A inovação social nas políticas públicas de proximidade

Este trabalho aborda a inovação social ao nível das iniciativas desenvolvidas pelas Juntas de Freguesia. A inovação social procura encontrar soluções para as necessidades/problemas sociais que, não sendo asseguradas pelo Estado (Governo Central), nem pelo mercado, podem ser implementadas via políticas públicas de proximidade de uma autarquia (Câmara Municipal ou Junta de Freguesia). Com a presente investigação pretende-se, por um lado, conhecer os principais problemas que são colocados às Juntas de Freguesia na sua relação de proximidade com a população, e por outro, descrever e analisar alguns projetos desenvolvidos e os seus impactos na população alvo. Os resultados do estudo mostram que a sensibilidade social dos autarcas é uma condição determinante para o desenvolvimento de projetos sociais. A análise custobenefício simples permite concluir que os projetos sociais desenvolvidos recolhem da população uma apreciação bastante favorável, atendendo quer à importância que lhe atribuem, quer à predisposição para comparticipação; Social Innovation in the Local Public Policies ABSTRACT: This study is concerned with social innovation at the level of the initiatives developed by four town councils [translation of “Juntas de Freguesia”], and it aims to present a global vision on the initiatives of social nature developed by these town councils. The choice of this theme of social innovation is justified by: i) the interest in the new attributions and competences of the Town Councils and their increasing intervention in the social area and ii) to the need to know the process of intervention in the local community. The results of the study point out the social sensitivity of the local authorities as a determining condition for the development of social projects with effective impacts to the real needs and expectations of the population. Through the simple cost-benefit analysis we observe that the developed social projects collect from the population a very favorable appreciation considering both the importance they attribute to it and the predisposition that they demonstrate to share the costs

The prevalence of malnutrition according to the new ESPEN definition in four diverse populations

© 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.Background & aims: Consensus on the definition of malnutrition has not yet been reached. Recently, The European Society for Clinical Nutrition and Metabolism (ESPEN) proposed a consensus definition of malnutrition. The aim of the present study was to describe the prevalence of malnutrition according to the ESPEN definition in four diverse populations. Methods: In total, 349 acutely ill middle-aged patients, 135 geriatric outpatients, 306 healthy old individuals and 179 healthy young individuals were included in the study. Subjects were screened for risk of malnutrition using the SNAQ. The ESPEN definition of malnutrition, i.e. low BMI (< 18.5 kg/m2) or a combination of unintentional weight loss and low FFMI or low BMI was applied to all subjects. Results: Screening identified 0, 0.5, 10 and 30% of the healthy young, the healthy old, the geriatric outpatients and the acutely ill middle-aged patients as being at risk of malnutrition. The prevalence of malnutrition ranged from 0% in the healthy young, 0.5% in healthy old individuals, 6% in the geriatric outpatients to 14% in the acutely ill middle-aged patients. Prevalence of low FFMI was observed in all four populations (14-33%), but concurred less frequently with weight loss (0-13%). Conclusions: Using the ESPEN definition, 0%-14% malnutrition was found in the diverse populations. Further work is needed to fully address the validity of a two-step approach, including risk assessment as an initial step in screening and defining malnutrition. Furthermore, assessing the predictive validity of the ESPEN definition is needed

Resilience to cognitive impairment in the oldest-old: design of the EMIF-AD 90+ study

BACKGROUND: The oldest-old (subjects aged 90 years and older) population represents the fastest growing segment of society and shows a high dementia prevalence rate of up to 40%. Only a few studies have investigated protective factors for cognitive impairment in the oldest-old. The EMIF-AD 90+ Study aims to identify factors associated with resilience to cognitive impairment in the oldest-old. In this paper we reviewed previous studies on cognitive resilience in the oldest-old and described the design of the EMIF-AD 90+ Study. METHODS: The EMIF-AD 90+ Study aimed to enroll 80 cognitively normal subjects and 40 subjects with cognitive impairment aged 90 years or older. Cognitive impairment was operationalized as amnestic mild cognitive impairment (aMCI), or possible or probable Alzheimer's Disease (AD). The study was part of the European Medical Information Framework for AD (EMIF-AD) and was conducted at the Amsterdam University Medical Centers (UMC) and at the University of Manchester. We will test whether cognitive resilience is associated with cognitive reserve, vascular comorbidities, mood, sleep, sensory system capacity, physical performance and capacity, genetic risk factors, hallmarks of ageing, and markers of neurodegeneration. Markers of neurodegeneration included an amyloid positron emission tomography, amyloid β and tau in cerebrospinal fluid/blood and neurophysiological measures. DISCUSSION: The EMIF-AD 90+ Study will extend our knowledge on resilience to cognitive impairment in the oldest-old by extensive phenotyping of the subjects and the measurement of a wide range of potential protective factors, hallmarks of aging and markers of neurodegeneration. TRIAL REGISTRATION: Nederlands Trial Register NTR5867 . Registered 20 May 2016

The Effect of Complex Interventions on Depression and Anxiety in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Background Depression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective. Methods and Findings Systematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n = 2063) were included in the meta-analysis. Overall, psychological and/or lifestyle interventions were associated with small reductions in symptoms of depression (standardised mean difference −0.28, 95% confidence interval −0.41 to −0.14) and anxiety (standardised mean difference −0.23, 95% confidence interval −0.38 to −0.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference −0.47, 95% confidence interval −0.66 to −0.28), and for anxiety (standardised mean difference −0.45, 95% confidence interval −0.71 to −0.18). Conclusions Complex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population

Through the lens of slavery: Dutch Sri Lanka in the eighteenth century

OBJECTIVES: To describe the current knowledge and practice of sarcopenia diagnosis and treatment among health-care professionals before, directly after and 6 months after a professional development event on sarcopenia. METHODS: This longitudinal study included Australian and New Zealand health-care professionals who completed questionnaires on knowledge, practice and barriers regarding sarcopenia before, directly after and 6 months after attending a professional development event on sarcopenia. RESULTS: A total of 250 professionals participated; 84 completed the 6-month questionnaires. Before, directly after and at 6 months, respectively, 14.7%, 93.4% and 59.5% identified sarcopenia as a disease; 2.0%, 79.6% and 38.1% correctly answered the sex-specific cut-offs for low handgrip strength. Respectively, 12.0% and 14.3% reported to make sarcopenia diagnoses as part of their practice before and at 6 months. CONCLUSIONS: Knowledge about sarcopenia is limited among health-care professionals who attended a professional development event. Retention of knowledge remains a challenge to be addressed

The use of a portable metabolic monitoring device for measuring RMR in healthy adults

Objective measurement of RMR may be important for optimal nutritional care but is hindered by the price and practicality of the metabolic monitoring device. This study compared two metabolic monitoring devices for measuring RMR and VO2 and compared the measured RMR with the predicted RMR calculated from equations. RMR was measured using QUARK RMR (reference device) and Fitmate GS (COSMED) in a random order for 30 min, each on fasted participants. In total, sixty-eight adults participated (median age 22 years, interquartile range 21-32). Pearson correlation showed that RMR (r 0·86) and VO2 (r 0·86) were highly correlated between the two devices (P < 0·05). Intraclass correlation coefficients (ICC) showed good relative agreements regarding RMR (ICC = 0·84) and VO2 (ICC = 0·84) (P < 0·05). RMR measured by QUARK RMR was significantly higher (649 (sd 753) kJ/d) than Fitmate GS. Equations significantly overpredicted RMR. Accurate RMR (i.e. within ±10 % of the RMR measured by QUARK RMR) was found among 38 % of the participants for Fitmate GS and among 46-68 % depending on the equations. Bland-Altman analysis showed a low absolute agreement with QUARK RMR at an individual level for both Fitmate GS (limits of agreement (LOA): -828 to +2125 kJ/d) and equations (LOA ranged from -1979 to +1879 kJ/d). In conclusion, both Fitmate GS and predictive equations had low absolute agreements with QUARK RMR at an individual level. Therefore, these limitations should be considered when determining RMR using Fitmate GS or equations

Is being malnourished according to the ESPEN definition for malnutrition associated with clinically relevant outcome measures in geriatric outpatients?

10.1007/S41999-018-0057-zEUROPEAN GERIATRIC MEDICINE93389-39

White matter hyperintensities are related to pain intensity in an outpatient memory clinic population: preliminary findings

Tarik T Binnekade,1 Roberto SGM Perez,2 Andrea B Maier,3 Hanneke FM Rhodius-Meester,4 Nienke Legdeur,5 Marijke C Trappenburg,6,7 Didi Rhebergen,8&ndash;10 Frank Lobbezoo,11,12 Erik JA Scherder11Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands; 2Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands; 3Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia; 4Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 5Department of Neurology, Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, Netherlands; 6Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands; 7Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands; 8Department of Psychiatry, GGZ inGeest, Amsterdam, The Netherlands; 9Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; 10Department of Mental Health, Amsterdam UMC, Amsterdam, The Netherlands; 11Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 12MOVE Research Institute Amsterdam, Amsterdam, The NetherlandsBackground: The association between pain and dementia is complicated and may depend on underlying brain pathology. It was hypothesized that both medial temporal atrophy (MTA) and global cortical atrophy (GCA) predicted no/mild pain, while white matter hyperintensities (WMH) predicted moderate/severe pain.Objectives: To study the association between pain intensity and measures of brain pathology, more specifically MTA, GCA, and WMH.Methods: In total, 115 consecutive patients visiting an outpatient memory clinic were included. In total, diagnoses included dementia (N=70), mild cognitive impairment (N=30), and subjective cognitive impairment (N=15). Without administering stimuli, pain intensity was assessed with the Brief Pain Inventory. MTA, GCA, and WMH were measured with a MRI visual rating scale. Logistic regression analyses to examine the relationship between WMH, MTA, GCA, and self-reported pain intensity (no/mild pain versus moderate/severe pain) were adjusted for confounders.Results: Mean age of the patients was 81 years (IQR: 78&ndash;85, 53% female). Moderate/severe pain was reported by 23.5% and associated with greater WMH (OR =3.34, 95% CI =1.01&ndash;10.97, p=0.047), but not MTA or GCA.Conclusions: In contrast to the present results, earlier studies have reported either a positive or negative relationship between pain and brain volume. It is suggested that the presence of dementia may explain the absence of a relationship between pain and brain volume. WMH is positively related with pain in an older memory outpatient population. Considering the small sample size, our findings should be interpreted with caution. Hence, our conclusions are preliminary findings, warranting future replication.Keywords: pain, dementia, Alzheimer&rsquo;s disease, brain atrophy, white matter hyperintensitie

White matter hyperintensities are related to pain intensity in an outpatient memory clinic population: preliminary findings

Background: The association between pain and dementia is complicated and may depend on underlying brain pathology. It was hypothesized that both medial temporal atrophy (MTA) and global cortical atrophy (GCA) predicted no/mild pain, while white matter hyperintensities (WMH) predicted moderate/severe pain. Objectives: To study the association between pain intensity and measures of brain pathology, more specifically MTA, GCA, and WMH. Methods: In total, 115 consecutive patients visiting an outpatient memory clinic were included. In total, diagnoses included dementia (N=70), mild cognitive impairment (N=30), and subjective cognitive impairment (N=15). Without administering stimuli, pain intensity was assessed with the Brief Pain Inventory. MTA, GCA, and WMH were measured with a MRI visual rating scale. Logistic regression analyses to examine the relationship between WMH, MTA, GCA, and self-reported pain intensity (no/mild pain versus moderate/severe pain) were adjusted for confounders. Results: Mean age of the patients was 81 years (IQR: 78-85, 53% female). Moderate/severe pain was reported by 23.5% and associated with greater WMH (OR =3.34, 95% CI =1.01-10.97, p=0.047), but not MTA or GCA. Conclusions: In contrast to the present results, earlier studies have reported either a positive or negative relationship between pain and brain volume. It is suggested that the presence of dementia may explain the absence of a relationship between pain and brain volume. WMH is positively related with pain in an older memory outpatient population. Considering the small sample size, our findings should be interpreted with caution. Hence, our conclusions are preliminary findings, warranting future replication

Zelfmanagement bij chronische ziekten

Self-management is trendy: it is a recognized component of the treatment of chronic disorders and expectations are high. Even so, there are barriers to the introduction of self-managements programmes. Despite considerable research, there is still no hard evidence of the efficacy of self-management programmes, in part because of differences in terminology. There are indications that self-management has potential, but not all patients respond to these interventions. Differences between programmes and patient populations make it difficult to establish which programme works for which patient group. Terminological confusion, also among care providers, policy makers, and the public, harbours the risks that ‘self-management’ may become a meaningless concept. This article clarifies terminology and evaluates the strength of evidence for the efficacy of self-management programmes. It is clear that not all patients benefit from the ‘one size fits all’ approach and that there is a need for tailored care, based on the individual patient. This requires further investigation of determinants of success; which type of intervention, and with what content, form, and intensity, has the great est likelihood of success in specific patient groups. The research consortium Tailored Self-management & Ehealth (TASTE) is trying to unravel these factors and to develop tailored interventions. For the moment, primary care practitioners would do well to evaluate the suitability of self-management programmes for individual patients