Mobilidade funcional, risco de queda, nível de actividade física e percepção de saúde em indivíduos com 65 ou mais anos

RESUMO:O objectivo deste estudo foi analisar a relação entre mobilidade funcional, risco de queda, nível de actividade física e percepção de saúde de 34 indivíduos praticantes (n=18) e não praticantes (n=16) de exercício físico duas ou mais vezes por semana durante pelo menos 45 minutos, residentes na comunidade e ambulatórios. Tipo de estudo: transversal exploratório-descritivo. Metodologia: foi feito um levantamento das variáveis de caracterização (idade, sexo, habilitações literárias, situação sócio-económica, situação familiar) e do estado cognitivo e estado emocional/depressão (Mini-Mental State Examination e Geriatric Depression Scale). As variáveis em análise foram: a mobilidade funcional avaliada através do Timed up and GoTest, o risco de queda medido com o Funtional Reach Test, o nível de actividade física avaliado através do Questionário Internacional de Actividade Física (IPAQ) e a percepção de saúde medida através do SF-6D. Foi também questionada a prática de alguma modalidade de exercício físico, da sua frequência e duração. Os dados foram analisados através de estatística descritiva, foi realizada uma regressão linear múltipla e uma análise bivariada das correlações, utilizando o coeficiente de correlação linear de Pearson (p ≤ 0,05).Resultados: verificou-se que, na amostra global, a maioria dos indivíduos apresentou uma mobilidade funcional considerada normal (TUG<10 segundos), e um risco de queda moderado (FRT entre 15,24 e 25,40 cm), embora sem diferenças entre os grupos em análise. A actividade física apresentou uma duração média de 685,88±540,16 minutos por semana, sendo que 18 indivíduos praticavam exercício físico pelo menos 45 minutos e duas ou mais vezes por semana.A percepção do estado de saúde foi bastante satisfatória, sendo a pontuação média do SF-6D de 0,915±0,067. A análise entre grupos demonstrou que o grupo que praticava exercício físico apresentava um maior número de indivíduos na faixa etária dos 65-74 anos, tinha mais escolarização e melhor estado cognitivo. Estes indivíduos eram fisicamente mais activos e faziam-o, na sua maioria, com uma frequência bissemanal, apenas um desempenhando uma modalidade de intensidade vigorosa. A análise estatística demonstrou que: a mobilidade funcional e o risco de queda eram mais desfavoráveis nos indivíduos com mais idade; o estado cognitivo estava associado a maior mobilidade funcional; uma boa mobilidade funcional correspondeu a um risco de queda reduzido, a mais prática de actividade física, a melhor percepção do estado de saúde e a manutenção do estado cognitivo. Os indivíduos com menor risco de queda apresentaram melhor estado cognitivo e emocional. E este último correspondeu a uma melhor percepção do estado de saúde e a um melhor estado cognitivo. Conclusão: a manutenção da mobilidade funcional reduz o risco de queda aumenta a prática de actividade física e melhora a percepção de saúde de indivíduos com 65 ou mais anos residentes na comunidade.--------- ABSTRACT: Objective: the aim of this study was to analyze the relationship between functional mobility, falls risk, level of physical activity and health perception in a sample of 34 subjects, 18 that practice exercise two or more times a week for at least 45 minutes and 16 that don’t practice exercise, residents and community. Designs: cross-sectional exploratory-descriptive survey. Methods: descriptive variables are age, sex, education, socio-economic level, family status, cognitive status (Mini-Mental State Examination) and emotional status/depression (Geriatric Depression Scale). We analyze the functional mobility with the Timed up and Go Test, the falls risk with Functional Reach Test, the level of physical activity with the International Physical Activity Questionnaire (IPAQ) and health perception with SF-6D. We also questioned the practice of exercise, their frequency and duration. Data were analyzed using descriptive statistics, a multiple linear regression analysis and bivariate correlations, using the linear correlation coefficient of Pearson (p ≤ 0.05). Results: we found that, in the total sample, most individuals had considered a normal functional mobility (TUG <10 seconds), and a moderate falls risk (FRT between 15.24 and 25.40 cm), but no difference between groups. Physical activity showed an mean of 685.88 ± 540.16 minutes per week, with 18 individuals pratice physical exercise at least 45 minutes and two or more times per week. The mean score of the SF-6D was 0.915 ± 0.067 and the perception of health was satisfactory. The analysis between groups showed that the group that practice physical exercise had a greater number of individuals aged 65-74 years, had more schooling and better cognitive status. These subjects were more physically active and mostly did it two times a weak and only one playing a kind of vigorous intensity. The multiple linear regression and correlations, using the linear correlation coefficient of Pearson (p≤0.05) showed that: functional mobility and fall risk decrease with age increase. The cognitive status was associated with greater functional mobility, a good functional mobility corresponded to a reduced falls risk, more physical activity, a better perception of health status and maintenance of cognitive status. Subjects with lower falls risk had better cognitive and emotional state. And subjects with a better emotional status have a better health perception and better cognitive status. Conclusion: the maintenance of functional mobility reduces falls risk, increase physical activity and improves health perception of individuals with 65 years or older living in the community

The Lockdown Impact on the Relations between Portuguese Parents and Their 1- to 3-Year-Old Children during the COVID-19 Pandemic

Funding Information: In Portugal, during the first lockdown, with few exceptions, families with children under 12 years old were given a choice. One parent could suspend his/her professional activity temporarily and receive financial support from the National Social Security System []. Most families, especially those with little children, chose this option. Publisher Copyright: © 2022 by the authors.Many countries have applied mandatory confinement measures in response to the COVID-19 pandemic, such as school and kindergarten closures, which confined families to their homes. The study concerns the impacts of the first COVID-19 lockdown on the relationships between Portuguese parents and their children, in a non-clinical population composed of fathers and mothers of children between the ages of 12 months and 3 years and 364 days. An online questionnaire (set by the research team) and the Parenting Daily Hassles Scale (PDHS) concerning the confinement period were applied between 17 June and 29 July 2020. To assess the impacts of the lockdown, outcomes regarding the impacts perceived by the parents, the potential regression in the development of children, and the willingness to promote changes in family routines in the future, were considered. Of the total sample (n = 1885), 95.4% of the parents (n = 1798) said that, after confinement, the relationship with their children had improved or remained similar to the pre-confinement period; 97.3% (n = 1835) noticed positive changes in the development of their children, and 63.7% (n = 1200) noted that the relationships with their children during the confinement period would lead to some changes in family routines in the future. Multivariate regression analyses showed that most of the sociodemographic variables chosen were not associated with the outcomes. However, significant levels of pressure over parenting and parental overload (reported by high scores in the PDHS intensity and frequency scales), challenging behaviors of the children, and the impacts they had on parental tasks had negative influences on the studied outcomes. On the contrary, the number of adults living with their children, the perceptions regarding the development of their children, and sharing new experiences with them were significant factors for positively-perceived impacts on the relationships between them or in the desire to bring about changes in family routines in the future. The impacts of the lockdown on the relationships between parents and children aged between 1 and 3 years old were more dependent on relational aspects and on the parents’ sense of competence in exercising parental functions. We conclude that, despite the increased demands imposed by the lockdown, nearly all of the parents evaluated the quality of the relationship with their children as positive after this period.publishersversionpublishe

Programa Mais Família Mais Jovem: estudo exploratório em contexto clínico

Introdução: A crescente prevalência dos Problemas de Comportamento na Infância e Adolescência tem motivado a procura de respostas que permitam a sua prevenção, e intervenção, na prática clínica de Pedopsiquiatria. Do mesmo modo que sabemos que as interações familiares desadequadas podem fortalecer a sua ocorrência, tem sido realçado o papel crucial dos pais e cuidadores como agentes de mudança na intervenção pluridisciplinar concernente a estas perturbações. As intervenções parentais em grupo de forma estruturada e sustentada, baseadas na promoção de Parentalidade positiva, apresentam-se como uma medida de implementação promissora, neste âmbito. Objetivos: Apurar as principais mudanças obtidas com o programa Mais Família, Mais Jovem, aplicado ao longo de doze semanas com sessões de duas horas semanais, numa amostra clínica de pais de crianças acompanhadas em consulta de segunda infância de pedopsiquiatria (população de três a doze anos), Hospital Dona Estefânia, Lisboa. Métodos: Antes e após a implementação do programa procedeu-se à aplicação de um conjunto de instrumentos (Questionário de Capacidades e de Dificuldades: versão mãe/pai; Índice de Parentalidade Autorizada: versão pai/mãe) que permitem avaliar a eficácia da implementação do mesmo. A avaliação e discussão dos resultados foi ainda estendida a um período de follow-up a três meses. Resultados e Conclusões: A participação dos pais na intervenção traduz-se numa melhoria percecionada, em todos os tempos de avaliação, das suas práticas de aceitação e apoio aos filhos, assim como na redução da noção de sobrecarga parental. Estes dados suportam a evidência apontada pelo programa, no desenvolvimento de padrões de relacionamento saudáveis com os filhos, no exercício da autoridade, diálogo, respeito e educação pelo afeto, permitindo a aquisição de competências parentais nestes domínios. De acordo com o esperado, também os problemas externalizantes das crianças e a avaliação global das suas dificuldades evidenciam uma redução sustentada. A principal limitação encontrada foi a reduzida dimensão da amostra, pelo que estes resultados suportam a necessidade de maior investimento na aplicação do programa nos serviços de Psiquiatria da Infância e da Adolescência, bem como a realização de mais estudos para confirmar a sua eficácia

Unidade de Internamento Psiquiátrico para Jovens dos 15 aos 25 Anos: Um Estudo de Follow-up

Introduction: Adolescence and early adulthood are life stages characterized by significant physical, psychological, and social transformations. The transitional age, between 15 and 25 years old, is considered a high-risk period for the development of psychopathology, representing a critical period of opportunities and challenges for mental health intervention. Our objective was to do 4-year follow-up study was conducted on young individuals who were hospitalized during the year 2018 in the acute psychiatric inpatient unit Unidade Partilhada, dedicated to individuals aged 15 to 25 years old. The aim was to assess the sociodemographic and clinical characteristics of the sample, inpatient characteristics, rehospitalization rate, psychopathological status, quality of life, satisfaction with the provided care, and maintenance of follow-up appointments; establishing relationships between the mentioned variables. Methods: Standardized telephone interviews were conducted using the reduced version of the Mental Health Inventory (MHI) and the World Health Organization’s Abbreviated Instrument for Quality of Life Assessment. Clinical records were also consulted. Results: There was a higher percentage of female patients (52.1%). The discharge diagnosis of mood disorders (54.3%) was significantly higher in females, while psychotic disorders (23.4%) were significantly higher in males (Fisher = 40; p&lt;0.001). The duration of hospitalization (average=16.1 days; SD=13.6 days) was significantly longer for psychotic disorders compared to mood disorders (p=0.009). A percentage of 41.5% of young individuals were readmitted, with 6.3% readmitted within 30 days and 35.2% readmitted within 365 days. At the time of the follow-up interview, 80.9% considered themselves “better,” and 62.7% reported being “satisfied” or “very satisfied” with their lives. A percentage of 74.5% continued to receive outpatient care, with significantly lower MHI scores observed among individuals without current follow‐up. A percentage of 37.2% reported being “very satisfied” or “extremely satisfied” with the care provided. Conclusion: Obtaining knowledge and data that allow for the characterization of psychiatric hospitalization during the transitional age is fundamental for the planning, organization, and optimization of care provided to this population. Valuing patient opinions and fostering closer relationships between healthcare professionals and young patients promotes treatment adherence.Introdução: A adolescência e início da idade adulta, são fases do ciclo de vida marcadas por grandes transformações físicas, psicológicas e sociais. A faixa etária de transição, entre os15 e 25 anos, é considerada uma idade de risco para o desenvolvimento de psicopatologia, representando um período crítico de oportunidades e desafios para a intervenção em saúde mental. O nosso objetivo foi realizar um estudo de follow-up a 4 anos dos jovens internados durante o ano de 2018 na unidade de internamento agudo psiquiátrico Unidade Partilhada, destinado a jovens dos 15 aos 25anos de idade; pretendeu‐se avaliar as características sociodemográficas e clínicas da amostra, as características do internamento, a taxa de reinternamento, o estado psicopatológico, qualidade de vida, grau de satisfação com os cuidados prestados e manutenção do seguimento em consulta; estabelecendo relações entre as variáveis mencionadasMétodos: Entrevista telefónica padronizada, com aplicação da versão reduzida do Mental Health Inventory (MHI) e o Instrumento Abreviado de Avaliação da Qualidade de Vida da Organização Mundial de Saúde; consulta de processo clínico.Resultados: Há uma maior percentagem de doentes do sexo feminino (52,1%). O diagnóstico de alta de perturbaçãodo humor (54,3%) foi significativamente superior no sexo feminino e o de perturbação psicótica (23,4%) foi significativamente superior no sexo masculino (Fisher= 40; p&lt;0,001). A duração do internamento (média=16,1 dias; DP=13,6 dias) foi significativamente superior para as perturbações psicóticas em comparação com as perturbações do humor (p=0,009). Dos jovens, 41,5% foram readmitidos, 6,3% num período inferior a 30 dias e 35,2% num período inferior a 365 dias. À data da entrevista de follow-up, 80,9% consideram estar “melhor”; e 62,7% estar “satisfeitos”ou “muito satisfeitos” com a sua vida. Mantêm acompanhamento em consulta 74,5%, sendo a pontuação do MHI significativamente inferior nos jovens sem seguimento atual. Referem estar “muito satisfeitos” ou “mais que muito” com o atendimento prestado, 37,2%.Conclusão: O conhecimento e obtenção de dados que permitam a caracterização do internamento psiquiátrico em idade de transição é fundamental para a planificação, organização e otimização dos cuidados prestados a esta população. A valorização da opinião do doente e a aproximação entre profissionais de saúde e doentes jovens, favorece a adesão ao tratamento

Networking and Participatory Research Promoting Quality of Life and Well-Being in Portuguese-Speaking African Countries

Spread across the planet each human being, individually or in community, aspires for well-being and quality of life, according to the ideal of each one. However, we all believe that there are always ways to live better. For many people the measurement of a better life translates into the guarantee of social rights, the right to basic services, good land, seed and sufficient nutritious food for their community members. The Mechanism to Facilitate the Participation of Universities in the Food and Nutrition Security Council of the Community of Portuguese Speaking Countries is a cooperative academic network fomented by the Community of Portuguese Speaking Countries (CPLP) with support from the Food and Agriculture Organization of the United Nations. This mechanism works with teaching, research and extension in the CPLP Food and Nutrition Security Strategy. The pillars of CPLP Strategy are the strengthening of the governance of public policies on Food and Nutrition Security at all levels of government, social protection based on guaranteeing access to food and family farming with a strategy to increase the availability of good quality food, promoting social and environmental sustainability. CPLP University Mechanism has provided training processes for technicians who work in public policies for Food and Nutrition Security and has contributed to the strengthening of postgraduate programs in Portuguese-speaking African countries. As consequence, it has favored participatory research and mixed methods as a theoretical methodological approach. Therefore, it seeks to focus on the territories of Food and Nutrition Security practices to transform reality, as recommended by CPLP Strategy, however, with the autonomous assumptions of the collaborative network. This chapter presents how local researchers perceive the results of a process of inducing an academic network to transform the local reality and promote Food and Nutrition Security in the context of the CPLP

Leer en comunidad: creación y desarrollo de clubes de lectura de literatura escrita por mujeres dentro y fuera de la universidad

Depto. de Lengua Española y Teoría de la LiteraturaFac. de FilologíaFALSEsubmitte

Leer en comunidad: creación de clubes de lectura de literatura escrita por mujeres en la universidad

Depto. de Lengua Española y Teoría de la LiteraturaFac. de FilologíaFALSEUniversidad Complutense de Madridsubmitte

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Endoscopic Management of Colonic Perforation due to Ventriculoperitoneal Shunt: Case Report and Literature Review

The authors report the case of a 41-year-old woman with a colonic perforation due to a ventriculoperitoneal shunt (VPS) catheter. Left-sided colonic perforation was diagnosed by abdominal computed tomography 28 years after shunt placement, following acute meningitis caused by Escherichia coli. The proximal end of the VPS was exteriorized and it was decided to remove the distal end by colonoscopy. After pulling out the catheter with a polypectomy snare, it broke at the site where it was entering the colon, leaving a small perforation in the colonic wall which was closed with 2 endoclips. The endoluminal fragment of the catheter, being 20 cm in length, was removed through the rectum. The patient is asymptomatic at the 12-month follow-up. A review of the literature regarding 9 endoscopically managed cases of digestive tract perforation caused by VPS is presented