Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results

INTRODUCTION: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil’s rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO (‘Epidemiologia do Idoso’) Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.

Estudo sobre as representações sociais face à deficiência em contexto escolar

A descriminação e a ausência de igualdade de oportunidades no acesso a direitos fundamentais inscritos na constituição portuguesa continuam a ser para as pessoas com deficiência um tema bastante actual e uma das preocupações nucleares de todos aqueles que directa ou indirectamente se interessam por estas questões. O acesso a educação e ao emprego, ainda que incentivado por políticas sociais inclusivas, continua a ser extremamente dificultado pela existência de barreiras, com configurações diversas, mas quase sempre organizadas em torno de representações acerca da deficiência pouco coerentes e coincidentes com o entendimento actual deste fenómeno. O trabalho por nós realizado teve como objectivo contribuir para o estudo das representações sociais relativamente à deficiência em Portugal, perspectivada a análise a partir dos agentes educativos do agrupamento de escolas do distrito de Viana do Castelo, uma das zonas do país com maior número de pessoas com deficiência, de acordo com o Censo de 2001. O inquérito por questionário de auto-administração realizado a uma amostra de 56 agentes educativos foi concordante com muitas das crenças e estereótipos face às pessoas com deficiência encontrados em estudos similares, nomeadamente no que reporta às atitudes negativas de pena e de culpa e à visualização da pessoa com deficiência como incapaz e pouco autónoma. Esta situação sugere a necessidade de se continuar a desenvolver estudos de caracterização destes traços em diferentes micro-culturas, no sentido de se desenvolverem estratégias personalizadas que permitam a sua remissão e o desmantelar das barreiras ainda existentes para a inclusão destes cidadãos na sociedade.

O impacto do uso da tala nocturna na qualidade de vida do indivíduo com Síndrome do Túnel Carpiano

Síndrome do Túnel Carpiano (STC) é uma neuropatia compressiva do nervo mediano ao nível da articulação rádio-cubital inferior. Caracteriza-se fisiologicamente pelo aumento da pressão ao nível do canal carpiano o que desencadeia a diminuição da função do nervo a esse nível. Independentemente da fase de evolução da patologia, o indivíduo apresenta défices motores e sensoriais que interferem com o desempenho dos seus diversos papéis ocupacionais e, concomitantemente, com a sua Qualidade de Vida (QV). Como forma de reduzir esse impacto, existem várias abordagens possíveis, entre as quais se destaca o uso da tala nocturna de repouso. Este trabalho tem como objectivo principal definir quais os benefícios do uso da tala nocturna e o impacto manifesto na QV do indivíduo com STC. Simultaneamente pretende-se definir em que medida a relação benefício/melhoria da dor e normalização sensitiva se relaciona com o uso da tala. Por último, identificar quais as variáveis sociodemográficas que estão relacionadas ao problema em estudo e aos valores obtidos com as escalas SF-36 e PDI, nos indivíduos dos grupos controlo e experimental. Para a realização deste estudo, utilizou-se uma amostra de 46 indivíduos do sexo feminino aos quais aplicouse as escalas referidas anteriormente e os Monofilamentos de Semmes-Weinstein. Os resultados obtidos com o SF-36 revelaram uma maior percepção do estado de saúde no domínio Saúde Geral, no grupo ao qual se aplicou a tala, sugerindo que esta intervenção permite uma melhoria da QV. Simultaneamente, o PDI permitiu inferir que a aplicação da tala nocturna tem um impacto positivo no que concerne à percepção do nível da dor nas diversas actividades da vida diária e, consequentemente, na QV. No que se refere à sensibilidade, os resultados obtidos não permitem afirmar que existem melhoras a este nível. Relativamente às variáveis socio-demográficas, apenas os casos classificados como ligeiros apresentam uma melhor percepção do nível de Saúde Geral o que é sugestivo de que com o evoluir da patologia há perda de QV.

Pregnancy rates and predictors in women with HIV/AIDS in Rio de Janeiro, Southeastern Brazil

OBJECTIVE: To assess incidence and predictors of first pregnancy among women with HIV/AIDS. METHODS: Prospective cohort study was conducted in Rio de Janeiro, southeastern Brazil, between 1996 and 2003. This study comprised 225 women with HIV/AIDS followed up until their first pregnancy or first censored event (hysterectomy, tubal ligation, menopause, 50 years of age, loss to follow-up, death or the end of December 2003). Pregnancy and abortion rates were estimated, and Cox proportional hazards models were used to identify baseline characteristics associated with pregnancy risk. RESULTS: The women were followed up for 565 person/years with a median follow-up of 3 years per women. The mean age was 32 years (SD: 7), and 54.7% were white. There were 60 pregnancies in 39 women, and 18 were terminated (induced abortions), accounting for a rate of 6.9% and 2.1% women/year, respectively. Repeated pregnancies occurred in 33.3% of the women (13/39). Higher pregnancy risk was seen among younger women (HR=3.42; 95%CI: 1.69;6.95) and those living with their partners (HR=1.89; 95%CI: 1.00;3.57). Lower pregnancy risk was associated with higher education level (HR=0.43; 95%CI: 0.19;0.99) and use of antiretroviral therapy (HR=061; 95%CI: 0.31;1.17). CONCLUSIONS: Lower pregnancy rates were found in our cohort than in the general population. Sociodemographic characteristics should be taken into consideration in the management of reproductive health in HIV-positive childbearing age women. Reproductive and family planning counseling must be incorporated into HIV/AIDS programs for women to help preventing HIV transmission to their partners and offspring.

Check your biosignals here: a new dataset for off-person ECG biometrics

The Check Your Biosignals Here initiative (CYBHi) was developed as a way of creating a dataset and consistently repeatable acquisition framework, to further extend research in electrocardiographic (ECG) biometrics. In particular, our work targets the novel trend towards off-the-person data acquisition, which opens a broad new set of challenges and opportunities both for research and industry. While datasets with ECG signals collected using medical grade equipment at the chest can be easily found, for off-the-person ECG data the solution is generally for each team to collect their own corpus at considerable expense of resources. In this paper we describe the context, experimental considerations, methods, and preliminary findings of two public datasets created by our team, one for short-term and another for long-term assessment, with ECG data collected at the hand palms and fingers. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Interface between Intellectual Disability and Mental Health: hermeneutic review

A literature review was conducted aiming to understand the interface between the Intellectual Disability and Mental Health fields and to contribute to mitigating the path of institutionalizing individuals with intellectual deficiencies. The so-called dual diagnosis phenomenon remains underestimated in Brazil but is the object of research and specific public policy internationally. This phenomenon alerts us to the prevalence of mental health problems in those with intellectual disabilities, limiting their social inclusion. The findings reinforce the importance of this theme and indicate possible diagnostic invisibility of the development of mental illness in those with intellectual disabilities in Brazil, which may contribute to sustaining psychiatric institutionalization of this population. 

Brazilian version of the Quality of Care Scale: the perspective of people with disabilities

OBJECTIVE To analyze evidence of the validity and reliability of a Brazilian Portuguese version of the Quality of Care Scale from the perspective of people with physical and intellectual disabilities.METHODS There were 162 people with physical disabilities and 156 with intellectual disabilities from Porto Alegre and metropolitan region, who participated in the study in 2008. Classical psychometrics was used to independently analyze the two samples. Hypotheses for evidence of criterion validity (concurrent type) were tested with the Mann-Whitney test for non-normal distributions. Principal components analysis was used to explore factorial models. Evidence of reliability was calculated with Cronbach alpha for the scales and subscales. Test-retest reliability was analyzed for individuals with intellectual disabilities through intra-class correlation coefficient and the Willcoxon test.RESULTS The principal components in the group with physical disabilities replicated the original model presented as a solution to the international project data. Evidence of discriminant validity and test-retest reliability was found.CONCLUSIONS The transcultural factor model found within the international sample project seems appropriate for the samples investigated in this study, especially the physical disabilities group. Depression, pain, satisfaction with life and disability may play a mediating role in the evaluation of quality of care. Additional research is needed to add to evidence of the validity of the instruments.

Functional disability of adults in Brazil: prevalence and associated factors

ABSTRACT OBJECTIVE To estimate the prevalence and factors associated with functional disability in adults in Brazil. METHODS We used information from the health supplement of the National Household Sample Survey in 2008. The dependent variable was the functional disability among adults of 18 to 65 years, measured by the difficulty of walking about 100 meters; independent variables were: health plan membership, region of residence, state of domicile, education level, household income, economic activity, self-perception of health, hospitalization, chronic diseases, age group, sex, and color. We calculated the gross odds ratios (OR), and their respective confidence intervals (95%), and adjusted them for variables of study by ordinal logistic regression, following hierarchical model. Sample weights were considered in all calculations. RESULTS We included 18,745 subjects, 74.0% of whom were women. More than a third of adults reported having functional disability. The disability was significantly higher among men (OR = 1.17; 95%CI 1.09;1.27), people from 35 to 49 years (OR = 1.30; 95%CI 1.17;1.45) and 50 to 65 years (OR = 1.38; 95%CI 1.24;1.54); economically inactive individuals (OR = 2.21; 95%CI 1.65;2.96); adults who reported heart disease (OR = 1.13; 95%CI 1.03;1.24), diabetes mellitus (OR = 1.16; 95%CI 1.05;1.29), arterial systemic hypertension (OR = 1.10; 95%CI 1.02;1.18), and arthritis/rheumatism (OR = 1.24; 95%CI 1.15;1.34); and participants who were admitted in the last 12 months (OR = 2.35; 95%CI 1.73;3.2). CONCLUSIONS Functional disability is common among Brazilian adults. Hospitalization is the most strongly associated factor, followed by economic activity, and chronic diseases. Sex, age, education, and income are also associated. Results indicate specific targets for actions that address the main factors associated with functional disabilities and contribute to the projection of interventions for the improvement of the well-being and promotion of adults' quality of life.

Building a person home behavior model based on data from smart house sensors 2015

Dissertação para a obtenção do grau de Mestre em Engenharia Electrotécnica Ramo de Energia

Age-period-cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk

Introduction: Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000–2008. Methods: From the National Hospital Discharge Register, we selected admissions (aged ≥49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age–period–cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. Results: There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable–increasing), 1940 (decreasing–increasing) and 1950 (increasing–decreasing only among women). Conclusions: Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.

Person Localization Using Sensor Information Fusion

Nowadays the incredible grow of mobile devices market led to the need for location-aware applications. However, sometimes person location is difficult to obtain, since most of these devices only have a GPS (Global Positioning System) chip to retrieve location. In order to suppress this limitation and to provide location everywhere (even where a structured environment doesn’t exist) a wearable inertial navigation system is proposed, which is a convenient way to track people in situations where other localization systems fail. The system combines pedestrian dead reckoning with GPS, using widely available, low-cost and low-power hardware components. The system innovation is the information fusion and the use of probabilistic methods to learn persons gait behavior to correct, in real-time, the drift errors given by the sensors.

Off-the-person electrocardiography: performance assessment and clinical correlation

Previous work by our group introduced a novel concept and sensor design for “off-the-person” ECG, for which evidence on how it compares against standard clinical-grade equipment has been largely missing. Our objectives with this work are to characterise the off-the-person approach in light of the current ECG systems landscape, and assess how the signals acquired using this simplified setup compare with clinical-grade recordings. Empirical tests have been performed with real-world data collected from a population of 38 control subjects, to analyze the correlation between both approaches. Results show off-the-person data to be correlated with clinical-grade data, demonstrating the viability of this approach to potentially extend preventive medicine practices by enabling the integration of ECG monitoring into multiple dimensions of people’s everyday lives. © 2015, IUPESM and Springer-Verlag Berlin Heidelberg.

Unidade de interação e controlo para uma cadeira de rodas elétrica automática

Num mundo onde cerca de 1% da população necessita de utilizar uma cadeira de rodas para a sua deslocação, a acessibilidade a este tipo de veículo no exterior ainda encontra-se num estado bastante precário. Falta de rampas nos passeios, buracos, caminhos em declive e determinados obstáculos como carros estacionados por cima do passeio, são alguns de muitos exemplos dos desafios que uma pessoa em cadeira de rodas enfrenta quando tenta deslocar-se no exterior, o que faz com que a autonomia e a segurança na condução de uma cadeira de rodas seja bastante reduzida, sendo por muitas vezes necessário recorrer de forma constante à ajuda de terceiros, que, por consequência, reduz a sua, já limitada, liberdade de locomoção. É com base nestes problemas que o projeto RevoChair surgiu. Este projeto consiste no desenvolvimento de um sistema para cadeira de rodas elétrica que permita ao utilizador movimentar-se no exterior automaticamente, sempre que possível, sem ter de se preocupar com os obstáculos a sua volta. Esta tese incide-se concretamente sobre três dos problemas do desenvolvimento deste projeto, a definição das componentes necessárias para a implementação do sistema, a forma como o utilizador interage com o sistema e a forma como os componentes comunicam entre si, tendo como foco a unidade de interação e a unidade de controlo responsável por gerir a comunicação entre os diversos componentes do sistema.

Ascariasis in the subdistrict of Cavacos, municipality of Alterosa (MG), Brazil: effect of mass treatment with albendazole on the intensity of infection

The clinical and epidemiologic aspects of infection with Ascaris lumbricoides were studied in a random stratified sample of the population of the subdistrict of Cavacos, municipality of Alterosa (Minas Gerais, Brazil). The effect of mass treatment with a single dose of albendazole on the prevalence and intensity of infection was also studied six months later in the same population. During the first phase of the study, a questionnaire was applied to 248 individuals to obtain information about the socioeconomic, sanitary and clinical conditions of the population surveyed. A total of 230 fecal samples were also examined by the Kato-Katz technique in order to determine the intensity of A. lumbricoides infection. Two hundred and two individuals were simultaneously submitted to blood counts and 70 children aged 12 years or less were evaluated for nutritional status. The presence of A. lumbricoides and other helminth eggs was also determined in 22 soil samples collected in the urban zone of Cavacos. Infection with enteroparasitic helminths was detected in 29.1% of the sample, with a predominance of A. lumbricoides (23.9%). Parasitism and/or intensity of A. lumbricoides infection were significantly correlated with age range (15 years or less), social class, sanitary and living conditions (water, sewage and domiciliary area per person), and presence of abdominal pain. However, these parameters were not correlated with nutritional status or hematocrit levels. During the second phase of the study, a slight but not statistically significant decrease in the prevalence of A. lumbricoides infection was detected after treatment with albendazole. However, an important and significant reduction in the amount of A. lumbricoides eggs eliminated through the feces was detected, indicating that the intensity of A. lumbricoides infection was lower in all the age ranges of the Cavacos population, especially among younger individuals, even six months after administration of the anthelminthic agent.

Desatando os nós da solidão com laços de afeto: Intervenção psicossocial em contexto domiciliário

Apesar de haver diferenças de indivíduo para indivíduo, todas as pessoas se encontram num processo de envelhecimento, que se pretende que seja ativo e saudável. Porém, à medida que nos aproximamos da velhice, e por inúmeros fatores, a probabilidade da pessoa se sentir só, de ter sentimentos como a solidão, de estar isolada ou socialmente excluída, aumenta. Este relatório surge de um projeto desenhado e desenvolvido com pessoas que se sentiam sozinhas, sendo pessoas idosas ou com deficiência, e que, por esse motivo, foram encaminhadas para apoio domiciliário. Pretendeu-se assim colmatar algumas das necessidades quotidianas dessas pessoas, sendo relevante entender se esse apoio contribuiu para melhorar a qualidade de vida, evitar ou diminuir os momentos e sentimentos de solidão, através da (re)ativação de redes de apoio. O projeto “Desatando os nós da solidão com laços de afeto” foi, na medida das suas possibilidades, desenhado e desenvolvido com os participantes. Este projeto ramificou-se em três subprojetos, correspondendo cada um, de forma mais específica, às necessidades e aos problemas que cada pessoa sentia, tentando contribuir para a melhoria da qualidade de vida, recorrendo às potencialidades de cada um e aos recursos existentes na comunidade. É um projeto que terá continuidade, pois envolveu voluntários e técnicos da instituição e pessoas das redes de apoio mais próximas dos participantes, mas que já proporcionou algumas mudanças, sendo esse um ponto de partida para alcançar a utopia orientadora do projeto.