Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-12-05T13:29:31Z No. of bitstreams: 1 RUY_DE_ALMEIDA_BARCELLOS.pdf: 2171813 bytes, checksum: d242fe874538146ea8081420b788cadb (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-12-06T18:13:57Z (GMT) No. of bitstreams: 1 RUY_DE_ALMEIDA_BARCELLOS.pdf: 2171813 bytes, checksum: d242fe874538146ea8081420b788cadb (MD5) / Made available in DSpace on 2018-12-06T18:20:07Z (GMT). No. of bitstreams: 1 RUY_DE_ALMEIDA_BARCELLOS.pdf: 2171813 bytes, checksum: d242fe874538146ea8081420b788cadb (MD5) Previous issue date: 2018-09-24 / Objective: To evaluate the impact of the implantation of a checklist during multidisciplinary daily round in the period of using invasive mechanical ventilation (MV) and permanence in the ICU. Methods: In a non-randomized clinical trial with historical controls, 466 patients submitted to MV were evaluated in a Hospital in Caxias do Sul (RS). Of this total, 235 and 231 were evaluated in the pre-intervention and post-intervention phases, respectively. The outcomes studied were SAPS-3, SOFA, frequency of infections, ICU stay, days of MV, reintubations, rehospitalizations, deaths in the ICU and hospital. Results: There was a significant reduction after the routine use of the checklist in the lenght of permanence in 37.5% (p <0.001) and 60% (p <0.001) in the time of mechanical ventilation. The frequency of pulmonary focus infection was reduced by 11.9% (p = 0.030). Conclusions: The multidisciplinarity structured through the use of checklists has an impact on the reduction of the days of use of mechanical ventilation and stay in the ICU. / Objetivo: Avaliar o impacto da implanta??o de uma lista de verifica??o durante round di?rio multiprofissional nos tempos de ventila??o mec?nica invasiva (VM) e perman?ncia na UTI. M?todos: Em um ensaio cl?nico n?o randomizado com controles hist?ricos, foram avaliados 466 pacientes submetidos ? VM em um hospital em Caxias do Sul (RS). Foram avaliados 235 e 231 pacientes nas fases pr?-interven??o e p?s-interven??o respectivamente. As vari?veis estudadas foram: Simplified Acute Physiology Score (SAPS-3), Sequential Organ Failure Assessment (SOFA), frequ?ncia de infec??es, perman?ncia na UTI, dias de VM, reintuba??es, reinterna??es, ?bitos na UTI e hospitalar. Resultados: Houve redu??o significativa ap?s a implanta??o da lista de verifica??o no tempo de perman?ncia em 37,5% (p<0,001) e de 60% (p<0,001) no tempo de ventila??o mec?nica. A frequ?ncia de infec??o de foco pulmonar teve redu??o 11,9% (p=0,030). Conclus?es: A multidisciplinaridade estruturada atrav?s da utiliza??o da lista de verifica??o teve impacto na redu??o dos dias de utiliza??o de ventila??o mec?nica e perman?ncia na UTI.

Made available in DSpace on 2014-12-17T14:46:33Z (GMT). No. of bitstreams: 1 VilaniMAN.pdf: 541744 bytes, checksum: 32f1ac55baa1cad72f311f6e5ab3eb2a (MD5) Previous issue date: 2008-05-13 / A descriptive and exploratory Study, quantitative in nature, with the aim to assess the Quality of Life (QL) of the elderly leaving in a Long Residence Institution (LRI) according to their own perception. It was conducted in six Public Institutions of Long Residence for Seniors, in the municipality of Natal - RN, in the period of July to August 2007. The data was collected using two structured interview forms: the first, containing questions about socio-demographic aspects and the second - the WHOQUOL-OLD, prepared by the World Health Organization to assess elderly s quality of life. The reference population was 266 old persons, and a random sample, of 43, being 28 women and 15 men, who account for 30%. The results indicated there is a predominance of older women (65.1%) and the average age is 76.6 years; the predominant religion is the Catholic - 44.2% and, 32.6% are unmarried without children. As for schooling and precedence, 41.9% are illiterate and 67.4% come from the rural area. The time of residency in the institution goes between 1 to 5 years for 69.8% of the elderly, 37.2% of them residing in the institution for not having another option. Most elderly informed using medicines. 51.3% said they are taking anti-hypertensive. As for the other aspects of QL: sensory aspects, autonomy, past, present and future activities, social participation, death and dying and intimacy, the WHOQOL-OLD, showed an average total score of 52.9% (scale of 0 to 100), with a tendency to neutrality, denoting that the elderly, in this study, evaluated their QL as neither satisfactory or unsatisfactory. Of all the facets of the instrument of QL, the sensory facet secured the highest average scores (68,1%), showing that the elderly are "happy" in the situation in which they find themselves, not showing significant disabilities. The facet of autonomy, which refers to the independence and the ability to make decisions on their own life, received the lowest average scores (40.7%), showing the dissatisfaction of the elderly on this aspect. The evaluation of the elderly on other facets were: social participation (48.2%); activities past, present and future (44.6%) and intimacy (50.6%), all perceived as neither unsatisfactory or satisfactory. On the item death and dying, the elderly people declared themselves satisfied, with average score of 65.5%. The analysis of the reliability of the WHOQOL-OLD by the Cronbach Alpha showed 0.57, considering the 24 items that cover the instrument, showing regular internal reliability of the instrument, in our reality. The result is probably due to differences between the regions south and east and the broader sociocultural diversity. We believe that the elderly in this study, tended to realize their QL as neutral, considering it as neither unsatisfactory or satisfactory, result likely related to the resignation with the destine, characterized, at the time, by the finitude of life, feeling very common among elderly, or perhaps, even for an accommodation, often accompanied by discouragement, present in the daily life of many of them / Estudo descritivo e explorat?rio, de natureza quantitativa, com o prop?sito de avaliar a Qualidade de Vida (QV) de idosos residentes em Institui??o de Longa Perman?ncia (ILP) segundo sua pr?pria percep??o. Foi realizado em seis Institui??es P?blicas de Longa Perman?ncia para Idosos, no Munic?pio de Natal RN, no per?odo de julho a agosto de 2007. Para a coleta dos dados, foi utilizada a entrevista estruturada, guiada por dois formul?rios: o primeiro contendo quest?es acerca dos aspectos s?cio-demogr?ficos e o segundo, o WHOQUOL-OLD, elaborado pela Organiza??o Mundial de Sa?de, para avaliar a qualidade de vida em pessoas idosas. A popula??o de refer?ncia foi de 266 idosos, e uma amostra aleat?ria simples, de 43 idosos, 28 mulheres e 15 homens, que correspondem a 30%. Os resultados indicaram haver predomin?ncia de mulheres idosas (65,1%) e m?dia de idade de 76.6 anos, predomin?ncia da religi?o cat?lica (44,2 %) e solteiros sem filhos (32,6%). Quanto ? escolaridade e ? proced?ncia, (41,9% n?o alfabetizados) e 67,4%, procedentes da zona rural. O tempo de resid?ncia na institui??o foi de 1 a 5 anos para 69,8% dos idosos, com 37,2% deles residindo na institui??o por n?o ter outra op??o de moradia. A maioria dos idosos informou fazer uso de medicamentos, sendo que, 51,3% afirmaram tomar anti-hipertensivos. Quanto aos aspectos da QV, referentes ?s facetas sensorial, autonomia, atividades passadas, presentes e futuras, participa??o social, morte e morrer e intimidade, do WHOQOL-OLD, observou-se um escore m?dio total de 52,9% (escala de 0 a 100), com tend?ncia ? neutralidade, denotando que os idosos, desse estudo, avaliaram sua QV como nem satisfat?ria, nem insatisfat?ria, Dentre as facetas do instrumento de QV, destaca-se a sensorial que obteve a maior m?dia dos escores (68,1%), revelando que os idosos referem-se como satisfeitos na situa??o em que se encontram, n?o apresentando defici?ncia significativa. Destacou-se, tamb?m, a faceta autonomia, que refere-se ? independ?ncia e ? capacidade de tomar decis?es e que obteve a menor m?dia dos escores (40,7%), mostrando a insatisfa??o dos idosos quanto a este quesito. A avalia??o dos idosos relativa ?s demais facetas foram: participa??o social (48,2%); atividades passadas, presentes e futuras (44,6%); e intimidade (50,6%), todas percebidas como nem insatisfat?rias nem satisfat?rias.Na faceta morte e morrer os idosos declaram-se satisfeitos, com escore m?dio 65,5%. A an?lise da confiabilidade do WHOQOL-OLD pelo Alpha de Cronbach teve como valor total 0,57, nos 24 itens que englobam o instrumento, atestando confiabilidade interna regular do instrumento, em nossa realidade, provavelmente devido ?s diferen?as existentes entre as regi?es sul e nordeste e pela ampla diversidade s?cio-cultural. Consideramos que os idosos nesse estudo, tenderam a perceber sua QV de forma neutra, considerando-a como nem insatisfat?ria, nem satisfat?ria, resultado provavelmente, relacionado ? resigna??o com o destino, caracterizado no momento, pela finitude da vida, sentimento muito comum entre os idosos ou talvez at? por uma acomoda??o, muitas vezes acompanhada por des?nimo, presente no cotidiano de muito deles

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-04-01T19:24:53Z No. of bitstreams: 1 WagnerIvanFonsecaDeOliveira_DISSERT.pdf: 1988371 bytes, checksum: a07fe40eb2121344eae3a44c3e03b924 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-04-06T23:16:55Z (GMT) No. of bitstreams: 1 WagnerIvanFonsecaDeOliveira_DISSERT.pdf: 1988371 bytes, checksum: a07fe40eb2121344eae3a44c3e03b924 (MD5) / Made available in DSpace on 2016-04-06T23:16:55Z (GMT). No. of bitstreams: 1 WagnerIvanFonsecaDeOliveira_DISSERT.pdf: 1988371 bytes, checksum: a07fe40eb2121344eae3a44c3e03b924 (MD5) Previous issue date: 2015-06-09 / As Institui??es de Longa Perman?ncia para Idosos (ILPIs) s?o uma importante alternativa de cuidado em todo mundo, por?m o Brasil ainda n?o disp?e de instrumento v?lido para monitorar a qualidade dessas institui??es. Nos Estados Unidos, utiliza-se o Observable Indicators of Nursing Home Care Quality Instrument (IOQ) o qual avalia a qualidade do cuidado nas ILPIs a partir de 30 indicadores de estrutura (2 dimens?es) e processo (5 dimens?es) relacionados ? dimens?o da qualidade aten??o centrada na pessoa. Objetivou-se neste estudo adaptar transculturalmente o IOQ para avaliar a qualidade do cuidado das ILPIs no contexto brasileiro. Realizou-se a equival?ncia conceitual e de itens para avaliar a pertin?ncia e viabilidade do IOQ ? realidade nacional atrav?s do ?ndice de Validade do Conte?do (IVC) junto a um comit? de especialistas formado por 10 participantes e diretamente envolvidos com o objeto de estudo. Em seguida, cumpriu-se a equival?ncia operacional, idiom?tica e a sem?ntica concomitantemente. Esta constituiu-se em 5 fases: (1) duas tradu??es e (2) respectivas retradu??es; (3) aprecia??o formal referente ao significado referencial e geral; (4) revis?o por um segundo comit? de especialistas; (5) aplica??o do pr?-teste em tr?s ILPIs por pares de diferentes entes sociais: profissionais de sa?de, reguladores da vigil?ncia sanit?ria e potenciais consumidores. Avaliou-se a equival?ncia de mensura??o a partir do teste de alfa de Cronbach para verificar a consist?ncia interna do instrumento. Para mensurar a concord?ncia entre os pares de avaliadores, utilizou-se o ?ndice de Concord?ncia Geral (ICG) e o coeficiente Kappa. Estimou-se o cumprimento pontual e Intervalo de Confian?a 95% dos indicadores, dimens?es e construto total. O IVC apresentou resultados elevados tanto para relev?ncia (95,3%) quanto para viabilidade (94,3%) ao contexto brasileiro. Quanto ao significado referencial, observou-se similaridade variando entre 90-100% para a primeira retradu??o e 70-100% para a segunda. Com rela??o ao significado geral, a vers?o 1 foi melhor avaliada, recebendo classifica??o ?inalterado? em 80% dos itens, enquanto a vers?o 2 apresentou apenas 47%. No pr?-teste, o IOQ mostrou-se compreens?vel e de f?cil aplica??o. Obteve-se um alfa de Cronbach elevado (0,93), ICG satisfat?rio (75%) e concord?ncia substancial atrav?s do coeficiente Kappa (0,65) entre os pares de avaliadores: profissionais de sa?de, reguladores da Subcoordenadoria da Vigil?ncia Sanit?ria (SUVISA) e potenciais consumidores. ? poss?vel assumir a equival?ncia operacional realizada uma vez que se preservou o layout do instrumento original na vers?o brasileira a partir da manuten??o das caracter?sticas no modo de aplica??o, op??es de respostas, n?mero de itens, enunciados e pontua??es. O desempenho das ILPIs obteve m?dia aproximada de 87 pontos, apresentando uma varia??o de 55 a 111, considerando uma escala de 30 a 150. Piores resultados estiveram relacionados ao processo (m?dia=2,85), enquanto a estrutura obteve uma m?dia de 3,75, considerando uma escala de 1 a 5. A menor pontua??o foi alusiva ? dimens?o referente ? presta??o de cuidados (m?dia=2). Identificou-se o IOQ como sendo v?lido e confi?vel no contexto brasileiro. Sugere-se o uso para avaliar e monitorar a qualidade do cuidado nas ILPIs por profissionais de sa?de, reguladores e potenciais consumidores e evidenciar oportunidades de melhoria. / The Nursing Homes are an important alternative care in the world, but Brazil still has no valid instrument to monitor the quality these institutions. In the United States, the Observable Indicators of Nursing Home Care Quality Instrument (OIQ) is used to assess the quality of Nursing Home care using 30 indicators of structure (2 dimensions) and process (5 dimensions) related to quality person-centered care. The present study aimed at cross-culturally adapting the OIQ in order to evaluate the quality of Nursing Home care in Brazil. Conceptual and item equivalence were determined to assess the relevance and viability of OIQ in the Brazilian context, using the Content Validity Index (CVI) and a group of specialists composed of 10 participants directly involved in the object of study. Next, operational, idiomatic and semantic equivalence were carried out concurrently. This consisted of 5 phases: (1) two translations and (2) their respective back translations; (3) formal appraisal of referential and general meaning; (4) review by a second group of specialists; (5) application of the pretest at three Nursing Homes by different social entities: health professionals, sanitary surveillance regulators and potential consumers. Measurement equivalence was evaluated by the Cronbach?s alpha test to verify the internal consistency of the instrument. To measure inter-evaluator agreement, the General Agreement Index (ICG) and Kappa coefficient were used. Timely compliance and 95% Confidence Interval of indicators, dimensions and total construct were estimated. The CVI obtained high results for both relevance (95.3%) and viability (94.3%) in the Brazilian context. With respect to referential meaning, similarity was observed, ranging between 90-100% for the first back translation and 70-100% for the second. In relation to general meaning, version 1 was better, classified as ?unchanged? in 80% of the items, whereas in version 2 it was only 47%. In the pretest, the OIQ was easy to understand and apply. The following outcomes were obtained: a high Cronbach?s alpha (0.93), satisfactory ICG (75%) and substantial agreement between the pairs of evaluators (health professionals, regulators from the Superintendency of Sanitary Surveillance ?SUVISA-, and potential consumers), according to the Kappa coefficient (0.65). It?s possible take the operational equivalence held since it preserved the original layout in the Brazilian version from the maintenance in application mode, response options, number of items, statements and scores. The performance of nursing homes obtained approximate average scores of 87, a variation 55-111 considering a range from 30 to 150 points. The worst outcomes were related to process indicators with a mean of 2.8 per item, while structure was 3.75 on a scale of 1 to 5. The lowest score was obtained for the care dimension (mean 2). The OIQ version was deemed to be a valid and reliable instrument in the Brazilian context. It is recommended that health professionals, regulators and potential consumers adopt it to access and monitor the quality of Nursing Home care and demonstrating opportunities for improvement.

Made available in DSpace on 2014-12-17T15:16:14Z (GMT). No. of bitstreams: 1 CristinaMAH_DISSERT.pdf: 984384 bytes, checksum: dfe0fc420bd6e5c96fec7d33e3020b1d (MD5) Previous issue date: 2011-03-04 / Introduction: The Frailty Syndrome is characterized by the decrease of energy reserve and the reduced resistance to stressors. Studies indicate that the neuroendocrine markers can be related to the appearance of this syndrome. The main endocrine answer to stress is the increase of cortisol levels. Objective: To analyze the correlation between the frailty syndrome the salivary cortisol in elderly residing in nursing homes. Method: A traversal study was accomplished, in Jo?o Pessoa city, PB, with a sample composed by 69 institutionalized elderly. The collected data refer to the frailty phenotype (weight loss, exhaustion, slowness, weakness, and lower level of physical activity) and to salivary cortisol parameters (first measure - 6-7h; second measure - 11-12h; third measure - 16-17h). In the statistical analysis the Pearson s correlation test was used, Chi square Test and Anova and Simple Linear Regression analyses. Results: The sample was composed by 37.7% of men and 62.3% of women, with age average of 77.52 (?7.82). There was a percentile of 45.8% frail elderly. The frail elderly obtained higher cortisol values in the third measure (p=0.04) and the frailty load was significantly associated to the first measure (r=0.25, p=0.04). The simple linear regression analysis presented a determination rate (R2=0.05) between frailty load and first cortisol measure. Conclusion: The largest cortisol values in the morning and before sleeping among the frail elderly supply indications that can have a relationship of cortisol increase levels and the frailty presence in elderly from nursing homes. / Introdu??o: A S?ndrome da fragilidade ? caracterizada pela diminui??o da reserva de energia e pela resist?ncia reduzida aos estressores. Estudos indicam que os marcadores neuroend?crinos podem estar relacionados ao surgimento desta s?ndrome. A principal resposta end?crina ao estresse ? o aumento dos n?veis de cortisol. Objetivo: Analisar a correla??o entre a s?ndrome da fragilidade e o cortisol salivar em idosos residentes em institui??es de longa perman?ncia. M?todo: Foi realizado um estudo transversal, na cidade de Jo?o Pessoa-PB, com uma amostra composta de 69 idosos institucionalizados. Os dados coletados referem-se ao fen?tipo de fragilidade (perda de peso, fadiga, lentid?o fraqueza, e baixo n?vel de atividade f?sica) e aos par?metros do cortisol salivar (primeira medida 6-7h; segunda medida 11-12h; terceira medida- 16-17h). Na an?lise estat?stica utilizou-se o teste de correla??o de Pearson, Teste Qui quadrado e Anova. Posteriormente a an?lise de Regress?o Linear simples. Resultados: A amostra foi composta de 37,7% de homens e 62,3% de mulheres, com m?dia de idade de 77,52 (?7,82). Houve um percentual de 45,8% de idosos fr?geis. Os idosos fr?geis obtiveram maiores valores de cortisol na terceira medida (p=0,04) e a carga de fragilidade esteve associada significativamente ? primeira medida (r=0,25, p=0,04). A an?lise de regress?o linear simples apresentou uma taxa de determina??o (R2=0,05), entre carga de fragilidade e primeira medida de cortisol. Conclus?o: Os maiores valores de cortisol pela manh? e antes de dormir entre os idosos fr?geis fornecem ind?cios de que possa haver uma correla??o positiva entre os n?veis de cortisol e a fragilidade em idosos de institui??es de longa perman?ncia.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2018-02-15T11:29:27Z No. of bitstreams: 1 EdileneDayseAraujoDaSilva_DISSERT.pdf: 3247544 bytes, checksum: 8559c0b25624e619618966ea9616cedd (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-02-16T12:15:13Z (GMT) No. of bitstreams: 1 EdileneDayseAraujoDaSilva_DISSERT.pdf: 3247544 bytes, checksum: 8559c0b25624e619618966ea9616cedd (MD5) / Made available in DSpace on 2018-02-16T12:15:13Z (GMT). No. of bitstreams: 1 EdileneDayseAraujoDaSilva_DISSERT.pdf: 3247544 bytes, checksum: 8559c0b25624e619618966ea9616cedd (MD5) Previous issue date: 2017-07-31 / Os lugares nas universidades paulatinamente est?o sendo ocupados por mais estudantes das camadas populares, um fato recente nas institui??es de ensino superior do Brasil. Estudos sobre o acesso aos diplomas universit?rios, especialmente na perspectiva da sociologia da educa??o, apontam que ? crucial compreender n?o apenas o ingresso e a perman?ncia desses discentes oriundos de grupos sociais desfavorecidos, como tamb?m conhecer a realidade de suas viv?ncias acad?micas. Assim, esse estudo tem como principal objetivo compreender a condi??o de perman?ncia do estudante de origem popular na Universidade a partir do seu processo de socializa??o. A UFRN- Universidade Federal do Rio Grande do Norte foi o l?cus da pesquisa, com a participa??o dos graduandos populares de cursos das ?reas de Humanas (Ci?ncias Sociais e Direito), Biom?dica (Ci?ncias Biol?gicas e Odontologia) e Tecnol?gica (Matem?tica e Engenharia Civil). Na primeira etapa da investiga??o, incluindo uma abordagem etnogr?fica com registros descritivos do campo das observa??es, aplicou-se um question?rio em turmas a partir do terceiro per?odo (semestre) do curso. No segundo momento, realizou-se entrevistas semiestruturadas com seis representantes, um estudante de cada gradua??o delimitada. A partir da fala dos sujeitos, definiram-se quatro categorias anal?ticas: a) Trajet?rias formativas: escolares e familiares; b) Caminhos acad?micos: tensionados e fact?veis; c) Socializa??o universit?ria: formal e cordial; e, d) Prospectiva profissional: continuada e (des)continuada. Da an?lise dessas categorias resultou uma interpreta??o dos significados sociol?gicos e educacionais atribu?dos pelos estudantes, a despeito das suas pr?prias condi??es econ?micas desfavor?veis e de suas fam?lias, ponto crucial nesse estudo. Por?m, considerando-se as v?rias dificuldades para a perman?ncia, independentemente da origem social, todos os estudantes t?m que (re)inventar-se para se manterem em seus cursos. Nesse cen?rio de barreiras econ?micas e obst?culos educacionais, os la?os de amizade, parcerias em grupos, sociabilidade nas pra?as, bares, cantinas e a ajuda dos pares, s?o vistos como sendo essenciais para a sobreviv?ncia estudantil, fen?meno que devido a essas rela??es sociais e afetivas denominou-se de socializa??o acad?mica cordial. / More popular classes? students progressively occupy the universities places, a recent fact in the higher education institutions in Brazil. Studies about the access to universities diplomas, especially in the sociology of education perspective, point that is crucial understand not just the admission and permanence of those students arise from disadvantaged social groups, but as well know the reality of their academic living. Thus, this study have as principal aim understanding the permanence condition of the grassroots student in the University from the socialization processes. The Universidade Federal do Rio Grande do Norte was the research locus with the participation of popular classes? students of the Humanities courses (Social Sciences and Law), Biomedical courses (Biological Sciences and Dentistry) and Technological courses (Mathematics and Civil Engineering). In the first investigation step, includes an ethnography approach with descriptive registers of the observational field, it applied a questionnaire in the third period (semester) classes of the course. In a second moment, it realized semi structured interviews with six representatives, one student of which delimited course. From the subjects speech it defined four analytical categories: a) Formative trajectories: academic and familial; b) Academic paths: tensioned and feasible; c) University socialization: formal and cordial; e, d) Professional prospective: continue and (dis)continue. From those categories it resulted an interpretation of sociological and educational significances attributed by the students, in despite of their selves and theirs family disadvantaged economic conditions, crucial point in this study. However, considering the numerous difficulties for the permanence, independently of the social origins, all the students have to (re)invent their selves to remain in theirs courses. In the scenario of economic barriers and educational obstacles, the bonds of friendship, partnerships groups, squares sociability, bars, canteens and the pairs help, are seeing as essentials to the student survive, phenomena due to these social and affective relationships it named as cordial academic socialization.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-01-27T14:20:58Z No. of bitstreams: 1 FabienneLouiseJuvencioPaesDeAndrade_TESE.pdf: 1561318 bytes, checksum: 80c7dc22ce094332bc25950a71f37f1f (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-01-31T15:53:29Z (GMT) No. of bitstreams: 1 FabienneLouiseJuvencioPaesDeAndrade_TESE.pdf: 1561318 bytes, checksum: 80c7dc22ce094332bc25950a71f37f1f (MD5) / Made available in DSpace on 2017-01-31T15:53:29Z (GMT). No. of bitstreams: 1 FabienneLouiseJuvencioPaesDeAndrade_TESE.pdf: 1561318 bytes, checksum: 80c7dc22ce094332bc25950a71f37f1f (MD5) Previous issue date: 2016-07-01 / O acelerado processo de envelhecimento da popula??o brasileira est? associado ao incremento das doen?as cr?nicas n?o transmiss?veis, tornando cada vez maior a demanda por servi?os de sa?de. As taxas de interna??o hospitalar de idosos s?o mais elevadas do que as observadas em outros grupos et?rios, principalmente entre aqueles que residem em Institui??es de Longa Perman?ncia para Idosos (ILPI), devido ? maior vulnerabilidade e fragilidade destes. Nesse sentido, o objetivo do presente estudo foi verificar a incid?ncia e fatores de risco para hospitaliza??o em idosos institucionalizados da cidade do Natal/RN. Trata-se de estudo de coorte prospectivo, realizado entre outubro de 2013 a janeiro de 2015, com dura??o de 12 meses de acompanhamento, composto por idosos com 60 anos e que residiam nas 10 ILPI participantes do estudo. Na coleta dos dados inicial, foram obtidas informa??es sociodemogr?ficas, relacionadas ? institui??o e condi??es de sa?de. No per?odo do seguimento, foi observada a ocorr?ncia de hospitaliza??o, bem como a incid?ncia de quedas e fraturas, decl?nio da capacidade cognitiva, mobilidade, contin?ncia (urin?ria e/ou fecal) e informa??es referentes ? medica??o. Os dados foram coletados dos prontu?rios e diretamente com o idoso ou profissionais da sa?de. Foi realizada an?lise m?ltipla de regress?o log?stica, utilizando-se o m?todo Stepwise Forward, considerando o n?vel de signific?ncia de 5% e intervalo de confian?a (IC) de 95%. Dos 320 idosos participantes, houve predom?nio de idosos do sexo feminino (75,3%), com idade m?dia de 81,4 anos (DP: 9,0). Destes, 20,6% (IC 95%: 16,5-25,4) foram hospitalizados, com a perman?ncia m?dia de 16,1 dias (DP: 17,1). A principal causa da hospitaliza??o foram as doen?as pulmonares (30,3%). O modelo final mostrou que a presen?a de desnutri??o ou risco de desnutri??o (p=0,016) e fazer uso de medicamentos para o sistema cardiovascular (p=0,003) foram fatores de risco para a hospitaliza??o, ajustados pela idade, sexo e tipo de institui??o. Estes achados apontam uma alta incid?ncia de hospitaliza??o entre os idosos institucionalizados. Al?m disto, a desnutri??o ou risco de desnutri??o e o uso de medicamentos cardiovasculares foram considerados fatores de risco para a hospitaliza??o. Assim, h? a necessidade de maior aten??o na avalia??o multiprofissional, bem como nas interven??es e servi?os prestados aos idosos institucionalizados. / The accelerated aging process of the Brazilian population is associated with an increase in non-transmissible chronic diseases, which in turn increases the demands for health services. The hospitalization rates of older adults are higher than what is observed in other age groups, especially in those that reside in Long Term Institutions for the Elderly (LTIE), due to inherent vulnerability and frailty of these individuals. The objective of the work presented herein was to verify the incidence and risk factors associated with the hospitalization of institutionalized older adults in the city of Natal/RN, Brazil. A prospective cohort study, conducted from october 2013 to january 2015, was carried out throughout a monitoring period of 12 months, with older adults over the age of 60, who resided in the 10 LTIE that accepted to participate in the study. Initial data collection included sociodemographic information related to the institution and health conditions. In the period of follow-up, was observed the incidence of hospitalization, and the incidence of falls and fractures, decline in cognitive ability, mobility, continence (urinary and / or fecal) and information relating to the medication. Data were collected from medical records and directly with the elderly or health professionals. The Stepwise Forward method was utilized for Multiple Logistic Regression Analysis, with a 5% significance level and confidence interval (CI) 95%. Of the participating 320 elderly, there was a predominance of females (75.3%), average age 81.4 years (Standard Deviation, SD: 9.0). Of these, 20.6% (CI 95%: 16,5-25,4) were hospitalized, with an average permanence time of 16,1 days (SD: 17.1). The main hospitalization cause was pulmonary disease (30.3%). The final model showed that malnutrition or risk of malnutrition (p=0.016) and the use of medication for the cardiovascular system (p=0.003) were risk factors for hospitalization, adjusted by age, sex and type of institution. These findings indicate a high incidence of hospitalization in institutionalized elderly. Malnutrition or risk of malnutrition and the use of cardiovascular medication were considered to be risk factors for hospitalization. There is a clear need for increased attention in multiprofessional evaluation, as well in interventions and services rendered to institutionalized elderly.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-02-10T16:52:35Z No. of bitstreams: 1 JavierJerezRoig_TESE.pdf: 3511641 bytes, checksum: 4ae07f46d035d68bf8ef148cfa29afe2 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-02-10T22:20:22Z (GMT) No. of bitstreams: 1 JavierJerezRoig_TESE.pdf: 3511641 bytes, checksum: 4ae07f46d035d68bf8ef148cfa29afe2 (MD5) / Made available in DSpace on 2017-02-10T22:20:22Z (GMT). No. of bitstreams: 1 JavierJerezRoig_TESE.pdf: 3511641 bytes, checksum: 4ae07f46d035d68bf8ef148cfa29afe2 (MD5) Previous issue date: 2016-08-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O presente trabalho teve como objetivos principais: verificar a preval?ncia de incapacidade funcional (IF) para as atividades b?sicas da vida di?ria (ABVD) e os fatores associados (Estudo 1), assim como verificar a incid?ncia de decl?nio funcional e os fatores progn?sticos de decl?nio funcional (Estudo 2) em idosos institucionalizados. A amostra do trabalho foi formada por indiv?duos de 60 anos ou mais pertencentes a 10 institui??es de longa perman?ncia para idosos (ILPI) da cidade do Natal/RN, sendo exclu?dos os hospitalizados ou em processo de cuidados paliativos. O Estudo 1 ? de tipo transversal (Outubro e Dezembro de 2013) e foi avaliada a IF mediante a escala de Katz e caracterizada quando houve limita??o em uma ou mais ABVD (alimenta??o, controle de esf?ncteres, transfer?ncias posturais, higiene pessoal, capacidade para se vestir e tomar banho). Como vari?veis independentes foram consideradas as sociodemogr?ficas, as relacionadas ? institui??o e ?s condi??es de sa?de. Usaram-se o teste qui-quadrado, teste de Fisher ou teste qui-quadrado de tend?ncia linear para a an?lise bivariada, assim como a regress?o log?stica para a multivariada. A amostra foi de 321 idosos e a preval?ncia de IF de 72,9% (IC 95%: 67,8-77,5%). A tarefa mais afetada foi o ?banho?, seguido por ?vestir-se? e ?ir ao banheiro?. O modelo final constatou associa??o com a institui??o de tipo privado (RP=1,33, p<0,001), idade igual ou superior a 83 anos (RP=1,26, p=0,003), ser institucionalizado por n?o ter cuidador (RP=1,17, p=0,033) e osteoporose (OR=1,23, p=0,045), ajustado por sexo. O Estudo 2 ? longitudinal de 24 meses de acompanhamento com intervalos de follow-up de 6 meses (5 ondas). Al?m dos crit?rios aplicados no Estudo 1, foram exclu?dos aqueles que apresentavam IF para todas as ABVD (banho, higiene pessoal, vestir-se, ir ao banheiro, caminhar, transfer?ncias posturais e comer) no in?cio do estudo. Foi considerada a presen?a de decl?nio funcional quando houve redu??o na pontua??o total das ABVD, as quais foram avaliadas mediante uma escala tipo Likert de 5 pontos. Foram analisadas todas as vari?veis independentes do Estudo 1, mais o estado de mobilidade, cognitivo (teste de Pfeiffer), h?bitos t?xicos e atividade f?sica, al?m de vari?veis dependentes do tempo. Para a an?lise estat?stica, foi utilizado o m?todo atuarial, o teste log-rank, a an?lise univariada de Cox e a regress?o de Cox. A coorte esteve composta por 280 idosos: 140, 50,0% (IC 95%: 44,2-55,8%), sofreram decl?nio funcional, 94, 33,6% (IC 95%: 28,3-39,3%) mantiveram a capacidade funcional, e 40, 14,3% (IC 95%: 10,7-18,9%), apresentaram melhora funcional em uma ou mais avalia??es. A probabilidade acumulada de manuten??o funcional foi de 44,0% (IC 95%: 37,7-50,2%) aos 24 meses. A capacidade de se alimentar foi a que apresentou maior decl?nio durante o per?odo (-0,54 pontos), seguido por deambula??o (-0,43), vestir-se (-0,35), transfer?ncias posturais (-0,31), banho (-0,29), higiene pessoal (-0,24) e ir ao banheiro (-0,22). O modelo multivariado mostrou que os fatores predictores de decl?nio funcional foram a incapacidade cognitiva grave (HR=1,98; p=0,003), decl?nio da contin?ncia (HR=1,70; p=0,013) e incid?ncia de hospitaliza??es (HR=1,65; p=0,023). / The main objectives of this work were: to verify the prevalence of functionaldisability (FD) inthe basic activities of daily living (BADL) and its associated factors (Study 1) and verify the incidence of functional decline and predictor factors of functional decline (Study 2) in institutionalized older people. The sample of the study was formed by individuals aged 60 years and over belonging to 10 nursing homes (NH) in Natal/RN, being excluded hospitalized or palliative care residents. The Study 1 is a cross-sectional study (October-December 2013) and FD was evaluated by Katz scale and characterized when there was limitation in one or more BADL (eating, sphincter control, transferring, personal hygiene, dressing and bathing). As independent variables sociodemographic, instituition-related health-related variables were considered. The Chi-square test, Fisher's exact test or the linear Chi-square test for the bivariate analysis and logistic regression for multivariate analysis were applied. The sample consisted of 321 individuals and the prevalence of FD was 72.9% (95% CI: 67.8-77.5%). The most affected task was 'bathing', followed by 'dressing' and 'toileting.' The final model found association with private NH (PR=1.33, p<0.001), age 83 and over (RP=1.26, p=0.003), reason for institutionalization ?lack of caregiver? (RP=1.17, p=0.033) and osteoporosis (RP=1.23, p=0.045), adjusted by sex. The Study 2 is a 24-months longitudinal study with follow-up every 6 months (5 waves). Apart from the criteria considered in the Study 1, residents with FD for all BADL (bathing, personal hygiene, dressing, toileting, walking, transferring and eating) at baseline were excluded. The presence of functional decline was defined when there was a reduction the total score of BADL, which were assessed by a 5-point Likert scale. All independent variables of the Study 1 were considered, as well asthe mobility status, cognitive status (Pfeiffer test), toxic habits, physical activity and time-dependent variables. Statistical analysis was performed using the actuarial method, log-rank test, Cox univariate analysis and Cox regression. The cohort was composed of 280 individuals: 140, 50.0% (95% CI: 44.2-55.8%) experienced functional decline; 94, 33.6% (95% CI: 28.3-39.3%), maintained their functional capacity, and; 40, 14.3% (95% CI: 10.7-18.9%), showed functional improvement at one or more waves. The cumulative probability of functional maintenance was 44.0% (95% CI: 37.7-50.2%) at 24 months. The ability to eat showed the largest decline during the period (-0.54 points), followed by walking (-0.43), dressing (-0.35), transferring (-0.31), bathing (-0.29), personal hygiene (-0.24) and toileting (-0.22). The final model showed that the predictors factors of functional decline were severe cognitive impairment (HR=1.96, p=0.001), continence decline (HR=1.85, p=0.002) and incidence of hospitalizations (HR=1.62, p=0.020).

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-08-10T11:59:48Z No. of bitstreams: 1 LeonidasDeOliveiraNeto_TESE.pdf: 1668906 bytes, checksum: 3fa7c80c1f7980340ddded1cd5fc5726 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-08-11T15:48:54Z (GMT) No. of bitstreams: 1 LeonidasDeOliveiraNeto_TESE.pdf: 1668906 bytes, checksum: 3fa7c80c1f7980340ddded1cd5fc5726 (MD5) / Made available in DSpace on 2017-08-11T15:48:54Z (GMT). No. of bitstreams: 1 LeonidasDeOliveiraNeto_TESE.pdf: 1668906 bytes, checksum: 3fa7c80c1f7980340ddded1cd5fc5726 (MD5) Previous issue date: 2017-06-05 / Introdu??o: O diagn?stico da sarcopenia ? restrito aqueles com boa capacidade f?sica e cognitiva, n?o sendo adaptado ?s condi??es dos idosos institucionalizados. Al?m disso, apesar da perda de massa muscular ser determinante para seu diagn?stico, redu??o associada de massa gorda tem sido observada na sarcopenia. Ademais, embora o estado inflamat?rio seja considerado um gatilho da perda de massa muscular, a redu??o no tecido adiposo tem sido associado ? redu??o do estado inflamat?rio, concorrendo no constructo te?rico da associa??o entre inflamm-aging e sarcopenia. Objetivo: Discutir o diagn?stico para sarcopenia em idosos institucionalizados e verificar a associa??o entre inflamm-aging e sarcopenia, assim como analisar seus fatores associados. Metodologia: Tr?s estudos foram conduzidos em idosos de ambos os sexos, residentes em institui??es de longa perman?ncia na cidade do Natal/RN. No estudo 1 (n=219) foi realizado uma adapta??o do Consenso Europeu para Diagn?stico da Sarcopenia (2010) agregando idosos com baixa capacidade f?sica e cognitiva. No estudo 2 (n=219) foi verificado quais os fatores est?o associados ? sarcopenia. No estudo 3 (n=187) foi realizado an?lise de conglomerados de idosos segundo seu estado inflamat?rio e verificado os fatores associados ? esta condi??o. Resultados: Inclus?o de idosos com baixa condi??o f?sica e cognitiva (estudo 1) acresceu em 32,2% a preval?ncia de sarcopenia. No estudo 2, os fatores associados ? sarcopenia foram altura do joelho, eutrofia e excesso de peso (segundo IMC) e capacidade de deambular. No estudo 3 foi poss?vel verificar que aumento de 1 unidade ?g/dL no LDL, HDL e triglicer?deos apresentaram aumento de 1,5%, 4,1% e 0,9% a chance de inflamm-aging e idosos longevos (?80 anos) possu?ram 84,9% mais de chance de inflamm-aging. Conclus?o: Inclus?o de idosos com baixa capacidade f?sica e cognitiva para c?lculo de sarcopenia ? valida e representa de modo mais adequado os idosos institucionalizados, apresentando o aspectos antropom?tricos e f?sicos como seus principais fatores associados. Ademais, os indicadores bioqu?micos e antropom?tricos demonstraram rela??o da sarcopenia com desnutri??o. Al?m disso, n?o foi observado associa??o do inflamm-aging com sarcopenia, corroborando o constructo de que na sarcopenia n?o ocorre perda seletiva da massa muscular. / Introduction: The diagnosis of sarcopenia is restricted to those with good physical and cognitive capacity, not being adapted to the conditions of the institutionalized elderly. In addition, dispite the loss of muscle mass is determinant for its diagnosis, associated reduction of fat mass has been observed in sarcopenia. Although the inflammatory state is considered a trigger to loss of muscle mass, reduction in adipose tissue has been associated with the reduction of the inflammatory state, competing in the theoretical construct of the association between inflammation and sarcopenia. Objective: To discuss the diagnosis of sarcopenia in institutionalized elderly patients and to verify the association between inflammation and sarcopenia, as well as to analyze their associated factors. Methodology: Three studies were conducted in elderly people of both sexes, living in nursing homes in the city of Natal / RN. In study 1 (n = 219) an adaptation of the European Consensus for Diagnosis of Sarcopenia (2010) was carried out, adding elderly people with low physical and cognitive capacity. In study 2 (n = 219) it was verified which factors are associated with sarcopenia. In study 3 (n = 187), the analysis of elderly conglomerates according to their inflammatory state was performed and the factors associated with this condition were verified. Results: Inclusion of elderly people with low physical and cognitive status (study 1) increased the prevalence of sarcopenia by 32.2%. In study 2, the factors associated with sarcopenia were knee height, eutrophy and excess weight (according to BMI) and the ability to ambulate. In study 3 it was possible to verify that increase of 1 unit ?g / dL in LDL, HDL and triglycerides presented a 1.5%, 4.1% and 0.9% increase in the chance of inflamm-aging and elderly individuals (?80 years ) had an 84.9% greater chance of inflammation. Conclusion: Inclusion of elderly with low physical and cognitive capacity to calculate sarcopenia is valid and represents more appropriately the institutionalized elderly, presenting the anthropometric and physical aspects as their main associated factors. In addition, the biochemical and anthropometric indicators demonstrated a relationship of sarcopenia with malnutrition. In addition, no association of inflammation with sarcopenia was observed, corroborating the construct that in sarcopenia there is no selective muscle mass loss.

Made available in DSpace on 2014-12-17T14:23:31Z (GMT). No. of bitstreams: 1 CristianeADA_DISSERT.pdf: 5621618 bytes, checksum: feb61d4327573fb26291a997347a2647 (MD5) Previous issue date: 2013-02-22 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The aging population and individual have been the subject of a multitude of studies nowadays. This is probably due to the impact of this phenomenon in various sectors of society, like social security, social assistance and public health. The process of aging of the individual imply the demand for specific services, considering the limitations and vulnerabilities of the individual at that stage of life cycle. The growth of the elderly contingent in the last decades raises challenges for policymakers, the family and also for the society at large. In this scenario, long-stay institutions for the elderly (LSIEs) appear as an option to aid and support the elderly and their family, assisting in all or part in the activities of daily living and self-care. Inside these LSIEs we find the professional responsible for the direct care of the elderly, the formal caregiver. In this context, this dissertation presents two main objectives: an analysis of the phenomenon of population aging in a given brazilian municipality Natal / RN, based on the Demographic Censuses of 2000 e 2010; and a social, demographic and economic characterization of the Formal caregiver for the institutionalized elderly in the municipality, evaluating aspects of his quality of life and also analyzing the institutions where they are inserted. Furthermore, we intend to identify demographic, socioeconomic and quality of life factors that are correlated with caregivers quitting the job. The data used in the second part of this work comes from the research project named Long-Stay Institutions for Elderly: abandonment or a family need? . This survey interviewed 92 caregivers in eleven LSIEs in Natal/RN. In the data treatment logistic regressions, cluster analysis and statistical tests were used. The survey revealed that aging in Natal is more pronounced in the older, more traditional districts: Petr?polis, Lagoa Seca and Tirol. It also allowed a broad characterization of the formal caregivers in LSIEs. Most of these professionals are female. The educational level is predominantly complete high school and more. Most caregivers reported being married or in union, or have ever been in a union. Family monthly income is under three times the minimum wage. The mean age is of 37.4 years. The mean time of work as a caregiver was 5.93 years. The associations showed that being woman, not being single, having caregiving training and physical limitations (regarding quality of life) are related to wanting to quit the caregiving job. As for the characterization of the LSIEs, it was found that the philanthropic ones are older and have most (62.5%) of the institutionalized elderly. The institutions managers gave social interaction and affinity with the elderly as the main criteria with which to evaluate and hire caregivers. It is intended with this study to contribute to improving the quality of life of the elderly and their caregiver, providing information on aspects of institutionalization of elderly both in the philanthropic and particular institutions, in Natal/RN; this dissertation may also be used as a starting point for later works / O envelhecimento populacional e individual tem sido objeto de diversos estudos na atualidade. Isso se deve, provavelmente, ao impacto desse fen?meno em diversos setores da sociedade, principalmente nos de previd?ncia social, assist?ncia social e sa?de p?blica. O envelhecimento do indiv?duo, na figura do idoso, demanda servi?os espec?ficos, tendo em vista as limita??es e vulnerabilidades do indiv?duo nessa fase da vida humana. O crescimento desse contingente nas ?ltimas d?cadas traz desafios para os gestores, para a fam?lia e para a sociedade. Nesse cen?rio, as institui??es de longa perman?ncia para idosos (ILPI) surgem como uma op??o de aux?lio e amparo ao idoso e a sua fam?lia, com a presta??o de assist?ncia integral ou parcial nas atividades de vida di?ria e no autocuidado. No ambiente dessas ILPIs se encontra o profissional respons?vel pelo cuidado direto ao idoso, o cuidador formal de idosos. Diante de tal contexto, a disserta??o apresenta dois grandes enfoques: uma an?lise do fen?meno do envelhecimento populacional num determinado munic?pio brasileiro &#8210; Natal/RN, &#8210; com base nos Censos Demogr?ficos de 2000 e 2010, e uma caracteriza??o social, demogr?fica e econ?mica do cuidador formal de idosos institucionalizado do munic?pio, avaliando os aspectos de sua qualidade de vida, e tamb?m, analisando as institui??es onde est?o inseridos. Ademais, pretende-se identificar os fatores socioecon?micos e demogr?ficos, e os ligados ? qualidade de vida que levam os cuidadores a deixar essa ocupa??o. Os dados utilizados na segunda parte deste trabalho prov?m do projeto de pesquisa intitulado Institui??es de longa perman?ncia para idosos: abandono ou. uma necessidade familiar? . A pesquisa envolveu 92 cuidadores formais, distribu?dos em onze ILPIs localizadas em Natal/RN. No tratamento dos dados, foram utilizadas Regress?es Log?sticas, An?lise de Agrupamento e Testes Estat?sticos. A pesquisa permitiu constatar que o envelhecimento no munic?pio de Natal ? maior nos bairros mais antigos e tradicionais: Petr?polis, Lagoa Seca e Tirol. Permitiu tamb?m uma ampla caracteriza??o dos cuidadores formais lotados nas ILPIs. A maioria ? do sexo feminino. A escolaridade predominante ? ensino m?dio completo e mais. A maior parte dos cuidadores declararam estar casados/unidos ou alguma vez unidos. A renda familiar mensal ? inferior a tr?s sal?rios. Quanto ? idade, em m?dia, ? de 37,4 anos. O tempo m?dio de exerc?cio da fun??o de cuidador ? de 5,93 anos. As associa??es mostraram que ser mulher, n?o ser solteiro, fazer o curso de cuidador e a limita??o por aspectos f?sicos (dom?nio da qualidade de vida) se relacionam a pretens?o de deixar de ser cuidador de idosos (atividade). Quanto ? caracteriza??o das ILPIs, verificou-se que as de natureza filantr?pica s?o mais antigas e concentram o maior n?mero de idosos institucionalizados (62,5%). Para contratar os cuidadores, os dirigentes das ILPIs citaram como principal qualidade/capacidade a intera??o social e a afinidade com o idoso. Pretende-se, com este estudo, contribuir para a melhoria da qualidade de vida do idoso e de seu cuidador formal, fornecendo informa??es sobre aspectos da institucionaliza??o do idoso, tanto em estabelecimentos filantr?picos quanto em estabelecimentos privados, no munic?pio de Natal/RN, que poder?o servir de par?metro para estudos posteriores mais aprofundados