Functional capacity and self-care profiles of older people in senior care homes.

The reduction of the functional capacity in older people is the result of physical, psychological and functional changes related to the ageing process, compromising the performance of daily life activities. Assessing their functional capacity and their self-care profile can facilitate the planning of targeted strategies related to stimulation, as well as cognitive and motor rehabilitation. This study aims to evaluate and analyse the functional capacity, as well as the level of dependence in self-care of older people in senior care centres. This is a transversal exploratory study, quantitative in nature. The sample was comprised of 313 participants, randomly selected from a set of senior care centres, with an average age of 83.41 (SD=7.14) years, recruited from the interior North of Portugal. The data collection instruments included the Barthel Index, the Lawton and Brody Scale, the Evaluation Form of Dependence in Self-care, the Self-care of Home Dwelling Elderly (self-care subscale profiles) and a questionnaire on demographic data. The elderly showed several levels of dependence on different self-care items. It was possible to observe that the staff often replaces the elderly in many of the tasks that could still be performed by them, and thus aggravates their levels of dependence. The link observed between functional capacity and self-care profiles highlights the need to focus on the notion of a healthy and active ageing process, especially in some profiles. The monitoring of the functional capacity and the self-care profile can provide knowledge concerning the potential for autonomy and individual needs, thus enabling targeted and more responsive interventions for the individual and the real needs of older people.

Factorial Validity of the Toronto Alexithymia Scale (TAS-20) in Clinical Samples: A Critical Examination of the Literature and a Psychometric Study in Anorexia Nervosa.

There is extensive use of the 20-item Toronto Alexithymia Scale (TAS-20) in research and clinical practice in anorexia nervosa (AN), though it is not empirically established in this population. This study aims to examine the factorial validity of the TAS-20 in a Portuguese AN sample (N = 125), testing four different models (ranging from 1 to 4 factors) that were identified in critical examination of existing factor analytic studies. Results of confirmatory factor analysis (CFA) suggested that the three-factor solution, measuring difficulty identifying (DIF) and describing feelings (DDF), and externally oriented thinking (EOT), was the best fitting model. The quality of measurement improves if two EOT items (16 and 18) are eliminated. Internal consistency of EOT was low and decreased with age. The results provide support for the factorial validity of the TAS-20 in AN. Nevertheless, the measurement of EOT requires some caution and may be problematic in AN adolescents.

Reference values and changes in infant sleep-wake behaviour during the first 12 months of life: a systematic review.

This paper is a systematic review on the reference values and changes in infant sleep-wake behaviour during the first 12 months of life. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Seventy-four papers were included, and the reference values and changes in sleep-wake behaviour during the first 12 months of life were identified. Sleep duration during the 24-h period, and day and sleep periods during the night decreased over the first 12 months of life. Night wakings and bedtime/sleep-onset time decreased, while the longest sleep period increased at night during the first 6 months. High discrepancy was noted between studies in the reference values of sleep-wake behaviour, while more congruence was noted regarding changes, especially those occurring in the first 6 months of life. Several methodological differences were identified between studies and may partially explain inconsistencies in the results, including the assessment of different sleep-wake behaviours, the focus on specific ages or age ranges, the use of self-report, observational or direct measures, the recruitment of small or large representative samples, and the countries where the research was conducted. These aspects should be considered in future research and caution should be taken when generalizing results from studies with diverse methodological characteristics. Nonetheless, this review identifies normative reference values and the changes occurring in infant sleep-wake behaviour, and could inform both practitioners and researchers, helping them identify infants with sleep delays or problems.

Efficacy and safety of repetitive Transcranial Magnetic Stimulation and transcranial Direct Current Stimulation in memory deficits in patients with Alzheimer's disease: Meta-analysis and systematic review.

Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are two of the most used non-pharmacological interventions for Alzheimer's Disease (AD). However, most of the clinical trials have focused on evaluating the effects on global cognition and not on specific cognitive functions. Therefore, considering that memory loss is one of the hallmark symptoms of AD, we aim to assess the efficacy and safety of tDCS and rTMS in memory deficits. For that, multilevel random effect models were performed considering the standardized mean difference (SMD) between active and sham stimulation. A total of 19 studies with 411 participants demonstrated positive effects in memory after tDCS (SMD=0.20, p = 0.04) and rTMS (SMD=0.44, p = 0.001). Subgroup analysis revealed that tDCS had greater efficacy when administered in temporal regions (SMD=0.32, p = 0.04), whereas rTMS was superior when applied in frontal regions (SMD=0.61, p < 0.001). Therefore, depending on the brain region of stimulation, both interventions produced a positive effect on memory symptoms in AD patients. Finally, the safety of both techniques was observed in the AD population after the reporting of almost no serious events.

Adaptation and psychometric properties of the student career construction inventory for a Portuguese sample: formative and reflective constructs.

The adaptation of the student career construction inventory was carried out with a Portuguese sample of 356 first-year economics, management, psychology, nursing, nutrition sciences, bio-engineering, and biosciences students (244 women, 112 men; M age = 19.4, SD = 4.4) in the Catholic University of Portugal, Porto. Confirmatory factorial analysis supported the prior structure of the reflective models, with acceptable fit indexes. Internal consistency coefficients for the scales were poor to acceptable (.51 to .89). The formative nature of career adaptability was supported in a complex model identified by structural relations for which the fit indexes were weak but acceptable for a preliminary study.

Self-care profiles of the elderly institutionalized in Elderly Care Centres.

The concept of self-care in the elderly has been frequently associated with autonomy, independence and personal accountability. Self-care practices are a result of individual lifestyles and paths adapted to the circumstances and expectations of the elderly. Based on the model by Backman and Hentinen (1999), the present study attempts to categorically describe the types of self-care of the elderly. This is an exploratory study, transversal, of a quantitative nature. The sample was comprised of 313 participants, randomly selected among Elderly Care Centres in the interior North of Portugal. The Portuguese version of Self-care of Home Dwelling Elderly was used for data collection. The results call for a replication of the study, using the theoretical derivation of the four self-care profiles (responsible, formally guided, independent and abandoned).

Submandibular duct transposition for drooling in children: A Casuistic review and evaluation of grade of satisfaction.

INTRODUCTION: Drooling of saliva is the unintentional loss of saliva from the mouth resulting in excess pooling of saliva in the anterior portion of the oral cavity. It is considered normal in infants and usually resolves itself by 15-18 months of age. It is a common problem in pediatric patients with cerebral palsy or other neurological disorders. Drooling interferes with speech, impairs oral hygiene and contributes to oral dermatitis, aspiration pneumonias and fluid electrolyte imbalances. It has a profoundly negative impact on quality of life and contributes to social exclusion, self-esteem problems and significant discomfort, especially amongst school-aged children. In addition, it can present a serious challenge for caregivers. Various approaches to manage this condition have been described in the literature. Submandibular duct relocation allows salivary flow and is the surgical approach undertaken by the authors. OBJECTIVES: The aim of this study is to share our experience with the surgical approach to drooling children and to evaluate clinical outcomes and long-term caregiver satisfaction outcomes. METHODS: The authors conducted a retrospective study with a review of the medical records of 43 children and adolescents who had been submitted to submandibular duct relocation in the Centro Hospitalar Tondela-Viseu, between January 2003 and December 2017. The authors analyzed the clinical history, bibs used per day before and after surgery, and caregivers' satisfaction was assessed by interview using a questionnaire. The results of this procedure, technical considerations and outcomes are presented in this work. RESULTS: Forty-three patients (15 girls and 28 boys), between the ages of 3 and 18 at time of surgery (mean age of 9), underwent bilateral submandibular duct transposition for drooling. All children have neurological disorders, with cerebral palsy being the predominant diagnosis. The majority were hospitalized for 1-2 days and no surgical complications were observed. The number of bib or clothing changes fell from more than ten in 23 patients (53%) pre-operatively to less than five in 33 patients (77%) post-operatively. 30% of caregivers were satisfied and 53% were very satisfied with the results of surgery. CONCLUSIONS: The results of this study show that submandibular duct relocation is an effective method in the resolution of uncontrolled drooling in children, contributing to the improvement of children's quality of life. The degree of satisfaction with the surgical results is in agreement with the published international studies, proving once again the effectiveness of the surgical technique implemented in our Hospital.

The link between cognitive state and general self-esteem among institutionalized elderly persons: can health condition serve as a mediating factor? / Associação entre estado cognitivo e autoestima global em idosos institucionalizados: será a condição de saúde um mediador?

Abstract Objective: to assess whether the health condition of an elderly person can serve as a mediating factor between the cognitive state and general self-esteem of the institutionalized elderly. Method: a quantitative, cross-sectional correlational study was performed, based on the path analysis technique.The following instruments were used for data collection: the Mini-Mental State Examination, the Tinetti Performance Oriented Mobility Assessment, the Mini Nutritional Evaluation and the Rosenberg Self-Esteem Scale. Results: the sample was composed of 312 elderly patients of both genders (112 men and 200 women), with an average age of 83.39 (+7.09) years. Most of the elderly persons were widowed, with a low educational level, and had been institutionalized in Residential Care Facilities for the Elderly for on average 54.6 (+51.69) months. The mediating factor of health condition renders the link between the cognitive state and self-esteem of the elderly null. However, the analysis of the decomposition of the effects showed a significant indirect effect between the cognitive state and health condition. The total effect of cognitive state on the health condition of the elderly is significant, positive and direct. Conclusion: based on the results of this study we maintain that cognitive changes can affect the nutritional state and physical balance of the institutionalized elderly. AU

Resumo Objetivo: testar se a condição de saúde da pessoa idosa é mediadora na associação entre o estado cognitivo e a autoestima global de idosos institucionalizados. Método: estudo de natureza quantitativa, transversal do tipo correlacional, recorreu à análise de caminhos. Na recolha de dados utilizaram-se as versões portuguesas dos seguintes instrumentos: Mini-Mental State Examination, Tinetti Performance Oriented Mobility Assessement, Miniavaliação Nutricional e a Rosenberg Self-Esteem Scale. Resultados: a amostra foi constituída por 312 idosos de ambos os gêneros (112 homens e 200 mulheres), com média etária de 83,39 (±7,09) anos. A maioria dos idosos eram viúvos, com baixa escolaridade, institucionalizados em Equipamentos Residenciais para Pessoas Idosas em média há 54,60 (±51,69) meses. Não se confirmou a mediação da condição de saúde na associação entre estado cognitivo e autoestima nos idosos. Contudo, a análise da decomposição dos efeitos indicou a existência de um efeito significativo indireto do estado cognitivo na autoestima e na condição de saúde. O efeito total do estado cognitivo na condição de saúde dos idosos é significativo, positivo e direto. Conclusão: os resultados desse estudo permitem-nos afirmar que as alterações cognitivas podem afetar o estado nutricional e o equilíbrio corporal dos idosos institucionalizados. AU

Macrophage Response to UHMWPE Submitted to Accelerated Ageing in Hydrogen Peroxide.

Ultra-high molecular weight polyethylene (UHMWPE) has been the most commonly used bearing material in total joint arthroplasty. Wear and oxidation fatigue resistance of UHMWPE are regarded as two important properties to extend the longevity of knee prostheses. The present study investigated the accelerated ageing of UHMWPE in hydrogen peroxide highly oxidative chemical environment. The sliced samples of UHMWPE were oxidized in a hydrogen peroxide solution for 120 days with their total level of oxidation (Iox) characterized by Fourier Transformed Infrared Spectroscopy (FTIR). The potential inflammatory response, cell viability and biocompatibility of such oxidized UHMWPE systems were assessed by a novel biological in vitro assay based on the secretion of nitric oxide (NO) by activated murine macrophages with gamma interferon (IFN-gamma) cytokine and lipopolysaccharide (LPS). Furthermore, macrophage morphologies in contact with UHMWPE oxidized surfaces were analyzed by cell spreading-adhesion procedure using scanning electron microscopy (SEM). The results have given significant evidence that the longer the period of accelerated aging of UHMWPE the higher was the macrophage inflammatory equivalent response based on NO secretion analysis.

Adolescência e jovem adultícia: crescimento pessoal, separação-individuação e o jogo das relações / Adolescence and emerging adulthood: personal growth, separation-individuation and the relational game

O presente artigo procura problematizar a importância das dinâmicas relacionais no crescimento pessoal. Tendo como ponto de partida a teoria da apego, o desenvolvimento pessoal é pautado por processos de separação-individuação; são estes os processos que permitem a construção de um sentido de autonomia. Recentemente o conceito de "adultos emergentes" tem vindo a ganhar destaque, gerindo a discussão em torno dos factores internos e externos que eventualmente potenciam a entrada na adultícia. Pais, irmãos e pares assumem relevância neste processo, o que implica posteriormente um alargamento da rede social ao contexto de trabalho e às relações amorosas. As implicações desta transição serão discutidas à luz do processo de separação-individuação e dos factores moderadores do crescimento pessoal.

The purpose of the present article is to discuss the importance of the relationship dynamics in personal development. Taking the attachment theory as a starting point, the personal development path is guided by separation-individuation processes; these processes allow building a sense of autonomy. Recently the concept of "emerging adults" has gained importance, managing the debate around the internal and external factors that may enhance the entry into adulthood. Parental figures, siblings and peers assume a relevant role in the process, supporting the adolescent's inclusion in broader social contexts like work and romantic relationships. The implications of this transition will be discussed according to the separation-individuation process and moderating factors of personal growth.

Adolescência e jovem adultícia: crescimento pessoal, separação-individuação e o jogo das relações / Adolescence and emerging adulthood: personal growth, separation-individuation and the relational game

O presente artigo procura problematizar a importância das dinâmicas relacionais no crescimento pessoal. Tendo como ponto de partida a teoria da apego, o desenvolvimento pessoal é pautado por processos de separação-individuação; são estes os processos que permitem a construção de um sentido de autonomia. Recentemente o conceito de "adultos emergentes" tem vindo a ganhar destaque, gerindo a discussão em torno dos factores internos e externos que eventualmente potenciam a entrada na adultícia. Pais, irmãos e pares assumem relevância neste processo, o que implica posteriormente um alargamento da rede social ao contexto de trabalho e às relações amorosas. As implicações desta transição serão discutidas à luz do processo de separação-individuação e dos factores moderadores do crescimento pessoal.(AU)

The purpose of the present article is to discuss the importance of the relationship dynamics in personal development. Taking the attachment theory as a starting point, the personal development path is guided by separation-individuation processes; these processes allow building a sense of autonomy. Recently the concept of "emerging adults" has gained importance, managing the debate around the internal and external factors that may enhance the entry into adulthood. Parental figures, siblings and peers assume a relevant role in the process, supporting the adolescent's inclusion in broader social contexts like work and romantic relationships. The implications of this transition will be discussed according to the separation-individuation process and moderating factors of personal growth.(AU)