ANALYSIS OF FUNCTIONAL STATUS OF ELDERLY RESIDENTS IN LONG-TERM CARE INSTITUTIONS

Objective: To evaluate the functional status of elderly residents in long-term institutions. Methods: Exploratory-descriptive study, developed in two long-term care institutions for the elderly (LTC), in city of Fortaleza, Ceará. The instruments utilized were: 1) Sociodemographic form, 2) Functional Independence Measure (FIM), and 3) International Classification of Functioning (ICF). Data was descriptively analyzed through the calculation of frequency, mean and standard deviation. Results: There was a predominance of males (n=47; 59.49%), with mean age of 74.58 (± 8.89) years, 68.35% (n=54) have been or are married, and 49.37% (n=39) are illiterate. In reference to the FIM, it was observed that the elderly perform the activities in a complete or modified mode and 18.99% (n=15) have difficulty climbing stairs. As to the association between the FIM and the ICF, in relation to self-care, it was seen that 96.20% (n=76) have no difficulty in performing tasks; 92.40% (n=73) move around without difficulty; and 98.73% (n=78) have preserved the cognition. In relation to the capacity of maintaining and controlling social interactions, all exhibit this domain preserved. Conclusion: The surveyed elderly presented good cognitive status and little dependence in activities regarding personal care, mobility and communication. The use of the ICF allows the visualization of the functionality scenario among the elderly, what can facilitate more effective health promotion strategies for this population.

Estado emocional e satisfação com o suporte social após uma interrupção voluntária da gravidez

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

DIFFERENCES IN PSYCHOPATHOLOGY AMONG SUBSTANCE USERS IN RESIDENTIAL TREATMENT RELATED TO HIV STATUS

HIV-positive individuals engage in substance use at higher rates than the general population and are more likely to also suffer from concurrent psychiatric disorders and substance use disorders. Despite this, little is known about the unique clinical concerns of HIV-positive individuals entering substance use treatment. This study examined the clinical characteristics of clients (N=1712) entering residential substance use treatment as a function of self-reported HIV status (8.65% HIV-positive). Results showed higher levels of concurrent substance use and psychiatric disorders for HIV-positive individuals, who were also significantly more likely to meet criteria for bipolar disorder and borderline personality disorder. Past diagnoses of depression, posttraumatic stress disorder, and social phobia were also significantly more common. Study findings indicate a need to provide more intensive care for HIV-positive individuals, including resources targeted at concurrent psychiatric problems, to ensure positive treatment outcomes following residential substance use treatment discharge.

Social/economic costs and health-related quality of life in patients with epidermolysis bullosa in Europe

BACKGROUND: The aim of this study was to determine the social/economic costs and health-related quality of life (HRQOL) of patients with epidermolysis bullosa (EB) in eight EU member states. METHODS: We conducted a cross-sectional study of patients with EB from Bulgaria, France, Germany, Hungary, Italy, Spain, Sweden and the United Kingdom. Data on demographic characteristics, health resource utilisation, informal care, labour productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. RESULTS: A total of 204 patients completed the questionnaire. Average annual costs varied from country to country, and ranged from euro9509 to euro49,233 (reference year 2012). Estimated direct healthcare costs ranged from euro419 to euro10,688; direct non-healthcare costs ranged from euro7449 to euro37,451 and labour productivity losses ranged from euro0 to euro7259. The average annual cost per patient across all countries was estimated at euro31,390, out of which euro5646 accounted for direct health costs (18.0 %), euro23,483 accounted for direct non-healthcare costs (74.8 %), and euro2261 accounted for indirect costs (7.2 %). Costs were shown to vary across patients with different disability but also between children and adults. The mean EQ-5D score for adult EB patients was estimated at between 0.49 and 0.71 and the mean EQ-5D visual analogue scale score was estimated at between 62 and 77. CONCLUSION: In addition to its negative impact on patient HRQOL, our study indicates the substantial social/economic burden of EB in Europe, attributable mostly to high direct non-healthcare costs.

Modeling the impact of social discrimination on the physical and mental health of portuguese gay, lesbian and bisexual people

Background: Despite growing acceptance of same-sex sexuality in Portugal, identity development of lesbian, gay and bisexual (LGB) individuals is still restricted by negative societal attitudes, which maintain the experience of stigmatization and discrimination. The purpose of this study is to document the frequency of discriminatory events experienced by sexual minorities and their association with indicators of physical and mental health in Portugal. Methods: A total of 610 LGB participants completed an online survey (mean age = 34.48, SD = 11.54). Most participants were single and self-identified as gay (73.8%). The survey included five categories of survey items: demographic information, social support, physical health, mental health, and discrimination experiences. Results: Physical and mental health results revealed that bisexual people were more likely to report higher levels of psychological distress than gay men. Overall, between one-fifth and one-fourth of the participants in this sample frequently felt the need to hide their sexual orientation to prevent discrimination experiences across the different settings. Regarding actual discrimination experiences, close to 20% reported having suffered from verbal abuse, followed by close to 10% who suffered from written threats, harassment, and physical threats. A hierarchical multiple regression analysis was performed to assess the effects of anticipated and actual discrimination on mental health. Possible confounding variables were added in the first block – age, sexual orientation, being in a relationship, body mass index, and HIV status. Anticipated and actual discrimination experiences were added in the second block. The first block of the analysis explained 6% of the overall variance, while the second block – discrimination experiences – explained an additional 17%. Conclusion: Portuguese culture and stigma/discrimination create discriminatory experiences which impact LGB people’s health. Unless policies are changed to allow for the acceptance of LGB people, they will continue to experience violence and discrimination as a result of homophobia.

Self-Presentation Styles, Status, and Influence

This research examined effects of individual self-presentation styles on influence in groups. Perceived competence and social acceptance both play a role in determining how much influence group members enjoy. Aggrandizing and deprecating self-presentation styles may affect perceived competence, social acceptance, and ultimately influence. I predicted that aggrandizing self-presentation would lead to perceptions of competence and that self-deprecation would lead to social acceptance. The anticipated strength of those trends, however, was unclear, and I proposed that they would vary depending on status. I conducted two studies designed to assess whether aggrandizing or deprecating self-presentation styles lead to differences in influence outcomes for high and low-status individuals. In Study 1, participants gave feedback and a promotion recommendation for a fictitious (male or female) job candidate based on employee evaluation information presenting the candidate as either deprecating or aggrandizing. The main findings from Study 1 were that aggrandizers were rated as less likable than deprecators. No other predictions were supported. Study 2 was an online experiment in which participants made hiring recommendations in reference to résumés from fictitious applicants that varied by race, gender, and presentation style (aggrandizing, deprecating, or neutral). Results provided some evidence that low-status candidates were punished for using aggrandizing self-presentation strategies. The results of the studies suggest no one- best technique for self-presentation and that there may be costs for aggrandizing or deprecating depending on race and gender.

Social dominance modulates eavesdropping in zebrafish

Group living animals may eavesdrop on signalling interactions between conspecifics and integrate it with their own past social experience in order to optimize the use of relevant information from others. However, little is known about this interplay between public (eavesdropped) and private social information. To investigate it, we first manipulated the dominance status of bystander zebrafish. Next, we either allowed or prevented bystanders from observing a fight. Finally, we assessed their behaviour towards the winners and losers of the interaction, using a custom-made video-tracking system and directional analysis. We found that only dominant bystanders who had seen the fight revealed a significant increase in directional focus (a measure of attention) towards the losers of the fights. Furthermore, our results indicate that information about the fighters' acquired status was collected from the signalling interaction itself and not from post-interaction status cues, which implies the existence of individual recognition in zebrafish. Thus, we show for the first time that zebrafish, a highly social model organism, eavesdrop on conspecific agonistic interactions and that this process is modulated by the eavesdroppers' dominance status. We suggest that this type of integration of public and private information may be ubiquitous in social learning processes.

Nivel de sobrecarga y factores asociados de los cuidadores primarios de los/as pacientes del centro de atención ambulatoria 302 del Instituto Ecuatoriano de Seguridad Social, Cuenca Ecuador, 2014

OBJETIVOS: Identificar el nivel de sobrecarga y sus factores asociados en los cuidadores primarios de los /as pacientes del Centro de Atención Ambulatoria 302 del IESS. METODOLOGÍA: Es un estudio cuantitativo analítico-transversal, cuyo universo es 222 cuidadores primarios de adultos mayores, controlados en el Centro de Atención Ambulatoria 302 del Instituto Ecuatoriano de Seguridad Social, Cuenca Ecuador. Los datos se obtuvieron del formulario que consta de un apartado sociodemográfico, variables de estudio, Índice de Katz y Escala del Nivel de Sobrecarga de Zarit. Se tabuló y analizó la información obtenida exponiéndola en los resultados. RESULTADOS: En promedio los cuidadores tienen 53 años, en su mayoría de sexo femenino, 52% de ellos casados, casi el 60% son hijos y un 11% conyugues del adulto mayor. La mayoría los cuida 12 horas en el día, los 7 días de la semana y llevan cuidándolos al menos 5 años. Se observó que 26% de adultos mayores tiene una dependencia moderada y el 38% dependencia severa. De acuerdo al test de Zarit el 18,7% de cuidadores tienen sobrecarga leve y el 14% sobrecarga intensa. CONCLUSIONES: El 18,7% de los cuidadores primarios presentan una sobrecarga leve y el 14% perciben una sobrecarga intensa.

Effective Approaches to Enhancing the Social Dimension of Higher Education

Despite all intentions in the course of the Bologna Process and decades of investment into improving the social dimension, results in many national and international studies show that inequity remains stubbornly persistent, and that inequity based on socio-economic status, parental education, gender, country-of-origin, rural background and more continues to prevail in our Higher Education systems and at the labour market. While improvement has been shown, extrapolation of the gains of the last 40 years in the field show that it could take over 100 years for disadvantaged groups to catch up with their more advantaged peers, should the current rate of improvement be maintained. Many of the traditional approaches to improving equity have also necessitated large-scale public investments, in the form of direct support to underrepresented groups. In an age of austerity, many countries in Europe are finding it necessary to revisit and scale down these policies, so as to accommodate other priorities, such as balanced budgets or dealing with an aging population. An analysis of the current situation indicates that the time is ripe for disruptive innovations to mobilise the cause forward by leaps and bounds, instead of through incrementalist approaches. Despite the list of programmes in this analysis there is very little evidence as to the causal link between programmes, methodologies for their use and increases/improvements in equity in institutions. This creates a significant information gap for institutions and public authorities seeking for indicators to allocate limited resources to equity improving initiatives, without adequate evidence of effectiveness. The IDEAS project and this publication aims at addressing and improving this information gap. (DIPF/Orig.)

The evolution of the occupational status in Spain: An intergenerational approach

The relationship between the socio-economic status of parents and children is referred by the literature as intergenerational social mobility. The scope of this mobility encompasses different aspects such as educational attainment, income, wealth, prestige and occupational status. In particular, intergenerational occupational mobility is an interesting topic in the economic literature because it is positively associated with the economic achievement and the professional success. Low mobility implies that human capital, skills and talent can be misallocated. As a consequence, the workers’ efforts, their motivation and productivity could be negatively affected, which would have adverse effects on the economy growth and its competitiveness. This paper attempts to carry out the study of the evolution of intergenerational social mobility in Spain during the 21st century. The methodology applied involves to associate the National Classification of Occupations (CNO-94) with the New International Socio-economic Index of Occupational Status (ISEI-08), in order to establish a socio-economic hierarchy. Afterwards, once the occupational ranking is defined, we use statistic and econometric methods to assess the occupational transitions between fathers and children and to analyse the covariates’ effects on these transitions, including as explanatory variable the children’s educational attainment. Data used corresponds to the 2005 and 2011 Living Condition Survey (INE, 2005, 2011). The results of the study are displayed by distinguishing children according to their birth cohort.

Qualidade de vida, percepção de saúde, resiliência, auto-regulação e suporte social nos adolescentes portugueses com a doencça crónica

Tese de Doutoramento em Psicologia na área de especialidade Psicologia da Saúde

Non-institutionalized nonagenarians health-related quality of life and nutritional status: is there a link between them?

Introduction: Nonagenarian population, clearly increasing, shows different characteristics from the rest of elderly people. Health-related quality of life is a way to study population health in physical, psychological and social dimensions. Objectives: To examine the relationship between nutritional status and health-related quality of life in a group of free-living nonagenarians. Differences with octogenarians were also studied. Methods: Within Villanueva Older Health Study, 20 non-institutionalised people (92.5±3.5 years; 80% women) make the nonagenarian subsample. Nutritional risk was assessed by Mininutritional Assessment questionnaire, dietary intake by a 24-hour dietary recall and health-related quality of life by EuroQoL-5D questionnaire. SPSS was used for statistical analysis. Results: 40% nonagenarians were at risk of malnutrition. Dietary assessment showed magnesium, zinc, potassium, folic acid, vitamin D and vitamin E deficiencies. Problems in mobility were more frequently reported (80%). EQ-5Dindex was associated with MNA (p<0.05). Self-care dimension was associated with calcium and niacin (p<0.05), retinol and cholesterol (p<0.01) intake. Usual activities dimension was associated with niacin (p<0.01) and cholesterol(p<0.05) intake. Pain/discomfort dimension was associated with protein (p<0.01), energy, selenium and niacin (p<0.05) intake. Anxiety/depression was associated with protein(p<0.01) and selenium (p<0.05) intake. Conclusions: Risk of malnutrition is a factor associated to health-related quality of life. Results suggest that energy and some nutrient intakes could be possibly associated to health-related quality of life but further research on this influence is required.

NUTRITION AND HEALTH STATUS OF HIV-INFECTED ADULTS ON ARVS AT AMREF CLINIC KIBERA URBAN SLUM, KENYA

The health of people living with HIV and AIDS (PLWHA) is nutritionally challenged in many nations of the world. The scourge has reduced socio-economic progress globally and more so in sub-Saharan Africa (SSA) where its impact has been compounded by poverty and food insecurity. Good nutrition with proper drug use improves the quality of life for those infected but it is not known how PLWHA exposed to chronic malnutrition and food shortages from developing nations adjust their nutrition with use of Anti-Retro-viral Drugs (ARVs). This study assessed nutritional status, dietary practices, and dietary management of common illnesses that hinder daily food intake by the patients and use of ARVs with food recommendations provided by the health care givers. A descriptive case study design was used to sample 120 HIV-infected patients using systematic sampling procedure. These patients sought health care from an urban slum, Kibera AMREF clinic. Data were collected by anthropometric measurements, bio-chemical analysis, semi-structured questionnaire and secondary data. The Statistical Package for Social Sciences (SPSS) and the Nutri-Survey software packages were used to analyze data. Dietary intakes of micro-nutrients were inadequate for >70% of the patients when compared to the Recommended Daily Requirements. When Body Mass Indices (BMI) were used, only 6.7% of the respondents were underweight (BMI<18.5kg/m2) and 9.2% were overweight (BMI> 25kg/m2), serum albumin test results (mean 3.34±0.06g/dl) showed 60.8% of the respondents were protein deficient and this was confirmed by low dietary protein intakes. The BMI was not related to dietary nutrient intakes, serum albumin and CD4 cell counts (p>0.05). It appeared that there was no significant difference in BMI readings at different categories of CD4 cell count (p>0.05) suggesting that the level of immunity did not affect weight gain with ARV as observed in many studies from developed countries. Malnutrition was, therefore, evident among the 60.8% of the cases as identified by serum albumin tests and food intake was not adequate (68%) for the patients as they ate once a day due to lack of food. National food and nutrition policy should incorporate food security boosting guidelines for the poor people infected with HIV and using ARVs.

Social Mobility and Demand for Redistribution. A Comparative Analysis

The literature on preferences for redistribution has paid little attention to the effect of social mobility on the demand for redistribution, which is in contrast with the literature on class-voting, where studies on the effect of social mobility has been very common. Some works have addressed this issue but no systematic test of the hypotheses connecting social mobility and preferences has been done. In this paper we use the diagonal reference models to estimate the effect of origin and destination class on preferences for redistribution in a sample of European countries using data from the European Social Survey. Our findings indicate that social origin matters to a little extent to explain preferences, as newcomers tend to adopt the preferences of the destination class. Moreover, we have found only limited evidence supporting the acculturation hypothesis and not support for the status maximization hypothesis. Furthermore, the effect of social origin varies largely between countries. In a second step of the analysis we investigate what are the national factors explaining this variation. The empirical evidence we present leads to conclude that high rates of upward social mobility sharply reduce the effect of social origin on preferences for redistribution

A Qualitative Study of the Status of Children’s Play From the Viewpoints of Experts and Suggestions for Promotion Interventions

Background: The latest national census reports the population of Iranian children (1 - 8 years old) about 11 millions. On the other hand, the latest population policies approved by supreme cultural revolution council (SCRC) will make this population increase faster. Childhood development is one of the social determinants of health, of which “child’s play” is a part. Objectives: This study is an effort to identify difficulties and challenges of the plays influential on Iranian children’s health nationwide, in order to present enhancive strategies by utilizing the views of stakeholders and national studies. Patients and Methods: Analyzing children’s play stakeholders, main organizations were identified and views of 13 informed people involved in the field were investigated through deep semi-structured interview. A denaturalized approach was employed in analyzing the data. In addition to descriptions of the state, interventions development, and designing the conceptual model, national reports and studies, and other countries’ experiences were also reviewed. Results: Society’s little knowledge of “children’s plays”, absence of administrators for children’s play, shortage of public facilities for children’s play and improper geographical and demographic availability, absence of policies for Iranian “toy”, and little attention of media to the issue are the five major problems as stated by interviewees. Conclusions: The proposed interventions are presented as “promoting the educational levels of parents and selected administrators for children’s play”, “approving the play and toy policy for Iran 2025”, and “increasing public facilities for children’s play with defined distribution and availability”.