The disease surden morbidity assessment: a validation study

Introduction: Population aging is a process that is taking place all over the world. One of the consequences is the increase in the prevalence of chronic conditions, and therefore also the co-existence of them, so-called comorbidity or multimorbidity. Different instruments exist to assess multimorbidity, and the choice of instrument depends on the study context and outcomes of interest. The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire in which participants rate the disease burden caused by a number of medical conditions. It was designed and validated to be associated with patient-centered outcomes. However, a validation following psychometric or clinimetric methodology had not been performed yet. Objectives: The objectives of this thesis were to validate the DBMA according to the Classical Test Theory(CTT) (Study 1), to assess known-groups, convergent and predictive validity (Study 2) and to perform a Rasch analysis of the scale (Study 3). Methods: Data were used from the Ageing in Spain Longitudinal Study, Pilot Survey (ELES-PS). The DBMA consists of a list of 21 chronic medical conditions. Participants are asked for every condition whether they have it and if so, to what extent it interferes with their everyday life on a scale from 1 (not at all) tot 5 (a lot). Scores are summed to obtain a measure of disease burden. In the first study, psychometric properties of the scale (feasibility, acceptability, scaling assumptions, reliability and construct validity) were analyzed. Dimensionality was assessed through an exploratory factor analysis. In Study 2, known-groups validity for sex and age groups (< 75 years vs. ≥75 years) was assessed. For convergent validity, a multivariate linear regression model was used to evaluate differences in DBMA scores as a function of age and sex, patient-centered outcomes and utilization outcomes. For predictive validity, the association with four-year mortality was assessed using a Cox model and Kaplan-Meier curves. In the Rasch analysis, test of fit to the Rasch model, reliability, unidimensionality, response dependency, category structure, scale targeting and differential item functioning (DIF) were studied in an iterative way. Construct validity of the linear measure provided by the Rasch analysis was subsequently assessed. Results: In the CTT analysis, satisfactory feasibility and acceptability were found, except for large floor effects (>50%) as well as a skewed distribution (skewness=1.8). Item-total corrected correlation ranged 0.10-0.49, item homogeneity index was 0.09, and Cronbach’s alpha was 0.72. Disease burden correlated strongly with physical functioning and perceived health, and moderately with depression and quality of life. Exploratory factor analysis extracted 5 factors, explaining 44% of the variance. The known-groups analysis in Study 2 found higher disease prevalences and also higher disease burden per present condition for women. The same differences were found for age groups but less pronounced. In the multivariate regression, sex, perceived health, physical functioning, quality of life, affect balance and primary/outpatient care utilization were significantly associated with the DBMA. The Cox model displayed a hazard ratio of 1.07 and the Kaplan-Meier curves showed lower survival rates in participants with higher DBMA scores. In the Rasch analysis, items needed to be rescored by collapsing response categories to achieve an adequate fit to the Rasch model. Reliability (person separation index) was low. The scale was unidimensional and neither response dependency nor relevant DIF were found. Relative precision analysis showed that the linear measure discriminated better between age groups than the original raw score, but for sex no difference was found. Conclusions: Despite some limitations such as reliability below the expected and high floor effects, support was found for the validity of the DBMA. In our ageing society, with increasing numbers of older people with multimorbidity, the DBMA can be applied to better understand and improve care for older persons with multiple chronic conditions

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills

Envelhecimento vocal: estudo acústico-articulatório das alterações de fala com a idade

Background: Although the aging process causes specific alterations in the speech organs, the knowledge about the age effects in speech production is still disperse and incomplete. Objective: To provide a broader view of the age-related segmental and suprasegmental speech changes in European Portuguese (EP), considering new aspects besides static acoustic features, such as dynamic and articulatory data. Method: Two databases, with speech data of Portuguese adult native speakers obtained through standardized recording and segmentation procedures, were devised: i) an acoustic database containing all EP oral vowels produced in similar context (reading speech), and also a sample of semispontaneous speech (image description) collected from a large sample of adults between the ages 35 and 97; ii) and another with articulatory data (ultrasound (US) tongue images synchronized with speech) for all EP oral vowels produced in similar contexts (pseudowords and isolated) collected from young ([21-35]) and older ([55-73]) adults. Results: Based on the curated databases, various aspects of the aging speech were analyzed. Acoustically, the aging speech is characterized by: 1) longer vowels (in both genders); 2) a tendency for F0 to decrease in women and slightly increase in men; 3) lower vowel formant frequencies in females; 4) a significant reduction of the vowel acoustic space in men; 5) vowels with higher trajectory slope of F1 (in both genders); 6) shorter descriptions with higher pause time for males; 7) faster speech and articulation rate for females; and 8) lower HNR for females in semi-spontaneous speech. In addition, the total speech duration decrease is associated to non-severe depression symptoms and age. Older adults tended to present more depressive symptoms that could impact the amount of speech produced. Concerning the articulatory data, the tongue tends to be higher and more advanced with aging for almost all vowels, meaning that the vowel articulatory space tends to be higher, advanced, and bigger in older females. Conclusion: This study provides new information on aging speech for a language other than English. These results corroborate that speech changes with age and present different patterns between genders, and also suggest that speakers might develop specific articulatory adjustments with aging.Contextualização: Embora o processo de envelhecimento cause alterações específicas no sistema de produção de fala, o conhecimento sobre os efeitos da idade na fala é ainda disperso e incompleto. Objetivo: Proporcionar uma visão mais ampla das alterações segmentais e suprassegmentais da fala relacionadas com a idade no Português Europeu (PE), considerando outros aspetos, para além das características acústicas estáticas, tais como dados dinâmicos e articulatórios. Método: Foram criadas duas bases de dados, com dados de fala de adultos nativos do PE, obtidos através de procedimentos padronizados de gravação e segmentação: i) uma base de dados acústica contendo todas as vogais orais do PE em contexto semelhante (leitura de palavras), e também uma amostra de fala semiespontânea (descrição de imagem) produzidas por uma larga amostra de indivíduos entre os 35 e os 97 anos; ii) e outra com dados articulatórios (imagens de ultrassom da língua sincronizadas com o sinal acústico) de todas as vogais orais do PE produzidas em contextos semelhantes (pseudopalavras e palavras isoladas) por adultos de duas faixas etárias ([21-35] e [55-73]). Resultados: Tendo em conta as bases de dados curadas, foi analisado o efeito da idade em diversas características da fala. Acusticamente, a fala de pessoas mais velhas é caracterizada por: 1) vogais mais longas (ambos os sexos); 2) tendência para F0 diminuir nas mulheres e aumentar ligeiramente nos homens; 3) diminuição da frequência dos formantes das vogais nas mulheres; 4) redução significativa do espaço acústico das vogais nos homens; 5) vogais com maior inclinação da trajetória de F1 (ambos os sexos); 6) descrições mais curtas e com maior tempo de pausa nos homens; 7) aumento da velocidade articulatória e da velocidade de fala nas mulheres; e 8) diminuição do HNR na fala semiespontânea em mulheres. Além disso, os idosos tendem a apresentar mais sintomas depressivos que podem afetar a quantidade de fala produzida. Em relação aos dados articulatórios, a língua tende a apresentar-se mais alta e avançada em quase todas as vogais com a idade, ou seja o espaço articulatório das vogais tende a ser maior, mais alto e avançado nas mulheres mais velhas. Conclusão: Este estudo fornece novos dados sobre o efeito da idade na fala para uma língua diferente do inglês. Os resultados corroboram que a fala sofre alterações com a idade, que diferem em função do género, sugerindo ainda que os falantes podem desenvolver ajustes articulatórios específicos com a idade.Programa Doutoral em Gerontologia e Geriatri

CSR practices in a Telecomm Company: Information and communication technologies (ICTs) for elderly healthcare management in Portugal

The phenomenon of population aging is resulting in a global demographic change, a consequence of an unbalance relationship between life expectancy increase and low birth rates, where the United Nation Report positions Portugal as the 4th oldest country in the world by 2050. Living longer does not necessarily mean living better. The Portuguese Public Healthcare system is facing sustainability challenges to provide the necessary assistance to an increasingly older population, with unsustainable hospitalizations costs related to chronic uncommunicable diseases. Domiciliary health assistance is a viable solution for this, if an efficient health monitoring assistance is provided, hospitalizations would be prevented. Information and Communication Technologies (ICTs) applied in the healthcare sector as telemedicine can have an important role not only improving healthcare assistance but also allowing new forms of information sharing and communication through distance, reducing elderly isolation. This project was developed in partnership with Altice Portugal, as an in-company project, with the objective to provide improvement recommendations for the ICT solution that company is developing for elderly domiciliary healthcare management, that includes remote monitoring of vital signs. For that, a conceptual framework was developed in order to schematize the relationship between the variables that influence Elderly Use and Acceptance of Health ICTs, using a face-to-face questionnaire tool to a group of 142 participants. This research permits to understand the importance of Healthcare ICTs, identifying the existing innovations and future trends.O fenómeno do envelhecimento da população está a resultar numa mudança demográfica global, resultado de relação desequílibrada entre o aumento da esperança média de vida e baixa natalidade, onde o relatório das Nações Unidas positionou Portugal como o quarto país do mundo mais envelhecimento em 2050. Viver mais anos não significa necessariamente viver melhor. O Sistema de Nacional de Saúde Português (SNS) apresenta alguns desafios de forma a proporcionar a devida assistência a uma população cada vez mais envelhecida, registando custos de hospitalização insustentáveis associados a doenças crónicas relacionadas com o envelhecimento. Muitos destes casos de hospitalização podem ser prevenidos através de uma monitorização eficaz da saúde, sendo a assistência ao domicilio umas solução viável. A aplicação de tecnologias de informação e comunicação (TICs) no sector da saúde, como por exemplo a telemedicina, podem ter um papel importante, não apenas melhorando a assistência de saúde, bem como permitindo novas formas de partilha de informação e comunicação à distância, reduzindo o isolamento dos idosos. Este projecto foi desenvolvido em parceria com a Altice Portugal com o objectivo de dar recomedações de melhoria para a solução TIC que a empresa se encontra a desenvolver para melhorar o apoio domiciliário a idosos, incluindo o controlo remoto dos sinais vitais. Com esse intuito, um modelo conceptual foi desenvolvido de forma a esquematizar a relação entre as variáveis que podem influenciar o Uso e Aceitação das TICs na saúde por parte dos idosos, através de questionário presencial a um grupo de 142 participantes

Contemporary Perspectives on Ageism

Older adults outnumbering children; Gerontology/geriatrics; Aging world population; The study of ageism; Ageism is the most prevalent form of discriminatio

Internet addiction and lonliness among Portugese elementary school students: an exploratory quantitative study [poster]

1st World Congress of Children and Youth Health Behaviors / 4th National Congress on Health Education: Viseu, Portugal: May 23-25, 201

"I'm not what you think I am": The power of threat and challenge responses to negative age-based meta-stereotypes on thriving at work and spillover effect

Age diversity in the workplace is no longer an option or an ethical duty, but necessary for the economic functioning of societies. However, age-based negative attitudes (ageism) persist, with important consequences. This research is composed of two studies with distinct but related objectives. Study 1 aimed to identify, in a Portuguese sample (N=123), which age-based stereotypes are most associated with each age group. A reluctance to attribute negative stereotypes to both younger and older people was observed. Study 2 aimed to assess work-related consequences of ageism for the target, namely the relationship between the activation of age-based threat and challenge responses at work on thriving at work and negative spillover, through the longitudinal intensive daily diary methodology. Data were collected during seven workdays via participants' cellphones (N=44, 301 observations). Although no variation across time was found, hindering multilevel longitudinal analyses, a negative association between threat response and thriving at work was found, and a positive association with negative spillover. Additional analyses showcased value in considering thriving dimensions (learning and vitality) separately. Challenge was not a predictor of either thriving or spillover unlike expected. Although preliminary and limited, the findings of the study can serve as a guide for future studies, and for organizations to rethink the benefits of diversity and design more age-inclusive processes. Overall, it aims to bring awareness to the topic of workplace ageism and its potential harmful effects both at work and outside.A diversidade etária no trabalho já não é opcional ou um dever, mas necessária para o funcionamento económico das sociedades. No entanto, as atitudes negativas baseadas na idade (idadismo) persistem, com importantes consequências. Esta investigação é composta por dois estudos com objetivos distintos mas relacionados. O Estudo 1 visava identificar, numa amostra portuguesa (N=123), quais os estereótipos etários mais associados a cada grupo etário. Observou-se relutância em atribuir estereótipos negativos tanto a pessoas mais jovens como a mais velhas. O Estudo 2 visava avaliar consequências do idadismo para o alvo, nomeadamente a relação entre ativações de ameaça e de desafio, e o thriving no trabalho e spillover negativo, através de dados recolhidos diariamente via app. Os dados foram recolhidos durante sete dias de trabalho através dos telemóveis dos participantes (N=44, 301 observações). Embora não tenha existido variação ao longo do tempo, impedindo análises longitudinais, encontrou-se uma associação negativa entre ameaça e prosperidade, e uma associação negativa com o spillover. Análises adicionais salientaram mais-valia em separar as dimensões de thriving (aprendizagem e vitalidade). O desafio não foi um preditor de thriving ou spillover, ao contrário do esperado. Embora preliminares e limitadas, as conclusões do estudo podem servir de guia para estudos futuros, e para as organizações repensarem os benefícios da diversidade e conceberem processos mais inclusivos em termos etários. Globalmente, pretende sensibilizar para o tema do idadismo no trabalho e os seus potenciais efeitos nocivos, tanto no trabalho como fora dele