Autonomia funcional em idosos : caracterização multidimensional em idosos utentes de um centro de saúde urbano

RESUMO: Tivemos como objectivo do presente trabalho avaliar a capacidade funcional, e factores eventualmente a ela associados, numa amostra de 152 idosos ambulatórios, sem doenças agudas ou graves, utentes de um centro de saúde urbano. Cada avaliação consistiu numa entrevista, mediante um inquérito sobre capacidade funcional, morbilidade, estado mental e aspectos sociais, e no estudo da composição corporal. As perguntas referentes às variáveis estudadas foram por nós desenvolvidas e estruturadas com base em escalas internacionais validadas e de utilização comum na avaliação de idosos, excepto para as variáveis em que não encontrámos escalas com essas características. Os seus quesitos foram incluídos como perguntas e respostas estruturadas e pré-codificadas, permitindo a atribuição de uma pontuação a cada variável e a sua posterior divisão dicotómica. Aplicámos as escalas de Katz e de Lawton para a avaliação das actividades de autonomia física e instrumental da vida diária, a escala de Grimby para a avaliação da actividade física, a escala de Hamilton e o teste de Folstein para a avaliação do estado mental nas vertentes afectiva e cognitiva e a escala de Graffar para caracterizar a classe social, e perguntas sobre locomoção, autoavaliação da saúde, queixas de saúde presentes e rede social. Fizemos o registo da morbilidade segundo a International Classification of Primary Care - ICPC. A avaliação antropométrica constou da medição do peso, da altura, dos perímetros do braço, da cintura, da anca e proximal da coxa, e das pregas bicipital, tricipital, sub-escapular e supra-ilíaca. Foi também feita a estimativa da composição corporal por cálculos derivados de índices antropométricos e de bioimpedância eléctrica corporal total, o doseamento de algumas proteínas plasmáticas e a quantificação da força de preensão. Analisámos os resultados obtidos por grupos quanto ao sexo e à idade, dividida nos escalões etários 65 a 74 anos e mais do que 74 anos. Por regressão linear múltipla, foi testado o efeito do sexo e da idade sobre os valores medidos, para cada uma das variáveis e cada uma das suas pontuações parciais, sendo considerado como evidência de um efeito estaticamente significativo um valor “p” inferior a 0,05.Resumimos do seguinte modo os dados obtidos e a sua comparação com os dos estudos que seleccionámos como referência: A média de idades da amostra foi de 74 anos, sendo um terço destes do sexo masculino. Na sua maioria eram independentes em locomoção e funcionalidade, praticavam alguma actividade física, classificavam a sua saúde como razoável ou boa, apresentavam sintomatologia activa, não tinham depressão ou demência, tinham quem os acompanhasse embora cerca de metade apresentasse algum grau de isolamento, eram de baixa classe social, tinham excesso de peso, valores elevados de massa gorda, parâmetros plasmáticos proteicos compatíveis com ausência de doenças agudas ou graves e considerável força muscular de preensão. Na análise descritiva por grupos quanto ao sexo e/ou à idade, verificou-se que as mulheres e os mais idosos apresentavam maior isolamento social e os valores mais baixos de massa magra, hemoglobina e força de preensão. As mulheres tinham maior prevalência de dependência em autonomia física, depressão e valores mais baixos de transferrina. Os mais idosos apresentavam maior dependência em funcionalidade, menor actividade física, maior prevalência de demência, índice de massa corporal menos elevado, e valores mais baixos de albumina. Não se verificou prevalência de piores resultados dicotómicos nos homens nem no escalão etário menos idoso. Não teve relação com o sexo ou a idade o compromisso em autonomia instrumental, a presença de morbilidade ou a baixa classe social, assim como a não perturbação da locomoção e dos níveis de somatomedina-C. A análise comparativa com estudos multidimensionais em idosos portugueses e europeus ambulatórios revelou que a nossa amostra apresentava muitas características semelhantes às desses idosos. Assim, tinham elevada independência em locomoção, considerável independência em autonomia física e menor independência em autonomia instrumental; prática de actividade física ligeira, as mulheres dentro e os homens fora de casa; maior prevalência de morbilidade a nível dos aparelhos locomotor e cardiocirculatório, nos nossos idosos com pouca flutuação na autoavaliação de saúde; pequena prevalência de depressão e de demência; maior isolamento social nas mulheres e nas mais idosas; factores de classe social de baixo nível, diferindo apenas em relação aos idosos do norte da Europa que apresentavam elevada escolaridade e profissões mais diferenciadas; características biométricas sobreponíveis às dos idosos portugueses e às dos do sul da Europa, com tendência para o excesso de peso e proporção elevada de massa gorda; e doseamentos plasmáticos proteicos e força muscular de preensão compatíveis com ausência de doenças agudas ou crónicas graves. A comparação com os referidos estudos em relação ao risco de dependência, revelou semelhanças na associação entre dependência funcional e idade avançada, morbilidade, alteração do estado mental e isolamento social. Na amostra que estudámos não obtivemos associação entre dependência e o sexo feminino, facto que se verificou no estudo nacional de Almeida et al. e nos estudos multicêntricos europeus, ou o grau de escolaridade, como no estudo francês. Podemos concluir que, com o instrumento de avaliação que utilizámos, foi possível detectar e caracterizar perturbações numa amostra de idosos ambulatórios, a maioria funcionalmente independentes, sem alterações do estado mental, mas apresentando morbilidade activa, tendência para a obesidade, e actividade física ligeira. Nos que apresentaram alterações, estas foram mais frequentes no sexo feminino e nos indivíduos com mais de 74 anos. A escala de funcionalidade desenvolvida foi sensível aos efeitos da idade e permitiu o cálculo do risco de dependência em relação às outras variáveis estudadas, sendo mais marcante a associação com baixa actividade física, presença de queixas de saúde, demência e índice de massa corporal elevado. Consideramos que a metodologia que empregámos poderá contribuir para a avaliação de capacidades, cujo conhecimento sistemático nos idosos se impõe. ------------- ABSTRACT: The main objective of the present work was to evaluate functional capacity and related factors, in a sample of 152 ambulatory elderly, free from acute or serious disease, attending an urban health centre. Each evaluation included an interview, with a questionnaire about functional capacity, morbidity, mental health and social aspects, and the study of body composition. The questions were developed and structured in accordance with international validated scales usually applied in the evaluation of the elderly, whenever there were scales for that purpose. Their items were included as structured pre-coded questions and answers, so that each variable could have its own quotation and be dichotomised. We employed Katz and Lawton scales for basic and instrumental activities of daily living, Grimby scale for physical activity, Hamilton scale for depression, Folstein’s Mini Mental State Examination for cognitive ability and Graffar scale for social class, and questions about walking, health perception, active complaints and social network. The symptoms register was done according to the International Classification of Primary Care - ICPC. The anthropometric exam involved the determination of height and weight, arm, waist, hip and proximal thigh circumferences, and biceps, triceps, subscapular and suprailiac skinfolds. For the body composition calculation we employed equations derived from anthropometric indices, and from measurement of total body bioelectric impedance. We also measured some plasma proteins and handgrip strength. The analysis of results was done by sex and age groups, separating those with 65 to 74 years from those older than 74 years. The effects of sex and age were tested by linear multiple regression, for each variable and its components. Presented "p" values being considered statistically significative if less than 0,05. The results we obtained and their comparison with the studies we choose as reference can be summarised as follows: Mean age of the sample was 74 years and about one third were men. Most of them were independent in gait and functionality, practised some physical activity, rate their health as fair or good, had physical complaints, had not depression or dementia, had some companionship although almost half of them with stigmas of isolation, belonged to low social class, were in the range of overweight, had raised values of fat mass, plasma proteins in accordance with no acute or serious disease, and considerable handgrip strength. The analysis of groups by sex and age revealed that women and the eldest had the greater social isolation and the lowest values of free fat mass, haemoglobin and handgrip strength. Women had the higher dependence in basic activities of daily living, more depression and lower levels of transferrin. The eldest were more dependent in functionality, had greater prevalence of dementia, less physical activity, less raised body mass index and lower levels of albumin. Men alone and the age range of 65 to 74 did not show any prevalence of the worse dichotomised results. There was no relationship between sex or age and instrumental activities of daily living, morbidity or low social class, and unaffected gait or somatomedin-C levels. The comparison of results with multidimensional studies in portuguese and european ambulatory elderly showed that our sample had many similarities with theirs. They were independent in gait and activities of daily living; practiced light physical activity, women indoors and men outdoors; had greater morbidity at locomotor and cardiovascular systems, with small latitude in health evaluation; low prevalence of depression and dementia; social isolation predominantly in older women; and low social class factors, witch is only different from those of north Europe who had higher education levels and professional carriers; biometric characteristics similar to other portuguese and south Europe elders, with tendency for overweight and high proportion of fat mass; and plasma protein levels and handgrip strength in accordance with no acute or chronic serious disease. The comparison to the referred studies in relation to dependency risk, showed similarities in the association of dependency and age, morbidity,altered mental state and social isolation. We did not find association between dependency and sex, as it was found in the portuguese study of Almeida et al. and the european multicentric studies, or the education level, as in the french study. We conclude that, with the evaluation battery we employed, it was possible to detect and characterise alterations in a sample of ambulatory elderly, most of whom were functionally independent and had no alterations in mental state, but had active morbidity, tendency to obesity, and only light physical activity. Those that had some alteration, were more frequently women and the eldest. The functionality scale we developed showed to be sensitive to age effects and suitable for the calculation of risk of dependency, being more important the association with low physical activity, active complaints, dementia and high body mass index. We consider that the methodology we applied can contribute to the evaluation of capabilities that should be systematically sought for in the elderly.

O emprego de uma força de segurança de natureza militar nas missões de paz

The conflicts currently taking place around the world demand that the international intervention fits the intensity and extent of the threat. This is particularly important in post-conflict scenarios, leading to a greater participation of the Security Forces in those scenarios, in order to foster lasting peace, enforce the order and improve law enforcement services in those regions. The transition from armed conflict to peacekeeping may entail high risk situations and greater instability periods, so-called “intermediate situations”. Accordingly, in the face of persisting high volatility, a robust response is still required post-conflict. Therefore, it is appropriate to deploy Security Forces with military nature and status, the gendarmeries, which have training and response capabilities similar to Armed Forces in peacekeeping operations. Their double facet as police and military forces enables them to perform police duties in high risk and unsafe environments. In light of these features, the Portuguese gendarmerie, Guarda Nacional Republicana (GNR), is able to carry out tasks in these scenarios, which it has been doing through individual operatives or larger units. This dissertation focuses on the use of Security Forces of military nature in peacekeeping missions, in particular the Portuguese GNR, relying mostly on the inductive approach and using literature research, document analysis, interviews and statistics. After a brief description of international peacekeeping missions, we describe the contribution of Security Forces of a military nature in such operations. Then we introduce and analyse the GNR, focusing on its deployment in different kinds of peacekeeping operations, from its first participation in 1995 until today. We also report some reactions to the performance of GNR. Finally, we discuss whether there is indeed a unique role for this type of forces in international peacekeeping missions.

Knowledge management framework based on brain models and human physiology

The life of humans and most living beings depend on sensation and perception for the best assessment of the surrounding world. Sensorial organs acquire a variety of stimuli that are interpreted and integrated in our brain for immediate use or stored in memory for later recall. Among the reasoning aspects, a person has to decide what to do with available information. Emotions are classifiers of collected information, assigning a personal meaning to objects, events and individuals, making part of our own identity. Emotions play a decisive role in cognitive processes as reasoning, decision and memory by assigning relevance to collected information. The access to pervasive computing devices, empowered by the ability to sense and perceive the world, provides new forms of acquiring and integrating information. But prior to data assessment on its usefulness, systems must capture and ensure that data is properly managed for diverse possible goals. Portable and wearable devices are now able to gather and store information, from the environment and from our body, using cloud based services and Internet connections. Systems limitations in handling sensorial data, compared with our sensorial capabilities constitute an identified problem. Another problem is the lack of interoperability between humans and devices, as they do not properly understand human’s emotional states and human needs. Addressing those problems is a motivation for the present research work. The mission hereby assumed is to include sensorial and physiological data into a Framework that will be able to manage collected data towards human cognitive functions, supported by a new data model. By learning from selected human functional and behavioural models and reasoning over collected data, the Framework aims at providing evaluation on a person’s emotional state, for empowering human centric applications, along with the capability of storing episodic information on a person’s life with physiologic indicators on emotional states to be used by new generation applications.

Optimization of export support systems: How to promote exports from Portugal to Germany in the area of information technology and electronics

This work project focuses on developing new approaches which enhance Portuguese exports towards a defined German industry sector within the information technology and electronics fields. Firstly and foremost, information was collected and a set of expert and top managers’ interviews were performed in order to acknowledge the demand of the German market while identifying compatible Portuguese supply capabilities. Among the main findings, Industry 4.0 presents itself as a valuable opportunity in the German market for Portuguese medium sized companies in the embedded systems area of expertise for machinery and equipment companies. In order to achieve the purpose of the work project, an embedded systems platform targeting machinery and equipment companies was suggested as well as it was developed several recommendations on how to implement it. An alternative approach for this platform was also considered within the German market namely the eHealth sector having the purpose of enhancing the current healthcare service provision.

Structural transformation in the product space: Patterns and implications

Product fundamentals are essential in explaining heterogeneity in the product space. The scope for adapting and transferring capabilities into the production of different goods determines the speed and intensity of the structural transformation process and entails dissimilar development opportunities for nations. Future specialization patterns become then partly determined by the current network of products’ relatedness. Building on previous literature, this paper explicitly compares methodological concepts of product connectivity to conclude in favor of the density measure we propose combined with the Revealed Relatedness Index (RRI) approach presented by Freitas and Salvado (2011). Overall, RRI specifications displayed more consistent behavior when different time horizons are equated.

Genome-scale metabolic network reconstruction of Polaromonas sp. strain JS666: analysis of cDCE degradation rates and design of experiments for bioremediation improvement

Release of chloroethene compounds into the environment often results in groundwater contamination, which puts people at risk of exposure by drinking contaminated water. cDCE (cis-1,2-dichloroethene) accumulation on subsurface environments is a common environmental problem due to stagnation and partial degradation of other precursor chloroethene species. Polaromonas sp. strain JS666 apparently requires no exotic growth factors to be used as a bioaugmentation agent for aerobic cDCE degradation. Although being the only suitable microorganism found capable of such, further studies are needed for improving the intrinsic bioremediation rates and fully comprehend the metabolic processes involved. In order to do so, a metabolic model, iJS666, was reconstructed from genome annotation and available bibliographic data. FVA (Flux Variability Analysis) and FBA (Flux Balance Analysis) techniques were used to satisfactory validate the predictive capabilities of the iJS666 model. The iJS666 model was able to predict biomass growth for different previously tested conditions, allowed to design key experiments which should be done for further model improvement and, also, produced viable predictions for the use of biostimulant metabolites in the cDCE biodegradation.

Temporal distribution of tuberculosis in the State of Amazonas, Brazil

Tuberculosis (TB) is one of the infectious diseases that contributes most to the morbidity and mortality of millions of people worldwide. Brazil is one of 22 countries that accounts for 80% of the tuberculosis global burden. The highest incidence rates in Brazil occur in the States of Amazonas and Rio de Janeiro. The aim of this study was to describe the temporal distribution of TB in the State of Amazonas. Between 2001 and 2011, 28,198 cases of tuberculosis were reported in Amazonas, distributed among 62 municipalities, with the capital Manaus reporting the highest (68.7%) concentration of cases. Tuberculosis was more prevalent among males (59.3%) aged 15 to 34 years old (45.5%), whose race/color was predominantly pardo (64.7%) and who had pulmonary TB (84.3%). During this period, 81 cases of multidrug-resistant TB were registered, of which the highest concentration was reported from 2008 onward (p = 0.002). The municipalities with the largest numbers of indigenous individuals affected were São Gabriel da Cachoeira (93%), Itamarati (78.1%), and Santa Isabel do Rio Negro (70.1%). The future outlook for this region includes strengthening the TB control at the primary care level, by expanding diagnostic capabilities, access to treatment, research projects developed in collaboration with the Dr. Heitor Vieira Dourado Tropical Medicine Foundation .;Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD).; and financing institutions, such as the project for the expansion of the Clinical Research Center and the creation of a hospital ward for individuals with transmissible respiratory diseases, including TB.

Product extension services deployment platform

Due to the progresses made in the branch of embedded technologies, manufacturers are becoming able to pack their shop floor level manufacturing resources with even more complex functionalities. This technological progression is radically changing the way production systems are designed and deployed, as well as, monitored and controlled. The dissemination of smart devices inside production processes confers new visibility on the production system while enabling for a more efficient and effective management of the operations. By turning the current manufacturing resources functionalities into services based on a Service Oriented Architecture (SOA), in order to expose them as a service to the user, the binomial manufacturing resource/service will push the entire manufacturing enterprise visibility to another level while enabling the global optimization of the operations and processes of a production system while, at the same time, supporting its accommodation to the operational spike easily and with reduced impact on production. The present work implements a Cloud Manufacturing infrastructure for achieving the resource/service value-added i.e. to facilitate the creation of services that are the composition of currently available atomic services. In this context, manufacturing resource virtualization (i.e. formalization of resources capabilities into services accessible inside and outside the enterprise) and semantic representation/description are the pillars for achieving resource service composition. In conclusion, the present work aims to act on the manufacturing resource layer where physical resources and shop floor capabilities are going to be provided to the user as a SaaS (Software as a Service) and/or IaaS (Infrastructure as a Service).

Development of paper transistor with memory effect

This work will discuss the use of different paper membranes as both the substrate and dielectric for field-effect memory transistors. Three different nanofibrillated cellulose membranes (NFC) were used as the dielectric layer of the memory transistors (NFC), one with no additives, one with an added polymer PAE and one with added HCl. Gallium indium zinc oxide (GIZO) was used as the device’s semiconductor and gallium aluminium zinc oxide (GAZO) was used as the gate electrode. Fourier transform infrared spectroscopy (FTIR) was used to access the water content of the paper membranes before and after vacuum. It was found that the devices recovered their water too quickly for a difference to be noticeable in FTIR. The transistor’s electrical performance tests yielded a maximum ION/IOFF ratio of around 3,52x105 and a maximum subthreshold swing of 0,804 V/decade. The retention time of the dielectric charge that grants the transistor its memory capabilities was accessed by the measurement of the drain current periodically during 144 days. During this period the mean drain current did not lower, leaving the retention time of the device indeterminate. These results were compared with similar devices revealing these devices to be at the top tier of the state-of-the-art.

A decision- theoretic model for M&A sale processes

A Work Project, presented as part of the requirements for the Award of a Masters Double Degree in Economics and International Business from the NOVA – School of Business and Economics and Insper Instituto de Ensino e Pesquisa

The value creation radar applied to the space engineering sector

This case study illustrates the application of the Value Creation Radar (VCR) to SenSyF, an Earth Observation (EO) system which was developed by Deimos Engenharia S.A. (DME), the Portuguese affiliate of Elecnor Deimos. It describes how a team of consultants adopted the VCR in order to find new market applications for SenSyF, selected the one with the highest potential, and defined a path to guarantee a sustainable market launch. This case study highlights the main challenges of bringing a technology-driven company closer to the market in the pursuit of long-term sustainability, while not compromising its technological capabilities

How to increase reach efficiency and effectiveness of MEO’s digital marketing campaigns?

Field lab: Business project

Sustained competitive advantage of different sized multinational corporations in rural base of the pyramid markets

This thesis explores how multinational corporations of different sizes create barriers to imitation and therefore sustain competitive advantage in rural and informal Base of the Pyramid economies. These markets require close cooperation with local partners in a dynamic environment that lacks imposable property rights and follows a different rationale than developed markets. In order to explore how competitive advantage is sustained by different sized multinational corporations at the Base of the Pyramid, the natural-resource-based view and the dynamic capabilities perspective are integrated. Based on this integration the natural-resource-based view is extended by identifying critical dynamic capabilities that are assumed to be sources of competitive advantage at the Base of the Pyramid. Further, a contrasting case study explores how the identified dynamic capabilities are protected and their competitive advantage is sustained by isolating mechanisms that create barriers to imitation for a small to medium sized and a large multinational corporation. The case study results give grounds to assume that most resource-based isolating mechanisms create barriers to imitation that are fairly high for large and established multinational corporations that operate at the rural Base of the Pyramid and have a high product and business model complexity. On the contrary, barriers to imitation were found to be lower for young and small to medium sized multinational corporations with low product and business model complexity that according to some authors represent the majority of rural Base of the Pyramid companies. Particularly for small to medium sized multinational corporations the case study finds a relationship- and transaction-based unwillingness of local partners to act opportunistically rather than a resource-based inability to imitate. By offering an explanation of sustained competitive advantage for small to medium sized multinational corporations at the rural Base of the Pyramid this thesis closes an important research gap and recommends to include institutional and transaction-based research perspectives.

Distributed solar micro generation

Taking into account the fact that the sun’s radiation is estimated to be enough to cover 10.000 times the world’s total energy needs (BRAKMANN & ARINGHOFF, 2003), it is difficult to understand how solar photovoltaic systems (PV) are still such a small part of the energy source matrix across the globe. Though there is an ongoing debate as to whether energy consumption leads to economic growth or whether it is the other way around, the two variables appear correlated and it is clear that ensuring the availability of energy to match a country’s growth targets is one of the prime concerns for any government. The topic of centralized vs distributed electricity generation is also approached, especially in what regards the latter fit to developing countries needs, namely the lack of investment capabilities and infrastructure, scattered population, and other factors. Finally, Brazil’s case is reviewed, showing that the current cost of electricity from the grid versus the cost from PV solutions still places an investment of this nature with 9 to 16 years to reach breakeven (from a 25 year panel lifespan), which is too high compared to the required 4 years for most Brazilians. Still, recently passed legislation opened the door, even if unknowingly, to the development of co-owned solar farms, which could reduce the implementation costs by as much as 20% and hence reduce the number of years to breakeven by 3 years.

A Justiça como instituição política

Neste estudo, procede-se á análise histórica e comparativa as diferentes teorias de justiça, com especial incidência nas modernas teorias igualitárias, quer das conceções liberais, quer das conceções comunitaristas. Para o efeito a Teoria da justiça de Rawls constitui um “marco” importante, tomando-se para reflexão as críticas e alternativas que posteriormente foram sendo apresentadas na teoria política tendo em conta variáveis como o multiculturalismo e problemas específicos. A conclusão inclinar-se-á para a tese de Amartya Sen e a ênfase dada à igualização das capabilidades, assente na razão deliberativa própria da democracia, bem como a necessidade de tratar problemas locais e específicos sob a perspetiva da justiça política que remete para a problemática do Estado-Providência como garante da distribuição de serviços sociais que permitem alcançar a equidade como objetivo.