Metaestudio cualitativo sobre vivencias y gestión del cotidiano en adultos mayores que padecen enfermedades crónicas

Objetivo: Describir la experiencia cultural, interpersonal y personal de los adultos mayores con enfermedades crónicas e identificar las estrategias y redes de apoyo que utilizan en su entorno cotidiano para gestionar la enfermedad. Método: Se desarrolló un metaestudio tipo metaanálisis cualitativo. La estrategia metodológica constó de cuatro etapas: Búsqueda bibliográfica, Categorización de los estudios, Evaluación de la calidad metodológica y Análisis de resultados. Resultados: Se obtuvo una muestra bibliográfica de 22 estudios de naturaleza cualitativa. Los hallazgos se organizaron en 4 categorías: Compresión del padecimiento, Autogestión en el cotidiano, Percepción de los Servicios de Salud y Cotidiano del cuidador. Conclusiones: El esfuerzo de los adultos mayores por alcanzar un nuevo equilibrio social y personal se articula en las estrategias de autogestión que utilizan en su día a día para afrontar sus padecimientos. Las interrelaciones con los servicios de salud, familia y redes de apoyo son fundamentales para gestionar la cronicidad.

Doença inflamatória intestinal pediátrica e comorbilidades psiquiátricas

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

O licopeno como composto bioativo do tomate

A crescente preocupação com o bem-estar físico e a saúde tem vindo a refletir-se na forma como escolhemos os alimentos presentes na nossa alimentação. Todos nós somos consumidores mais informados e escolhemos cada vez mais alimentos saudáveis. Por outro lado, algumas doenças como os acidentes vasculares cerebrais, o cancro e a aterosclerose podem de alguma forma ser minimizados através da ingestão de alguns compostos denominados compostos bioativos ou funcionais. A presente dissertação tem como objetivo efetuar uma revisão na literatura dos estudos publicados sobre os efeitos do licopeno na saúde humana na prevenção de doenças, desempenhando assim o papel de composto bioativo do tomate. Os radicais livres atuam no organismo, podendo provocar lesões celulares que podem estar na base do desenvolvimento de alguns cancros e doenças crónicas. Conhecido como um dos melhores supressores de radicais livres, o licopeno é um dos antioxidantes mais poderosos, sendo o carotenóide predominante nos tomates, mas a sua biodisponibilidade aumenta em produtos de tomate processado, razão pela qual será o fruto abordado na presente dissertação. Fez-se uma abordagem do licopeno como composto bioativo do tomate, da sua respetiva química, da sua biodisponibilidade, do papel fundamental dos carotenoides na nossa alimentação e do seu papel na prevenção de várias doenças. Por fim é apresentada uma breve perspetiva nutricional sobre a adição de licopeno a alguns alimentos como forma de aproveitar os resíduos que a indústria do tomate origina, tornando-os nutricionalmente mais ricos.

Influência da localização geográfica de produção nas propriedades de mirtilos 'Vaccinium Corymbosum L.' cv Bluecrop

Os antioxidantes na dieta podem ter um papel importante na prevenção de algumas doenças crónicas em seres humanos resultantes da oxidação de lípidos e outros componentes celulares por radicais livres. Os mirtilos (Vaccinium sp.) são considerados, de entre os frutos frescos, uma das melhores fontes de antioxidantes. Neste trabalho foram estudados mirtilos Nothern Highbush, da cultivar Bluecrop colhidos no estado de maturação comercial em 5 localizações diferentes: Bouças -Sever do Vouga, Estarreja, Queirã – Vouzela, Oliveira do Hospital e Vila Verde. Foram avaliadas as características físico-químicas (ºbrix, acidez, humidade, calibre, firmeza, elasticidade e parâmetros colorimétricos) dos frutos. Para a determinação da composição fenólica e a atividade antioxidante os mirtilos foram submetidos a extrações sucessivas, com metanol (2x) e depois 2 vezes com uma solução aquosa de acetona (40% v/v), durante 1 h, com o auxílio de um banho de ultrassons. Os extratos obtidos foram utilizados para a determinação da composição fenólica (compostos fenólicos totais, antocianinas e taninos) e da capacidade antioxidante (utilizando os métodos ABTS, DPPH e FRAP). Foi ainda avaliada a influência da conservação durante 6 meses a -20ºC no teor de compostos fenólicos e capacidade antioxidante dos frutos. Pelos resultados obtidos, nos parâmetros de textura avaliados a amostra BBO revelou maior firmeza e elasticidade, e na avaliação da cor a amostra BES apresentou uma tonalidade azul mais acentuada. Os mirtilos provenientes de Estarreja eram os mais ricos em compostos fenólicos totais, em antocianinas e taninos, e que também apresentavam maior atividade antioxidante. O armazenamento durante 6 meses a -20ºC, originou diferenças significativas nas antocianinas e na atividade antioxidante. Em geral as amostras apresentavam diferenças significativas tanto nas suas propriedades físico-químicas, como na composição fenólica e na atividade antioxidante.

Qualidade de vida e vulnerabilidade ao stress dos cuidadores formais de uma unidade de cuidados continuados integrados do Alentejo

Viver um maior número de anos não significa necessariamente que se viva com qualidade. Devido às alterações demográficas verificadas nos últimos anos e face ao envelhecimento progressivo da população mundial e consequente aumento da esperança média de vida, ao acréscimo das doenças crónicas e à dependência a elas associada, surgem dificuldades que os doentes e os seus cuidadores enfrentam no seu quotidiano de internamento. Assim, surgiu a necessidade de equacionar a problemática da Qualidade de Vida e a Vulnerabilidade ao Stress dos Cuidadores Formais, que diariamente trabalham numa Unidade de Cuidados Continuados Integrados do Alentejo. Este trabalho foi desenvolvido numa Unidade de Cuidados Continuados Integrados com duas valências de internamento, a Média e a Longa Duração, com os Cuidadores Formais que nele aceitaram participar. Entre eles, encontram-se as mais diversas profissões, desde Auxiliares de Lar, Enfermeiros, Fisioterapeutas, Psicólogos, Animadores Socioculturais, Técnicos de Psicomotricidade, Terapeutas da Fala e Assistentes Sociais. Todos eles representam um papel muito importante no cuidado aos seus clientes, cada um na sua área. Ao delinear este estudo, o Problema prático identificado foi se existia uma relação entre a Qualidade de Vida e a Vulnerabilidade ao Stress dos Cuidadores Formais de uma Unidade de Cuidados Continuados Integrados do Alentejo. Este estudo foi desenvolvido com uma população de 63 elementos, todos Cuidadores Formais a desempenhar funções no local de estudo já referenciado. Foi utilizada a abordagem quantitativa, que é uma metodologia de investigação de vertente epistemológica positivista. Neste estudo, foram utilizados dois instrumentos para aplicar e recolher os dados: um destinado a medir a vulnerabilidade ao stress (23 QVS) dos cuidadores formais; outro para avaliar a qualidade de vida (WHOQOL-Bref), gentilmente cedidos pelos seus autores. Os dados recolhidos, após analisados apontaram no sentido de que à medida que a qualidade de vida aumentava nos diferentes domínios, diminuía a vulnerabilidade ao stress.

Cardiovascular disease in Switzerland - health care, mortality and geographical pattern

SUMMARY Switzerland is facing an aging population and a growing amount of patients with chronic diseases. It is crucial to display health care processes and pathways, to identify inequalities and obstacles, and to point out possibilities for improvements of the Swiss health care system (e.g. increase efficiency). The introductory part of the thesis presents a brief description of the Swiss health care system, health services research and regional variation as well as an introduction of CVD and its epidemiological key figures, aetiology and treatments. This is followed by the description of the utilized methods and data, and the objectives of this thesis. The subsequent sections present the four articles included in this thesis. The first article focuses on a small area analysis on regional variation of avoidable hospitalisations in Switzerland including density of primary care physicians and specialists, rurality and hospital supply factors as explanatory variables in the analysis. Lower rates of avoidable hospitalisations were found in areas with very high supply of primary care physicians, increased avoidable hospitalisation rates in areas with more specialists and in areas with higher proportion of rural residents. The second article aims to examine whether emergency patients with acute ST-segment elevation myocardial infarction were adequately treated, i.e. according to the treatment guidelines, in Switzerland. Results show that older and female patients were less likely to receive revascularization which suggests that the treatment guidelines may not be uniformly applied in Switzerland. Similar to the first article, also in the third article a small area analysis was performed but this time investigating regional variation in costs at the end of life. Strongest associations of cost was found with cause of death, age and language region of the decedents. The strong spatial variation of costs could only partly be explained by the included covariates. Article four aims to examine the relationship of distance to different hospital types and mortality from AMI or stroke. We found that AMI mortality in the Swiss population 30 and older and stroke mortality in those 65 and above increased with distance to central and university hospitals, while adjusting for sociodemographic and economic characteristics of the population. The presentation of the four articles is followed by a discussion, which summarizes the main findings and the strengths and limitations of the presented articles. The thesis concludes with a discussion about the challenges for policy, practice and future research.

Breuis epitome valde utilis ad praedicendum futura in morbis acutis /

Mode of access: Internet.

Television microscopy in cytopathology,

Mode of access: Internet.

Obesity Prevention Initiative : a report to the Illinois General Assembly /

Understanding the health, economic and social costs of a growing obesity epidemic to Illinois and its citizens, the Illinois General Assembly passed the Obesity Prevention Initiative Act (PA 96-0155) in the spring of 2009. In accordance with the act, the Illinois Department of Public Health convened public hearings in Chicago, Springfield and Carbondale to: Illuminate the social and human costs of obesity and to highlight existing state and community level initiatives. Identify existing plans and opportunities for action and expansion of initiatives. Inform policymakers and the public about effective solutions to the problem. Identify and engage stakeholders to promote action to reduce obesity, to improve nutrition and to increase physical activity.

Über die Erkenntniss und Cur der chronischen Krankheiten des menschlichen Organismus /

Bd 1. Einleitung in die Lehre von den chronischen Krankheiten überhaupt. - Bd 2. Die chronischen Krankheiten des sensibeln Systems. - Bd 3. Chronische Krankheiten des reproductiven Systems.

The sanative influence of climate; with an account of the best places of resort for invalids in England, the south of Europe, &c.

Earlier eds. issued under title: The influence of climate in the prevention and cure of chronic diseases.

Is the association between late-life morbidity and disability attenuated over time? : Exploring the dynamic equilibrium of morbidity hypothesis

Context: There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of disabling chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these seemingly contradictory trends are due to the attenuation of the morbidity-disability link over time. The aim of this study was to empirically test this assumption.Methods: Data were drawn from three repeated cross-sections of SWEOLD, a population-based survey among the Swedish men and women ages 77 and older. Logistic regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined in both multiplicative and additive models.Results: Between 1992 and 2011, the odds of ADL disability significantly declined among women whereas the odds of IADL disability significantly declined among men. During the same period, the prevalence of most chronic morbidities including multimorbidity went up. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, psychological distress, and multimorbidity.Conclusion: In agreement with the dynamic equilibrium hypothesis, this study concludes that the associations between chronic conditions and disability among the Swedish older adults have largely waned over time.

Insights on food and nutrition in the Federated States of Micronesia: a review of the literature

Background: Nutrition-related disorders, including vitamin A deficiency (VAD) and chronic diseases, are serious problems in the Federated States of Micronesia (FSM). Many suggest that these disorders are new problems related to dietary and lifestyle changes. In the past four decades, imported foods, such as white rice, flour, sugar, refined foods and fatty meats, have increasingly replaced local foods in the diet. Aim: A literature review was conducted to understand underlying issues related to dietary change and obtain insights for nutrition research and interventions. Method: Published and unpublished papers from different disciplines were reviewed and collated for information on food and nutrition in FSM. Topics covered were historical background, local foods, infant and child feeding, dietary assessment, and nutritional status. Particular focus was on information and data relating to VAD, the primary topic that led to the review of the literature. Conclusions: FSM, a tropical country of abundant agricultural resources, has suffered a great loss in production and consumption of local foods. Inconsistent external and internal government policies and food aid programmes have contributed to the problem. Further research on the nutrient content of local foods and factors affecting production, acquisition and consumption is needed, as well as a broad, well-planned, intersectoral intervention aimed at dietary improvement for all age groups in the population.

Micronesian banana, taro, and other foods: newly recognized sources of provitamin A and other carotenoids

Vitamin A deficiency (VAD) and chronic diseases are serious problems in the Federated States of Micronesia and other Pacific island countries. Nutrition education programs to address these in Micronesia have had limited success, partly due to lack of information on nutrient content in local foods. The study objective was to identify local plant foods rich in provitamin A and other carotenoids that have high levels of cultural acceptability. Food cultivars likely to be carotenoid-rich (suggested by coloration) were identified using an ethnographic approach including key informant interviews. Raw and cooked samples (mostly cultivars previously not analyzed) of 12 banana, 13 giant swamp taro, 10 breadfruit cultivars and four other local foods were analyzed by high-performance liquid chromatography. Many banana and taro cultivars were found with significant levels of beta- and alpha-carotene; the beta-carotene levels ranged from 30 to 2780 mug/100 g (banana) and. 50 to 2040 mug/100 g (taro). The results highlight the potential significance of cultivar differences in human nutrition, important for evaluation of the diet, establishment of locally relevant dietary guidelines, and research on the relationship between diet, health, and disease. These highly acceptable food cultivars could play an important role in VAD and chronic disease prevention programs in the Pacific. (C) 2003 Elsevier Science Ltd. All rights reserved.

Factors to consider in Micronesian food-based interventions: a case study of preventing Vitamin A deficiency

Background: Many factors need to be considered in a food-based intervention. Vitamin A deficiency and chronic diseases, such as diabetes, heart disease and cancer, have become serious problems in the Federated States of Micronesia (FSM) following the decreased production and consumption of locally grown foods. However, agricultural and social conditions are still favourable for local food production. Aim: To identify key factors to consider in a Micronesian food-based intervention focusing on increased production and consumption of four major Micronesian staple foods: banana, breadfruit, giant swamp taro and pandanus. Methods: Ethnographic methods including key informant interviews and a literature review. Results: Pacific and Micronesian values, concepts of food and disease, and food classifications differ sharply from Western concepts. There are few FSM professionals with nutrition expertise. Traditional foods and food cultivars vary in nutrient content, consumption level, cost, availability, status, convenience in growing, storing and cooking, and organoleptic factors. Conclusions: A systematic consideration of the factors that relate to a food-based intervention is critical to its success. The evaluation of which food and cultivar of that food that might be most effectively promoted is also critical. Regional differences, for example FSM inter-island differences between the staple foods and cultivars, must be considered carefully. The evaluation framework presented here may be relevant to Pacific island and other countries with similar foods where food-based interventions are being planned. An ethnographic approach was found to be essential in understanding the cultural context and in data collection and analysis.