Indicators in the Sustainable Refurbishment: Calculating Quality of Life Indicator in a Residential Building in Málaga

How can we measure ‘quality of life’? The sustainable refurbishment goes beyond strictly energy aspects. Sustainability indicators are needed to facilitate data collection and to provide information which does not require too time-consuming calculations. Thus, you can offer an idea of the extent and quality of the rehabilitation before starting the project and, also, the obtained results can be evaluated in an agile way after the refurbishment. From a list of social indicators gathered from different methods, sustainability assessment tools and International and European standards, three social indicators are proposed: Users Satisfaction, Participation Agreement and Quality of Life. This paper shows the development of Quality of Life social indicator, the more closely related to the main objectives of Researchand Development Project “Sustainable Refurbishment”: improving energy efficiency and wellbeing of users in existing residential buildings. Finally, this social indicator is applied to a real case study in Málaga (Spain).

Soundscape quality analysis by fuzzy logic: A field study in Cordoba, Argentina

This research studies urban soundscapes through the comparative analysis of twelve public open spaces in the city of Córdoba (Argentina), taken as case studies. The work aims to examine selection of indicators and assessment tools intended to characterize soundscape quality. The field study was carried out through surveys and acoustic and psychoacoustic indicators, that are used together to objectively describe the sound quality of urban spaces. The study shows that, while there is a relationship of these indicators with the sound quality of the spaces, this is not linear. Their relative importance or influence depends on the interrelations occurring between the parameters studied. A model analyzing and correlating the parameters with the sound quality, based on the postulates of fuzzy logic, was applied as a tool of analysis, and it was seen to achieve a very close approximation to the subjective or perceptual response of the inhabitants. This close match between the model results and the perceptual response of the users confirms the fuzzy model as an effective tool for the study, not only of soundscapes, but also for those situations in which objective parameters must be related to the perceptual response of users.

Avaliação e correlação clínica/tomográfica dos biótipos periodontais

O biótipo gengival, definido como a espessura da gengiva no sentido vestíbulo-lingual, desempenha importante papel na homeostasia dos tecidos periodontais, podendo ser considerado um preditor no sucesso em longo prazo das terapias periodontais e periimplantares. Assim sendo, é de suma importância reconhecer as dimensões do tecido gengival e as diferentes formas de qualificá-lo e principalmente quantificá-lo. Apesar de haver descrito na literatura inúmeros métodos para este fim, existem poucos estudos comparando a efetividade de um método em relação a outro. Desta maneira, este estudo buscou avaliar se há concordância entre avaliações clínicas e tomográficas na classificação do biótipo gengival, se existe correlação entre o biótipo gengival e a espessura óssea subjacente, além de descrever um novo método de tomada tomográfica que permita a análise quantitativa do biótipo gengival. Foram avaliados 12 indivíduos os quais realizaram tomografias computadorizadas de feixe cônico como exame imaginológico de diagnóstico ou planejamento pré-cirúrgico. Em cada paciente foram realizados quatro diferentes métodos de avaliação qualitativa da espessura gengival (transparência a sondagem, transgengival, visual através de fotografia e tomográfico), dois métodos de avaliação quantitativa (transgengival e tomográfico) da espessura gengival e avaliação da espessura óssea através da tomografia computadorizada de feixe cônico. Os resultados foram avaliados estatisticamente através do teste KAPPA, Teste t pareado e coeficiente de correlação de Pearson (pM0.05). O novo método de tomada tomográfica descrito neste estudo é eficaz para avaliação do biótipo gengival, havendo grande concordância (86,1% Kappa 0,51) e forte correlação (r=0,824) entre ele e o método transgengival (padrão ouro). A correlação entre a espessura óssea e a espessura gengival foi moderada quando utilizado o método transgengival e tomográfico (r=0,567 e r=0,653 respectivamente).

Avaliação quantitativa dos efeitos da levodopa e da estimulação do núcleo subtalâmico sobre o equilíbrio em pacientes com doença de Parkinson

INTRODUÇÃO: Os efeitos da levodopa (LD) e da estimulação cerebral profunda (ECP) de núcleo subtalâmico (STN) sobre o equilíbrio e sintomas axiais são até o momento controversos. OBJETIVOS: Avaliar quantitativamente os efeitos da ECP de STN e da LD sobre o equilíbrio estático em pacientes com DP operados, em comparação com a LD em pacientes não operados. MÉTODOS: Trinta e um pacientes submetidos a ECP de STN entre 3 meses e 1 ano e meio antes da avaliação e 26 controles portadores de DP não operados, estágios Hoehn e Yahr 2 a 4 foram avaliados usando UPDRS para avaliação clínica e plataforma de força para avaliar oscilações posturais. O primeiro grupo foi avaliado com ECP e sem medicação, com ECP e com medicação e sem ECP e sem medicação. O segundo grupo foi avaliado com e sem medicação. Cada paciente foi avaliado com os olhos abertos e fechados. O deslocamento do centro de pressão anteroposterior, laterolateral, a área, velocidade e deslocamento total linear foram medidos pela plataforma de força. Os dados paramétricos foram comparados usando o teste t de Student e os dados não-paramétricos foram comparados pelo teste de Kruskal-Wallis. A avaliação clínica consistiu na parte 3 da escala UPDRS e na escala Hoehn e Yahr. Nível de significância estatística considerada foi p=0,05. RESULTADOS: Os pacientes não operados oscilaram mais quando sob efeito da levodopa do que sem medicação. No grupo operado, a maior oscilação é no grupo com ECP desligada e sem medicação. Tende a reduzir sob efeito da ECP apresenta redução significativa sob efeito simultâneo de ECP e levodopa. CONCLUSÃO: A associação da ECP de NST com medicação tem impacto positivo sobre o controle postural. O efeito da ECP de NST reverte o efeito negativo da levodopa sobre as oscilações observadas em pacientes não operados

Interpreting Empirical Assessments from a Behavioral Perspective: A Rationale for Why and How

This paper provides a rationale on why and how to utilize assessment tools effectively within the behavioral framework through idiographic assessment. Empirical assessment instruments can provide guidance to the behaviorist that may prove useful in the idiographic formation of a behaviorally-based treatment plan. The paper will focus on two of the major traditional instrument tools, the Minnesota Multiphasic Personality Inventory and the Rorschach inkblot test.

The Utility of the CVLT-C as an Embedded Validity Indicator After Pediatric Mild Traumatic Brain Injury.

Results of neuropsychological examinations depend on valid data. Whereas clinicians previously believed that clinical skill was sufficient to identify non-credible performance by examinees on standard tests, research demonstrates otherwise. Consequently, studies on measures to detect suspect effort in adults have received tremendous attention in the previous twenty years, and incorporation of validity indicators into neuropsychological examinations is now seen as integral. Few studies exist that validate methods appropriate for the measurement of effort in pediatric populations. Of extant studies, most evaluate standalone measures originally developed for use with adults. The present study examined the utility of indices from the California Verbal Learning Test – Children's Version (CVLT-C) as embedded validity indicators in a pediatric sample. Participants were 225 outpatients aged 8 to 16 years old referred for clinical assessment after mild traumatic brain injury (mTBI). Non-credible performance (n = 39) was defined as failure of the Medical Symptom Validity Test (MSVT). Logistic regression demonstrated that only the Recognition Discriminability index was predictive of MSVT failure (OR = 2.88, p < .001). A cutoff of z ≤ -1.0 was associated with sensitivity of 51% and specificity of 91%. In the current study, CVLT-C Recognition Discriminability was useful in the identification of non-credible performance in a sample of relatively high-functioning pediatric outpatients with mTBI. Thus, this index can be added to the short list of embedded validity indicators appropriate for pediatric neuropsychological assessment.

The Health Behavior Change Competency Checklist (HBCCC): Instrument development and psychometric evaluation.

More than half of morbidity and mortality in the United States can be attributed to behavior-related disease, such as tobacco use, physical inactivity, poor diet and alcohol consumption. Given the increased prevalence of behaviorally related medical health concerns, physician competence in the implementation of effective behavior change strategies is quickly becoming an essential skill. However, only recently have primary care residency programs begun to systematically teach and evaluate motivational interviewing skills critical to influencing health behavior, and use of standardized, objective assessment tools to assess skillfulness has been largely absent. This paper reports the development of a checklist, the Health Behavior Change Competency Checklist (HBCCC). The instrument captures the theoretical model of behavior change, motivational interviewing, in a practical and versatile manner. Psychometric evaluation demonstrated moderate efficacy. Namely, results indicated the HBCCC possesses good reliability, as evidenced by high internal consistency, and adequate construct validity. It also displayed considerable utility and practical application. While these results provide several reasons for confidence in the HBCCC, item revision and additional testing are required in order to establish it as a meaningful and valuable instrument.

Conocimiento tecnológico, pedagógico y disciplinario del profesorado: el caso de un Centro Educativo Inteligente

En este estudio se analiza la integración de las TIC en un escenario de aprendizaje específico: un centro público de Alicante catalogado como Centro Educativo Inteligente [CEI], según el programa de pilotaje homónimo de la Comunidad Valenciana. Se pondera detenidamente, mediante una investigación mixta el conocimiento tecnológico, pedagógico y disciplinar de los docentes a partir del Modelo TPACK. Como instrumentos de evaluación se han utilizado encuestas, entrevistas y grupos de discusión. Entre los resultados alcanzados, destaca la constatación de la inseguridad del profesorado al aplicar los conocimientos tecnológico-pedagógicos en sus clases, si bien se trata de un CEI. Se analiza detenidamente la paradoja establecida entre tal percepción del profesorado y la opinión del equipo directivo, que postula lo contrario.

INSTRUMENTOS PARA LA EVALUACIÓN DE LA ATENCIÓN PRIMARIA DE SALUD ADAPTADOS PARA ARGENTINA

La evaluación de la atención primaria de la salud (APS) es una actividad de investigación que no se puede limitar al contexto académico y científico sino que está íntimamente ligada a la planificación y a la gestión de los recursos de Salud Pública, tanto en el contexto programático de Ministerios y Secretarías de Salud gubernamentales, de obras sociales o de proveedores privados de cobertura médica, como el de equipos locales de profesionales proveedores de servicios de salud. La evaluación de servicios sanitarios recurre habitualmente a datos de estructura, procesos y resultados obtenidos sistemáticamente por procedimientos administrativos de financiamiento y de prestación de servicios. En cambio, el desarrollo de líneas de investigación sobre la base de modelos conceptuales integrales y capaces de obtener datos de otras fuentes, son escasas en nuestro país. Por ejemplo, existe una notable carencia de conocimiento sobre la perspectiva de la población acerca de su salud y de sus experiencias con la atención médica para analizar si los servicios provistos son apropiados o existe una brecha de necesidades no cubiertas. El grupo de investigación que realiza esta propuesta adaptó un conjunto de cuestionarios para evaluar la APS (PCAT: Primary Care Assessment Tools) cuyo uso a nivel internacional es muy promisorio (ver Descripción del tema abordado). El Ministerio de Salud de la Provincia de Córdoba y la Dirección de Atención Primaria de la Salud (DAPS) de la Municipalidad de Córdoba, manifestaron su interés por la difusión de estos instrumentos entre gestores y efectores de salud para promover su implementación. En la ciudad de Córdoba, estas instituciones tienen a su cargo la totalidad de centros de atención médica pública de primer nivel, 95 municipales y 20 provinciales, que con un plantel profesional de más de 900 personas proporciona cuidados de salud a más de 500.000 habitantes de la ciudad de Córdoba. En boletín estadístico 2009 de la DAPS informa que en los 95 CAPS y en el transcurso de un año, se atienden aproximadamente un 1.000.000 de consultas. Datos provenientes de acciones preventivas muestran que el Programa de Control de Crecimiento y Desarrollo del Niño atiende mensualmente a unos 42.000 niños y niñas menores de 5 años, el de Control de Embarazo y Puerperio registra cada año entre 4.000 y 5.000 mujeres, mientras que en 2009 se contabilizó más de 50.000 mujeres en el Programa de Salud Reproductiva. En cuanto a la población adulta, los Programas de Hipertensión Arterial y de Control del Paciente Diabético registran más de 12.000 y de 6.500 personas, respectivamente. Estos datos dan cuenta de acciones que responden mayoritariamente a demandas efectuadas por la población para los cuales se cuenta con un programa en particular. La información disponible a nivel provincial es aún más acotada y heterogénea, ya que los servicios de APS están descentralizados, a cargo de los municipios. El Ministerio de Salud participa en el financiamiento de la APS a través de los llamados pactos sanitarios y otros tipos de acuerdos. El control de gestión se realiza también a través de indicadores administrativos, por lo que existe un gran interés por la implementación de un nuevo modelo de evaluación de la APS a nivel provincial. La difusión del modelo conceptual y las herramientas PCAT pretende facilitar el acceso a otro tipo de información acerca de características transversales de la organización y particularmente, sobre aspectos de calidad de la atención para la evaluación y la planificación de los servicios. Esta información, que podría ser colectada de una manera uniforme, sería útil para explicar los resultados de la atención sanitaria en función de las necesidades en salud de la población.

Risco de fratura da anca na população idosa institucionalizada no distrito de Portalegre: a influência dos fatores de risco da osteoporose

A osteoporose é uma doença caracterizada pela diminuição da massa óssea e deterioração da microarquitectura do tecido ósseo, levando à fragilidade mecânica e consequente predisposição a fraturas. As fraturas relacionadas com a osteoporose, além de poderem provocar consequências fatais, também constituem um grave problema de saúde pública com elevados reflexos a nível económico e social. Este estudo surgiu com a finalidade de perceber qual o risco de fratura a que a população idosa institucionalizada no distrito de Portalegre está sujeita e de que forma é que os fatores de risco da osteoporose são uma influência. Para chegar a respostas conclusivas neste âmbito, foram implementados dois instrumentos de avaliação a 278 idosos institucionalizados. Através da realização dos questionários, foi possível verificar que existe falta de conhecimento sobre os riscos da osteoporose e a forte relação que esta tem com os hábitos de vida diários. Associado a este problema, enfatiza-se a necessidade de políticas educativas, orientando a população para a necessidade de estilos de vida saudáveis.

Prospective longitudinal voxel-based morphometry study of major depressive disorder in young individuals at high familial risk

BACKGROUND Previous neuroimaging studies indicate abnormalities in cortico-limbic circuitry in mood disorder. Here we employ prospective longitudinal voxel-based morphometry to examine the trajectory of these abnormalities during early stages of illness development. METHOD Unaffected individuals (16-25 years) at high and low familial risk of mood disorder underwent structural brain imaging on two occasions 2 years apart. Further clinical assessment was conducted 2 years after the second scan (time 3). Clinical outcome data at time 3 was used to categorize individuals: (i) healthy controls ('low risk', n = 48); (ii) high-risk individuals who remained well (HR well, n = 53); and (iii) high-risk individuals who developed a major depressive disorder (HR MDD, n = 30). Groups were compared using longitudinal voxel-based morphometry. We also examined whether progress to illness was associated with changes in other potential risk markers (personality traits, symptoms scores and baseline measures of childhood trauma), and whether any changes in brain structure could be indexed using these measures. RESULTS Significant decreases in right amygdala grey matter were found in HR MDD v. controls (p = 0.001) and v. HR well (p = 0.005). This structural change was not related to measures of childhood trauma, symptom severity or measures of sub-diagnostic anxiety, neuroticism or extraversion, although cross-sectionally these measures significantly differentiated the groups at baseline. CONCLUSIONS These longitudinal findings implicate structural amygdala changes in the neurobiology of mood disorder. They also provide a potential biomarker for risk stratification capturing additional information beyond clinically ascertained measures.

Factors associated with the wish to hasten death: a study of patients with terminal illness

Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions. Method. A sample of terminally ill cancer patients (N=256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998-2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated. Results. A high WTHD was reported by 14% of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P

Foot orthotics in the treatment of lower limb conditions: A musculoskeletal physiotherapy perspective

Orthotic therapy is frequently advocated for the treatment Of musculoskeletal pain and injury of the lower limb. The clinical efficacy, mechanical effects, and Underlying mechanism of the action of foot orthotics has not been Conclusively determined making it difficult for practitioners to agree on a reliable and valid clinical approach to their application and indeed even their fabrication. This problem is compounded by evidence suggesting that the most commonly used approach for orthotic prescription, the (Biomechanical Evaluation of the Foot. Vol. 1. Clinical Biomechanics Corporation, Los Angeles, 1971) approach, has poor validity and many of the associated clinical measurements of that approach lack adequate levels of reliability. This paper proposes a new approach that is based on two key elements. One is the identification, verification and quantification of physical tasks that serve as client specific outcome measures. The second is the application of specific physical manipulations during the performance of these physical tasks. The physical manipulations are selected on the basis of motion dysfunction and their immediate effects on the client specific outcome measures serve as the basis to making an informed decision on the propriety of using orthotics in individual clients. The motion dysfunction also guides the type of orthotic that is applied. Practical case examples as well Lis generic and specific guidelines to the application of this clinical assessment process and orthotics are provided in this paper. (C) 2004 Published by Elsevier Ltd.

Determining the fetal scalp lactate level that indicates the need for intervention in labour

Background: Fetal scalp lactate testing has been shown to be as useful as pH with added benefits. One remaining question is What level of lactate should trigger intervention in the first stage of labour?' Aims: This study aimed to establish the lactate level in the first stage of labour that indicates the need for intervention to ensure satisfactory outcomes for both babies and mothers. Methods: A prospective study at Mater Mothers' Hospital, Brisbane, Australia, a tertiary referral centre. One hundred and forty women in labour, with non-reassuring fetal heart rate traces, were tested using fetal blood scalp sampling of 5 mu L of capillary blood tested on an Accusport (Boeringer, Mannheim, East Sussex, UK) lactate meter. Decision to intervene in labour was based on clinical assessment plus a predetermined cut off. Main outcome measures were APGAR scores, cord arterial pH, meconium stained liquor and Intensive Care Nursery admission. Results: Two-graph receiver operating characteristic (TG-ROC) analysis showed optimal specificity, and sensitivity for predicting adverse neonatal outcomes was a scalp lactate level above 4.2 mmol/L. Conclusions: Fetal blood sampling remains the standard for further investigating-non-reassuring cardiotocograph (CTG) traces. Even so, it is a poor predictor of fetal outcomes. Scalp lactate has been shown to be at least as good a predictor as scalp pH, with the advantages of being easier, cheaper and with a lower rate of technical failure. Our study, found that a cut off fetal scalp lactate level of 4.2 mmol/L, in combination with an assessment of the entire clinical picture, is a useful tool in identifying those women who need intervention.

Measuring mobility in frail older people: reliability and validity of the Physical Mobility Scale

Objectives: The study was designed to show the validity and reliability of scoring the Physical Mobility Scale (PMS). PMS was developed by physiotherapists working in residential aged care to specifically show resident functional mobility and to provide information regarding each resident's need for supervision or assistance from one or two staff members and equipment during position changes, transfers, mobilising and personal care. Methods: Nineteen physiotherapists of varying backgrounds and experience scored the performances of nine residents of care facilities from video recordings. The performances were compared to scores on two 'gold standard' assessment tools. Four of the physiotherapists repeated the evaluations. Results: The PAIS showed excellent content validity and reliability. Conclusions: The PAIS provides graded performance of physical mobility, including level of dependency on staff and equipment. This is a major advantage over existing functional assessment tools. There is no need for specific training for physiotherapists to use the tool.