Reabilita����o auditiva e qualidade de vida dos idosos

Mestrado em Interven����o S��cio-Organizacional na Sa��de - ��rea de especializa����o: Diagn��stico e Interven����o Organizacional e Comunit��ria

Audiologists��� preferences for patient-centredness: a cross-sectional questionnaire study of cross-cultural differences and similarities among professionals in Portugal, India and Iran

Objective Patient-centredness has become an important aspect of health service delivery; however, there are a limited number of studies that focus on this concept in the domain of hearing healthcare. The objective of this study was to examine and compare audiologists��� preferences for patient-centredness in Portugal, India and Iran. Design The study used a cross-sectional survey design with audiologists recruited from three different countries. Participants A total of 191 fully-completed responses were included in the analysis (55 from Portugal, 78 from India and 58 from Iran). Main outcome measure The Patient���Practitioner Orientation Scale (PPOS). Results PPOS mean scores suggest that audiologists have a preference for patient-centredness (ie, mean of 3.6 in a 5-point scale). However, marked differences were observed between specific PPOS items suggesting these preferences vary across clinical situations. A significant level of difference (p<0.001) was found between audiologists��� preferences for patient-centredness in three countries. Audiologists in Portugal had a greater preference for patient-centredness when compared to audiologists in India and Iran, although no significant differences were found in terms of age and duration of experience among these sample populations. Conclusions There are differences and similarities in audiologists��� preferences for patient-centredness among countries. These findings may have implications for the training of professionals and also for clinical practice in terms of optimising hearing healthcare across countries.

Tradutor da l��ngua gestual portuguesa modelo de tradu����o bidireccional

O projeto tem como objetivo desenvolver e avaliar um modelo que facilita o acesso para pessoas surdas ou com defici��ncia auditiva, o acesso ao conte��do digital - em particular o conte��do educacional e objetos de aprendizagem ��� a cria����o de condi����es para uma maior inclus��o social de surdos e deficientes auditivos. Pretende-se criar um modelo bidirecional, em que permite a pessoas com defici��ncias auditivas, possam se comunicar com outras pessoas, com a tradu����o da L��ngua Gestual Portuguesa (LGP) para a L��ngua Portuguesa (LP) e que outras pessoas n��o portadoras de qualquer defici��ncia auditiva possam por sua vez comunicar com os surdos ou deficientes auditivos atrav��s da tradu����o da LP para a LGP. H�� um conjunto de t��cnicas que poder��amos nos apoiar para desenvolver o modelo e implementar a API de tradu����o da LGP em LP. Muitos estudos s��o feitos com base nos modelos escondidos de Markov (HMM) para efetuar o reconhecimento. Recentemente os estudos est��o a caminhar para o uso de t��cnicas como o ���Dynamic Time Warping��� (DTW), que tem tido mais sucesso do que outras t��cnicas em termos de performance e de precis��o. Neste projeto optamos por desenvolver a API e o Modelo, com base na t��cnica de aprendizagem Support Vector Machines (SVM) por ser uma t��cnica simples de implementar e com bons resultados demonstrados em reconhecimento de padr��es. Os resultados obtidos utilizando esta t��cnica de aprendizagem foram bastante ��timos, como iremos descrever no decorrer do cap��tulo 4, mesmo sabendo que utilizamos dois dispositivos para capturar dados de descri����o de cada gesto. Toda esta tese integra-se no ��mbito do projeto cient��fico/ investiga����o a decorrer no grupo de investiga����o GILT, sob a coordena����o da professora Paula Escudeiro e suportado pela Funda����o para Ci��ncia e Tecnologia (FCT).

The interrogation of witnesses abroad in execution of a european investigation order: an examination from eyes of the defence

European Master Human Rights and Democratisation

Sound levels and risk perceptions of music students during classes

It is well recognized that professional musicians are at risk of hearing damage due to the exposure to high sound pressure levels during music playing. However, it is important to recognize that the musicians��� exposure may start early in the course of their training as students in the classroom and at home. Studies regarding sound exposure of music students and their hearing disorders are scarce and do not take into account important influencing variables. Therefore, this study aimed to describe sound level exposures of music students at different music styles, classes, and according to the instrument played. Further, this investigation attempted to analyze the perceptions of students in relation to exposure to loud music and consequent health risks, as well as to characterize preventive behaviors. The results showed that music students are exposed to high sound levels in the course of their academic activity. This exposure is potentiated by practice outside the school and other external activities. Differences were found between music style, instruments, and classes. Tinnitus, hyperacusis, diplacusis, and sound distortion were reported by the students. However, students were not entirely aware of the health risks related to exposure to high sound pressure levels. These findings reflect the importance of starting intervention in relation to noise risk reduction at an early stage, when musicians are commencing their activity as students.

Hearing impairment in patients with tuberculosis from Northeast Brazil

The aim of this paper is to describe the auditory profile of subjects who were given streptomycin treatment for tuberculosis in the years 2000 and 2001, in Recife, Northeast Brazil. The Injury Notification Database at the Municipal Department of Health was consulted and 78 individuals who had been on streptomycin during the period under study were selected. Forty-two individuals were excluded, of whom five were over 59 years of age and two were under 18 years. Nineteen turned out to be deceased, 13 could not be found, two were serving prison terms and one refused to participate. As a result, only 36 subjects participated in the study. These 36 individuals were interviewed and underwent meatoscopy and audiometry. The mean age of the group under study was 38.8 years old and males predominated (79.4%). Twenty-seven patients (75%) showed hearing impairment, the bilateral sensorineural type (63.9%) being the most frequent, mainly affecting the high frequencies over 4000 Hz. In the light of findings showing a high percentage of hearing impairment complaints among users of streptomycin, this issue seems to warrant an in-depth investigation, as does the implementation of an auditory follow-up routine for patients undergoing such chemotherapy for tuberculosis.

Viability of ceramic residues in lime-based mortars

3rd Historic Mortars Conference, 11-14 September 2013, Glasgow, Scotland

Long-term characterization of air lime mortars with ceramic waste

Due to their exposure to environmental conditions, outer coatings composed by render and painting system are usually the first construction elements to deteriorate and require intervention. A correct conservation and rehabilitation of these materials is fundamental once they provide protection to other fa��ade materials. It is known that old mortar renders were essentially air lime based mortars. To maintain the integrity of the whole wall-render elements, the image of the building and to avoid accelerated degradation, conservation and rehabilitation must be implemented with compatible mortars. As that, lime based mortars would be preferable. It was also common, in ancient renders, the incorporation of ceramic residues, which is, nowadays, an abundant material, especially in Central Region of Portugal. The reuse of these materials has great relevance once their landfilling causes serious environmental issues. In an attempt to combine the environmental and technical advantages of the use of ceramic waste in mortars��� production for rehabilitation purposes, a research has been developed at the University of Coimbra, in cooperation with Nova University of Lisbon, on the long term behaviour of air lime mortars with ceramic residues. In this paper the most significant up to one year results of an experimental campaign with air lime mortars with 1:3 and 1:2 volumetric proportions and ceramic residues are presented.

Barriers preventing the successful integration of mental health services into Primary Health Care in Nigeria : a mixed methods approach

RESUMO: A Nig��ria tem uma popula����o estimada em cerca de 170 milh��es de pessoas. O n��mero de profissionais de sa��de mental �� muito diminuto, contando apenas com 150 psiquiatras o que perfaz aproximadamente um r��cio de psiquiatra: popula����o de mais de 1:1 milh��o de pessoas. O Plano Nacional de Sa��de Mental de 1991 reconheceu esta insufici��ncia e recomendou a integra����o dos servi��os de sa��de mental nos cuidados de sa��de prim��rios (CSP). Depois de mais de duas d��cadas, essa pol��tica n��o foi ainda implementada. Este estudo teve como objetivos mapear a estrutura organizacional dos servi��os de sa��de mental da Nig��ria, e explorar os desafios e barreiras que impedem a integra����o bem-sucedida dos servi��os de sa��de mental nos cuidados de sa��de prim��rios, isto segundo a perspectiva dos profissionais dos cuidados de sa��de prim��rios. Com este objetivo, desenvolveu-se um estudo explorat��rio sequencial e utilizou-se um modelo misto para a recolha de dados. A aplica����o em simult��neo de abordagens qualitativas e quantitativas permitiram compreender os problemas relacionados com a integra����o dos servi��os de sa��de mental nos CSP na Nig��ria. No estudo qualitativo inicial, foram realizadas entrevistas com listagens abertas a 30 profissionais dos CSP, seguidas de dois grupos focais com profissionais dos CSP de duas zonas governamentais do estado de Oyo de forma a obter uma vis��o global das perspectivas destes profissionais locais sobre os desafios e barreiras que impedem uma integra����o bem-sucedida dos servi��os de sa��de mental nos CSP. Subsequentemente, foram realizadas entrevistas com quatro pessoas-chave, especificamente coordenadores e especialistas em sa��de mental. Os resultados do estudo qualitativo foram utilizados para desenvolver um question��rio para an��lise quantitativa das opini��es de uma amostra maior e mais representativa dos profissionais dos CSP do Estado de Oyo, bem como de duas zonas governamentais locais do Estado de Osun. As barreiras mais comummente identificadas a partir deste estudo incluem o estigma e os preconceitos sobre a doen��a mental, a forma����o inadequada dos profissionais dos CPS sobre sa��de mental, a perce����o pela equipa dos CSP de baixa prioridade de a����o do Governo, o medo da agress��o e viol��ncia pela equipa dos CSP, bem como a falta de disponibilidade de f��rmacos. As recomenda����es para superar estes desafios incluem a melhoria sustentada dos esfor��os da advocacia �� sa��de mental que vise uma maior valoriza����o e apoio governamental, a forma����o e treino organizados dos profissionais dos cuidados prim��rios, a cria����o de redes de refer��ncia e de apoio com institui����es terci��rias adjacentes, e o engajamento da comunidade para melhorar o acesso aos servi��os e �� reabilita����o, pelas pessoas com doen��a mental. Estes resultados fornecem indica����es ��teis sobre a perce����o das barreiras para a integra����o bem sucedida dos servi��os de sa��de mental nos CSP, enquanto se recomenda uma abordagem hol��stica e abrangente. Esta informa����o pode orientar as futuras tentativas de implementa����o da integra����o dos servi��os de sa��de mental nos cuidados prim��rios na Nig��ria.------------ABSTRACT: Nigeria has an estimated population of about 170 million people but the number of mental health professionals is very small, with about 150 psychiatrists. This roughly translates to a psychiatrist:population ratio of more than 1:1 million people. The National Mental Health Policy of 1991 recognized this deficiency and recommended the integration of mental health into primary health care (PHC) delivery system. After more than two decades, this policy has yet to be implemented. This study aimed to map out the organizational structure of the mental health systems in Nigeria, and to explore the challenges and barriers preventing the successful integration of mental health into primary health care, from the perspective of the primary health care workers. A mixed methods exploratory sequential study design was employed, which entails the use of sequential timing in the combined methods of data collection. A combination of qualitative and uantitative approaches in sequence, were utilized to understand the problems of mental health services integration into PHC in Nigeria. The initial qualitative phase utilized free listing interviews with 30 PHC workers, followed by two focus group discussions with primary care workers from two Local Government Areas (LGA) of Oyo State to gain useful insight into the local perspectives of PHC workers about the challenges and barriers preventing successful integration of mental health care services into PHC. Subsequently, 4 key informant interviews with PHC co-ordinators and mental health experts were carried out. The findings from the qualitative study were utilized to develop a quantitative study questionnaire to understand the opinions of a larger and more representative sample of PHC staff in two more LGAs of Oyo State, as well as 2 LGAs from Osun State. The common barriers identified from this study include stigma and misconceptions about mental illness, inadequate training of PHC staff about mental health, low government priority, fear of aggression and violence by the PHC staff, as well as non-availability of medications. Recommendations for overcoming these challenges include improved and sustained efforts at mental health advocacy to gain governmental attention and support, organized training and retraining for primary care staff, establishment of referral and supportive networks with neighbouring tertiary facilities and community engagement to improve service utilization and rehabilitation of mentally ill persons. These findings provide useful insight into the barriers to the successful integration of mental health into PHC, while recommending a holistic and comprehensive approach. This information can guide future attempts to implement the integration of mental health into primary care in Nigeria.

Isokinetic assessment of knee flexor/extensor muscular strength in elderly women

OBJECTIVE: To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients. METHODS: Twenty-six volunteers aged 75 to 83 years were studied using a Cybex�� 6000 isokinetic dynamometer. The chosen angular velocity was 60 ��/s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate. RESULTS: There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 �� 9.09 Nm / ND = 40.65 �� 9.38 Nm) and extensor (D = 76.92 �� 13.97 Nm / ND = 77.65 �� 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides. CONCLUSIONS: The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 ��/s is proper and safe for isokinetic assessment of elderly people.

Assessment of overlay masonry strengthening system under in-plane monotonic and cyclic loading using the diagonal tensile test

The development of novel strengthening techniques to address the seismic vulnerability of masonry elements is gradually leading to simpler, faster and more effective strengthening strategies. In particular, the use of fabric reinforced cementitious matrix systems is considered of great potential, given the increase of ductility achieved with simple and economic strengthening procedures. To assess the effectiveness of these strengthening systems, and considering that the seismic action is involved, one important component of the structural behaviour is the in-plane cyclic response. In this work is discussed the applicability of the diagonal tensile test for the assessment of the cyclic response of strengthened masonry. The results obtained allowed to assess the contribution of the strengthening system to the increase of the load carrying capacity of masonry elements, as well as to evaluate the damage evolution and the stiffness degradation mechanisms developing under cyclic loading.

Development of innovative hybrid sandwich panel slabs: Experimental results

The authors appreciate the collaboration of the following labs: Civitest for developing DHCC materials, PIEP for conducting VARTM process (Eng. Luis Oliveira) and Department of Civil Engineering of Minho University to perform the tests (Mr. Antonio Matos and Eng. Marco Jorge).

Tensile creep of a structural epoxy adhesive: experimental and analytical characterization

Epoxy adhesives are nowadays being extensively used in Civil Engineering applications, mostly in the scope of the rehabilitation of reinforced concrete (RC) structures. In this context, epoxy adhesives are used to provide adequate stress transference from fibre reinforced polymers (FRP) to the surrounding concrete substrate. Most recently, the possibility of using prestressed FRPs bonded with these epoxy adhesives is also being explored in order to maximize the potentialities of this strengthening approach. In this context, the understanding of the long term behaviour of the involved materials becomes essential. Even when non-prestressed FRPs are used a certain amount of stress is permanently applied on the adhesive interface during the serviceability conditions of the strengthened structure, and the creep of the adhesive may cause a continuous variation in the deformational response of the element. In this context, this paper presents a study aiming to experimentally characterize the tensile creep behaviour of an epoxy-based adhesive currently used in the strengthening of concrete structures with carbon FRP (CFRP) systems. To analytically describe the tensile creep behaviour, the modified Burgers model was fitted to the experimental creep curves, and the obtained results revealed that this model is capable of predicting with very good accuracy the long term behaviour of this material up to a sustained stress level of 60% of the adhesive���s tensile strength.

Application of near surface mounted (NSM) strengthening technique to traditional timber frame walls

Timber frame buildings are well known as an efficient seismic resistant structure popular all over the world not only due to their seismic performance, but also to their low cost and the strength they offer. These constructions still exist today and it is important to be able to preserve them, so a better knowledge on their behaviour is sought. Furthermore, historic technologies could be used even in modern constructions to build seismic resistant buildings using more natural materials with lesser costs. A great rehabilitation effort is being carried out on this type of buildings, as their neglect has led to decay or their change in use and alterations to the structure has led to the need to retrofit such buildings; only recently studies on their behaviour have become available and only a few of them address the issue of possible strengthening techniques for this kind of walls. In this scope, an innovative retrofitting technique (near surface mounted steel flat bars) is proposed and validated on traditional timber frame walls based on an extensive experimental program. The results of the static cyclic tests on distinct wall typologies retrofitted with the NSM technique are herein presented and discussed in detail. The main features on deformation, lateral stiffness, lateral resistance and seismic performance indexes are analysed

Mitigating the impact of occupational noise exposure for elderly workers: Setting the functional requirements for an ANC system

Noise affects people in very different aspects and in almost every aspect of our daily life. The most prominent impact of noise exposure is hearing loss. However, it can also impair people at their work settings due to other effects rather than hearing loss. Older works tend to be more susceptible to noise exposure effects at work, firstly because most of them already have some ���natural��� hearing loss, as a results of the ageing process, and secondly because they also tend to be more susceptible at an psychological level. The current study is an attempt to describe the potential problem and to make a survey to identify the available active noise cancelation systems, as well as to specific the main requirements of this type of systems to be applied in such contexts. Several aspects of characteristics of the ANC systems were identified and are presented in this study. From the obtained results it was possible to have a clearer idea about the potential of this technology, and to confirm that this type of solution can be extremely important as a component of an active ageing program, as the preservation of hearing will also impact on the social life of the exposed workers.