Background: Based on survey data from both Canada and abroad, most people would prefer to be cared for and to die in their own homes. Although 70% of elderly patients state a preference for comfort care over high technology life prolonging treatment in an inpatient setting, 54% are still admitted to intensive care units (ICUs). Understanding their wishes regarding end-of-life care, and being able to engage in evidence informed end-of-life discussions has never been so important, in order to empower patients, and to optimize scarce resource management. For the purpose of this thesis, “very old” patients will be defined as those eighty years of age and older. All three manuscripts will be based on data from the Realistic 80 study, a prospective cohort trial of 1671 critically ill very old patients admitted to 22 Canadian ICUs. Objectives: Manuscript 1: To describe the hospital outcomes of the entire cohort of Realistic 80 patients, including their ICU mortality and length of stay, their hospital mortality and length of stay, and their ultimate dispositions. Manuscript 2: To derive a clinical prediction rule for hospital mortality in the medical patient cohort. Manuscript 3: To derive a clinical prediction rule for hospital mortality in the emergency surgical patient cohort. Data Source: A prospective, multicenter cohort study of very elderly medical and surgical patients admitted to 22 Canadian academic and non-academic ICUs. Methods: Clinical decision rule methodology was used to analyze the data set and to create two separate clinical prediction tools, one for critically ill elderly medical patients, and one for critically ill surgical emergency patients. A third manuscript describing general clinical outcomes was also produced. Results of Manuscript 1: A total of 1671 patients were included in this section of the “Realities, Expectations and Attitudes to Life Support Technologies in Intensive Care for Octogenarians: The Realistic 80 Study (a prospective cohort of nearly 2000 critically ill Canadian patients over eighty years old enrolled from 22 ICUs across Canada) that will provide the data for this thesis. The Realistic 80 cohort had a mean age of 84.5, a baseline Apache II score of 22.4, a baseline SOFA score of 5.3, an overall ICU mortality of 21.8%, and an overall hospital mortality of 35%. The cohort had a median ICU length of stay of 3.7 days, and an overall median hospital length of stay of 16.6 days. Only 46.4% of the survivors were able to return home to live. Results of Manuscript 2: Age, renal function, level of consciousness, and serum pH were the important predictors of hospital mortality in critically ill elderly medical patients. Our clinical prediction tool is very good, particularly at the all-important extremes of prognosis, and ready for external validation. Results of Manuscript 3: Renal function and serum pH were the important predictors of hospital mortality in critically ill elderly surgical patients. Our model’s performance is very good, and will serve to inform clinical practice once validated. Conclusions: Very old medical patients have longer ICU stays and higher mortality than their surgical counterparts. Premorbid health status and severity of illness are associated with mortality. Our medical patient clinical prediction tool is very good and ready for external validation. Our surgical emergency clinical prediction tool shows promise, but will require the incorporation of more patients and a repeat derivation phase prior to external validation or clinical implementation.

L’objectif principal de la présente thèse est d’investiguer sur l’insertion sociale des personnes âgées dans les politiques publiques menées par l’État brésilien, dans les actions sociales réalisées par l’Église catholique, surtout dans les actions développées par les bénévoles de le Pastorale de la Personne Âgée à João Pessoa, capitale de l’Etat de Paraíba, située dans le nord-est du Brésil. Pour cela, nous avons opté pour une recherche empirique de nature qualitative. Nous avons utilisé comme instruments méthodologiques l’observation participante et l’entretien semi-directif. Deux catégories d’acteurs sociaux ont participé de la présente recherche : 20 personnes âgées qui participent à des activités du Centre de Productions Artistiques – Culturelles de la Personne Âgée, de João Pessoa; et 20 bénévoles de la Pastorale de la Personne Âgée de l’Archidiocèse de Paraíba. Les observations ont été réalisées entre les mois de septembre 2009 et février 2010. Les registres d’observations participantes ont été constitués à travers des réunions, des ateliers, des évènements culturels et loisirs dans le mentionné Centre de Production Artistique-Culturelle de la Personne Âgée et aussi aux moyens d’événements culturels et loisirs du Centre Social de Paroisse Notre Dame de la Conception à João Pessoa (Brésil). L’analyse menée dans le cadre de notre recherche se base sur des fondements théoriques dans le domaine de la sociologie, ainsi que dans les textes de lois brésiliennes et d’autres documents officiels concernant à l’insertion sociale des personnes âgées liées à l’Église catholique au Brésil. [etc.] / The main objective of this thesis is to investigate the social inclusion of elderly people within the public policies offered by the Brazilian government and the actions taken by the Catholic Church through the Pastoral of Elderly People in João Pessoa, Paraíba, Northeast of Brazil. For this, we chose a qualitative empirical research. We used as methodological tools, partici-pant observation and semi-direct interview. Two categories of social actors participated in this research: 20 seniors, who participate in the activities of the Center for Artistic Productions - cultural elderly in the city of João Pessoa, State of Paraíba, northeast of Brazil and 20 volun-teers from the Pastoral of Elderly People, in the Archdiocese of Paraíba . Observations were carried out between September 2009 and February 2010. Records of participatory observa-tions were made through meetings, workshops, cultural events and leisure center in Cultural-Artistic Production of the elderly and the pastoral center of the Immaculate Conception Parish in Joao Pessoa, Brazil. The analysis of our research is based on theoretical foundations in so-ciology, as well as texts of Brazilian laws and other official documents relating to social in-clusion. Results indicated that: the State, the Catholic Church and other institutions working with the elderly in Brazil must find new ways to support families, so they can stay in the family, allowing them to enjoy a pleasant place; the health of the elderly is poor, where the Brazilian SUS (Unified Health System) does not offer a quality service for the elderly; Brazil-ian public policies, designed to the elderly, in a theoretical point of view, are well structured, but in practice, do not favor the elderly; the pensions paid to the elderly, by the Brazilian state, does not guarantee their well-being and social; volunteers involved in the Pastoral of Elderly people , in the Catholic Church, are motivated by the pleasure of serving others. At the end of our investigation, we believe that Brazil is a country that has laws which are recog-nized around the world, but those, in practice, are not met. The social actions, developed by the Pastoral of Elderly People, of the Catholic Church in Brazil, help the social inclusion of elderly people in the society.

Background: Elderly patients have shown to have difficulties to adhere to a continuous independent exercising after a rehabilitation period. Therefore, there is a need for increased understanding among physiotherapists about how to prepare these patients to be independent. Aim: The aim of the study was to describe which factors elderly Arabic immigrants who has completed a clinical physiotherapy intervention, been advised to exercise on their own and then returned to physiotherapy again perceive as important factors for them to continue physical exercising on their own. Method: Ten semi-structured interviews were conducted with patients aged 65 years and more with Arabic background. The interviews were analysed with qualitative content analysis and were presented in themes and categories with illustrating quotes. Results: The result showed one theme "Factors influencing continued physical exercising "with four categories and sixteen subcategories that emerged from the analysis. The four categories were: Individual-related factors, Psychosocial-related factors, Physiotherapeutic factors, and Authority-supporting factors. All these factors varied in adherence to exercise among the participants, but were all common among all participants. Conclusion: Adherence to exercising in elderly Arabic immigrants individuals appeared to be multifactorial. The result of the study showed that the informants are aware of and acknowledge the influence of the individual-related factors that appeared to be the major motivators/inhibitors for them, such as: pain, mood, limited income, coldness and lack of discipline. Nevertheless the result of the study showed that the informants' views on the training are positive. The training gave them every day routines, to being a part of social life. Moreover getting support from physiotherapists was contributing factor to adherence to exercising. A large number of informants also indicated that they couldn’t continue their training because of the shortage in availability and affordability of training facilities which should be the responsibility of the authorities. Language barrier was expressed as an important factor that could contribute to misunderstanding and therefore non-adherence to exercising. / Bakgrund: Äldre patienter har visat sig ha svårigheter att följa en kontinuerlig självständig träning efter en rehabiliteringsperiod. Därför finns det ökat behov av förståelse bland fysioterapeuter om hur man förbereder dessa patienter för att vara självständiga. Syftet med studien var att beskriva vilka viktiga faktorer som äldre arabiska immigranter som har genomgått en färdig klinisk fysioterapeutisk behandling och har blivit rekommenderat att träna på egen hand uppfattar som viktiga faktorer för att de ska vara självständiga vid träning. Metod: Tio halvstrukturerade intervjuer genomfördes med patienter i åldern 65 år och mer med arabisk bakgrund. Intervjuerna analyserades med kvalitativ innehållsanalys och presenterades i teman och kategorier med illustrerande citat. Resultatet visade ett tema "Faktorer som påverkar fortsatt fysisk träning" med fyra kategorier och sexton subkategorier som framkom av analysen. kategorierna var: Individrelaterade faktorer, psykosociala faktorer, fysioterapeutiska faktorer och myndighetsstödande faktorer. Alla dessa faktorer varierade bland deltagarna, men var alla vanliga bland alla deltagare. Slutsats: Att hålla sig till fysiska övningar hos äldre arabiska immigranter tycktes vara multifaktoriella. Resultatet av studien visade att informanterna är medvetna om och bekräftar påverkan av de enskildrelaterade faktorer som verkade vara de främsta motivatorerna och hämmarna för dem, såsom: smärta, humör, begränsad inkomst, kyla och brist på disciplin. Resultatet av studien visade likväl att informatörernas syn på träning är positiva. Träningen gav dem dagliga rutiner och känsla av att vara en del av det sociala livet. Stödet från fysioterapeuterna var även motiverande faktor för försätta träning. Majoriteten av informanterna betonade också att de inte kunde fortsätta sin utbildning på grund av bristen på tillgänglighet och överkomliga kostnader för träningsanläggningar som borde vara myndigheternas ansvar. Språkbarriären uttrycktes som en viktig faktor som skulle kunna bidra till missförstånd och därmed inte överensstämma med träning.

This study examines the situation for generational conflict in terms of co-residence between the aging parents and their adult children in Korea. It investigates the history and problems of the intergenerational bond in Korean society and the Korean Church based on a hierarchical relationship. The study proposes a Christian approach about the intimate intergenerational relationship. In addition, it suggests the Church Round Table as a method for resolving the conflict. To develop this study, two kinds of methods, the first advocated by D Browning (1991) and the second by Rubin and Rubin (1995), are adopted. In traditional Korean society, the duty of family members to care for the elderly is a concept known as filial piety. It has been commonly assumed that elderly people are expected to depend on their children in their old age. However, during the past decades, Korea has experienced dramatic social restructuring. This rapid modernisation and industrialisation in Korea has deprived the elderly of many important family and social roles. Whereas the elderly, who had hardly prepared for their own well being, expect to live together under their children’s care, the adult children do not want to give full support to their parents, resulting in intergenerational conflict for family support. To create an intergenerational relationship with open dialogue, communicability is needed to resolve the conflict between the aging parents and the adult children, namely the communicability of the Church Round Table, as adapted from the story of King Arthur’s Round Table. The Church Round Table has three key issues: kenosis, equality, and reconciliation within all three participates: the aging parent, the adult child, and a pastor. In rule-governed interpersonal interaction by three issues, this thesis has developed by proposing the Church Round Table as place to resolve intergenerational conflict between them. To accomplish the claims, theoretical background and practical strategies are addressed in this study. / Thesis (PhD (Practical Theology))--University of Pretoria, 2007. / Practical Theology / unrestricted

Orientador: Arlete Maria Valente Coimbra / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-07T22:30:19Z (GMT). No. of bitstreams: 1 Teixeira_IlkaNiceiaD'AquinoOliveira_M.pdf: 2857396 bytes, checksum: c9862695fdd22acb97017904bd7b6295 (MD5) Previous issue date: 2006 / Mestrado / Mestre em Gerontologia

Orientador: Meire Cachioni / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T03:03:58Z (GMT). No. of bitstreams: 1 Lopes_LaisdeOliveira_M.pdf: 2003500 bytes, checksum: d72be147c3b29dfc875042acb3e7f7ea (MD5) Previous issue date: 2013 / Resumo: Objetivo: Investigar o impacto de um programa psicoeducacional dirigido a cuidadores familiares de idosos com Doença de Alzheimer (DA) a partir das avaliações desses cuidadores sobre o seu bem-estar subjetivo e sobre os ônus e benefícios do cuidado. Método: Trata-se de um estudo quase experimental. Foram utilizados os seguintes instrumentos: ficha de caracterização sociodemográfica do participante; roteiro para avaliar o contexto do cuidado; Escala de Satisfação Geral com a Vida; Escala de Satisfação Geral com a Vida Referenciada a Domínios; Inventário de Ônus e Benefícios associados ao Cuidado; Escala de Afetos Positivos e Afetos Negativos e Escala de Depressão Geriátrica. Tais instrumentos foram aplicados em 21 cuidadores antes e após a intervenção, composta por 15 sessões. Resultados: A intervenção apresentou impacto positivo sobre o bem-estar subjetivo, sobre as variáveis de satisfação geral com a vida, satisfação com o envolvimento social e equilíbrio entre afetos positivos e afetos negativos. Em relação ao ônus e aos benefícios percebidos, houve aumento de respostas nos domínios psicológico positivo e social positivo após a participação na intervenção. Conclusão: A intervenção psicoeducacional investigada apresentou um impacto positivo no bem-estar subjetivo em relação às variáveis de satisfação geral com a vida, satisfação com o envolvimento social e equilíbrio entre afetos positivos e afetos negativos. Além disso, os dados desse estudo mostraram que intervenções psicoeducacionais podem contribuir para o aumento de benefícios psicológicos e sociais em relação ao contexto do cuidado. É importante considerar as peculiaridades das diferentes etapas de vida em que o cuidador está vivendo, bem como a faixa etária, a renda, o gênero, as relações de parentesco e o tempo de cuidado, para que o desenvolvimento das intervenções atinja o objetivo proposto / Abstract: Objective: To investigate the impact of a psychoeducational program aimed at family caregivers of elders with Alzheimer's disease (AD) in relation to assessments of these caregivers about their subjective well-being and about the benefits and burdens of care. Method: This was a quasi-experimental study. The following instruments were used: plug sociodemographic characteristics of the participant; script to evaluate the context of care; General Satisfaction with Life Scale; General Satisfaction with Life Referenced to Domains Scale; Inventory of Burden and Benefits of the Care; The Positive and Negative Affects Scale, and the Geriatric Depression Scale. These instruments were applied in 21 caregivers before and after the intervention, consisting of 15 sessions. Results: The intervention investigated showed a positive impact on subjective well-being in relation to variables of overall satisfaction with life, satisfaction with social involvement and balance between positive and negative effect. Regarding the perceived burden and benefits, there was an increase of positive responses in the psychological and social impact after the participation in the intervention. Conclusion: The investigated psychoeducational intervention had a positive impact on subjective well-being in relation to variables of overall satisfaction with life, satisfaction with social involvement and balance between positive and negative effect. Furthermore, the data from this study showed that psychoeducational interventions can contribute to increased psychological and social benefits in relation to the context of care. It is important to consider the peculiarities of the different stages of life in which the caregiver is living, as well as age, income, gender, kinship relations and time of care, so the development of interventions achieve the proposed objective / Mestrado / Gerontologia / Mestra em Gerontologia

Orientador: Maria Filomena Ceolim / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T15:12:15Z (GMT). No. of bitstreams: 1 Pereira_AlexandreAlves_M.pdf: 1520399 bytes, checksum: 72e63b6e3cf94505105d6ffd2c213b81 (MD5) Previous issue date: 2011 / Resumo: Objetivo: Descrever a influência da atividade física, da velocidade da marcha, da capacidade funcional, dos sintomas de insônia, do cochilo diurno e dos sintomas depressivos sobre a ocorrência de quedas em idosos residentes na comunidade. Métodos: Estudo retrospectivo, de corte transversal. Dos 900 idosos recrutados em domicílio na cidade de Campinas, foram incluídos nesse estudo 689 idosos selecionados por desempenho superior à nota de corte no Mini-Exame do Estado Mental. Os instrumentos incluíram questionários para avaliação dos sintomas de insônia, cochilo diurno e ocorrência de quedas nos últimos 12 meses; medida observacional de velocidade da marcha; as versões brasileiras da Geriatric Depression Scale e do Minnesota Leisure Activity Questionnaire; 13 atividades avançadas de vida diária (AAVDs) e sete atividades instrumentais de vida diária (AIVDs). Resultados: A idade média foi 72,19 (dp = 5,33). Dos entrevistados, 68,8% eram do sexo feminino; 49,93% queixaram-se de um ou mais sintomas de insônia e 62,94% referiram o hábito de cochilar; 19,61% apresentaram sintomas depressivos; 56% eram sedentários, contudo a maioria mostrou-se independente funcionalmente (AAVDs, AIVDs e velocidade da marcha); a prevalência de quedas foi de 26,2%, sendo 11,87% a freqüência de quedas recorrentes. Dentre as variáveis investigadas, sexo feminino, idade igual ou acima de 80 anos, limitação funcional em AIVDs, uso de medicamentos para dormir, sintomas de insônia, cochilo diurno e sintomas depressivos apresentaram associação significativa com quedas recorrentes. No modelo multivariado de análise permaneceram associados a quedas recorrentes o sexo feminino, cochilos diurnos, sintomas depressivos e idade igual ou acima de 80 anos. Conclusões: os achados desse estudo mostraram que os sintomas de insônia e cochilo diurno estão associados ao risco aumentado de quedas em idosos da comunidade. As estratégias de prevenção de quedas em idosos da comunidade devem focar na intervenção dos fatores de risco modificáveis. Deste modo, os resultados dessa pesquisa indicam a necessidade de avaliação da qualidade do sono e suas conseqüências nessa população / Abstract: Objective: to describe the influence of physical activity, walking speed, functional performance, insomnia symptoms, daytime napping and depressive symptoms on the incident of fall in community-dwelling elderly people. Methods: Retrospective, cross-sectional study. Of the 900 elderly people recruited at home in Campinas, 689 were selected from those who scored above the cutoff point for the Mini-Mental State Examination. The instruments included questionnaires to assess insomnia symptoms, daytime napping and falls in the previous 12 months; walking speed; the Brazilian versions of the Geriatric Depression Scale and Minnesota Leisure Activity Questionnaire; 13 advanced activities of daily living (AAVDs) and seven instrumental activities of daily living. Results: Of the respondents, 68% were female; 49,93% complained one or more insomnia symptoms and the most of the sample reported napping; 19,61% had depressive symptoms; 56% were sedentary, although most proved to be functionally independent; the prevalence of falls was 26.2% and 11.87% frequency of recurrent falls. Among the variables investigated, female, age above 80 years, functional limitation in IADL, use of sleep medications, insomnia symptoms, daytime nap and depressive symptoms were significantly associated with recurrent falls. In multivariate analysis, female, age above 80 years, daytime napping and depressive symptoms remained associated with recurrent falls. Conclusion: the findings of this study showed that insomnia symptoms and daytime napping are associated with greater risk of falls in community elderly people. The strategies to prevent falls in community elderly people should aim to the intervention in the modifiable risk factors. Thus, the results of this survey indicate the need for assessment of sleep quality and its consequences in this population / Mestrado / Gerontologia / Mestre em Gerontologia

Orientador: Maria Filomena Ceolim / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T13:43:19Z (GMT). No. of bitstreams: 1 Schlosser_ThalytaCristinaMansano_M.pdf: 2939462 bytes, checksum: 6e1d2f0cfc842774b01c9e02706e81b7 (MD5) Previous issue date: 2011 / Resumo: Introdução: O envelhecimento traz consigo maior probabilidade de ocorrência de doenças crônicas, entre elas o câncer. Uma importante conseqüência do câncer é a má qualidade do sono, que também é mais freqüente em idosos. Objetivos: Avaliar a relação entre qualidade do sono e fadiga em idosos com diagnóstico de câncer, sob tratamento quimioterápico ambulatorial; identificar a associação entre qualidade do sono e variáveis sócio-demográficas e clínicas. Sujeitos e Métodos: Estudo descritivo, transversal, com amostra não probabilística de 140 idosos (idade média 69,8 anos DP = 6,8; 52,1% eram mulheres; 4,0 anos de estudo em média) desenvolvido em dois serviços especializados de um hospital universitário do interior do estado de São Paulo. Os dados foram coletados por entrevista e consulta aos prontuários, empregando-se os instrumentos: Questionário de Caracterização Sóciodemográfica e Clínica, Índice de Qualidade de Sono de Pittsburgh (PSQI) e Escala de Fadiga de Piper-revisada. Os instrumentos demonstraram consistência interna adequada (coeficiente alfa de Cronbach de 0,71 para o PSQI e de 0,98 para a Escala de Piper), validados no Brasil. As variáveis numéricas apresentavam distribuição diferente da normal (teste de Kolmogorov-Smirnov). Análise: Estatística descritiva; teste do Qui-quadrado para verificar associação entre as categorias de qualidade do sono (boa ou má) e características sócio-demográficas e clínicas; teste de Mann- Whitney para comparar a distribuição das variáveis numéricas em relação às categorias de qualidade do sono, e a distribuição dos escores de qualidade do sono em relação às categorias de variáveis sócio-demográficas e clínicas. Ajustou-se um modelo de regressão logística univariada para avaliar possíveis fatores de risco associados à qualidade do sono (p ? 0,20 na análise bivariada). O valor de p< 0,05 (?=5,0%) foi adotado como nível crítico para todos os testes. Resultados: Observou-se que 62,9% dos idosos apresentavam sono de má qualidade e 37,1%, sono de boa qualidade, de acordo com o PSQI. O escore global médio nesse instrumento foi de 7,7 (DP=4,0), mediana de 7,0, indicativo de sono de má qualidade. Observou-se que 30,7% dos idosos referiam sono noturno de duração inferior a seis horas. Quanto à fadiga, foi relatada por 42,9% dos idosos, sendo o escore mais elevado atribuído à Dimensão Afetiva (média 3,7, desvio padrão 4,3, mediana 0,0). Encontrou-se associação significativa entre má qualidade do sono e: presença de fadiga (p=0,03) e ocorrência de dor (p=0,00). Os idosos com sono de má qualidade referiram dor de maior intensidade (p=0,00) e obtiveram escores significativamente mais elevados (p<0,05) nas dimensões Comportamental e Sensorial/psicológica da escala de fadiga, em relação àqueles com sono de boa qualidade. A análise de regressão logística múltipla revelou que, conforme a intensidade da dor aumenta em um ponto na escala de dor, há um acréscimo de 21% na probabilidade de apresentar sono de má qualidade. Conclusões: Este estudo aponta para a associação entre fadiga, dor e sono de má qualidade em pacientes com câncer, destacando a necessidade de avaliar os mesmos e tratá-los em conjunto, e não isoladamente. Este projeto integra-se à Linha de Pesquisa Processo de Cuidar em Saúde e Enfermagem / Abstract: Introduction: Old age brings greater likelihood of chronic diseases, including cancer. An important consequence of cancer is the poor quality of sleep, which is more common in the elderly. Objectives: To evaluate the relationship between sleep quality and fatigue in elderly patients with cancer diagnosis undergoing outpatient chemotherapy treatment, as well as to identify possible association between sleep quality and clinical and socio-demographic variables. Subjects and Methods: Cross sectional, descriptive study conducted with a non-probability sample of 140 elderly (mean age 69.8 years SD = 6.8; 52.1% female, average schooling of 4.0 years), developed at two specialized cancer services of a university hospital in Southeastern Brazil . Data were collected through interviews and by consulting medical charts, using the instruments: Sociodemographic and Clinical Questionnaire, Pittsburgh Sleep Quality Index (PSQI) and Piper Fatigue Scale-revised. The instruments demonstrated good internal consistency, with Cronbach's alpha of 0.71 for PSQI and 0.98 for Piper Scale. According to Kolmogorov-Smirnov test, continuous variables showed non-normal distribution. Analysis: descriptive statistics; Chi-square test in order to assess the association between categories of sleep quality (good or bad) and socio-demographic and clinical data; Mann-Whitney test to compare the distribution of numerical variables according to categories of sleep quality, and distribution of sleep quality scores according to the categories of socio-demographic and clinical data. A univariate logistic regression model was fit to evaluate possible risk factors associated with sleep quality (p ? 0.20 in bivariate analysis). The value of p <0.05 (? = 5.0%) was adopted as the critical level for all tests. Results: Results show that 62.9% of subjects had poor sleep quality and 37.1%, good-quality sleep, according to the PSQI. Overall mean scores were 7.7 (SD = 4.0), median 7.0, indicating poor sleep quality. It was observed that 30.7% of subjects reported less than six hours of night sleep. Fatigue was reported by 42.9% of the elderly, the highest score assigned to Affective Dimension (mean 3.7, SD 4.3, median 0.0). Significant association was found between bad sleep quality and: fatigue (p = 0.03); pain (p = 0.00). The elderly with poor sleep quality reported greater pain intensity (p = 0.00) and scored significantly higher (p <0.05) in Behavioral and Sensorial/psychological dimensions of Piper Scale, compared to those with sleep good quality. A multiple logistic regression analysis revealed that, as the intensity of pain rises one point on the scale of pain, there is an increasing of 21% in the probability of having poor sleep quality. Conclusions: This study points to the relationship between fatigue, pain and poor sleep quality in cancer patients, stressing the need to evaluate and treat them as a whole. This project is part of the Research Line Process in Health Care and Nursing / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Over the last two decades social vulnerability has emerged as a major area of study, with increasing attention to the study of vulnerable populations. Generally, the elderly are among the most vulnerable members of any society, and widespread population aging has led to greater focus on elderly vulnerability. However, the absence of a valid and practical measure constrains the ability of policy-makers to address this issue in a comprehensive way. This study developed a composite indicator, The Elderly Social Vulnerability Index (ESVI), and used it to undertake a comparative analysis of the availability of support for elderly Jamaicans based on their access to human, material and social resources. The results of the ESVI indicated that while the elderly are more vulnerable overall, certain segments of the population appear to be at greater risk. Females had consistently lower scores than males, and the oldest-old had the highest scores of all groups of older persons. Vulnerability scores also varied according to place of residence, with more rural parishes having higher scores than their urban counterparts. These findings support the political economy framework which locates disadvantage in old age within political and ideological structures. The findings also point to the pervasiveness and persistence of gender inequality as argued by feminist theories of aging. Based on the results of the study it is clear that there is a need for policies that target specific population segments, in addition to universal policies that could make the experience of old age less challenging for the majority of older persons. Overall, the ESVI has displayed usefulness as a tool for theoretical analysis and demonstrated its potential as a policy instrument to assist decision-makers in determining where to target their efforts as they seek to address the issue of social vulnerability in old age. Data for this study came from the 2001 population and housing census of Jamaica, with multiple imputation for missing data. The index was derived from the linear aggregation of three equally weighted domains, comprised of eleven unweighted indicators which were normalized using z-scores. Indicators were selected based on theoretical relevance and data availability.

A corrida de rua é uma das atividades que obteve maior número de adeptos entre a população idosa. É sabido que, durante a corrida, idosos apresentam padrões diferente de adultos jovens, como um maior ângulo de toe-out. No entanto, não é conhecida a relação com a carga mecânica nas articulações dos membros inferiores. Muitos estudos apontam para uma relação entre o momento adutor externo do joelho e o ângulo de toe-out, inclusive como mecanismo de proteção em indivíduos com osteoartrite do joelho, doença comum em pessoas acima dos 65 anos. Assim, pretendeu-se investigar uma possível relação do ângulo de toe-out aumentado nesses indivíduos e o momento do joelho no plano frontal. Vinte e dois adultos jovens corredores, 23 idosos corredores e 13 idosos sedentários andaram a 5 km/h e correram a 7, 10 km/h e na velocidade média da última prova de 10 km. Na velocidade de 5 km/h e 10 km/h os indivíduos corredores realizaram também uma condição com o toe-out aumentado além do natural. Os indivíduos executaram estas tarefas em uma esteira instrumentada com duas cintas independentes e com duas plataformas de força de seis componentes operando a 600 Hz (Bertec, USA) e tiveram os movimentos dos membros inferiores registrados por um sistema de análise tridimensional do movimento composto por oito câmeras de infravermelho operando a 150 Hz (Motion Analysis Corporation, USA). Uma completa análise cinemática e cinética das tarefas foi realizada por meio dos softwares Visual3D (CMotion. Inc., USA) e Matlab (Mathworks, USA). Em particular, o ângulo de toe-out e o momento adutor externo do joelho foram mensurados em todas as condições e comparados entre as condições com e sem o toe-out aumentado e entre os grupos a partir de análise de variâncias fatorial mistas e ANOVA, respectivamente. Os ângulos e momentos artivulares foram comparados entre os grupos com testes de Wicoxon Signed-rank com correção de Bonferroni. Em geral, os adultos corredores, idosos corredores e idosos sedentários apresentaram diferenças nos padrões cinemáticos e cinéticos do movimento dos membros inferiores durante o andar a 5 km/h e durante o correr a 7 km/h. Também foram observadas diferenças, porém em menor número, durante a corrida a 10 km/h e a corrida na velocidade média da última prova de 10 km para os adultos corredores e idosos corredores. Quanto à relação do ângulo de toe-out e o momento adutor externo do joelho, contrariamente à literatura, nós não observamos um aumento deste ângulo para os idosos durante o andar ou correr em relação aos adultos, assim como uma relação inversa entre o ângulo de toe-out e o momento adutor externo do joelho, talvez pelas coletas terem sido realizadas sobre uma esteira com cinta dupla, o que pode ter levado à alteração do posicionamento natural dos pés (toe-out) / Running is one of the activities that had the highest number of participants among elderly population. It is known that during running, elderly have different patterns of young adults, as a greater toe-out angle. However it is still unknown the relationship between the mechanical loads at the joints of the lower limbs. Several studies point to a correlation between the external knee adduction moment and the toe-out angle, including as a protective mechanism among people with knee osteoarthritis, a common disease in people over 65 years old. Thus, we sought to investigate a possible relationship between the toe-out angle increased in these individuals and the knee moment in the frontal plane. Twenty-two young adult runners, 23 elderly runners and 13 sedentary elderly walked at 5 km/h and ran at 7, 10 km/h and at the mean speed of the last 10 K race. At the speed of 5 km/h and 10 km/h the individuals who were runners also performed a condition with the toe-out angle increased beyond the natural. The subjects did all tasks in an instrumented treadmill with independent two belts and two force plates with six components operating at 600 Hz (Bertec, USA) and had the lower limb movements registered by a tridimentional motion analysis system with eight infrared cameras operating at 150Hz (Motion Analysis Corporation, USA). A complete kinematics and kinectics analysis were made using Visual3D (CMotion. Inc., USA) and Matlab (Mathworks, USA) softwares. The toe-out angle and the external knee adduction moment were measured during all conditions and compared between the condition with and without the toe-out angle increased, and between the groups with a mixed effects modeling and ANOVA respectivelly. The joint angles and joint moments were compared between groups with Wilcoxon Signed-rank tests with Bonferroni correction. In general, young adult runners, elderly runners and elderly sedentaries had differences in kinematic and kinetic pattern of movement of lower limbs during walk at 5 km/h and run at 7 km/h. There were also differences, though in smaller number, during run at 10 km/h and run at mean speed of the last 10 K race between young adult runners and elderly runners. Contrasting the literature there was no relation between toe-out angle and external knee adduction moment and we didnt observe a greater angle in elderly than young adults during walk or run, it maybe can be explained by the fact that the tasks were above a double belt treadmill, what can lead to a different feet position (toe-out)