Rede e apoio social entre idosos atendidos em um ambulatório de Geriatria

O objetivo geral deste estudo foi analisar a relação entre a rede e apoio social, satisfação com o apoio social recebido e as variáveis sociodemográficas, de saúde física e mental, dos idosos atendidos em um Ambulatório de Geriatria de um Hospital Geral Terciário do interior paulista. Trata-se de um estudo descritivo, transversal e exploratório, realizado com 98 idosos atendidos no referido ambulatório. Para a coleta de dados, utilizaram-se o Mini Exame do Estado Mental, um questionário de caracterização sociodemográfica e de saúde, a Escala de Depressão Geriátrica (EDG-15), o Índice de Katz, a Escala de Lawton e Brody, a Escala de medida da rede e apoio social do Medical Outcomes Study e a Escala de Satisfação com o Suporte Social. Os aspectos éticos foram respeitados conforme a Resolução 466/2012 do Conselho Nacional de Saúde. A média de idade dos idosos foi de 80,1 anos, 70,4% eram mulheres, 49,0% viúvos; a média de anos de estudo foi 2,3; 24,5% dos idosos residiam com o cônjuge e filhos ou somente com os filhos; a renda familiar média foi de R$1.773,70. Quanto à capacidade funcional, 80,6% eram independentes para as atividades básicas da vida diária e 88,8% eram parcialmente dependentes para as instrumentais. Os idosos possuíam, em média, 5,3 diagnósticos médicos e os sintomas depressivos estiveram presentes para 61,2% deles. Quanto à rede social, o escore total médio foi de 6,4 pessoas para contato na rede, sendo que 36,7% apresentavam médio contato e participação em atividades sociais. Em relação ao apoio social, o maior escore médio foi para a dimensão material (90,2) e o menor para a interação social positiva (81,8); já para a satisfação com o suporte social, 36,7% e 32,7% apresentaram alta e média satisfação, respectivamente. Foi encontrada correlação inversa entre os escores de todas as dimensões da escala de apoio social e os escores da EDG-15, indicando que quanto maior o apoio social em todas as dimensões, menor é a presença de sintomas depressivos e houve diferenças estatisticamente significativas para todas as dimensões, material (p=0,014), afetiva (p=0,026), interação (p=0,011), emocional (p=0,001) e informação (p=0,005); já a correlação entre os escores das dimensões da escala de apoio social e os escores na escala de Lawton e Brody, foi inversa e fraca para as dimensões material (r=-0,157) e informação (r=-0,027), sugerindo que quanto menor a independência para as AIVDs, maior o apoio social nas referidas dimensões, porém, não houve diferença estatisticamente significativa, material (p=0,121) e informação (p=0,789). A correlação entre os escores da EDG-15 e os escores da escala de satisfação com o apoio social, foi inversa e moderada (r=- 0,467), indicando que quanto maior a satisfação com o apoio social, menor a presença de sintomas depressivos, sendo estatisticamente significativa (p=0,000). Evidencia-se a importância de conhecer se os idosos estão inseridos em rede social e se percebem o apoio social para um melhor direcionamento da assistência prestada ao idoso e para o planejamento e formulação de políticas públicas, programas e projetos voltados a essa população

O monitoramento domiciliar das condições crônicas e a tomada de decisão por idosos diabéticos e hipertensos

Introdução: A prevalência de doenças crônicas, sobretudo na população idosa, nos coloca diante da necessidade de modelos longitudinais de cuidado. Atualmente os sujeitos estão sendo cada vez mais responsabilizados pelo gerenciamento de sua saúde através do uso de dispositivos de monitoramento, tais como o glicosímetro e o aferidor de pressão arterial. Esta nova realidade culmina na tomada de decisão no próprio domicílio. Objetivos: Identificar a tomada de decisão de idosos no monitoramento domiciliar das condições crônicas; identificar se as variáveis: sexo, escolaridade e renda influenciam a tomada de decisão; identificar a percepção dos idosos quanto às ações de cuidado no domicílio; identificar as dificuldades e estratégias no manuseio dos dispositivos de monitoramento. Materiais e métodos: Estudo quantitativo, exploratório e transversal. Casuística: 150 sujeitos com 60 anos de idade ou mais, sem comprometimento cognitivo, sem depressão e que façam uso do glicosímetro e/ou do aferidor de pressão arterial no domicílio. Instrumentos para seleção dos participantes: (1) Mini Exame do Estado Mental; (2) Escala de Depressão Geriátrica e (3) Escala de Atividades Instrumentais de Vida Diária de Lawton e Brody; Coleta de dados: realizada na cidade de Ribeirão Preto - SP entre setembro de 2014 e outubro de 2015. Instrumentos: (1) Questionário Socioeconômico; (2) Questionário sobre a tomada de decisão no monitoramento da saúde no domicílio (3) Classificação do uso de dispositivos eletrônicos voltados aos cuidados à saúde. Análise dos dados: Realizada estatística descritiva e quantificações absolutas e percentuais para identificar a relação entre tomada de decisão de acordo com o sexo, escolaridade e renda. Resultados: Participaram 150 idosos, sendo 117 mulheres e 33 homens, com média de idade de 72 anos. Destes, 113 são hipertensos e 62 são diabéticos. Quanto à tomada de decisão imediata, tanto os que fazem uso do aferidor de pressão arterial (n=128) quanto do glicosímetro (n=62) referem em sua maioria procurar ajuda médica, seguida da administração do medicamento prescrito e opções alternativas de tratamento. Em médio prazo destaca-se a procura por ajuda profissional para a maioria dos idosos em ambos os grupos. Foi notada pequena diferença na tomada de decisão com relação ao sexo. Quanto à escolaridade, os idosos com mais anos de estudos tendem a procurar mais pelo serviço de saúde se comparado aos idosos de menor escolaridade. A renda não mostrou influencia entre os usuários do glicosímetro. Já entre os usuários do aferidor de pressão arterial, idosos de maior renda tendem a procurar mais pelo serviço de saúde. A maioria dos participantes se refere ao monitoramento domiciliar da saúde de maneira positiva, principalmente pela praticidade em não sair de casa, obtenção rápida de resultados e possibilidade de controle contínuo da doença. As principais dificuldades no manuseio do glicosímetro estão relacionadas ao uso da lanceta e fita reagente, seguida da checagem dos resultados armazenados. Já as dificuldades no uso do aferidor de pressão arterial estão relacionadas a conferir o resultado após cada medida e ao posicionamento correto do corpo durante o monitoramento. Em ambos os grupos as estratégias utilizadas são pedir o auxílio de terceiros e tentativa e erro. Conclusão: Os idosos tem se mostrado favoráveis às ações de monitoramento domiciliar da saúde. De maneira geral, de imediato decidem por ações dentro do próprio domicílio para o controle dos sintomas e isto reforça a necessidade do investimento em informação de qualidade e educação em saúde para que o gerenciamento domiciliar possa vir a ser uma vertente do cuidado integral no tratamento das condições crônicas.

Plant regeneration functional groups modulate the response to fire of soil enzyme activities in a Mediterranean shrubland

Soil enzymes are critical to soil nutrient cycling function but knowledge on the factors that control their response to major disturbances such as wildfires remains very limited. We evaluated the effect of fire-related plant functional traits (resprouting and seeding) on the resistance and resilience to fire of two soil enzyme activities involved in phosphorus and carbon cycling (acid phosphatase and β-glucosidase) in a Mediterranean shrublands in SE Spain. Using experimental fires, we compared four types of shrubland microsites: SS (vegetation patches dominated by seeder species), RR (patches dominated by resprouter species), SR (patches co-dominated by seeder and resprouter species), and IP (shrub interpatches). We assessed pre- and post-fire activities of the target soil enzymes, available P, soil organic C, and plant cover dynamics over three years after the fire. Post-fire regeneration functional groups (resprouter, seeder) modulated both pre- and post-fire activity of acid phosphatase and β-glucosidase, with higher activity in RR and SR patches than in SS patches and IP. However, we found no major differences in enzyme resistance and resilience between microsite types, except for a trend towards less resilience in SS patches. Fire similarly reduced the activity of both enzymes. However, acid phosphatase and β-glucosidase showed contrasting post-fire dynamics. While β-glucosidase proved to be rather resilient to fire, fully recovering three years after fire, acid phosphatase showed no signs of recovery in that period. Overall, the results indicate a positive influence of resprouter species on soil enzyme activity that is very resistant to fire. Long-lasting decrease in acid phosphatase activity probably resulted from the combined effect of P availability and post-fire drought. Our results provide insights on how plant functional traits modulate soil biochemical and microbiological response to fire in Mediterranean fire-prone shrublands.

Control and Guidance of Low-Cost Robots via Gesture Perception for Monitoring Activities in the Home

This paper describes the development of a low-cost mini-robot that is controlled by visual gestures. The prototype allows a person with disabilities to perform visual inspections indoors and in domestic spaces. Such a device could be used as the operator's eyes obviating the need for him to move about. The robot is equipped with a motorised webcam that is also controlled by visual gestures. This camera is used to monitor tasks in the home using the mini-robot while the operator remains quiet and motionless. The prototype was evaluated through several experiments testing the ability to use the mini-robot’s kinematics and communication systems to make it follow certain paths. The mini-robot can be programmed with specific orders and can be tele-operated by means of 3D hand gestures to enable the operator to perform movements and monitor tasks from a distance.

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

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

Forgiven, not Forgotten: Communicative Translation Activities in Second Language Teaching

Although frequently discarded and despised in the 20th century, translation now seems to find wider acceptance within the Second Language Teaching (SLT) field. However, it still has a long way to go before recovering its due place in the L2 classroom. The aim of this paper is to suggest a number of translation (and interpreting)-based activities covering the different competence levels, thus showing that communicative content and translation can perfectly go hand in hand so that old, unjustified prejudices can be superseded once and for all.

Exploring the use of cooperative activities in a language subject to develop students’ social competences at the University

Cooperative learning has been successfully implemented in the last 60 years for teaching at different educational levels including the Higher Studies due to its solid theoretical foundation, the principles it proposes and its practical applications. The purpose of this article is to offer a proposal for some cooperative activities that allow students to work in small groups in a language subject in order to learn not only contents but also putting into practice what they learn, i.e., they learn by being active. This article discusses how the said activities make it possible for students to work with the main principles of cooperative learning, i.e.: positive interdependence, face-to-face interaction, individual and group accountability, interpersonal and small-group skills and group processing. Moreover, this research will also point out that the proposed activities allow students to acquire some of the social competences required in the labour market such as leadership, conflict solving and cooperation.

Computational models for improved diagnosis and prognosis of stroke using robot-based biomarkers

Stroke is a leading cause of death and permanent disability worldwide, affecting millions of individuals. Traditional clinical scores for assessment of stroke-related impairments are inherently subjective and limited by inter-rater and intra-rater reliability, as well as floor and ceiling effects. In contrast, robotic technologies provide objective, highly repeatable tools for quantification of neurological impairments following stroke. KINARM is an exoskeleton robotic device that provides objective, reliable tools for assessment of sensorimotor, proprioceptive and cognitive brain function by means of a battery of behavioral tasks. As such, KINARM is particularly useful for assessment of neurological impairments following stroke. This thesis introduces a computational framework for assessment of neurological impairments using the data provided by KINARM. This is done by achieving two main objectives. First, to investigate how robotic measurements can be used to estimate current and future abilities to perform daily activities for subjects with stroke. We are able to predict clinical scores related to activities of daily living at present and future time points using a set of robotic biomarkers. The findings of this analysis provide a proof of principle that robotic evaluation can be an effective tool for clinical decision support and target-based rehabilitation therapy. The second main objective of this thesis is to address the emerging problem of long assessment time, which can potentially lead to fatigue when assessing subjects with stroke. To address this issue, we examine two time reduction strategies. The first strategy focuses on task selection, whereby KINARM tasks are arranged in a hierarchical structure so that an earlier task in the assessment procedure can be used to decide whether or not subsequent tasks should be performed. The second strategy focuses on time reduction on the longest two individual KINARM tasks. Both reduction strategies are shown to provide significant time savings, ranging from 30% to 90% using task selection and 50% using individual task reductions, thereby establishing a framework for reduction of assessment time on a broader set of KINARM tasks. All in all, findings of this thesis establish an improved platform for diagnosis and prognosis of stroke using robot-based biomarkers.

SCAPHOID AND LUNATE CARPAL MECHANICS OVER THE SPECTRUM OF HEALTHY FUNCTION

When ligaments within the wrist are damaged, the resulting loss in range of motion and grip strength can lead to reduced earning potential and restricted ability to perform important activities of daily living. Left untreated, ligament injuries ultimately lead to arthritis and chronic pain. Surgical repair can mitigate these issues but current procedures are often non-anatomic and unable to completely restore the wrist’s complex network of ligaments. An inability to quantitatively assess wrist function clinically, both before and after surgery, limits the ability to assess the response to clinical intervention. Previous work has shown that bones within the wrist move in a similar pattern across people, but these patterns remain challenging to predict and model. In an effort to quantify and further develop the understanding of normal carpal mechanics, we performed two studies using 3D in vivo carpal bone motion analysis techniques. For the first study, we measured wrist laxity and performed CT scans of the wrist to evaluate 3D carpal bone positions. We found that through mid-range radial-ulnar deviation range of motion the scaphoid and lunate primarily flexed and extended; however, there was a significant relationship between wrist laxity and row-column behaviour. We also found that there was a significant relationship between scaphoid flexion and active radial deviation range of motion. For the second study, an analysis was performed on a publicly available database. We evaluated scapholunate relative motion over a full range of wrist positions, and found that there was a significant amount of variation in the location and orientation of the rotation axis between the two bones. Together the findings from the two studies illustrate the complexity and subject specificity of normal carpal mechanics, and should provide insights that can guide the development of anatomical wrist ligament repair surgeries that restore normal function.

Record of undergraduates’ activities in virtual learning environments

Virtual learning environments (VLEs) have witnessed a high evolution, namely regarding their potentialities, the tools and the activities they provide. VLEs enable us to access large quantities of data resulting from both students and teachers’ activities developed in those environments. Monitoring undergraduates’ activities in VLEs is important as it allows us to showcase, in a structured way, a number of indicators which may be taken into account to understand the learning process more deeply and to propose improvements in the teaching and learning strategies as well as in the institution’s virtual environment. Although VLEs provide several data sectorial statistics, they do not provide knowledge regarding the institution’s evolution. Therefore, we consider the analysis of the activity logs in VLEs over a period of five years to be paramount. This paper focuses on the analysis of the activities developed by students in a virtual learning environment, from a sample of undergraduate students, approximately 7000 per year, over a period of five academic years, namely from 2009/2010 to 2013/2014. The main aims of this research work are to assess the evolution of activity logs in the virtual learning environment of a Portuguese public higher education institution, in order to fill possible gaps and to hold out the prospect of new forms of use of the environment. The results obtained from the data analysis show that overall, the number of accesses to the virtual learning environment increased over the five years under study. The most used tools were Resources, Messages and Assignments. The most frequent activities developed with these tools were respectively consulting information, sending messages and submitting assignments. The frequency of accesses to the virtual learning environment was characterized according to the number of accesses in the activity log. The data distribution was divided into five frequency categories named very low, low, moderate, high and very high, determined by the percentiles 20, 40, 60, 80 and 100, respectively. The study of activity logs of virtual learning environments is important not only because they provide real knowledge of the use that undergraduates make of these environments, but also because of the possibilities they create regarding the identification of a need for new pedagogical approaches or a reinforcement of previously consolidated approaches.