Evaluación de la calidad de vida relacionada con la salud mediante las láminas Coop-Wonca en una población de hemodiálisis

Ante la necesidad de disponer de instrumentos que permitan medir calidad de vida relacionada con la salud (CVRS) de una manera ágil y rápida, nos planteamos estudiar, en un grupo de pacientes en hemodiálisis, las propiedades de medición de las láminas Coop-Wonca con el objetivo de establecer si reúnen las condiciones para su uso rutinario en este tipo de pacientes. Métodos: Estudio transversal en 163 pacientes de hemodiálisis (106 varones y 57 mujeres) procedentes de 3 centros. Para medir la CVRS de la población estudiada se ha utilizado la versión validada española de las láminas Coop-Wonca completa. Este cuestionario comprende nueve dimensiones de función y bienestar de un único ítem: 1.– Forma física; 2.–Sentimientos; 3.–Actividades cotidianas; 4.–Actividades sociales; 5.–Cambio en el estado de salud; 6.–Estado de salud; 7.–Dolor; 8.–Apoyo social; y 9.–Calidad de vida en general. Las posibles respuestas se puntúan de 1 a 5, siendo las puntuaciones mayores las que reflejan una peor salud percibida. El instrumento permite la obtención de un índice (Coop total) que es un sumatorio de las puntuaciones de todas las dimensiones salvo la 5 (Cambio en el estado de salud). Resultados: El tiempo medio de cumplimentación del cuestionario fue inferior a 5 minutos. Las láminas resultaron fácilmente comprensibles para los pacientes y la autoadministración de las mismas no planteó problemas. Las puntuaciones más altas (peor CVRS) se obtuvieron en las dimensiones «forma física» (3,66 ± 0,8) y «estado de salud» (3,43 ± 0,8), y la menor (mejor CVRS) en la dimensión «actividades sociales» (1,98 ± 1,3). Entre los principales factores asociados a un peor estado de salud percibida figuran el sexo (mujer), la comorbilidad (presencia de diabetes y/o hepatopatía), la situación laboral (pensionista) y el medio de transporte (taxi-ambulancia). Un mayor tiempo en hemodiálisis se asoció a peores puntuaciones en las dimensiones «calidad de vida en general» y «Dolor». Los pacientes que se trasladaban en taxi o ambulancia presentaban peores puntuaciones en las dimensiones «Forma física», «Actividades cotidianas» y «Estado de salud». Una mayor se asoció a peor puntuación en «Forma física». Un número elevado de fármacos prescritos (más de seis) se asoció a peor puntuación en las dimensiones «Forma física», «Actividades sociales» y «Apoyo social». Los varones, los viudos y los solteros puntuaron peor en «Apoyo social». Los pacientes con mayor nivel de estudios mostraron puntuaciones más altas (peor CVRS) en la dimensión «Forma física». Conclusiones: Las láminas Coop-Wonca podrían ser un buen instrumento de medida de CVRS en los pacientes de hemodiálisis, por la rapidez de su cumplimentación y por ser de fácil comprensión lo que favorece la autoadministración que evita el posible sesgo del entrevistador. Todo ello favorecería su uso rutinario como indicador par valorar la evolución en el tiempo de la CVRS de los pacientes en hemodiálisis. No obstante, se precisan estudios ulteriores que permitan evaluar en mayor profundidad las propiedades psicométricas del instrumento en este tipo de pacientes.

Dependência no autocuidado dos idosos residentes em lar

O autocuidado é indispensável à conservação da vida e resulta do crescimento diário da pessoa, na experiência como cuidador de si mesmo e de quem faz parte das suas relações. É a chave dos cuidados de saúde, sendo interpretado como uma orientação para a ação de enfermagem que, através das ações de autocuidado, podem implementar intervenções para a promoção da saúde e/ou prevenção da doença. Os objetivos do estudo direcionam-se para a importância na identificação do perfil de autocuidado dos idosos, ou seja, na determinação dos diferentes níveis de dependência no autocuidado dos idosos a residir em lar. Entendemos este conhecimento, (proveniente dos resultados do estudo) como um contributo relevante no sentido de melhorar o modo como o apoio e/ou a ajuda pode ser ajustada a cada indivíduo, uma vez que estas adaptações só são possíveis perante o diagnóstico real da dependência das pessoas. Metodologia: Este estudo inclui-se num paradigma de investigação quantitativa, do tipo não experimental, transversal, descritivo e correlacional. A população em estudo são os idosos residentes no lar Residência Rainha D. Leonor em Viseu. Utilizou-se uma amostra não probabilística acidental, em função do peso relativo dos idosos desta instituição constituída por 136 idosos. O instrumento de colheita de dados inclui a escala de dependência no autocuidado. Resultados: Os idosos são maioritariamente mulheres, viúvas, com baixa instrução literária e com média de idade de 86 anos. Verificamos que as patologias predominantes são do foro cardíaco (70,6%), osteoarticular (62,5%) e neurológico (55,1%). Considerando o nível global de dependência no autocuidado, verificamos que 46,4% da amostra é independente, 36,0% é dependente em grau elevado e 17,6% dependente em grau parcial, ou seja, 53,6% apresenta algum grau de dependência no autocuidado. Conclusão: Os resultados deste estudo permitem a aquisição de conhecimento e desenvolvimento de competências que são de extrema importância na prática de cuidados de enfermagem de reabilitação, pois as necessidades de saúde desta população sofrem contínuas modificações ao longo do processo de envelhecimento, exigindo práticas atualizadas, no sentido de abranger a promoção dos processos de preservação e de autonomia. Palavras-Chave: Autocuidado, Idoso, Institucionalização.

Miscellany. Lane collections pamphlets.

Binder's title.

Municipal research : to promote the application of scientific principles to government /

Nos. 1-56, July 26, 1913-Aug. 15, 1914, were issued weekly in the form of leaflets; no. 57-92, Jan. 1915-Dec. 1917, monthly, in the form of pamphlets, containing studies in government; no. 93-95, irregularly issued.

Fundamental by-laws and tables of rates, for reversionary annuities, annuities and endowments,

Reprinted, 1876.

MESSIANISMO - DE RUTE AO BRASIL CONTEMPORÂNEO: SOFRIMENTO E ESPERANÇA

Esta dissertação analisa a relação existente entre os temas dialogados pelo redator do livro de Rute (4,1-12) e os livros que fazem parte da composição da História Deuteronomística. Havia três propostas, cada uma com a sua própria maneira de ver a situação, a missão e a organização do povo. A primeira é a de Zorobabel e Josué (Ed 3,1-13). A segunda de Esdras (Ed 9,1-10,44) (Ne 8,1-18) e a terceira de Neemias (5,1-19). Como abordar a pericope neste contexto foi realmente um desafio. Em um primeiro momento, ela foi situada no momento da História de Israel, vivenciando o pós exílio, com a volta dos deportados da Babilônia, época de reestruturação nacional de Judá. Em seguida, os personagens foram colocados em seus devidos papéis sociais. O povo da terra ficou em Judá e nos arredores. As injustiças sociais eram muitas: os campesinos estavam sendo desapropriados de suas próprias terras, pelos irmãos judeus que chegaram da Babilônia (Ne 51-5). Esses mesmos irmãos judeus são os que emprestaram dinheiro ao povo da terra e cobraram o pagamento com usura. O cenário era desanimador; os problemas intermináveis e de todos os tipos. A pobreza e a fome eram cada vez maiores (Ag 1,6), os pobres, estrangeiros e viúvas sobreviviam da respinga (Rt 2,2)

Una sociedad legalista: Abogados, procuradores de causas y la creación de una cultura legal colonial en Lima y Potosí, 1540–1670

This study deals with the formation, reproduction, and the role in litigation of two branches of the legal profession, lawyers and procurators. They were the experts in charge of civil, criminal, and ecclesiastical litigation during the Old Regime. While the lawyers provided erudite legal advice, procurators oriented and drove the procedure as legal representatives of their clients. The European legal revolutions of the twelfth and thirteenth centuries forged a new legal culture in which the lawsuit was reputed to be the best way to settle disputes. Likewise, that legal culture conferred an important place to specialists as legal facilitators of the contending parties. When Castilians exported their legal system to the New World, they spread a complex and bureaucratic framework, contributing to the reproduction of a class of experts in urban spaces. Lima and Potosi, two urban centers created in the sixteenth century, quickly became significant ‘legal cities’. This dissertation explores how the legal markets of these cities operated, the careers of their specialists, their professional options, social images regarding them, and litigation costs. This study examines the careers of 267 facilitators and demonstrates that they constituted a class of distinctive legal professionals. Legal culture embodies the representation and use of law. The closeness of specialists with litigants, in particular of procurators familiarized the parties with litigation and its complex processes. These specialists forged dominant legal discourses and manipulated juridical order. Litigants were not passive agents of their specialists. Caciques and members of the Hispanicized communities appropriated the law in a visible way as the growing litigiousness illustrates. Colonial law (of a pluralistic basis) was an arena of assertion and discussion of rights by different social actors, encomenderos, leading citizens, widows, native chieftains, artisans, and commoners. This study concludes that this struggle and manipulation served to legitimate the role of those legal experts and gave birth to a complex legalistic society in the Andes under Spanish Habsburg rule.

Widow begs on streets

General note: Title and date provided by Bettye Lane.

Sherman Alexie’s "The Toughest Indian in the World": Amalgamating the Oral and the Written Traditions

This article argues that The Toughest Indian in the World (2000) by Native-American author Sherman Alexie combines elements of his tribal (oral) tradition with others coming from the Western (literary) short-story form. Like other Native writers — such as Momaday, Silko or Vizenor — , Alexie is seen to bring into his short fiction characteristics of his people’s oral storytelling that make it much more dialogical and participatory. Among the author’s narrative techniques reminiscent of the oral tradition, aggregative repetitions of patterned thoughts and strategically-placed indeterminacies play a major role in encouraging his readers to engage in intellectual and emotional exchanges with the stories. Assisted by the ideas of theorists such as Ong (1988), Evers and Toelken (2001), and Teuton (2008), this article shows how Alexie’s short fiction is enriched and revitalized by the incorporation of oral elements. The essay also claims that new methods of analysis and assessment may be needed for this type of bicultural artistic forms. Despite the differences between the two modes of communication, Alexie succeeds in blending features and techniques from both traditions, thus creating a new hybrid short-story form that suitably conveys the trying experiences faced by his characters.

Deteção da simulação em indivíduos com e sem diagnóstico de depressão

A simulação consiste na produção voluntária de sintomas físicos e psicológicos para obter compensações externas. O presente estudo tem como objetivo avaliar a eficácia de um conjunto de instrumentos utilizados na identificação de situações de simulação, bem como averiguar se esses instrumentos são sensíveis a sintomas psicopatológicos. Deste modo, espera-se que os resultados obtidos pelos grupos com depressão e sem depressão honestos difiram significativamente dos resultados obtidos pelo grupo sem depressão simulador. Para tal, foi recolhida uma amostra de 59 sujeitos, todos do sexo feminino, divididos por três grupos: com diagnóstico de depressão (n=19), sem diagnóstico de depressão simuladores (n=20) e sem diagnóstico de depressão honestos (n=20). O protocolo de avaliação incluiu o Test of Memory Malingering (TOMM: Tombaugh, 1996), o Structured Inventory Malingered Symptomatology (SIMS: Widows & Smith), os subtestes de Memória de Dígitos e dos Cubos da WAIS-III, (Wechsler, 1997) e a Figura Complexa de Rey (FCR: Rey, 1988). Os resultados não sugerem diferenças significativas no primeiro e segundo ensaios de aprendizagem do TOMM entre os grupos em estudo. No ensaio de retenção, o grupo sem diagnóstico de depressão simulador difere significativamente do grupo sem diagnóstico de depressão honesto. No SIMS, apenas a subescala Psicose (P) difere significativamente entre os grupos com diagnóstico de depressão e sem diagnóstico de depressão simulador. As subescalas Défices Neurológicos (NI), Perturbações Afetivas (AF), P e Perturbações Mnésicas (AM), com exceção da escala Capacidade Intelectual Reduzida (LI) diferem significativamente entre os grupos com diagnóstico de depressão e sem diagnóstico de depressão honesto e entre este e o grupo sem diagnóstico de depressão simulador. No subteste de Memória de Dígitos verifica-se diferenças significativas entre os grupos sem diagnóstico de depressão simulador e honesto. No subteste dos Cubos não foram encontradas diferenças significativas entre os grupos estudados e na cópia da FCR foram encontradas diferenças significativas entre os grupos com diagnóstico de depressão e sem diagnóstico de depressão simulador. Este estudo contribui para o enriquecimento da literatura nacional e internacional, uma vez que inclui um grupo clínico e alguns instrumentos que não são habitualmente utilizados numa avaliação de simulação. Para além disso, estes resultados têm implicações no contexto clínico e forense, no sentido preventivo e de conhecimento da doença mental.

Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

Rzecz jako przepustka. Samotna ucieczka z Ravensbrück

Item as a pass: Lonely escape from Ravensbrück, in: B. Walęciuk-Dejneka (ed.) Patterns of women’s loneliness – maidens, widows, divorced, Kraków, pp. 77-86. This research represents a case study of Eugenia Kocwa's escape from Ravensbrück concentration camp in 1944, in which she was incarcerated for her activity in the resistance movement in 1941. Flights from the camps belonged to an extremely rare instances and almost always would have taken a form of group organized break-outs with an additional support from the outer world. The analyzed phenomenon is the only successful individual escape from Ravensbrück, and deserves therefore meticulous attention. In the analysis author lays strong emphasis on a material aspect of the escape and objects incorporated into it, which properly managed, had a decisive influence on fugitive's success. The article is based on testimonies of Eugenia Kocwa and other Ravensbrück prisoners, and adopts theoretical framework of Erving Goffman's total institutions and dramaturgical model

El principio de igualdad y no discriminación en relación con la pensión de viudedad y el «matrimonio gitano»

El punto de partida de nuestro estudio se sitúa en el polémico y discutido asunto resuelto por la sentencia del Tribunal Europeo de Derechos Humanos de 8 de diciembre de 2009, Caso Muñoz Díaz c. España, donde se condena al Estado español por denegar la pensión de viudedad a una ciudadana casada exclusivamente por el rito matrimonial gitano. Al hilo de esta resolución analizaremos, entre otras cuestiones, las diversas formas matrimoniales a las que nuestro legislador otorga efectos civiles, la incidencia de dichas disposiciones en el principio de igualdad y no discriminación consagrado en el artículo 14 de la Constitución y en el artículo 14 del Convenio Europeo de Derechos Humanos, y la posible vulneración de dicho principio en el marco de las prestaciones sociales reguladas en la Ley General de la Seguridad Social, recientemente reformada.

Economic well-being and poverty among the elderly: an analysis based on a collective consumption model

We apply the collective consumption model of Browning, Chiappori and Lewbel (2006) to analyse economic well-being and poverty among the elderly. The model focuses on individual preferences, a consumption technology that captures the economies of scale of living in a couple, and a sharing rule that governs the intra-household allocation of resources. The model is applied to a time series of Dutch consumption expenditure surveys. Our empirical results indicate substantial economies of scale and a wifeís share that is increasing in total expenditures. We further calculated poverty rates by means of the collective consumption model. Collective poverty rates of widows and widowers turn out to be slightly lower than traditional ones based on a standard equivalence scale. Poverty among women (men) in elderly couples, however, seems to be heavily underestimated (overestimated) by the traditional approach. Finally, we analysed the impact of becoming a widow(er). Based on cross-sectional evidence, we find that the drop (increase) in material well-being following the husbandís death is substantial for women in high (low) expenditure couples. For men, the picture is reversed.

Dependency in selfcare in the institutionalized elder: A descriptive study

Introduction.– Autonomy in the performance of daily living activities (DLA) are of extreme importance to the elder’s life. On pair with aging, the institutionalized elder, suffers a transition process from the changes of context from home to institution. This fact increases the elder’s dependency on self-care. By so, it is important to study the dependency degree in self-care in institutionalized elders, in order to rethink interventions to answer context changes and improve transition. Objective.– Identify the dependency degree in the institutionalized elder; explore the use of support products (SP) in self care and existance of structural barriers. Methods.– An exploratory-descriptive study, with a nonprobabilistic convinience sample was developed in two nursing homes. Instrument used was Hernâni’s Form (2009). Results.– In a total of 84 elders, averaging 87 years, with a minimum of 68 and maximum of 102 years, 45% widows, 17% analphabets, being the majority women (84%), 39% refered dependency of others as the motive for institutionalization. Bath self-care dependency was the highest self-care with dependency of the evaluated, with 79%presentedsomedegree of dependency. Eating self-careshowed the least degree of dependency (43%). Structural barriers found were steps with ramp, the SPs found were almost inexistence, being lateral support bars the most common. Conclusions.– The dependency degree of some self-cares lack interventions that target autonomy. As so, we consider that nurses should evaluate the elder’s potential for learning of new skills in order to reconstruct the process of autonomy, decreasing levels of dependency and increasing quality life.