Prevenção de quedas na pessoa idosa em ambiente hospitalar

Segundo vários autores, a ocorrência de quedas nos idosos é um dos principais fatores de mortalidade e morbilidade nesta faixa etária e a segunda causa de morte por acidentes involuntários, logo a seguir aos acidentes de viação, em Portugal e no resto do mundo. Os idosos têm um maior risco de sofrer lesões graves decorrentes de uma queda e esse risco aumenta com a idade. A evidencia diz-nos também que, anualmente, um grande número de pessoas institucionalizadas/internadas sofre quedas e esse número tende a ser maior com o aumento da idade. Em ambiente hospitalar as quedas resultam da interação de diversos fatores como as alterações no espaço físico, horários e organização dos cuidados, contribuindo para que sejam mais prevalentes do que na comunidade. Do ponto de vista económico, a ocorrência de quedas a nível institucional, especialmente quando ocorre dano/lesões, leva a um crescimento exponencial dos custos e a um aumento significativo do tempo médio de internamento, com consequências no aumento da dependência, perda de capacidade física e isolamento social. De forma a dar resposta a esta problemática, este trabalho sustentou-se no modelo de McCormack (2006), preconizado pelos cuidados centrados na pessoa, ou seja, nas suas especificidades e necessidades. Isto porque a maioria das quedas em idosos está associada a fatores identificáveis e modificáveis em que a implementação de medidas preventivas direcionadas a esses fatores de risco têm-se mostrado eficazes. Os programas de prevenção que demonstram ter melhores resultados recorrem à avaliação sistemática do risco, pilar básico na prevenção, à capacitação da pessoa idosa e família, envolvendo-os nos cuidados e na formação e supervisão da equipa. Durante os cinco meses de estágio aprofundou-se esta problemática e implementou-se um projeto de intervenção junto da equipa num serviço de medicina. A intervenção previamente desenhada e validada, baseou-se no programa TeamSTEPPS® 2.0 da AHRQ, que consiste numa estrutura baseada na evidência para otimizar o desempenho da equipa em todo o sistema de prestação de cuidados de saúde. Os resultados da intervenção apontam para uma melhoria das práticas e comportamentos da equipa na gestão do risco de queda na pessoa idosa hospitalizad

Preventing falls in hospitalized elderly: design and validation of a team intervention

The objective of the present study was the design and validation, by a panel of experts, of a team intervention to manage the risk of falls in the hospitalized elderly.info:eu-repo/semantics/publishedVersio

Evaluación de eficacia de una intervención en el equipo para prevenir caídas del anciano hospitalizado

To evaluate the effectiveness of an intervention program in practices and behaviors of a health team to prevent falls in hos pitalized elderly people. Method: This was an action, mixed-methods, and longitudinal study that applied an intervention based on TeamSTEPPS® , and organized into five domains: team training, communication, leadership, monitoring, and mutual support. The population was nurses and nursing aides who worked at the medical service of a Portuguese hospital center. Data were obtained by consulting process records and interviews, and by applying the Scale of Practices and Behaviors of Teams for Fall Prevention. Results: There was improvement in all indicators of the scale, with evident progress in discussion of risk factors and preventive measures to be implemented. Conclusion: This intervention promoted decision-making regarding the preventive measures to be applied to each elderly person and improved communication and the interest in identifying the causes of falls to prevent their recurrence.info:eu-repo/semantics/publishedVersio

Influenza seroprotection correlates with predominant circulating viruses during 2014/15 and 2015/16 seasons in Portugal

Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBACKGROUND: Population immune profile for influenza is highly affected by circulating influenza viruses, thus changing the risk of infection for influenza. This study aims to assess influenza immunity in the Portuguese population by age groups, during 2014 and 2015 and establish a relationship between seroprotection and circulating influenza viruses in 2014/15 and 2015/16 seasons. METHODS: Two cross-sectional studies were developed based on a convenience serum sample collected in June 2014 (n=626) and July 2015 (n=675) in hospitals from mainland and Azores and Madeira.Serums equally represent all age groups. Antibody titers were evaluated by HI assay for strains recommended for seasonal influenza vaccine northern hemisphere,2014/15 and 2015/2016. Seroprevalences were estimated for each strain by age group and the association with seasonal cumulative influenza-like illness (ILI) rates for influenza virus during both seasons was analised. RESULTS: In June 2014 the highest seroprotection was observed for influenza A(H3) (39.0%; 95% CI: 36.2-43.8%) and A(H1)pdm09 (29.7; 95% CI: 26.3-33.4%), with higher levels in children 5-14 years old. In 2014/2015 a dominant circulation of influenza B/Yamagata was observed with high incidence rates in individuals under 65 years old, the ones that had lower seroprotection. Although before the start of the season high protection for A(H3) was observed, the circulation of the new drift A(H3) strains had gained an immunological advantage,in accordance with A(H3) elevated incidence rates observed during 2014/15. In July 2015 the highest seroprotection was observed for influenza B/ Yamagata (55.1%; 95% CI: 51.4-58.9%), 2.4 times the estimated 2014.This increase was even more pronounced in younger (≤ 4 years old), 6.3 times increase in 2015.This fact is in agreement with the predominant influenza B virus detected and the high ILI incidence rate observed in children during 2014/2015 epidemic. Seroprotection levels for influenza A in July 2015 were not significantly different from 2014.During 2015/16 season, influenza A(H1N1)pdm09 was predominant, with high incidence rate in < 65 year old. Influenza B/Victoria lineage,although detected at low levels increased in frequency, in agreement with the lowest level of seroprotection detected in the general population before the start of 2015/2016 season (21.8%; 95% CI: 18.7-24.0%). CONCLUSIONS There was a correlation between virus circulation, incidence rates for each age group and the previous seroprotection for seasonal influenza viruses.Our study highlights the value of measuring the serological profile for influenza to establishe risk groups for infection for which an increase preventive measures, including vaccination, should be fostered.info:eu-repo/semantics/publishedVersio

ANÁLISE COMPARATIVA DO USO DE LISDEXANFETAMINA E DE METILFENIDATO NO TRATAMENTO DO TDAH

&nbsp; Considering the increasing prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and the need for effective and safe therapeutic interventions, this research aimed to conduct a comparative analysis between lisdexamfetamine and methylphenidate in the treatment of ADHD. To this end, a comprehensive qualitative literature review was conducted, using sources such as Scielo, Google Scholar, scientific journals, institutional repositories, and virtual libraries, without specific time period limitations. Thus, it was observed that both medications demonstrated efficacy in reducing ADHD symptoms. Lisdexamfetamine showed a more prolonged and consistent effect on dopaminergic neurotransmission and a potentially more favorable side effect profile, with fewer reports of severe adverse effects compared to methylphenidate. Methylphenidate, in turn, showed significant efficacy, especially in the short term. It is concluded that both lisdexamfetamine and methylphenidate are valid therapeutic options for the treatment of ADHD, with specific advantages in different clinical contexts. The choice between these medications should consider the individual characteristics of patients and the available evidence of efficacy and safety, contributing to the optimization of treatment and the improvement of the quality of life of patients with ADHD.Considerando a crescente prevalência do Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e a necessidade de intervenções terapêuticas eficazes e seguras, esta pesquisa objetivou realizar uma análise comparativa entre lisdexanfetamina e metilfenidato no tratamento do TDAH. Para tanto, procedeu-se a uma revisão bibliográfica qualitativa abrangente, utilizando fontes como Scielo, Google Acadêmico, revistas científicas, repositórios institucionais e bibliotecas virtuais, sem limitação de período específico. Desse modo, observou-se que ambos os medicamentos demonstraram eficácia na redução dos sintomas do TDAH. A lisdexanfetamina apresentou um efeito mais prolongado e consistente na neurotransmissão dopaminérgica e um perfil de efeitos colaterais potencialmente mais favorável, com menos relatos de efeitos adversos graves em comparação ao metilfenidato. O metilfenidato, por sua vez, mostrou eficácia significativa, especialmente em curto prazo. Conclui-se que tanto a lisdexanfetamina quanto o metilfenidato são opções terapêuticas válidas para o tratamento do TDAH, com vantagens específicas em diferentes contextos clínicos. A escolha entre esses medicamentos deve considerar as características individuais dos pacientes e as evidências de eficácia e segurança disponíveis, contribuindo para a otimização do tratamento e a melhoria da qualidade de vida dos pacientes com TDAH

La prevención de las caídas en ancianos hospitalizados: diseño y validación de una intervención en equipo

Objective The objective of the present study was the design and validation, by a panel of experts, of a team intervention to manage the risk of falls in the hospitalized elderly. Method The method used was a quanti-qualitative approach, using the Delphi method. The study was developed in two phases: in the first, five researchers designed the intervention; in the second, 13 professionals validated it. Results The analysis of the content of the intervention designed by the participants in the first phase of the study allowed assignment of the indicators to the following previously defined categories: team formation; communication; leadership; monitoring; and mutual support. After two rounds, all the indicators obtained a consensus higher than 80%. Conclusion The present study allowed validation of a team intervention by a panel of experts, so that teams can manage the risk of falls in hospitalized elderly. The reliability test results ensure that the intervention can be used safely in clinics and for research.Objetivo El objetivo del presente estudio fue el diseño y la validación, por un panel de expertos, de intervención en equipo para manejar el riesgo de caídas en los ancianos hospitalizados. Método El método empleado fue un abordaje cuanti-cualitativo, utilizándose el método Delphi. El estudio fue desarrollado en dos fases: en la primera, cinco investigadores diseñaron la intervención; en la segunda, 13 profesionales la validaron. Resultados El análisis del contenido de la intervención diseñada por los participantes en la primera fase del estudio permitió la evaluación de los indicadores para las siguientes categorías: formación de equipo; comunicación; liderazgo; monitoreo; y soporte mutuo. Luego de dos ruedas, todos los indicadores lograron un consenso superior al 80%. Conclusión El presente estudio permitió la validación de una intervención en equipo por un panel de expertos, a fin de que los equipos puedan manejar el riesgo de caídas en los ancianos hospitalizados. Los resultados de la prueba de confiabilidad aseguran que la intervención puede emplearse de modo seguro en la clínica y para investigación.Objetivo O objetivo do presente estudo foi a elaboração e validação, por um painel de especialistas, de intervenção em equipe para lidar com o risco de quedas nos idosos hospitalizados. Método O método usado foi uma abordagem quanti-qualitativa, utilizando o método Delphi. O estudo foi desenvolvido em duas fases: na primeira, cinco pesquisadores elaboraram a intervenção; na segunda, 13 profissionais a validaram. Resultados A análise do conteúdo da intervenção elaborada pelos participantes na primeira fase do estudo permitiu a avaliação dos indicadores para as seguintes categorias definidas previamente: formação de equipe; comunicação; liderança; monitoramento; e suporte mútuo. Após duas rodadas, todos os indicadores obtiveram um consenso superior a 80%. Conclusão O presente estudo permitiu a validação de uma intervenção em equipe por um painel de especialistas, para que as equipes possam lidar com o risco de quedas nos idosos hospitalizados. Os resultados do teste de confiabilidade garantem que a intervenção pode ser usada de forma segura na clínica e para pesquisa

Preventing falls in hospitalized elderly: design and validation of a team intervention

ABSTRACT Objective The objective of the present study was the design and validation, by a panel of experts, of a team intervention to manage the risk of falls in the hospitalized elderly. Method The method used was a quanti-qualitative approach, using the Delphi method. The study was developed in two phases: in the first, five researchers designed the intervention; in the second, 13 professionals validated it. Results The analysis of the content of the intervention designed by the participants in the first phase of the study allowed assignment of the indicators to the following previously defined categories: team formation; communication; leadership; monitoring; and mutual support. After two rounds, all the indicators obtained a consensus higher than 80%. Conclusion The present study allowed validation of a team intervention by a panel of experts, so that teams can manage the risk of falls in hospitalized elderly. The reliability test results ensure that the intervention can be used safely in clinics and for research

Evaluation of the effectiveness of an intervention in a health team to prevent falls in hospitalized elderly people

ABSTRACT Objective: To evaluate the effectiveness of an intervention program in practices and behaviors of a health team to prevent falls in hos pitalized elderly people. Method: This was an action, mixed-methods, and longitudinal study that applied an intervention based on TeamSTEPPS®, and organized into five domains: team training, communication, leadership, monitoring, and mutual support. The population was nurses and nursing aides who worked at the medical service of a Portuguese hospital center. Data were obtained by consulting process records and interviews, and by applying the Scale of Practices and Behaviors of Teams for Fall Prevention. Results: There was improvement in all indicators of the scale, with evident progress in discussion of risk factors and preventive measures to be implemented. Conclusion: This intervention promoted decision-making regarding the preventive measures to be applied to each elderly person and improved communication and the interest in identifying the causes of falls to prevent their recurrence

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved