Atuação dos profissionais no atendimento às famílias nos centros de atenção psicossocial

This study aimed to evaluate the work of professionals to care for families in Psychosocial Care Centers ( C APS) of Rio Grande do Norte ( RN), from the roles and functions performed by these professional services. For this, it was pointed out the following objectives: To describe the profile and the activities conducted by mental health teams in the RN CAPS ; Know the opinion of professionals in the mental health teams of the poli ti c , practices and training in mental health; Check the suitability of the roles and functions of professionals working in the RN CAPS in relation to care for families . This is an analytic al cross - sectional study of quantitative and qualitative approach . Data were c ollected through a questionnaire in 33 CAPS RN, between March and October 2014 , after being approved by the Research Ethics Committee / UFRN , opinion nº217.808 , CAAE : 10650612.8. 1001.5537 , on March 1 2013. T he sample was adopted , defined by inclusion and exclusion criteria , and is composed of 183 professionals. The database preparation followed two steps: 1. Preparation and processing of data of closed questions of the questionnai re concerning the characterization and practices in mental health research subjects through informational resource Statistical Package for Social Scienses (SPSS) Statistics version 20.0 ; 2. To check the significance level was chosen by applying the chi - squ are test. Preparation and treatment of the corpus formed by the answers to open questions relating to the policies, practices and training in psychiatry through Analyse lexicale pair Contexte software d' un Ensemble of Segments of Texte ( ALCESTE) together a nd categorized by content analysis technique , Bardin (2004) . The data analysis is supported in the literature . It m ade explicit the results through three articles waxing the following results. In the first, participants profile was characterized by a predo minance of females (76.5 %), aged 40 - 58 years ( 61.7 %). They work between 30 and 40 hours per week (63.5 %), working in mental health for over 10 years ( 98.4%). The sample directs the care of family groups ( 65.7%), predominantly the care team of social worke rs, nurses, psychologists and occupational therapists . The doctor performs emergency care without interaction with the staff (48.6%) . On the difficulties encountered in services are ranked in : materials and supplies ( 75.1%), financial ( 78.5%) and structura l ( 66.9%). The second article contains qualitative data organized into five categories : Promoting the rehabilitation of users of CAPS ; Needs training ; Conflicts and satisfactions of teamwork ; Practices developed in CAPS ; Effective difficulties of Mental He alth Policy . The third article highlights the inadequacy of care for families ( 93.4%) and comparing the care families and groups in CAPS both types show to be inadequate : family ( 92.63%), groups ( 92, 60%). The main data obtained reveal the urgent need for transformation in psychosocial care . It shows also the importance of investments in inputs, physical structure and training of human resources for the CAPS.

Diadenosine polyphosphates in the tears of aniridia patients

Purpose To quantify diadenosine polyphosphate levels in tears of congenital aniridia patients to estimate the ocular surface changes associated with congenital aniridia compared to normal individuals. Methods Fifteen patients diagnosed with congenital aniridia and a control group of forty volunteers were studied. Tears were collected to quantify the levels of diadenosine polyphosphates Ap4A and Ap5A by high-performance liquid chromatography (H.P.L.C). Break-up time (BUT), corneal staining, McMonnies questionnaire and the Schirmer I test were applied to both groups. Results Dinucleotides in congenital aniridia patients were higher than in control subjects. For the congenital aniridia group, under 15 years old, the values were 0.77 ± 0.01 μm and 0.17 ± 0.02 μm for Ap4A and Ap5A, respectively. The group aged from 15 to 40 years old provided concentrations of 4.37 ± 0.97 μm and 0.46 ± 0.05 μm for Ap4A and Ap5A, the group over 40 gave concentrations of 11.17 ± 5.53 μm and 0.68 ± 0.17 μm for Ap4A and Ap5A. Dinucleotide concentrations increased with age, being statistically significant different among the three age groups (p < 0.05). Congenital aniridia patients showed a normal tear secretion and no dry eye McMonnies scores, except for the group over 40 years old. BUT values decreased and corneal staining increased with age and correlated with the levels of diadenosine polyphosphates (p < 0.05). Conclusions The levels of dinucleotides in tears increase in aniridia patients compared with healthy subjects, and they seem to be related with the progression of corneal disorders in aniridia patients, both of which increase with ageing.

Medication review of children on long term medications:a review of the literature

INTRODUCTION: Children on long term medication may be under the care of more than one medical team including the patients GP. Children on chronic medication should be supported and their medications reviewed, especially in cases of polypharmacy. Medicines Use Reviews (MURs) were introduced into the pharmacy contract in 2005. The service was designed for community pharmacists to review patients on long term medication. The service specified that MURs were done on patients who can give consent and cannot be conducted with a parent or carer. Hence the service may be inaccessible to paediatric patients. This review aims to find studies that identify medication review services in primary care that cater for children on long term medication. METHODS: A literature search was conducted on 6th June 2015 using the keywords, ("Medication" or "review" or "Medication Review" or "Medicines use review" or "Medication use review" or "New Medicine Service") AND ("community pharmacy" OR "community pharmacist" OR "primary care" OR "General practice" OR "GP" OR "community paediatrician" OR "community pediatrician" OR "community nurse"). Bibliographic databases used were AMED, British Nursing Index, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO and Health Business Elite. Inclusion criteria were: paediatric specific medication review in primary care, for example by either a GP, community paediatrician, community nurse or community pharmacist. Exclusion criteria were studies of medication review in adults/unclear patient age and secondary care medication reviews. RESULTS: From the 417 articles, 6 relevant articles were found after abstract and full text review. 235 articles were excluded after title and abstract review (11 did not have full text in English); 96 were adult or non-age specified medication review/MUR/New Medicine Service studies; 63 referred to observational, evaluative studies of interventions in adults; 6 were non-paediatric specific systematic reviews and 17 were protocols, commentaries, news, and letters.The 6 relevant articles consisted of 1 literature review (published 2004), 3 research articles and 1 published protocol. The literature review[1] recommended that children's long term medication should be reviewed. The published protocol stated that the NMS minimum age for inclusion in the trial was for children aged over 13 years of age. The four studies were related to psychiatrists reviewing paediatric mental health patients in the USA, a pharmacist using Drug Related Problem to review patients in GP practices in Australia, a UK study based on an information prescription concept by providing children dispensed medications in community pharmacy with signposting them to health information and one GP practice based study observing pharmaceutical care issues in children and adults. CONCLUSION: The results show that there are currently no known studies on medication use reviews specific to children, whereas in adults, published evaluations are available. The terms of the MUR policy restrict children's access to the service and so more studies are necessary to determine whether children could benefit from such access.

Simplified Predictive Instrument to Rule Out Acute Coronary Syndromes in a High-Risk Population.

BACKGROUND: It is unclear whether diagnostic protocols based on cardiac markers to identify low-risk chest pain patients suitable for early release from the emergency department can be applied to patients older than 65 years or with traditional cardiac risk factors. METHODS AND RESULTS: In a single-center retrospective study of 231 consecutive patients with high-risk factor burden in which a first cardiac troponin (cTn) level was measured in the emergency department and a second cTn sample was drawn 4 to 14 hours later, we compared the performance of a modified 2-Hour Accelerated Diagnostic Protocol to Assess Patients with Chest Pain Using Contemporary Troponins as the Only Biomarker (ADAPT) rule to a new risk classification scheme that identifies patients as low risk if they have no known coronary artery disease, a nonischemic electrocardiogram, and 2 cTn levels below the assay's limit of detection. Demographic and outcome data were abstracted through chart review. The median age of our population was 64 years, and 75% had Thrombosis In Myocardial Infarction risk score ≥2. Using our risk classification rule, 53 (23%) patients were low risk with a negative predictive value for 30-day cardiac events of 98%. Applying a modified ADAPT rule to our cohort, 18 (8%) patients were identified as low risk with a negative predictive value of 100%. In a sensitivity analysis, the negative predictive value of our risk algorithm did not change when we relied only on undetectable baseline cTn and eliminated the second cTn assessment. CONCLUSIONS: If confirmed in prospective studies, this less-restrictive risk classification strategy could be used to safely identify chest pain patients with more traditional cardiac risk factors for early emergency department release.

Walking in hospital is associated with a shorter length of stay in older medical inpatients

Evidence suggests that inactivity during a hospital stay is associated with poor health outcomes in older medical inpatients. We aimed to estimate the associations of average daily step-count (walking) in hospital with physical performance and length of stay in this population. Medical in-patients aged ⩾65 years, premorbidly mobile, with an anticipated length of stay ⩾3 d, were recruited. Measurements included average daily step-count, continuously recorded until discharge, or for a maximum of 7 d (Stepwatch Activity Monitor); co-morbidity (CIRS-G); frailty (SHARE F-I); and baseline and end-of-study physical performance (short physical performance battery). Linear regression models were used to estimate associations between step-count and end-of-study physical performance or length of stay. Length of stay was log transformed in the first model, and step-count was log transformed in both models. Similar models were used to adjust for potential confounders. Data from 154 patients (mean 77 years, SD 7.4) were analysed. The unadjusted models estimated for each unit increase in the natural log of stepcount, the natural log of length of stay decreased by 0.18 (95% CI −0.27 to −0.09). After adjustment of potential confounders, while the strength of the inverse association was attenuated, it remained significant (βlog(steps) = −0.15, 95%CI −0.26 to −0.03). The back-transformed result suggested that a 50% increase in step-count was associated with a 6% shorter length of stay. There was no apparent association between step-count and end-of-study physical performance once baseline physical performance was adjusted for. The results indicate that step-count is independently associated with hospital length of stay, and merits further investigation.

The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Brazilian Social Segurity and Social Work: reflections on the Continuous Cash Benefit Programme

Guaranteed under the Federal Constitution of 1988, Brazilian social security covers rights relating to health, social welfare and social care. The Continuous Cash Benefit Programme (BPC) was approved as part of social care policy and is regulated under the Social Care Act (Ley Orgánica de Asistencia Social) of 1993. This benefit guarantees a minimum monthly income for persons with disabilities and for older adults. Certain requirements must be satisfied in order to obtain the assistance: medical and social assessment of disabled persons, a minimum age of 65 years for older adults, and, in both cases, the value of per capita income for the nuclear family in question, which must be lower than a quarter of the minimum wage. Regulation of the BPC has incorporated advances and setbacks in terms of legislation and implementation. In this framework, this article presents a theoretical reflection, an analysis of the legislation on the matter, and some reflections on the challenges that it poses for social workers.

Respiratory virus-associated severe acute respiratory illness (SARI) and viral clustering in Malawian children in a setting with a high prevalence of HIV, malaria and malnutrition

BACKGROUND:  We used four years of paediatric severe acute respiratory illness (SARI) sentinel surveillance in Blantyre, Malawi to identify factors associated with clinical severity and co-viral clustering.

METHODS:  From January 2011 to December 2014, 2363 children aged 3 months to 14 years presenting to hospital with SARI were enrolled. Nasopharyngeal aspirates were tested for influenza and other respiratory viruses. We assessed risk factors for clinical severity and conducted clustering analysis to identify viral clusters in children with co-viral detection.

RESULTS:  Hospital-attended influenza-positive SARI incidence was 2.0 cases per 10,000 children annually; it was highest children aged under 1 year (6.3 cases per 10,000), and HIV-infected children aged 5 to 9 years (6.0 cases per 10,000). 605 (26.8%) SARI cases had warning signs, which were positively associated with HIV infection (adjusted risk ratio [aRR]: 2.4, 95% CI: 1.4, 3.9), RSV infection (aRR: 1.9, 95% CI: 1.3, 3.0) and rainy season (aRR: 2.4, 95% CI: 1.6, 3.8). We identified six co-viral clusters; one cluster was associated with SARI with warning signs.

CONCLUSIONS:  Influenza vaccination may benefit young children and HIV infected children in this setting. Viral clustering may be associated with SARI severity; its assessment should be included in routine SARI surveillance.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives:Objectives To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods:We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field.Selection criteria:We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis:Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed.Main results:Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months’ follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months’ follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the serviceAuthors’ conclusions:There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries. 

Health in Ireland: Key Trends 2015

Health in Ireland Key Trends gives us insights into trends in demographics, population health, hospital and primary care and health service employment and expenditure. The presentation of trend data over the last decade in the 2015 report highlights the many significant achievements that Ireland has made in terms of key outcomes relating to the health and wellbeing of the population. However, it also highlights the challenges that persist in terms of the accessibility of timely healthcare and in the context of financial constraints. In the last decade alone, there has been an increase of two and a half years in life expectancy. These gains are driven largely by reductions in mortality rates from principal causes of deaths such as those from heart disease and cancer. Another striking feature is the growth in the number of people aged over 65. Each year this cohort increases by 20,000 people. This trend is set to continue into the future and will have implications for future planning and health service delivery. Ireland will see the largest proportional increases in the population aged 85 years and older. Ageing of the population in conjunction with lifestyle-related health threats continue to present major challenges now and into the future in sustaining and further improving health and health services in Ireland. Although difficult to quantify, the contribution of modern health services to these improvements in health outcomes and in life expectancy have been significant. Ireland’s fertility rates are still among the highest in Europe but the birth rate has fallen to its lowest rate for the last decade.  However, Ireland currently has the highest proportion of children and young people in our population among EU countries.  

Perfis de Redes Sociais Pessoais de Idosos com e Sem Apoio de Respostas Sociais: um contributo para o desenvolvimento de tipologias no Diagnóstico Social

Sendo um dos objetivos do Serviço Social a promoção do bem-estar social, e considerando a relevância das redes sociais pessoais e do suporte social no bem-estar das pessoas idosas, o presente estudo analisa perfis de redes sociais pessoais de idosos, tendo em conta as suas características estruturais, funcionais e relacionais-contextuais, na perspectiva do Serviço Social sistémico. Na última etapa da vida identificam-se na rede social de um individuo vários determinantes com efeitos cumulativos que favorecem o estreitamento das redes sociais, sendo os contextos de vida, as necessidades de apoio de respostas sociais e a institucionalização, fatores relevantes para a investigação. A investigação quantitativa, utilizou um inquérito por questionário para caracterizar sociodemograficamente a amostra e o Instrumento de Análise de Rede Social Pessoal (Guadalupe, 2009) para caracterizar a rede nas suas dimensões e características, privilegiando-se uma análise bivariada das variáveis. A amostra é composta por 317 idosos com idade igual ou superior a 65 anos. Comparámos três subamostras: 209 idosos que não usufruem do apoio de respostas sociais (65,9%), sendo estes maioritariamente de sexo feminino, casado(a)s ou a viver em união de facto e com média de 75 anos; 71 idosos que usufruem de apoio de respostas sociais (22,4%), na sua maioria de sexo feminino, viúvo(a)s e com 80 anos de média de idade; 37 idosos institucionalizados em Lar (11,7%), mulheres na sua maioria, viúvo(a)s, com média de 83 anos. A hipótese inicial do nosso estudo era a existência de três perfis distintos nas redes sociais pessoais de idosos, conforme a sua relação com as respostas sociais, no entanto, concluiu-se que existe um padrão comum nas redes sociais destes idosos, quer a nível estrutural, como a nível funcional ou contextual. Todavia, identificamos algumas diferenças significativas (p < 0,041) entre os perfis explorados, na composição das redes, na reciprocidade de apoio, na satisfação da rede, na densidade, na frequência de contactos, na distância geográfica e na durabilidades das relações. O estudo constitui-se como um contributo para o Serviço Social, na medida em que oferece conhecimento sobre as redes sociais dos idosos em diferentes contextos de vida, não oferecendo, no entanto, uma categorização que possibilite a construção cabal de tipologias, mas antes, fornece uma base orientadora da avaliação das redes sociais pessoais e de suporte social de idosos para o diagnóstico social. / Being one of Social Work goals the promotion of social well-being, and considering the relevance of personal social networks and social support in the well-being of the elderly, the present study analyzes personal social network’s profiles of elderly people, taking into account their structural, functional and relational-contextual characteristics, in a Social Work systemic perspective. In the last stage of life are identified in an individual's various social network determinants with cumulative effects favouring the narrowing of social networks, being life contexts, the support needs of social responses and institutionalization, relevant factors to the investigation. Our quantitative research used a survey to characterize socially and demographically the sample and the Personal Social Network Analysis Tool (Guadalupe, 2009) to characterize the network in its dimensions and characteristics, using a bivariate analysis of the variables. The sample is composed of 317 elderly aged 65 years old or more. We compared three sub-samples: 209 seniors who do not have the support of social services (65.9%), mostly female, married or cohabiting and with an average of 75 years old; 71 seniors who have support of social services (22.4%), mostly women, widowed and with 80 years of average age; 37 institutionalized elderly (11.7%), mostly women, widowed, with an average age of 83 years. The initial hypothesis of our study was the existence of three distinct personal profiles on social networks, according to their relationship to the social services, however, we have concluded that there is a common pattern in social networks of these elderly, at their structural, functional or contextual level. However, we identified some significant differences (p < 0.041) between the explored profiles, in the composition of networks, support reciprocity, network satisfaction, density, frequency of contacts, geographical distance and durability of relations. The study is a contribution to Social Work, insofar as it provides knowledge about personal social networks of the elderly in different life contexts, not offering, however, a fully categorization that allows the construction of typologies, but rather, provides guidance lines in the evaluation of personal social networks and social support of the elderly to the social diagnosis.

Participação Social e Redes Sociais Pessoais de Idosos

Objetivo: O objetivo central deste estudo é caracterizar as redes sociais pessoais de indivíduos com idade igual ou superior a 65 anos, a nível estrutural, funcional e relacional-contextual, analisando-as segundo o nível de participação social dos idosos ao longo da sua vida em estruturas comunitárias ligadas ao lazer, cultura, desporto, religião e voluntariado. Metodologia: Para a avaliação das variáveis em estudo foram utilizados o Instrumento de Análise da Rede Social Pessoal, versão para idosos (IARSP – Idosos) (Guadalupe, 2010; Guadalupe & Vicente, 2012) para avaliar as dimensões da rede social pessoal, um questionário para caracterizar as variáveis sociodemográficas e a participação social e a Satisfaction With Life Scale – SWLS (Diener, 1985) que permite avaliar o grau de satisfação com a vida. Participantes: A amostra é constituída por 567 idosos, com uma média de idades de 75 anos (DP=7,6), entre os 65 anos e os 98 anos, maioritariamente do sexo feminino (63,0%), casados ou em união de facto (53,7%) e com escolaridade (69,8%), sobretudo ao nível do quarto ano (51,3%). A maioria dos idosos inquiridos não vive só (79,4%) numa zona de residência maioritariamente inserida em aglomerado populacional em região rural (57,0%) e não usufrui de qualquer tipo de apoio de resposta social (75,5%). Resultados: A amostra divide-se entre os que participaram comunitariamente ao longo da vida (47,8%; n = 271) e os que não participaram (52,2%; n = 296), sendo que entre os que participam 16,7% fazem-no com elevada frequência. Os idosos do sexo feminino, com idade igual ou inferior a 75 anos, casados, com habilitações literárias e que vivem acompanhados, são os que têm uma maior probabilidade de ter uma participação social mais ativa. Os idosos que apresentam participação social têm uma rede maior, com um membro a mais em média (M = 8,52 vs. 7,51, p = 0,027), e uma composição distinta dos que não participam, com menor peso das relações familiares (M = 72,61% vs. 80,81%, p < 0,001), maior peso e mais relações de amizade (M = 15,43% vs. M = 9,24%, p < 0,001) e maior presença de relações de trabalho (M = 1,11% vs. 0,13%, p = 0,006). Relativamente às características funcionais, podemos constatar que a reciprocidade de apoio é percebida como maior (p = 0,010) entre os idosos que participam comunitariamente, não se verificando diferenças noutras variáveis funcionais e relacionais-contextuais. O nível de participação e a satisfação com o nível de participação correlacionam-se positivamente com a satisfação percebida com a vida (p < 0,001). Conclusão: As conclusões apontam para um efeito da participação social ao longo da vida em estruturas comunitárias nas características estruturais das redes sociais pessoais dos idosos, não se verificando interferência na maioria das características funcionais e nas relacionais-contextuais. Verificámos ainda que há uma associação entre a participação social e a satisfação com a vida, sendo mais satisfeitos os que participam em estruturas comunitárias. É possível constatar que a rede daqueles que referem ter participação social é tendencialmente maior e heterogénea na composição, quando comparada com as redes dos sem participação social, assumindo, assim, relevância na estruturação de uma rede mais diversa e ampla, devendo ser estimulada no sentido de promover uma rede com recursos potencialmente positivos e um envelhecimento mais ativo. / Objectives: The central objective of this study is to characterize the personal social networks of the elderly, aged 65 years or more, analyzing them according to the level of social participation throughout their life in community structures related to leisure, culture, sports, religion and volunteering. Methodology: For the evaluation of the variables we used the Social Network Analysis Tool (IARSP-elderly) (Guadalupe, 2010; Guadalupe Vicente, 2012) to assess the dimensions of the social network; a questionnaire to evaluate social participation; and the Satisfaction With Life Scale SWLS – (Diener, 1985) to acess the degree of satisfaction with life. Participants: The sample consists of 567 elderly, with an average age of 75 years old (SD = 7,595), between 65 and 98 years old, mostly female (63.0 %), married (53.7%) with education (69.8%), mainly with the 4th grade (51.3%). Most of the respondents do not live alone (79.4%) in agglomerations in rural region (57.0%) and are not users of social services (75.5%). Results: The sample is divided between those who had community participation throughout life (47.8 %; n = 271) and those who did not participated (52,2%; n = 296). Between the first, 16.7% do it with high frequency. The elderly women, aged less than 75 years old, married, with educational qualifications and living not alone, are those who have a higher likelihood of having a more active social participation. The elderly that present social participation have a larger network, with one more member (M = 8,52 vs. 7,51, p = 0,027), and a composition distinct from not participating, with less proportion of family relations (M = 72,61% vs. 80,81%, p < 0,001), greater proportion and more friendships (M = 15,43% vs. M = 9,24%, p < 0,001) and greater presence of working relations (M = 1,11% vs. 0,13%, p = 0,006). Regarding the functional dimension, the reciprocity of support is perceived as higher (p = 0.010) among seniors participating in community and there were no differences in other functional and relational-contextual variables. The level of participation and satisfaction with the level of participation correlate positively with perceived satisfaction with life (p <0.001). Conclusion: The findings point to an effect of lifelong social participation in community in structural characteristics of personal social networks of the elderly, not verifying interference in most of the functional and the contextual-relational characteristics. We have also found that there is an association between social participation and life satisfaction, being more satisfied when they participate in community structures. The social network of the elderly who reported having social participation tends to be larger and heterogeneous in composition compared with those without social participation, thus assuming importance in structuring a more diverse and extensive network, should be encouraged in order to promote a network with potentially positive resources and a more active aging.

Estudo Preliminar das Propriedades Psicométricas do Inventário de Lateralidade de Edinburgh numa Amostra de Adultos da População Portuguesa

Introdução: A lateralidade é a diferença na capacidade de controlo entre os dois lados do corpo. Os métodos utilizados para avaliar a lateralidade manual incluem a observação efetiva do uso do membro dominante ou a aplicação de inventários respondidos pelo próprio indivíduo avaliado. O Inventário de Lateralidade de Edinburgh (EHI) é o instrumento mais utilizado para avaliar a lateralidade manual. Apesar do seu uso amplo, em Portugal não existem estudos que avaliem a sua validade e fidedignidade. Objetivos: Estudar as propriedades psicométricas do Inventário de Lateralidade de Edinburgh numa amostra da população portuguesa. Métodos: A amostra é constituída por 290 pessoas (135 homens e 155 mulheres), com idades compreendidas entre os 18 e os 65 anos. Todos os participantes preencheram uma declaração de consentimento informado e uma bateria de testes neuropsicológicos Resultados: A média no EHI foi de 62,36 (DP = 38,00). Os resultados demonstraram que das seis variáveis sociodemográficas (idade, sexo, escolaridade, zona de residência, regiões e profissão) três apresentaram ter influência significativa nas pontuações do EHI: idade, zona de residência e regiões. A confiabilidade e a estabilidade temporal do EHI apresentaram resultados adequados. A análise fatorial confirmatória mostrou que o modelo não é melhor explicado por um fator. Para dois fatores o modelo continua a não ser adequado. Conclusão: Apesar de termos obtido uma boa consistência interna não nos é possível considerar este teste como o mais adequado para medir o constructo da lateralidade. / Introduction: The handedness is the difference in the control capacity between the two sides of the body. The methods used to evaluate the manual handedness include the effective observation of the use of dominant member or application of inventories answered by the person assessed. The Edinburgh Handedness Inventory (EHI) is the most used to evaluate manual handedness. Even though being widely used, in Portugal there are no studies that measure its validity and reliability. Objective: To study the psychometric properties of Edinburgh Handedness Inventory in a Portuguese sample. Methods: The sample consists of 290 people (135 men and 155 women), aged between 18 and 65 years. All participants filled an informed consent form and a battery of neuropsychological tests. Results: The average in EHI was 62.36 (SD = 38.00). The results showed that 3 of 6 sociodemographic variables showed significant influence in EHI scores. The reliability and temporal stability of EHI were adequate. Confirmatory factor analysis showed that the model is not better explained by one factor. A two-factor model was not also suitable. Conclusion: Even though we got a good internal consistency we cannot consider this test as the most appropriate for measuring the handedness construct.

Satisfação com a Vida e Redes Sociais Pessoais de Idosos

Objetivos: A investigação tem como objetivo geral analisar a associação entre a satisfação com a vida nos idosos e as características estruturais, funcionais e relacionais-contextuais das suas redes sociais pessoais. Metodologia: A recolha dos dados foi feita através de um questionário sociodemográfico, da Satisfaction With Life Scale – SWLS (Diener, 1985) que permite avaliar o grau de satisfação com a vida e também do Instrumento de Avaliação da Rede Social Pessoal – IARSP – Idosos (Guadalupe, 2009; Guadalupe & Vicente, 2012) que possibilita a análise das características das redes sociais pessoais dos idosos. Participantes: A amostra é constituída por 416 idosos com idades compreendidas entre os 65 anos e os 98 anos (M = 76,15; DP = 7,584). Os participantes são de ambos os sexos, mas na sua maioria do sexo feminino (63,7%; n = 265). A maioria dos sujeitos da amostra é casada (51,2%; n = 213) e tem escolaridade (64,2%; n = 267). Resultados: Verifica-se que são as mulheres idosas, os casados e com escolaridade que percebem uma maior satisfação com a vida. Constata-se que existe uma maior proporção de idosos satisfeitos com a vida (53,8%; n = 83) em comparação com os medianamente satisfeitos (26,2%; n = 109) e com os insatisfeitos (20%; n = 83). Os idosos que apresentam uma maior satisfação percebida têm uma média mais elevada na proporção das relações familiares nas redes (M = 80,67), no apoio emocional, material e instrumental, informativo, companhia social, e no acesso a novos vínculos, e consideram estar muito satisfeitos tanto com a rede (M = 2,92) como com o apoio que esta disponibiliza (M = 2,77). Conclusão: Verificaram-se associações estatisticamente significativas nas características estruturais da rede, no entanto são as características funcionais que atestam os principais resultados que nos permitem afirmar uma associação entre satisfação com a vida nos idosos e as relações interpessoais, pelo conteúdo das relações e pelo apoio que percecionam. Concluímos que os idosos que se consideram satisfeitos com a vida apresentavam, na generalidade, características de rede social mais positivas quando comparados com os que percebiam menor satisfação com a vida. / Objectives: The research has as main objective to analyze the association between life satisfaction in the elderly and the structural, functional and relational-contextual characteristics of their personal social networks. Methodology: The data collection was done through a sociodemographic questionnaire, the Satisfaction With Life Scale – SWLS (Diener, 1985) that evaluates the degree of satisfaction with life and also the Personal Social Network Analysis Tool – IARSP – Elderly (Guadalupe, 2009; Guadalupe & Vicente, 2012) for the analysis of personal social networks’ characteristics. Participants: The sample consisted of 416 elderly aged between 65 and 98 years (M = 76,15; SD = 7,584). Participants are both genders, but mostly female (63,7%; n =265). Most of the participants are married (51,2%; n = 213) and have education (64,2%; n = 267). Results: It is found that are the older women, married and with education that perceive a greater satisfaction with life. There is a greater proportion of elderly satisfied with the lives (53,8%; n = 83) compared to the moderately satisfied (26,2%; n = 109) and the unsatisfied (20%; n = 83). Seniors who have a higher satisfaction have a higher average in the proportion of family relationships in their networks (M = 80,67), emotional support, material and instrumental, informational, social companionship, and access to new bonds, and consider to be very satisfied with their social network (M = 2,92) and with the social support that it provides (M = 2,77). Conclusion: There were statistically significant associations in the structural characteristics of the network, however are the functional characteristics that allow us to state an association between life satisfaction in the elderly through interpersonal relationships, the content of relations and the support they perceive. We conclude that elderly people who consider themselves satisfied with life showed, in general, have more positive characteristics of social personal network when compared to those who perceive less satisfaction with life.

Serum copper evolution in patients that underwent endoscopic gastrostomy for long term enteral feeding

Background and aims: Copper (Cu) is a well studied trace element but little is known about Cu evolution in long term endoscopic gastrostomy (PEG) feeding. We aimed to evaluate the evolution serum Cu since the gastrostomy until 12 weeks after the procedure in PEG patients fed with homemade meals. Methods: A prospective observational study was performed evaluating serum copper, albumin, transferrin and body mass index (BMI) at the time of the gastrostomy, 4 weeks and 12 weeks after. Data also included age, gender, NRS 2002 and nature of the underlying disease causing dysphagia: head and neck cancer (HNC) or neurological dysphagia (ND). After gastrostomy, patients were fed with homemade PEG meals. Results: One hundred and forty-six patients enrolled, 89 men, aged 21-95 years, 90 with neurologic dysphagia (ND), and 56 with head and neck cancer (HNC). 78 (53%) showed low BMI. Initially, Cu ranged 42-160 μg/dl (normal: 70-140 μg/dl); 130 patients (89%) presented normal Cu, 16 (11%) presented hypocupremia, 53% low albumin (n = 77), and 94 (65%) low transferrin. After 4 weeks, 93% presented normal Cu, 7% presented hypocupremia, low albumin was present in 34%, and low transferrin in 52%. After 12 weeks, 95% presented normal Cu, 5% presented hypocupremia, low albumin was present in 25%, and low transferrin in 32%. Comparing age, gender, underlying disease, BMI, albumin and transferrin, there were no significant differences on serum Cu. Conclusions: Most patients present normal serum Cu when gastrostomy is performed. For patients presenting hypocupremia before gastrostomy, homemade meals are effective for normalizing serum Cu.