Needle tenotomy with PRP versus lidocaine in epicondylopathy: clinical and ultrasonographic outcomes over twenty months.

OBJECTIVE: To investigate whether pathological changes in elbow epicondylopathy, as assessed by conventional ultrasonography and clinical outcomes, could be modified following tenotomy with platelet-rich plasma (PRP) versus tenotomy with lidocaine. METHODS: This prospective sub-study was part of a patient- and assessor-blinded, superiority-type, randomized, lidocaine-controlled trial that was performed in a tertiary hospital to assess the effectiveness of PRP versus lidocaine as tenotomy adjuvants in patients with epicondylopathy. Patients were followed after two sessions of tenotomy with either PRP or lidocaine adjuvants (4 ml) within a 2-week interval. Tendon thickness, echotexture, and neovascularization were assessed as secondary outcome measurements at baseline and at 3, 6, 12, and 20 months after treatment, and correlations with clinical outcomes were examined. RESULTS: Twenty months after treatment, tenotomy induced changes in tendon structure, thickness (± = 0.0006), vascularity (p < 0.0001), and echotexture (p < 0.0001). In Disabilities of the Arm, Shoulder and Hand (DASH-E) and pain (VAS-P) scores, 80.85% and 90.91% of patients showed a meaningful clinical improvement, respectively, without differences between PRP and lidocaine. There were significant differences in between-group changes in vascularity over time, p = 0.037 and p = 0.049 in the unadjusted and adjusted models, respectively. There was no relationship between pain or function and sonographic entities at the various time points. CONCLUSIONS: Two successive needle tenotomies induced structural changes in recalcitrant epicondylopathy, with PRP displaying more vascularization and increased thickness over time compared to lidocaine. PRP compared with lidocaine did not result in improved function or decreased pain over 20 months.

3D reconstruction of magnetization from dichroic soft X-ray transmission tomography.

The development of magnetic nanostructures for applications in spintronics requires methods capable of visualizing their magnetization. Soft X-ray magnetic imaging combined with circular magnetic dichroism allows nanostructures up to 100-300 nm in thickness to be probed with resolutions of 20-40 nm. Here a new iterative tomographic reconstruction method to extract the three-dimensional magnetization configuration from tomographic projections is presented. The vector field is reconstructed by using a modified algebraic reconstruction approach based on solving a set of linear equations in an iterative manner. The application of this method is illustrated with two examples (magnetic nano-disc and micro-square heterostructure) along with comparison of error in reconstructions, and convergence of the algorithm.

An overview of in-home care for older people in Portugal: an empirical study about the customers.

BACKGROUND: The Portuguese in-home care services have never been adequately studied or identified. This is because of the lack of classification of variables related to the care receiver and to the demographic and organizational context in which it is inserted. METHODS: The 126 organizations in the central region of Portugal were categorized into four groups depending on whether they were located in a rural or urban environment and on whether they were large or small organizations. To obtain information, the In-Home Care Protocol (ProSAD), Elderly Assessment System (EASYcare), and the Center for Epidemiologic Studies-Depression (CES-D) scale were applied to 48 customers (6 randomly chosen customers of in-home care services of each of the 8 randomly selected organizations, 2 per group of variables). RESULTS: The rural context denoted a lack of diversity of services and the number of organizations available is reduced which implies less time spent with the customers. The more dependent customers at the time of registration (Kruskal-Wallis test [KW] = 12.79; p < .05) in large organizations (Mann-Whitney [U] = 190.5; p < .05) benefit more from the services. CONCLUSIONS: In-home care services are underused and are oriented to treat those that have a family caregiver. Overall, in-home care in Portugal still has much to achieve when compared with other European countries.

Sonographic pathoanatomy of greater trochanteric pain syndrome.

AIMS: To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis. MATERIALS AND METHODS: Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models. RESULTS: Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness (p = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus (p = 0.014); calcifications were associated with tendon thickness (p = 0.042), hypoechogenicity (p = 0.005) and the presence of partial tears (p = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension (p = 0.008) and dysfunction in patients with gluteal muscle atrophy (p = 0.001) and loss of fibrillar pattern in the gluteus medius (p = 0.002). CONCLUSION: GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.

Identification of ETP-46321, a potent and orally bioavailable PI3K α, δ inhibitor.

Phosphoinositide-3-kinase (PI3K) is an important target for cancer therapeutics due to the deregulation of this signaling pathway in a wide variety of human cancers. Herein, we describe the optimization of imidazo [1,2-a] pyrazines, which allow us to identify compound 14 (ETP-46321), with potent biochemical and cellular activity and good pharmacokinetic properties (PK) after oral dosing. ETP-46321 PK/PD studies showed time dependent downregulation of AKT(Ser473) phosphorylation, which correlates with compound levels in tumor tissue and demonstrating to be efficacious in a GEMM mouse tumor model driven by a K-Ras(G12V) oncogenic mutation. Treatment with ETP-46321 resulted in significant tumor growth inhibition.

[Montessori method applied to dementia - literature review]. / Método de Montessori aplicado à demência - revisão da literatura.

The Montessori method was initially applied to children, but now it has also been applied to people with dementia. The purpose of this study is to systematically review the research on the effectiveness of this method using Medical Literature Analysis and Retrieval System Online (Medline) with the keywords dementia and Montessori method. We selected lo studies, in which there were significant improvements in participation and constructive engagement, and reduction of negative affects and passive engagement. Nevertheless, systematic reviews about this non-pharmacological intervention in dementia rate this method as weak in terms of effectiveness. This apparent discrepancy can be explained because the Montessori method may have, in fact, a small influence on dimensions such as behavioral problems, or because there is no research about this method with high levels of control, such as the presence of several control groups or a double-blind study.

Reconfigurable Magnonic Crystals Based on Imprinted Magnetization Textures in Hard and Soft Dipolar-Coupled Bilayers.

Reconfigurable magnetization textures offer control of spin waves with promising properties for future low-power beyond-CMOS systems. However, materials with perpendicular magnetic anisotropy (PMA) suitable for stable magnetization-texture formation are characterized by high damping, which limits their applicability in magnonic devices. Here, we propose to overcome this limitation by using hybrid structures, i.e., a PMA layer magnetostatically coupled to a low-damping soft ferromagnetic film. We experimentally show that a periodic stripe-domain texture from a PMA layer is imprinted upon the soft layer and induces a nonreciprocal dispersion relation of the spin waves confined to the low-damping film. Moreover, an asymmetric bandgap features the spin-wave band diagram, which is a clear demonstration of collective spin-wave dynamics, a property characteristic for magnonic crystals with broken time-reversal symmetry. The composite character of the hybrid structure allows for stabilization of two magnetic states at remanence, with parallel and antiparallel orientation of net magnetization in hard and soft layers. The states can be switched using a low external magnetic field; therefore, the proposed system obtains an additional functionality of state reconfigurability. This study offers a link between reconfigurable magnetization textures and low-damping spin-wave dynamics, providing an opportunity to create miniaturized, programmable, and energy-efficient signal processing devices operating at high frequencies.

Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study.

BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.

Infrared Permittivity of the Biaxial van der Waals Semiconductor α-MoO3 from Near- and Far-Field Correlative Studies.

The biaxial van der Waals semiconductor α-phase molybdenum trioxide (α-MoO3 ) has recently received significant attention due to its ability to support highly anisotropic phonon polaritons (PhPs)-infrared (IR) light coupled to lattice vibrations-offering an unprecedented platform for controlling the flow of energy at the nanoscale. However, to fully exploit the extraordinary IR response of this material, an accurate dielectric function is required. Here, the accurate IR dielectric function of α-MoO3 is reported by modeling far-field polarized IR reflectance spectra acquired on a single thick flake of this material. Unique to this work, the far-field model is refined by contrasting the experimental dispersion and damping of PhPs, revealed by polariton interferometry using scattering-type scanning near-field optical microscopy (s-SNOM) on thin flakes of α-MoO3 , with analytical and transfer-matrix calculations, as well as full-wave simulations. Through these correlative efforts, exceptional quantitative agreement is attained to both far- and near-field properties for multiple flakes, thus providing strong verification of the accuracy of this model, while offering a novel approach to extracting dielectric functions of nanomaterials. In addition, by employing density functional theory (DFT), insights into the various vibrational states dictating the dielectric function model and the intriguing optical properties of α-MoO3 are provided.

Platelet-rich plasma versus lidocaine as tenotomy adjuvants in people with elbow epicondylopathy: a randomized controlled trial.

OBJECTIVES: To determine the efficacy of platelet-rich plasma (PRP) compared to lidocaine as a tenotomy adjuvant for people with elbow tendinopathy. METHODS: Our study was a parallel-group, double-blind, randomized trial involving 71 patients with recalcitrant elbow tendinopathy who received two sessions of ultrasound-guided tenotomy with either PRP or lidocaine in a tertiary public hospital. The primary end point was the percentage of patients with an improvement exceeding 25% reduction in disability (Spanish version of the Disabilities of the Arm, Shoulder and Hand questionnaires-DASH-E) at 6 and 12 months; the secondary outcome was the percentage of patients exceeding 25% reduction in pain (VAS-P). RESULTS: There was no evidence of significant differences in the proportion of patients who experienced clinically relevant improvements. After 6 months, 18 patients (78.59%) in the lidocaine group and 19 patients (73.08%) in the PRP group showed improved function above 25% (unadjusted odds ratio, 0.90; 95% confidence interval [CI], 0.90 (0.17 to 4.60)); 21 patients (72.21%) in the lidocaine group versus 22 patients (84.62%) in the PRP group achieved more than 25% pain reduction (unadjusted odds ratio, 0.48; 95% CI, 0.10 to 2.37). After 12 months, 17 patients (70.83%) in the lidocaine group versus 19 patients (76%) in the PRP group had improved function (unadjusted odds ratio, 0.71; 95% CI, 0.13 to 3.84), and 19 patients (76%) in the lidocaine group versus 20 patients (90.91%) in the PRP group had improved pain above 25% (unadjusted odds ratio, 0.35; 95% CI, 0.06 to 2.51). Hypercholesterolemia and baseline vascularization influenced outcomes. There were no differences between groups in the adjusted odds ratios. CONCLUSION: PRP results in similar improvements to those obtained with lidocaine. Selecting patients according to their pretreatment status can improve treatment efficacy. TRIAL REGISTRATION: NCT01945528 , EudraCT 2013-000478-32. Registered 18 August 2013, enrolment of the first participant 10 March 2014.

Advances with platelet rich plasma therapies for tendon regeneration.

INTRODUCTION: PRPs can be used in the management of tendinopathy if we improve our understanding of pathophysiology and to integrate molecular knowledge about PRP participation in healing mechanisms. AREAS COVERED: We provide new insights into the pathophysiology of tendinopathy, PRP therapies, and the potential links between both. We discuss the place of PRP in promoting tendon repair within what is currently understood regarding the role of PRP molecules in promoting tendon regeneration. EXPERT OPINION: Development of PRP treatments is challenging because a typical group of patients with tendinopathy does not exist, as it affects multiple segments of the population. Moreover, the pathophysiology and origin of pain are not elucidated yet. Although some degree of success has been achieved, PRP is not considered standard medical treatment, and it is largely not paid nor reimbursed by insurance companies. However, the arguments for using PRP in tendinopathy are increasing, and its potential to rebalance inflammation merits further research. Moreover, PRP contains tendoinductive factors that can drive the fate of stem cells. Tailoring PRPs to the specific needs of the host tendon has not been possible to date, because unanswered questions remain about the characteristics of tendinopathy within the different stages of progression.

Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study

ABSTRACT BACKGROUND: The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear. OBJECTIVE: To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND SETTING: Retrospective observational study in a tertiary-level hospital in Spain. METHODS: Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable. RESULTS: 690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism. CONCLUSIONS: This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.

Percutaneous needling of Morton's complex: a technical note.

BACKGROUND: the Morton's complex, i.e. fibrotic mass enfolding the medial plantar nerve, the bursa and the interdigital transverse ligament in the web space, is a common cause of pain and functional disability. Conservative and operative treatments are investigated but currently the best approach to treat the Morton's complex is unknown. METHODS: we describe a non-invasive, straight forward intervention consisting on multiple percutaneous punctures, shearing the fibrotic tissue in lateromedial and anteroposterior directions. The goal is to break up fibrosis occupying the intermetatarsal space thus releasing the affected nerve from the adjacent structures, there by stimulating tissue remodelling. RESULTS: slow tissue remodelling occurs following sequential fibrosis cleavage through multiple needling. Needling of the intermetatarsal fibrosis is performed every eight weeks until pain resolution. Echographic changes are associated to pain reduction as measured by Visual Analogue Score (VAS). CONCLUSION: we present an original idea that may improve Morton's management. Upcoming prospective clinical studies have to demonstrate the symptomatic benefits and the usefulness of this novel echographic intervention.

Perfil de funcionamento do SAD, Serviço de Apoio Domiciliário-caso de Braga, Portugal / Operating profile of SAD, Home Support Service, in the case of Braga, Portugal / Perfil operativo de SAD, Servicio de asistencia domiciliaria, en el caso de Braga, Portugal

O SAD português carateriza-se por um perfil tradicional. Reúne como principais caraterísticas funcionar de segunda a sexta-feira, com uma intensidade considerada baixa, com a prestação de cuidados voltadapara as AVD ́S, Atividades de vida diária dos idosos.Objetivos desteestudo: (i)identificar a oferta da estrutura de cuidados existentes,prestada pelo SAD, nas InstituiçõesParticulares de Solidariedade Social (IPSS)especificamentedo distrito de Braga (Portugal);e (ii) analisar seu perfil de funcionamento,com base nos comportamentos de gestãoe na existência ou não dos planos de cuidados no SAD.A metodologia utilizada foi a quantitativa, recorrendo-seà aplicação de inquéritos por questionário, por meiodo instrumento de avaliação,Protocolo de Serviço de Apoio Domiciliário, versão 2. A amostra foipor conveniência,composta pelos20 diretores técnicos das IPSS deBraga,Portugal.Como conclusões, oestudo aponta para um SAD tradicional, rural, com função assistencial, visando asatisfazer as AVD ́S, com declínio funcional, muito idosos,ou com idade inferior aos 65 anos,havendoa necessidade de completar a avaliação multidimensional realizada,e distribuir as tarefas executadas ainda centralizadas na figura do diretor técnico. São apontadas três prioridades:pensar numa boa gestão e rentabilização de recursos humanos; trabalhar os planos de cuidados com a área da saúde e a retaguarda familiar como principal enfoque;e uniformizar os critérios de exclusão e inclusão de acesso ao SAD,ostão importantes critérios de elegibilidade, dando lugar à implementação de um modelo de SAD que se baseienos cuidados pessoais individualizadoscom base na classificação do Rai Home Care.

The Portuguese SAD is characterized by a traditional profile. Its maincharacteristics are to operate from Monday to Friday, with a low intensity, with theprovision of care for ADLs, activities of daily living of the elderly. Objectives of this study:(i) to identify the provision of the existing care structure provided by SAD in the PrivateSocialSolidarity Institutions (IPSS) specifically in thedistrict of Braga (Portugal); and (ii) analyze itsoperating profile, based on managementbehaviors and the existence or otherwise ofcare plans in the DSS. The methodology usedwas quantitative, using surveys by means ofthe assessment instrument, Protocol of HomeSupport Service, version 2. The sample wasfor convenience, composed by the 20technical directors of Braga IPSS, Portugal. As conclusions, the study points to atraditional, rural DSS, with care function,aiming to satisfy the ADLs, with functionaldecline, very elderly, or under 65 years old,with the need to complete themultidimensional assessment performed, anddistribute the tasks performed still centered onthe technical director. Three priorities arepointed out: think about good managementand profitability of human resources; work withhealth care and family care plans as the mainfocus; and standardize the exclusion andinclusion criteria for access to SAD, the all-important eligibility criteria, leading to theimplementation of a model of SAD that isbased on individualized personal care basedon the Rai Home Care classification.

El SAD portugués se caracteriza por un perfil tradicional. Suscaracterísticas principales son operar de lunes a viernes, de baja intensidad, con laprestación de atención para las AVD, actividades de la vida cotidiana de los ancianos. Objetivos de este estudio: (i) identificar la provisión de la estructura de atención existenteproporcionada por SAD en las Instituciones Privadas de Solidaridad Social (IPSS)específicamente en el distrito de Braga (Portugal); y (ii) analizar su perfil operativo, enfunción de los comportamientos de gestión y la existencia o no de planes de atención en el DSS. La metodología utilizada fue cuantitativa, utilizando encuestas por medio delinstrumento de evaluación, Protocolo de Servicio de Apoyo a Domicilio, versión 2. La muestra fue por conveniencia, compuesta por los 20 directores técnicos de Braga IPSS,Portugal Como conclusiones, el estudio apunta a un DSS rural tradicional, con función asistencial, con el objetivo de satisfacer las AVD, con deterioro funcional, muy ancianoso menores de 65 años, con la necesidad de completar la evaluación multidimensionalrealizada, y distribuir las tareas aún en marcha centralizados en la figura del director técnico. Se identifican tres prioridades: pensar en una buena gestión y uso de los recursoshumanos; planes de trabajo de cuidar la salud y antecedentes familiares como el foco principal; y estandarizar los criterios de exclusión e inclusión para el acceso a SAD, loscriterios de elegibilidad más importantes, que conducen a la implementación de un modelo de SAD que se basa en el cuidado personal individualizado basado en laclasificación Rai Home Care.

Método de Montessori aplicado à demência: revisão da literatura / Montessori Method applied to dementia: literature review / Método Montessori aplicado a la demencia: revisión de la literatura

O método de Montessori foi aplicado inicialmente às crianças, mas atualmente aplica-se a pessoas com demência. O objetivo deste trabalho é fazer uma revisão sistemática da investigação sobre a eficácia desse método, utilizando a Medical Literature Analysis and Retrieval System Online (Medline) com as palavras-chave demência e método de Montessori. Foram selecionados 10 estudos, onde se verificam melhorias significativas na participação e no envolvimento construtivo e diminuição dos afectos negativos e do envolvimento passivo. Não obstante, as revisões da literatura acerca desta intervenção não farmacológica em demência classificam esse método como fraco, em termos de eficácia. Essa aparente discrepância pode explicar-se porque o método de Montessori pode ter, de fato, uma influência pouco significativa em dimensões como a dos problemas comportamentais ou porque não existe investigação acerca desse método com elevados níveis de controle como são a presença de vários grupos de controle ou o duplo-cego.

The Montessori method was initially applied to children, but now it has also been applied to people with dementia. The purpose of this study is to systematically review the research on the effectiveness of this method, using Medical Literature Analysis and Retrieval System Online (Medline) with the keywords dementia and Montessori method. We selected 10 studies, in which there were significant improvements in participation and constructive engagement, and reduction of negative affects and passive engagement. Nevertheless, systematic reviews about this non-pharmacological intervention in dementia rate this method as weak in terms of effectiveness. This apparent discrepancy can be explained because the Montessori method may have, in fact, a small influence on dimensions such as behavioral problems, or because there is no research about this method with high levels of control, such as the presence of several control groups or a double-blind study.

El método Montessori se aplicó inicialmente a los niños, pero ahora se aplica a las personas con demencia. El propósito de este estudio es revisar de forma sistemática la investigación sobre la eficacia de este método, utilizando Medical Literature Analysis and Retrieval System Online (Medline) con las palabras clave demencia y método Montessori. Se seleccionaron 10 estudios, que tienen mejoras significativas en la participación y en el compromiso constructivo, y la reducción de efectos negativos y de la participación pasiva. Sin embargo, la revisión de la literatura sobre esta intervención no farmacológica en la demencia clasifica este método como débil en términos de eficacia. Esta aparente discrepancia puede explicarse porque el método Montessori puede tener una influencia poco significativa en los problemas de conducta, o porque no hay investigación sobre este método con altos niveles de control como son la presencia de varios grupos de control o el estudio doble ciego.

Ajudas externas à memória na intervenção em pessoas idosas com comprometimento mnésico / External memory aids in intervention for older people with mnesic impairment

As estratégias de compensação são intervenções neuropsicológicas que reorganizam as funções psicológicas, incluindo as ajudas internas e externas e adaptações ambientais. As ajudas externas à memória atribuem importância a objectos externos ou ao ambiente, em prol de intervenções cognitivas ou comportamentais. O objectivo deste trabalho é analisar a eficácia e as condicionantes bio-psico-sociais inerentes à utilização das ajudas externas, por pessoas idosas com comprometimento mnésico. Procedeu-se à recolha bibliográfica de artigos científicos, maioritariamente em inglês, com critério de inclusão a intervenção em pessoas idosas, com comprometimento mnésico, e exclusão, jovens ou crianças e avaliação de outras estratégias de compensação. Os resultados sugerem que são os mecanismos compensatórios mais usados com a idade, diminuindo na demência. Devem inserir-se em sistemas de treino, ajustados às incapacidades mnésicas, potenciando a estimulação e manutenção da memória e independência.

Compensation strategies are one of the most effective ways in memory rehabilitation, including internal and external aids as well as environmental adaptations. External aids attach importance to external objects or the environment, in favor of cognitive or behavioral interventions. The purpose of this paper is to analyze the efficacy and bio-psycho-social indicators associated with the use of external aids, by older people with memory impairment. It was reviewed a variety of scientific studies, mostly in English, with inclusion criteria of intervention for older people with memory impairment. Exclusion criteria included youths or children and assessment of other compensation strategies. The findings presented them as the most commonly used compensatory mechanisms as age goes by, decreasing in dementia. It is concluded that older people should be integrated into training systems, adjusted to mnesic impairment, enhancing stimulation and maintenance of memory and independence.

Investigação e prática em Psicologia positiva / Research and practice in positive Psychology / Investigación y práctica en Psicología positiva

Volvida uma década desde a emergência da Psicologia positiva, o presente artigo constitui uma reflexão e síntese desse movimento em expansão. Focámo-nos no seu objecto de estudo e nos aspectos metodológicos que têm caracterizado as investigações nesse domínio, sublinhando tanto as limitações encontradas como as potencialidades e as inovações bem-sucedidas. Procedemos à análise da aplicação prática da Psicologia positiva em múltiplos domínios de intervenção. Situando a Psicologia positiva no cenário científico mundial através da identificação de alguns grupos de trabalho em actividade, reflectimos sobre aspectos que projectam um possível futuro para esse movimento, pautado pela integração de complexidade....(AU)

After a decade since the emergence of positive psychology, the present article is drawn on a reflection and synthesis of this crescent movement. We have focused on this subject of study and in methodological issues that have characterised the research in this domain, underlying the strengths, weaknesses and well succeeded innovations. We analyze the practical applications of positive psychology in multiple areas of intervention. We placed positive psychology within the world's scientific scene by identifying the currently active working groups and we reflected and forecasted a possible future of this movement, based on integrity and complexity....(AU)

Transcurrida una década desde la emergencia de la Psicología positiva, el presente artículo constituye una reflexión y síntesis de ese movimiento en expansión. Nos enfocamos en su objeto de estudio y en los aspectos metodológicos que han caracterizado las investigaciones en ese dominio, subrayando tanto las limitaciones encontradas como las potencialidades y las innovaciones con final positivo. Procedemos al análisis de la aplicación práctica de la Psicología positiva en múltiples dominios de intervención. Situando la Psicología positiva en el escenario científico mundial a través de la identificación de algunos grupos de trabajo en actividad, reflexionamos sobre aspectos que proyectan un posible futuro para ese movimiento, pautado por la integración de complejidad....(AU)

Análise da intensidade dos serviços de cuidado prestados aos utentes idosos do serviço de apoio domiciliário / Analysis of the intensity of care provided to elderly users of the home support service

A intensidade dos cuidados prestados pelo Serviço de Apoio Domiciliário (SAD) é um tema importante em diversos países. Em alguns casos, é considerada um critério de qualidade e a base de cálculo do pagamento do Serviço de Apoio Domiciliário. Este estudo tem como objectivos analisar quantitativamente a intensidade das tarefas de cuidado prestadas no Serviço de Apoio Domiciliário em Portugal, em termos de periodicidade e tempo despendido (em minutos), e fazer o cálculo dos valores de referência do consumo de tempo para cada tarefa de cuidado nas Actividades de Vida Diária (Básicas e Instrumentais). No total foram analisadas oito instituições promotoras do Serviço de Apoio Domiciliário, as quais se agruparam segundo o contexto territorial a que pertencem (rural/ urbano) e a capacidade de utentes que possuem (pequena/ grande dimensão). De cada instituição foram aleatoriamente seleccionados seis utilizadores, resultando em amostra final de 48 sujeitos. A recolha de dados foi realizada com o recurso ao Protocolo de Serviço de Apoio Domiciliário (ProSAD). Os resultados indicam que a intensidade é superior nos cuidados prestados em termos de Actividades Básicas de Vida Diária, mas os valores variam em função da presença/ausência de cuidador informal. Concluiu-se que a intensidade dos cuidados em Portugal é reduzida, sendo que os poucos serviços prestados incidem nas Actividades Básicas de Vida Diária. O tempo a ser utilizado por cada utente do Serviço de Apoio Domiciliário deve ter por base critérios objectivos, como o estado funcional do utente e a rede de suporte social.

Um programa de economia de fichas aplicado a doentes psiquiátricos crónicos com deterioração cognitiva / Un programme d´économie de jetons appliqué aux patients chroniques atteints de détérioration cognitive / Un programa de economía de fichas aplicado a enfermos psiquiátricos crónicos con deterioro cognitivo / A token economy program applied to chronic psychiatric inpatients with cognitive deterioration

Este artigo descreve uma intervenção com economia de fichas numa unidade psiquiátrica de internamentos de longo curso. No documento, referimos detalhadamente sua elaboração e adaptação a 10 sujeitos com múltiplos diagnósticos. A avaliação geral dos participantes da amostra evidencia resultados positivos no aumento de comportamentos adequados e diminuição de comportamentos desadequados. Essa intervenção foi particularmente eficaz na melhoria do comportamento facial e verbal dos participantes. Obtivemos ganhos estatisticamente significativos na redução de comportamentos bizarros, apesar de os índices de deterioração cognitiva serem elevados na maioria dos doentes. Tendo sido a maioria desses estudos implementados já há mais de 40 anos, julgamos importante a comparação de novos estudos com os prévios, dadas as mudanças que se efectuaram entretanto nos recintos hospitalares, bem como nas terapias farmacológicas.

This article describes a Token Economy group intervention in a long-term psychiatric inpatients unit. The document offers a detailed account about the intervention conception and methodology adapted to 10 participants with several diagnoses. A general evaluation shows positive results concerning appropriate behaviour and a decrease of inadequate behaviour. This intervention was particularly efficient concerning the improvement in the facial and verbal behavior of the participants. We conclude that, in this study, the Token Economy was efficient towards the bizarre behaviours, even considering the high cognitive deterioration deficits in most participants. The majority of these studies were implemented more than forty years ago. The comparison of new studies with previous ones, however, is important, due to the changes in hospital settings as well as in pharmacological therapies.

Cet article décrit une intervention en groupe d'économie de jetons dans une unité psychiatrique d'internement de longue durée, réalisé au centre hospitalier Casa de Saúde do Bom Jesus. Nous présentons brièvement ce type d'interventions et les méthodes appliquées aux 10 patients atteints de maladie chronique. Une évaluation des comportements des sujets de l'échantillon met en évidence des résultats positifs, à savoir, une augmentation des comportements appropriés et une diminution des comportements inadéquats. On en conclut que, dans cette étude, l'économie des fiches a été efficace, en particulier concernant les comportements faciaux et verbaux bizarres des participants, quoique les indices de détérioration cognitive étaient élevés chez la plupart des malades. Ces études ont été implémentées au cours de plus de quarante ans. If faut maintenant comparer les nouvelles études avec les précedentes, une fois qu´il y a eu des modifications des pratiques dans les hôpitaux et aussi des thérapies pharmacologiques.

Este artículo se propone describir una intervención mediante economía de fichas en una unidad psiquiátrica de internamiento de larga estancia. Se relatan detalladamente la elaboración y la adaptación del tratamiento en 10 participantes con múltiplos diagnósticos. La evaluación general de los participantes revela resultados positivos en el aumento de comportamientos adecuados y en la reducción de comportamientos inadecuados. La eficacia de la intervención se verifica en la mejoría del comportamiento facial y verbal de los participantes. Se encontraron resultados estadísticamente significativos en la reducción de comportamientos bizarros, aunque la mayoría de los enfermos presenta elevados índices de deterioro cognitivo. A conclusión, teniéndose en cuenta que gran parte de estos estudios se implementaron hace más de cuarenta anos, se ha juzgado importante la comparación de nuevos estudios con los previos, en vista del progreso de los hospitales y de las terapias farmacológicas.