Evaluar la calidad de vida de los cuidadores en enfermos de Alzheimer

[ES]Los cambios sociodemográficos y el aumento de la esperanza de vida han dado lugar a un aumento de algunas enfermedades, incluyendo la enfermedad de Alzheimer. La enfermedad de Alzheimer no sólo afecta a la persona que padece dicha enfermedad, sino que también repercute en la familia. Los cuidadores familiares son los que, de manera mayoritaria, se hacen cargo de la atención de estos pacientes con un compromiso de 24 horas, con lo que implica hacer cambios en sus estilos de vida. Los objetivos de este estudio son describir las características socio-demográficas, determinar la sobrecarga de los cuidadores informales y evaluar la calidad de sueño de los cuidadores. Se realizará un estudio transversal que incluirá a 40 cuidadores de enfermos de Alzheimer, seleccionados por un muestreo no probabilístico de selección por cuotas. Los participantes serán los cuidadores informales de pacientes con la enfermedad de Alzheimer que estén en el estadío III o IV de dicha enfermedad. Nuestra variable dependiente será el sueño y como variable independiente la sobrecarga. El estudio se realizará en la asociación de familiares de Alzheimer de Bilbao (A.F.A - Bizkaia), dónde se captará a la muestra de estudio y donde se procederá a aplicar los cuestionarios pertinentes para dicho estudio. Para participar en el estudio es necesario que firmen el consentimiento informado. Los instrumentos que se utilizarán son el cuestionario de Pittsburg que evalúa la calidad de sueño y la escala de carga de Zarit. Para el análisis de datos se utilizará el programa SPSS 15.0. Palabras clave: enfermedad de Alzheimer, cuidadores, cuidadores familiares, demencia, sobrecarga, sueño.

Influência da posição sócio-econômica ao longo da vida nas desigualdades de cor/raça na ocorrência de miomas uterinos: Estudo Pró-Saúde

Os miomas uterinos (MU) são considerados os tumores mais comuns do sistema reprodutor feminino. Estudos norte-americanos demonstram que mulheres negras são mais acometidas pelos MU que as de outros grupos étnico-raciais. No entanto, as causas da desigualdade racial na ocorrência dos tumores permanecem desconhecidas e possíveis mecanismos são pouco explorados na literatura. Em outra direção, devido às características dos MU (crescimento lento e longo período de latência) parte considerável dos estudos epidemiológicos utilizam um delineamento transversal, o que pode gerar problemas metodológicos, como os relacionados à utilização da idade coletada transversalmente (posteriormente a ocorrência dos MU) como proxy da idade do surgimento dos tumores. Assim, este trabalho de tese foi dividido em três partes, como se segue. A primeira, com características descritivas, teve por objetivo estimar a ocorrência de MU autorelatados segundo categorias demográficas e sócio-econômicas na população de estudo (compôs o artigo 1). A segunda, com componente analítico, propôs-se a avaliar o papel da PSE ao longo da vida como mediadora do efeito da cor/raça na ocorrência de MU auto-relatados (compôs o artigo 2). A terceira, com caráter metodológico, teve por objetivo comparar medidas de associação, entre variáveis aferidas transversalmente, em análises que incluem a co-variável idade no momento da coleta de dados e análises que consideram a idade ao diagnóstico dos MU (compôs o artigo 3). Para tanto, foram analisados dados transversais da população feminina participante das duas etapas da linha de base do Estudo Pró-Saúde, referentes à história auto-relatada de diagnóstico médico de MU e ainda a características sócio-demográficas, da vida reprodutiva e de acesso a serviços de saúde. Os resultados evidenciaram o aumento de ocorrência de MU em mulheres de maior idade e com a cor da pele mais escura (artigo 1); que a PSE ao longo da vida não medeia as associações entre cor/raça e MU (artigo 2); e que apesar das diferenças de pequena magnitude, a idade referida no momento da coleta de dados parece ser menos indicada para fins de especificação dos modelos analíticos do que a idade ao diagnóstico dos MU(artigo 3).

Percepções dos profissionais de farmácia sobre os conhecimentos na área da Homeopatia

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas

Early nutrition and eczema in infancy

Eczema prevalence rates among Irish infants are unreported, despite eczema being the most common inflammatory condition of infancy. Maternal and infant nutritional status including vitamin D and other fat-soluble vitamins as well as early infant feeding have been linked with eczema initiation and development. Therefore, early nutrition could be a potential modifiable risk factor. The objective of this thesis was to prospectively describe early infant feeding and complementary feeding practices, to evaluate infant vitamin D supplementation practice, to quantify cord serum 25-hydroxyvitamin D [25(OH)D] and propose reference intervals for vitamin D metabolites, to report eczema prevalence and explore the potential role of infant nutrition and eczema. These research needs were investigated through the Cork BASELINE (Babies After SCOPE: Evaluating the Longitudinal Impact with Neurological and Nutritional Endpoints) Birth Cohort Study (n 2137). This thesis was the first comprehensive report from the birth cohort, therefore it was important to describe the cohort sociodemographic profile. Although socio-demographic characteristics compared well with national data, there was an over-representation of educated mothers which may limit the generalizability of the results. From August 2008 through November 2011, comprehensive postnatal assessments were completed at day 2 and at 2, 6, 12 and 24 months. Breastfeeding rates were low, while complementary feeding practices were broadly compliant with national guidelines. The implementation of a national infant vitamin D supplementation policy had a major impact on supplementation practice. Low levels of serum 25(OH)D were universal among Irish neonates. Eczema is a complex and multifaceted disease, which is increasing globally. This was the first report of eczema prevalence data among Irish infants which compared with international reports. Given the high prevalence and considerable burden eczema has on the lives of sufferers, intensive research efforts to identify a cause and therapeutic strategies to prevent/reduce eczema was re-emphasized in this thesis.

Assessment of data quality in a multi-centre cross-sectional study of participation and quality of life of children with cerebral palsy

Background: SPARCLE is a cross-sectional survey in nine European regions, examining the relationship of the environment of children with cerebral palsy to their participation and quality of life. The objective of this report is to assess data quality, in particular heterogeneity between regions, family and item non-response and potential for bias. Methods: 1,174 children aged 8–12 years were selected from eight population-based registers of children with cerebral palsy; one further centre recruited 75 children from multiple sources. Families were visited by trained researchers who administered psychometric questionnaires. Logistic regression was used to assess factors related to family non-response and self-completion of questionnaires by children. Results: 431/1,174 (37%) families identified from registers did not respond: 146 (12%) were not traced; of the 1,028 traced families, 250 (24%) declined to participate and 35 (3%) were not approached. Families whose disabled children could walk unaided were more likely to decline to participate. 818 children entered the study of which 500 (61%) self-reported their quality of life; children with low IQ, seizures or inability to walk were less likely to self-report. There was substantial heterogeneity between regions in response rates and socio-demographic characteristics of families but not in age or gender of children. Item non-response was 2% for children and ranged from 0.4% to 5% for questionnaires completed by parents. Conclusion: While the proportion of untraced families was higher than in similar surveys, the refusal rate was comparable. To reduce bias, all analyses should allow for region, walking ability, age and socio-demographic characteristics. The 75 children in the region without a population based register are unlikely to introduce bias

Intimate Mixing - Bridging the Gap? Catholic-Protestant Relationships in Northern Ireland

For many years Northern Ireland has been a divided society where members of the two main religious groups, Catholics and Protestants, have limited opportunities to interact due to segregation in their social lives. Attempts have been made to encourage religious mixing through integration in schools, housing and workplaces predicated on the theory that bringing people together can improve community relations and remove prejudices – known as the ‘contact hypothesis’. However, little is known about those who enter into mixed-religion partnerships often against the wishes of their families and communities. This paper examines the characteristics and attitudes of mixed-religion couples and suggests that they differ in their socio-demographic characteristics and in their attitudes from those who marry within their own religion. These findings add to the weight of evidence from other countries in conflict suggesting that intermarriage has a role to play in contributing to less sectarian views and improved community relations.

Social capital at work as a predictor of employee health: Multilevel evidence from work units in Finland

The majority of previous research on social capital and health is limited to social capital in residential neighborhoods and communities. Using data from the Finnish 10-Town study we examined social capital at work as a predictor of health in a cohort of 9524 initially healthy local government employees in 1522 work units, who did not change their work unit between 2000 and 2004 and responded to surveys measuring social capital at work and health at both time-points. We used a validated tool to measure social capital with perceptions at the individual level and with co-workers' responses at the work unit level. According to multilevel modeling, a contextual effect of work unit social capital on self-rated health was not accounted for by the individual's socio-demographic characteristics or lifestyle. The odds for health impairment were 1.27 times higher for employees who constantly worked in units with low social capital than for those with constantly high work unit social capital. Corresponding odds ratios for low and declining individual-level social capital varied between 1.56 and 1.78. Increasing levels of individual social capital were associated with sustained good health. In conclusion, this longitudinal multilevel study provides support for the hypothesis that exposure to low social capital at work may be detrimental to the health of employees. (c) 2007 Elsevier Ltd. All rights reserved.

Knowledge of UK physical activity guidelines:Implications for better targeted health promotion

Objective. The aim of this study is to investigate the correlates of knowledge of the UK physical activity (PA) guidelines.

Method. A Northern Ireland-wide population survey (2010/2011) of 4653 adults provided cross-sectional data on PA, knowledge of guidelines and socio demographic characteristics. Multinomial logistic regression was used to investigate the associations between knowledge and socio-demographic characteristics (Model 1); and modifiable health behaviours (Model 2).

Results. Results showed that 47% of respondents were unaware of PA guidelines. Males who had a lower level of education (OR 5.91; 95% CI 1.67, 20.94), lived in more deprived areas (OR 4.80; 95% CI 1.87, 12.30), low income (OR 2.36; 95% CI 1.63, 3.41) and did no PA (OR 2.74; 95% CI 1.31, 5.76) were more likely to be unaware of the guidelines. Females who were younger (OR 1.03; 95% CI 1.02, 1.05) and reported poor health (OR 2.71; 95% CI 1.61, 4.58) were more likely to be unaware of the guidelines.

Conclusion. There is a lack of awareness about the levels of PA needed to promote health. An understanding of the characteristics of those who are unaware of the guidelines has important implications for the design of targeted, effective health promotion.

Addressing inequalities in physical activity participation: Implications for public health policy and practice

OBJECTIVE: To investigate the characteristics of those doing no moderate-vigorous physical activity (MVPA) (0days/week), some MVPA (1-4days/week) and sufficient MVPA (≥5days/week) to meet the guidelines in order to effectively develop and target PA interventions to address inequalities in participation.

METHOD: A population survey (2010/2011) of 4653 UK adults provided data on PA and socio-demographic characteristics. An ordered logit model investigated the covariates of 1) participating in no PA, 2) participating in some PA, and 3) meeting the PA guidelines. Model predictions were derived for stereotypical subgroups to highlight important policy and practice implications.

RESULTS: Mean age of participants was 45years old (95% CI 44.51, 45.58) and 42% were male. Probability forecasting showed that males older than 55years of age (probability=0.20; 95% CI 0.11, 0.28), and both males (probability=0.31; 95% CI 0.17, 0.45) and females (probability=0.38; 95% CI 0.27, 0.50) who report poor health are significantly more likely to do no PA.

CONCLUSIONS: Understanding the characteristics of those doing no MVPA and some MVPA could help develop population-level interventions targeting those most in need. Findings suggest that interventions are needed to target older adults, particularly males, and those who report poor health.

Choice of commuting mode among employees: Do home neighborhood environment, worksite neighborhood environment, and worksite policy and supports matter?

BACKGROUND: Promoting the use of public transit and active transport (walking and cycling) instead of car driving is an appealing strategy to increase overall physical activity.

PURPOSE: To quantify the combined associations between self-reported home and worksite neighborhood environments, worksite support and policies, and employees' commuting modes.

METHOD: Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone (n = 1,338) and provided information on socio-demographic characteristics, home and worksite neighborhoods, and worksite support and policies. Commuting mode was self-reported and categorized into car driving, public transit, and active commuting. Commuting distance was calculated using geographic information systems. Commuters providing completed data were included in the analysis. Multivariate logistic regression models were used to examine the correlates of using public transit and active commuting.

RESULT: The majority of participants reported commuting by driving (88.9%); only 4.9% used public transit and 6.2% used active modes. After multivariate adjustment, having transit stops within 10-15 minutes walking distance from home (p=0.05) and using worksite incentive for public transit (p<0.001) were associated with commuting by public transit. Commuting distance (p<0.001) was negatively associated with active commuting. Having free or low cost recreation facilities around the worksite (p=0.04) and using bike facilities to lock bikes at the worksite (p<0.001) were associated with active commuting.

CONCLUSION: Both environment features and worksite supports and policies are associated with the choice of commuting mode. Future studies should use longitudinal designs to investigate the potential of promoting alternative commuting modes through worksite efforts that support sustainable commuting behaviors as well as the potential of built environment improvements.

Global geriatric evaluation of the Algarve population

The ageing of population challenges communities to adapt and evolve to accommodate the needs of people that live longer (mostly out of work, either healthy, fragile or with chronic disease). Population ageing in the Algarve is higher than in overall Portugal. Studies on health conditions, frailty risk factors and elderly specific needs are undeveloped in Portugal and unknown in the Algarve. Objective To prepare a tool for Global Geriatric Evaluation, to be used in the “Survey of Health and Ageing in the Region of Algarve - SHARA”, a commitment to “European Innovation Partnership on Active and Healthy Ageing”. Methods A preliminary version of the screening tool, which includes well-known instruments to measure health condition (EASY-care), risk of fall (Tinetty), physical activity (Baecke’s modified questionnaire), nutritional condition (MNA), cognitive and depressive status (MMSE, Yesavage geriatric depression scale), together with socio-demographic characteristics, was applied to an independent sample of subjects from an elderly community centre - ARPI (“Associação de Reformados, Pensionistas e Idosos do Concelho de Faro”), with ages between 55 and 89. Results ARPI is mostly frequented by women, who either have risk of malnutrition or malnutrition incidence, a relevant risk of fall or are physically active. Those who live alone, show a higher risk of fall. Conclusions ARPI members are active, but with risk of malnutrition and fall, suggesting the relevance and importance of future interventions in these areas. The proposed screening tool showed to be adequate for the SHARA study, suitable to provide wider information on frailty.

Descrição de uma população narcoléptica portuguesa

Tese de mestrado, Ciências do Sono, Faculdade de Medicina, Universidade de Lisboa, 2015

A relação entre a preparação para a parentalidade no terceiro trimestre de gravidez e os níveis de atividade física das gestantes

Introdução: A atividade física (AF) parece ter um impacto positivo na saúde física e mental durante a gravidez, nascimento e puerpério, sendo que os programas de preparação para a parentalidade (PPP) poderão ser fundamentais para o seu suporte e estimulação. Objetivos: O objetivo do presente estudo foi avaliar a relação entre a preparação para a parentalidade no 3º trimestre de gravidez e os níveis de AF da gestante. Especificamente pretendeu-se verificar a relação entre as caraterísticas sociodemográficas das gestantes, os níveis de ansiedade e o PPP. Métodos: Efetuou-se um estudo transversal analítico onde se utilizaram duas amostras. Uma constituída por 42 gestantes que frequentaram o PPP no CHTS (GPP) e outra por 41 gestantes do HSJ que não frequentou (GNPP). A cada gestante foi pedido que preenchessem 3 questionários (caraterização sociodemográfica e saúde obstétrica, Questionário de Atividade Física para gestantes-PPAQ e Escala de ansiedade de Zung), administrados, individualmente, por um Fisioterapeuta. Resultados: Não se verificaram diferenças entre os grupos relativamente ao score da AF total (p=0,615), contudo, o GPP apresentou um número superior de gestantes que praticava desporto organizado durante a gravidez (p=0,016) comparativamente ao GNPP. Relativamente à intensidade da AF, verificou-se que o GPP apresentava uma prática maior de AF vigorosa (p=0,023). No que diz respeito ao tipo de AF, o GPP apresentou um número superior de gestantes a praticar AF desportiva (p<0,001) enquanto no GNPP se verificou uma maior AF ocupacional (p=0,002). Relativamente às caraterísticas sociodemográficas verificaram-se diferenças estatisticamente significativas entre os dois grupos relativamente à idade (p<0,001), paridade (p<0,001) e nível educacional (p<0,001). No que respeita aos níveis de ansiedade não se verificaram diferenças estatisticamente significativas entre os grupos (GPP vs GNPP p=0,916). Conclusão: No GPP um maior número de gestantes praticava atividade física desportiva e de intensidade vigorosa. Verificaram-se diferenças entre os dois grupos no que diz respeito à idade, paridade e nível educacional. Não se verificou associação entre o PPP e os níveis de ansiedade durante este período.

Tuberculose e infecção VIH/SIDA : uma análise comparativa em Portugal continental no biénio 2008-2009

RESUMO - Introdução: Actualmente 11,3 milhões de indivíduos estão co-infectados pela Tuberculose/Vírus Imunodeficiência Humana (TB/VIH), uma das principais causas de incapacidade e morte no mundo. É determinada pela exposição dos indivíduos aos factores de risco e condições/determinantes sociais de saúde. Várias são as medidas criadas a nível nacional e internacional na luta contra TB e a infecção VIH. Objectivo: Caracterizar e comparar os casos de TB entre os indivíduos não infectados com VIH e os infectados com VIH, considerando as características sócio-demográficas, o tratamento, patologias associadas e factores de risco. Método: Estudo descritivo, quantitativo e observacional. A informação foi obtida a partir da base de dados do Sistema Nacional de Vigilância Epidemiológica da Tuberculose dos casos de TB notificados entre 1 de Janeiro de 2008 a 31 de Dezembro de 2009. Para tratamento e análise estatística (descritiva e inferencial) o programa usado foi o SPSS versão 18,0. Resultados: 12,8% dos indivíduos estavam co-infectados com TB/VIH e 87,2% não estavam co-infectados. A presença de VIH nos casos de tuberculose apresenta evidência de relação com quase todas variáveis em estudo (p<0,00) excepto a presença de insuficiência renal (p<0,307). Apresentam maior probalidade de risco da co-infecção TB/VIH os homens, a faixa etária [35;44[, os estrangeiros, os desempregados, estar em retratamento e fumar. Os indivíduos com Doença Hepática (OR= 5,238; IC95%: 3,706;7,403; ORA = 3,104; IC95%: 2,164;4,454), patologias associadas (OR=13,199; IC95%: 11,246; 15,491; ORA=21,348; IC95%:17,569; 25,940) e factores de risco (OR=3,237; IC95%: 2,968; 3,531; ORA=2,644; IC95%: 2,414; 2,985) tem maior probalidade da co-infecção TB/VIH. O ajustamento para o sexo e a idade interferiu em todas variáveis em estudo. Conclusão: Os homens, da faixa etária [35;44 [, desempregados, estrangeiros, em retratamento, fumadores apresentam maior probalidade de risco de estar co-infectado com TB/VIH.

Qualidade de vida relacionada com a saúde em doentes com lúpus eritematoso sistémico neuropsiquiátrico em Portugal

RESUMO - Este estudo tem como objetivo principal analisar o impacto do lúpus eritematoso sistémico (LES) na qualidade de vida relacionada com a saúde num grupo de doentes portugueses, através de instrumentos genéricos. Trata-se de um estudo transversal, onde os instrumentos de colheita de dados foram o EQ-5D-3L e o SF-36 v.2, aplicados no decorrer de 2012, sendo a população constituída por 116 doentes com LES-NP, inscritos na Unidade de Doenças Autoimunes do Hospital Curry Cabral, Lisboa. Todos os doentes preencheram os critérios revistos ACR de 97 para a classificação de LES. Dos 116 doentes, 104 eram mulheres (89,7%) e 12 homens (10,3%). A idade média da amostra é de 46 anos. Os indivíduos apresentam um critério ACR médio de 5,0, um índice SLICC/ACR (SDI) médio de 0,6 (± 1,1) e uma duração média de doença de 13 anos, onde 50% dos participantes indica ser portador de LES pelo menos há 11 anos. Os resultados obtidos evidenciaram que a qualidade de vida relacionada com a saúde no LES varia em função de determinadas características demográficas dos doentes como são o caso da idade e o sexo, relacionando-se também com a duração da doença e o índice de irreversibilidade de lesão, nalgumas dimensões do EQ-5D-3L e SF-36. Estes dois instrumentos genéricos apresentam forte associação em todas as suas dimensões. Um achado relevante, prende-se com o facto de o LES apresentar uma pior qualidade de vida relacionada com a saúde em relação a outras doenças crónicas comparáveis.