Orthogeriatric management: Improvements in outcomes during hospital admission due to hip fracture

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery

Comportamiento del polietileno en un simulador de cadera

Se presentan los resultados del comportamiento friccional de cinco diferentes combinaciones de cabezas protésicas femorales y polietileno acetabular, investigadas en un simulador de cadera. Las cabezas femorales de aleaciones de Cr-Co-Mo, Cr-Co-Mo con implantación iónica y de cerámica de zirconia, se articularon con cotilos de polietileno de ultra-alto-peso molecular y se sometieron a tres millones de ciclos de marcha cada uno, utilizando un simulador de cadera de cinco estaciones. El desgaste de los cotilos protésicos, evaluado por mediciones gravimétricas demostró que cuando el espesor de polietileno era de 10,9 mm el desgaste producido por cabezas de Cr-Co-Mo de 28 mm era de 0,14 mm/año y de 0,09 mm/año si la cabeza utilizada era de 28 mm de aleación de Cr-Co- Mo con implantación iónica. Cuando el espesor del acetábulo era de 7 mm el desgaste ocasionado por cabezas de cerámica de zirconia de 28 mm fue de 0,04 mm/año; sin embargo si tenía espesor 10,9 mm y las cabezas de cerámica de zirconia eran de 28 y 32 mm, no aparecía desgaste alguno. Estos resultados indican que el diámetro de la cabeza de cerámica de 28 y 32 mm, parece no tener importancia alguna, pero sí la tiene el que el espesor del acetábulo protésico sea menor de 10 mm.Ultra high molecular weight polyethylene (UHMWPE) metal backed acetabular cups were articulated against Cr-Co-Mo alloy, ion implanted Cr-Co-Mo and zirconia ceramic femoral heads in a five station hip joint simulator, running three tests of three millions walking cycles with each one of the five different head-cup combinations. The wear rate of the acetabular cups was measured gravimetrically. When the thickness of the cup was 10.9 mm, the mean wear rate against 28 mm diameter Cr-Co-Mo femoral heads was 0.14 mm/year, and 0.09 mm/year 'when the cup was articulated against 28 mm ion implanted Cr-Co-Mo femoral heads. When the thickness of the cup was 7 mm the mean wear rate was 0.04 mm/year against 28 mm zirconia heads. The results indicate that significant reduction in the wear of the UHMWPE cup can be achieved when zirconia femoral head is used and that the diameter of the zirconia femoral head, 28 vs 32 mm, seems unimportant as wear factor. A cup thickness below 10 mm may result disadvantageous

Determinação da Carga Alergénica (Ole e1) Presente no Ar Atmosférico na Região de Évora: Correlação com o conteúdo polínico de Olea

Introdução: Em Portugal, o pólen da oliveira (Olea europaea) constitui uma das fontes mais relevantes de aero-alergénios, sendo uma causa frequente de polinose na região Mediterrânica, onde o Ole e 1 é um alergeno major. Apesar de se julgar apenas associado aos grãos de pólen, desconhece-se a variabilidade inter-anual da carga alergénica do pólen e ainda existe alguma controvérsia sobre a forma como este aeroalergeno se distribui no ar atmosférico. Objectivo: Este trabalho teve como objectivos: i) determinar a fracção dos bioaerossóis mais rica em Ole e 1; ii) avaliar a correlação dos conteúdos diários de pólen e aeroalergeno no ar atmosférico; iii) avaliar variação anual da carga alergénica do pólen. Métodos: Os aeroalergenos foram captados utilizando um colector de impacto CHEMVOL equipado com dois filtros com capacidade para reter partículas de diferentes dimensões: PM>10µm e 10µm>PM>2,5µm. Após 24h os filtros foram retirados, a fracção proteica foi extraída e os alergenos quantificados por ELISA. Simultaneamente o pólen foi monitorizado pela tecnologia padrão utilizando um colector volumétrico Burkard 7-Day Recording Volumetric Spore Trap. Os colectores foram ambos colocados numa mesma plataforma a 17m de altura, e a ≈3-4m um do outro. Resultados: Entre 2009 e 2011, registou-se uma variação inter-anual quer do perfil quer da duração da época polínica (39, 47 e 45 dias, respectivamente). O conteúdo polínico total no ar atmosférico também foi variável no intervalo de 7240 a 12524 grãos/m3. Mais de 90% do alergeno foi encontrado na fracção de bioaerossóis de PM>10µm. O conteúdo em Ole e 1 foi directamente proporcional ao número de grãos de pólen no ar atmosférico, tendo-se encontrado uma correlação positiva entre os valores diários dos dois parâmetros. Comparando as épocas estudadas, os conteúdos totais de Ole e1 e de pólen não foram proporcionais, tendo-se observado que a carga alergénica por grão de pólen variou mais de 3x. Conclusões: Estes resultados sugerem que o Ole e 1 está preferencialmente associado aos grãos de pólen. Os conteúdos em pólen e Ole e 1 variaram inter-anualmente, tendo a carga alergénica dos grãos de pólen sido diferente. Este trabalho poderá assim contribuir para o desenvolvimento de um indicador que permita melhorar a previsão do risco de exposição a aeroalergenos. Agradecimentos: Este foi realizado no âmbito do projecto europeu HIALINE (Executive Agency for Health and Consumers, grant agreement No 2008 11 07)

Allergenic Airborne Pollen in Portugal 2002-2004

Os calendários polínicos constituem instrumentos fundamentais para a orientação clínica de doentes alérgicos. Em Portugal, a sua elaboração de forma sistematizada teve início em 2002. Para tal foram colocados polinómetros volumétricos Burkard em cinco cidades do país: Porto, Coimbra, Lisboa, Évora e Portimão. O registo das contagens foi efectuado por método estandardizado. As contagens polínicas diárias expressam a concentração média por m3. Estas contagens foram objecto de análise descritiva e comparativa. O período de incidência polínica máxima decorre entre Março e Julho, sendo o pólen de Poaceae e de ervas silvestres os mais frequentemente identificados. Em Janeiro, Fevereiro e Dezembro existem níveis elevados de pólen de árvores em todo o território nacional. O Sul do país apresenta indicadores de polinização mais intensa

Integrated Continuous Healthcare Team Computer System Architecture

A computer-based pattern recognition system architecture destined to collect and process geographically referenced data about integrated continuous healthcare teams (ECCI) is presented and discussed in the chapter. These teams are part of Portugal's National Network of Integrated Continuous Care (RNCCI). The system is designed to collect data about the displacement of each team during healthcare assistance. The pattern recognition system handles information about the costs related to the provided healthcare. The architecture is designed around open source software resources. Virtual machines and container-based technologies provide hardware independence. The Python programming language ecosystem is chosen for all the main components of the s

Poor disability outcomes in the management of Low Back Pain patients in Portugal

Trabalho apresentado em 10th Interdisciplinary World Congress on Low Back & Pelvic Girdle Pain, 28-31 de outubro 2019, Antuérpia, BélgicaN/

How to Delineate the General Profiles of Functionality of Citizen’s Aged 65 Years and Old as a Function of Its Age

Objectives: A core set of International Classification of Functioning, Disability and Health codes was used, to ascertain the general profile of functionality as a function of biological and sociodemographic characteristics, notably the age of the citizens. Methods: Data were collected by health professionals in the participants’ houses. The factorial validity of the construct was assessed by a confirmatory factor analysis. An ordinal regression model was built to identify the general profile of functionality as a function of age. Results: It is expected that people under the age of 74 years will present no functional problems and that, after age 74, the most likely functionality problem will be a “MILD problem”. Discussion: The functional profile of each elderly is interrelated with his or her sociodemographic context as well as with the overarching biological, cultural, and environmental characteristics of society. A progressive decrease in GPF occurs with age. Conclusions: The evaluation of each person (even those with no perceived or incipient levels of functional impairment who are at risk of progressing to a more severe disability) about what are the factors that are related with this functional decline as people get older, allows identify the respective nursing interventions to be developed

Estuarine ecological risk based on hepatic histopathological indices from laboratory and in situ tested fish

Juvenile Senegalese soles were exposed through 28-day laboratory and field (in situ) bioassays to sediments from three sites of the Sado estuary (W Portugal): a reference and two contaminated by metallic and organic contaminants. Fish were surveyed for ten hepatic histopathological alterations divided by four distinct reaction patterns and integrated through the estimation of individual histopathological condition indices. Fish exposed to contaminated sediments sustained more damage, with especial respect to regressive changes like necrosis. However, differences were observed between laboratory- and fieldexposed animals, with the latest, for instance, exhibiting more pronounced fatty degeneration and hepatocellular eosinophilic alteration. Also, some lesions in fish exposed to the reference sediment indicate that in both assays unaccounted variables produced experimental background noise, such as hyaline degeneration in laboratory-exposed fish. Still, the field assays yielded results that were found to better reflect the overall levels of contaminants and physico-chemical characteristics of the tested sediments.info:eu-repo/semantics/publishedVersio

Psychometric Qualities of a Core Set to Ascertain the Functional Profile of Portuguese Elderly Citizens

psychometric qualities of a core set composed initially of 31 codes and extracted from International Classification of Functioning, Disability and Health, to ascertain the Functional Profile of Portuguese Elderly Citizens, residing in their own home or at a family or friends’ home. Methods: Cross-sectional, descriptive study, with a final sample totaled 351 elderlies. Data collected by health professionals in the participants’ houses, using the Elderly Nursing Core Set questionnaire. Results: The recommendation of the construct to the EFA was “excellent”. Regarding reliability, the construct revealed factorial reliability. In terms of validity, the construct presented factorial validity and convergent validity, although failing regarding discriminant validity. Discussion: Comparing psychometric qualities between the original Elderly Nursing Core Set previously applied to institutionalized citizens in relation to the one presented in this paper (citizens residing in their own home or at a family or friends’ home), lead to five latent factors and differences between functional profiles. More than half of the citizens are married and almost half of the sample never went to school, thus revealing an important aspect characterizing a lower literacy level of the citizens involved in this research. Conclusions: The work based on Core Sets extracted from the International Classification of Functioning, Disability and Health, delineated to assess the nursing care needs and/or the outcomes of nursing interventions of citizens aged 65 years old or older, will be an ongoing process that will lead to the promotion of an Healthy Ageing and functional ability, as stated by World Health Organization