Takanen Niklasson, C. Självrapporterad hälsa hos män som genomgått screening av bukaorta. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Högskola: Hälsa och Samhälle. Utbildningsområde omvårdnad 2012.Abdominellt aortaaneurysm (AAA) är den 13:e vanligaste orsaken till dödsfall i västvärlden på män över 65 år och är fyra gånger vanligare hos män än hos kvinnor. Sedan 2010 erbjuder Region Skåne ultraljuds screening av bukaorta till alla män är 65 år för att upptäcka ev. AAA. AAA uppkommer genom förhöjt kolesterol, rökning kombinerat med högt blodtryck. Även en genetisk faktor spelar roll. Syfte: Studiens syfte var att kartlägga självrapporterat hälsotillstånd och rökvanor hos patienter som via screening diagnostiserats med aortaaneurysm i jämförelse med män med normal aorta. Metod: Studien är en deskriptiv tvärsnittsstudie som bygger på självskattade hälsoformulär som har tagits fram för screeningverksamheten. Dessa fylldes i av männen i hemmet som de sedan lämnade på screeningmottagningen. Data analyserades manuellt i antal och procent i jämförelse mellan män med AAA och de med normal aorta. Resultat: Studiens resultat visade att män med AAA hade högt BMI (Body Mass Index) och led av andra sjukdomar. Vidare hade männen med AAA låg utbildning. Nästan hälften av männen med AAA rökte. Däremot beskrev männen oavsett grupp sin hälsa på liknande sätt i den öppna frågan rörande deras nuvarande hälsotillstånd. Slutsats: Resultatet kan indikera tidigare forskning som visat alla riskfaktorer som leder till ateroskleros även kan leda till utveckling av AAA. Men eftersom ingen statistik har använts i resultatet för att belägga skillnader kan datan endast ses som en trend. Denna kunskap kan utgöra en bas för sjuksköterskans preventiva arbete i mötet med patienter som diagnostiserats med AAA. / Takanen Niklasson, C. Self-reported health of men who underwent abdominal aortascreening. Degree Project, 15 Credit Points. Malmö University: Health and Society, Department of Nursing, 2012.Abdominal aortic aneurysm (AAA) is the 13:th most common cause of death in the western world in men over 65 years old and is four times more common in men than in women. The County Council of Skåne started in 2010 a screening program in men 65 years of age to possibly discover AAA. AAA generates through elevated cholesterol and smoking combined with high blood pressure. There is also a genetic factor involved. Aim: The aim of this study was to chart self-reported state of health and smoking habits of men diagnosed with AAA through screening compared with men with normal aorta. Method: the study is a descriptive cross-sectional survey built on self-rated health questionnaires which was developed for use in the screening program. These were filled out by the men at home and gathered at the screening examination. The data was analyzed manually in numbers and percent and compared between men with AAA and those with normal aorta. Results: The results showed that men with AAA had high BMI (Body Mass Index) and suffered from other diseases. Further had men with AAA a low educational level. Almost 50% of the men with AAA were also smoking. However, all men, irrespective of having AAA or not, described their health in a similar way in the open question regarding their current health status. Conclusion: The result can indicate previous research showing that all risk factors associated with development of atherosclerosis also is associated with the development of AAA. However, no statistics were being used in the result to claim differences so the data can only be a trend. This knowledge can constitute a base for nursing prevention measures in the care of men diagnosed with AAA.

Background Non-adherence to evidence based secondary prevention medicines (SPM) by coronary heart disease (CHD) patients limits their expected benefits and may result in a lack of improvement or significant deterioration in health. This study explored self-reported non-adherence to SPM, barriers to adherence, and the perception that patients in West Yorkshire have about their medicines in order to inform practice and improve adherence. Methods In this cross-sectional study a specially designed postal survey (The Heart Medicines Survey) assessed medicines-taking behaviour using the Morisky Medicines Adherence 8 items Scale (MMAS-8), a modified version of the Single Question Scale (SQ), the Adherence Estimator (AE), Beliefs about Medicines Questionnaire(BMQ) and additional questions to explore practical barriers to adherence. Patients were also asked to make any additional comments about their medicines-taking experience. A purposive sample of 696 patients with long established CHD and who were on SPM for at least 3 months was surveyed. Ethical approval was granted by the local ethics committee. Results 503 (72%) patients participated in the survey. 52%, 34% and 11% of patients were prescribed at least four, three and two SPMs respectively. The level of non-adherence to collective SPM was 44%. The AE predicted that 39% of those had an element of intentional non-adherence. The contribution of aspirin, statins, clopidogrel, beta blockers, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) to overall non-adherence as identified by the SQ scale was 62%, 67%, 7%, 30%, 22% and 5%, respectively. A logistic regression model for overall non-adherence revealed that older age and female gender were associated with less non-adherence (OR = 0.96, 95% CI: 0.94, 0.98; OR = 0.56, 95% CI: 0.34, 0.93; respectively). Specific concern about SPM, having issues with repeat prescriptions and aspirin were associated with more non-adherence (OR = 1.12, 95% CI: 1.07, 1.18; OR = 2.48, 95% CI: 1.26, 4.90, OR = 2.22, 95% CI: 1.18, 4.17). Other variables were associated with intentional and non-intentional non-adherence. 221 (44%) patients elaborated on their medicines-taking behaviour by providing additional comments about the need for patient tailored information and better structured medicines reviews. Conclusions The Medicines Heart Survey was successful in revealing the prevalence of self-reported non-adherence and barriers to adherence in our population. Healthcare professionals should examine specific modifiable barriers to adherence in their population before developing interventions to improve adherence. Conducting frequent structured medicines-reviews, which explore and address patients' concerns about their medicines and healthcare services, and enable them to make suggestions, will better inform practice and may improve adherence.

Self-reported health is typically captured as a response to the question, “In general, would you rate your health as excellent, very good, good, fair or poor?” Among community-dwelling older adults (≥65 years), self-reported health decreases as the number of chronic conditions increases. Despite this well-documented relationship, little is known about how other sociodemographic or health-related factors may shape this relationship, what may predict high self-reported health among this population, or how older adults perceive these factors as influencing their perceptions of health. Informed by the Lifecourse Model of Multimorbidity Resilience, the objective of this multimethod research study was to advance understanding of self-reported health among community-dwelling older adults. To this end, four research studies were completed: 1) scoping review of the factors associated with self-reported health, 2) cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging to understand the relationship between multimorbidity and self-reported health and the factors that predict high self-reported health; 3) qualitative case study to explore the influence of individual, social, and environmental factors on self-reported health, including multimorbidity resilience, in community-dwelling older adults, and; 4) a multimethod study that brought together all findings in a matrix analysis. From this work, two meta-inferences were generated: 1) the factors that shape self-reported health are multidimensional and complex; and 2) adaptation to health adversity, resulting from experiences acquired over the lifecourse, shape how older adults perceive their health. Findings from this work advance three implications. First, there is a need to use and apply information gained by asking about self-reported health in clinical practice to inform care planning. Second, there is a need for whole person care to guide health and social care policy for older adults. Third, future health research must further explore longitudinal understanding of self-reported health as well as additional qualitative understanding of the differences of those older adults with the well-being paradox. / Dissertation / Doctor of Philosophy (PhD)

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Made available in DSpace on 2016-12-12T17:32:58Z (GMT). No. of bitstreams: 1 Fernanda Fonseca.pdf: 58160 bytes, checksum: c9c16d7d5ac8b50498e52c991095d785 (MD5) Previous issue date: 2015-07-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Patients with chronic obstructive pulmonary disease (COPD) have reduced level and intensity of daily physical activity. The physical activity is related to the COPD prognosis and, therefore, the functional performance of these patients should be routinely assessed. The Self-Reported Functional Limitation scale (SRFL) has been used in COPD patients cohorts to assess functional performance, but neither its classification (with or without self-reported functional limitation) measurement properties have been tested nor a translation into Portuguese and cross-cultural adaptation to Brazil have been done. The aim of this study was to translate the SRFL into Portuguese and cross-culturally adapt it to Brazil, to assign scores for its response categories and to test its measurement properties in patients with COPD. Initially, the scale was translated into Portuguese, applied in six patients with COPD, then backtranslated into English and sent to one of the original version authors to have her appreciation of the Brazilian version. Then, scores (from zero to four) were assigned to their response categories. Later, the Brazilian version was applied in thirty patients with COPD (mean ± standard deviation: age = 64 ± 8 years old; post-BD FEV1 = 38.9 ± 15.3 %pred; BMI = 25.7 ± 4.71 kg/m2) for its inter-rater and test-retest reliability analysis. Nutritional status assessment, spirometry, handgrip dinamometry, physical activity in daily life (PADL) monitorization, and the application of the COPD Assessment Test (CAT), the modified Medical Research Council scale and the London Chest Activity of Daily Living scale (LCADL) were performed for the validity analysis. There was inter-rater (&#954;=1.00; ICC=0.92 and CI95%=0.85-0.96) and test-retest (&#954;=0.79; ICC=0.92 and CI95%=0.84-0.96) reliability for the SRFL classification and score (p<0.01 for all). In the validity analysis, there were associations of self-reported functional limitation classification with the COPD impact on health status, risk and symptoms, fat-free mass (FFM) depletion and body composition impairment (p<0.05 for all) and correlations between SRFL score and total (r=0.75) and %total (r=0.77) LCADL scores, handgrip strength (r=-0.36), CAT score (r=0.80) and fat-free mass index (FFMI) (r=-0.49) (p<0.05 for all). It was also observed absence floor and ceiling effects. The translated and cross-culturally adapted SRFL version was reliable, when applied by different raters or in diferente moments, and valid for assessing the perception of functional limitation in patients with COPD, considering both its classification and score. In addition, the SRFL score had a missing floor or ceiling effect. / Pacientes com doença pulmonar obstrutiva crônica (DPOC) apresentam redução do nível e da intensidade de atividade física diária. A atividade física está relacionada ao prognóstico da DPOC e, portanto, a performance funcional desses pacientes deve ser avaliada rotineiramente. A escala Self-Reported Functional Limitation (SRFL) tem sido utilizada em coortes de pacientes com DPOC para avaliação da performance funcional, mas ainda não foram testadas as propriedades de medida de sua classificação (com ou sem limitação funcional autorrelatada) e nem foi realizada sua tradução para a língua portuguesa e sua adaptação transcultural para o Brasil. Assim, o objetivo deste estudo foi traduzir a SRFL para a língua portuguesa, adaptá-la transculturalmente para o Brasil, atribuir escores para as categorias de resposta da mesma e testar suas propriedades de medida em pacientes com DPOC. Inicialmente, a escala foi traduzida para a língua portuguesa, aplicada em seis pacientes com DPOC, retrotraduzida para a língua inglesa e discutida com uma das autoras da versão original para conclusão de sua versão brasileira. Em seguida, foram atribuídos escores (de zero a quatro) as suas categorias de resposta. Posteriormente, a versão brasileira da escala foi aplicada em trinta pacientes com DPOC (média ± desvio-padrão: idade = 64 ± 8 anos; VEF1 pós-BD = 38,9 ± 15,3 %prev; IMC = 25,7 ± 4,71 kg/m2) para análise de sua confiabilidade interavaliadores e teste-reteste. Para análise de sua validade, foram realizadas a avaliação do estado nutricional, a espirometria e a dinamometria de preensão palmar, monitorizadas as atividades físicas na vida diária (AFVD) e aplicados o COPD Assessment Test (CAT), a escala Medical Research Council modificada (mMRC) e a escala London Chest Activity of Daily Living (LCADL). Observou-se confiabilidade interavaliadores (&#954;=1,00; CCI=0,92 e IC95%=0,85-0,96) e teste-reteste (&#954;=0,79; CCI=0,92 e IC95%=0,84-0,96) para a classificação da SRFL e para o escore da mesma (p<0,01 para todos). Na análise de validade, observaram-se associações da classificação de limitação funcional autorrelatada com as classificações de impacto da DPOC no estado de saúde, de risco e sintomas, de depleção de massa livre de gordura (MLG) e de prejuízo na composição corporal (p<0,05 para todos) e correlações entre o escore da SRFL e os escores total (r=0,75) e em %total (r=0,77) da LCADL, a força de preensão palmar (r=-0,36), o escore do CAT (r=0,80) e o índice de massa livre de gordura (IMLG) (r=- 0,49) (p<0,05 para todos). Foram observados também efeitos chão e teto ausentes. A versão traduzida e adaptada transculturalmente da SRFL mostrou-se confiável, quando aplicada por diferentes avaliadores e em diferentes momentos, e válida para a avaliação da percepção de limitação funcional de pacientes com DPOC, considerando tanto a sua classificação quanto o seu escore. Além disso, o escore da SRFL não apresentou efeito chão ou teto.

A criminalidade é um problema recorrente de grande relevância, o engajamento delituoso de jovens é um fenômeno preocupante e alarmante, de acentuado impacto na sociedade. A população, em geral, tende a acreditar que os jovens estão cada vez mais perigosos e envolvidos no agir antissocial. Faz-se necessário a realização de pesquisas que desvendem a problemática e busquem alternativas e possíveis soluções. No âmbito internacional, os questionários de delinquência autorrevelada são considerados o método mais seguro para indicar a prevalência e frequência de comportamentos delituosos entre os jovens. O objetivo do presente estudo foi, em termos gerais, conhecer o comportamento divergente e delituoso de adolescentes estudantes de instituições de ensino privadas, investigando a associação do fenômeno a variáveis potencialmente relacionadas e ampliar pesquisa anterior realizada junto a jovens de instituições de ensino públicas. Participaram do estudo 324 adolescentes, do sexo masculino, estudantes de três escolas particulares. Foi aplicado o Questionário sobre Comportamentos Juvenis, um instrumento de autorrelato que aborda questões relativas à família, escola, rotina, pares, local de residência e comportamentos divergentes e delituosos. Os resultados indicaram que 60,80% da amostra relatou já ter praticado algum comportamento delituoso e 68,88% algum comportamento divergente. O comportamento delituoso mais frequente foi a lesão corporal, seguido de dano. Quanto aos comportamentos divergentes 52,5% dos adolescentes declararam já ter consumido bebidas alcoólicas. Os adolescentes foram agrupados em 5 clusters de acordo com o nível de engajamento criminal, concluiu-se que 11,11% dos jovens são responsáveis por 81% dos delitos revelados praticados nos últimos 12 meses. Esses são aqueles de engajamento mais grave e que se diferenciaram dos outros agrupamentos pela idade de primeiro delito, pela diversidade e volume de delitos praticados. / Criminality is a relevant social problem. Juvenile delinquency is a worrying and alarming phenomenon with many impacts on society. The population, in general, Believes that young people are increasingly involved on antisocial behaviours. Studies about this, is necessary to looking for alternatives and possible solutions. In international level. Self-Reported delinquency are considered the best method to indicate the delinquency behaviors prevalence and frequency. The aim of the present study is to know the self-reported delinquency in private schools young boys; investigating the association of the phenomenon with potentially related variables and expanding previous research carried out with youngsters of public educational institutions. Thirty-four adolescents, male, private schoolss students from three participated in the study. The Self Reported Delinquency was applied; its a self-report questionnaire that investigating about family, school, routine, peers, place of residence and divergent and criminal behavior. The results indicated that 60.80% of the sample reported some delinquent behavior and 68.88% some problem behavior. The most frequent criminal behavior was hurt someone, followed by damage. Regarding divergent behaviors, 52.5% of adolescents reported having consumed alcoholic beverages. The adolescents were grouped into 5 clusters according to the level of criminal engagement, it was concluded that 11.11% of young people are responsible for 81% of de delinquency practiced in the last 12 months. These group (5) have more serious engagement and that differ from others, about age, diversity and frequency.

Base teórica: A doença de Parkinson (DP) é a segunda enfermidade neurodegenerativa mais frequente, crescendo proporcionalmente com o aumento da idade. É uma doença de comprometimento motor e não motor. Levodopa e agonistas dopaminérgicos (AD) são usados no tratamento da DP, permitindo um controle ótimo dos sintomas nos primeiros anos. Entretanto, em 5 anos, metade dos pacientes terão complicações motoras e nãomotoras induzidas pelo uso de antiparkinsonianos. Manifestações neuropsiquiátricas são frequentes, entre elas depressão, ansiedade, prejuízos cognitivos, sintomas psicóticos e transtorno de descontrole dos impulsos(DI). O DI é uma condição caracterizada pela falência em resistir a impulsos ou tentação de executar atos. O DI está associado ao uso de antiparkinsonianos, em especial, os agonistas dopaminérgicos A identificação desta condição é primordial para seu tratamento e estudo adequados. Na literatura atual, o questionário padrão-ouro foi validado na língua inglesa (QUIP), não existindo uma validação para língua portuguesa. Objetivo: Traduzir e validar o questionário QUIP-CS, em sua versão curta e aplicável no momento presente da DP, para lingua Portuguesa do Brasil Métodos: A versão curta da QUIP (QUIP-CS) foi traduzida para o Português por tradutor juramentado. Após, esta foi avaliada por 5 especialistas em DP no Brasil, sendo sugeridas pequenas correções. A versão corrigida em português foi retrotraduzida para o inglês por 2 tradutores juramentados nativos na língua original da escala (inglês), que compararam suas versões posteriormente, chegando-se a uma nova versão final neste idioma. Esta foi enviada ao autor da escala original, que concordou com esta versão, ou seja, foram mantidas as propriedades semânticas do instrumento. Após, a versão final em Português foi auto-aplicada em 65 indivíduos com diagnóstico de DP em tratamento no ambulatório especializado no HCPA, sendo que, de forma aleatória, para 30 foi aplicado um questionário de avaliação sobre o grau de dificuldade de compreensão de suas perguntas. Resultados: Em uma escala de 1 a 5 pontos, onde 1 era nenhuma compreensão das perguntas e 5, clara compreensão, a média de entendimento pelos pacientes foi de 4,06 +/- 0,69 DP. Conclusão: A avaliação desta versão foi considerada de fácil compreensão pelos próprios pacientes. O artigo para validação da tradução do conteúdo da versão em Português da QUIP-CS está em fase de revisão para publicação. / Background: Parkinson’s disease (PD) is the second most often neurodegenerative disease and proportionally growing with people aging. PD is a disease with motor and nonmotor clinical features. Levodopa and dopaminergic agonists (DA) are used for PD treatment, allowing an exquisite control of the motor symptoms during the first years. However, in five years, half patients will present motor or non-motor complications induced by cronic use of these medications. Neuropsychiatric symptoms are often, for example, depression, anxiety, cognitive impairment, psychotic symptoms and impulse control disorders (ICD). The ICD is characterized by failure on resisting an impulse or on performing an specific act. Identification of the PD affected patients is crucial for proper management and study of this condition. There is an already validated self-reported questionnaire for this purpose, the Parkinson's Disease Impulsive-Compulsive Disorders Questionnaire (QUIP), without equivalent in portuguese language. Objective: To translate and to validate the Portuguese short version of the gold-standard questionnaire for identifying ICDs PD affected patients, applicable at the current moment of PD Methods: QUIP-CS was first translated to Portuguese by a professional translator. This translated version was shown to 5 PD neurologist specialists. in Brazil, being suggested minor modifications on it. This new Portuguese revised version was back translated to English by two independent native English speakers. They were both asked to compare the version one another and checked for differences. Then, they contacted each other and got a final back translated version. This one was sent for the original author, that approved its new version comparing to his original and validated one, with no loss of it’s original properties. The Portuguese corrected version was applied to 65 patients in a random way at PD’s ambulatory at HCPA. From these, 30 were asked to answer a number that would represent their level of QUIP-CS questions’ comprehension. Results: In a 1 to 5 point scale, being 1 no comprehension and 5, total comprehension, the average was 4,06 +/- 0,69 DP. Conclusion: Our results on Portuguese version of QUIP-CS show that QUIP-CS translated and corrected version was easily understood and easily self-applied. The article is under revision to be submitted for publication.