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- Malnutrition and obesity in community-dwelling older adults : concomitant conditions? (PEN-3S study)Publication . Madeira, Teresa; Plácido, Catarina Peixoto; Sousa-Santos, Nuno; Mendonça, Nuno; Santos, Osvaldo; Alarcão, Violeta; Nicola, Paulo Jorge Morais Zamith; Lopes, Carla; Gorjão Clara, João Pedro PereiraBoth malnutrition (which here refers to undernutrition) and obesity are prevalent in older adults, but they are frequently seen as mutually exclusive. In fact, a low body mass index (BMI) is one of the aetiological diagnostic criteria for malnutrition. On the contrary, the concomitant presence of malnutrition and obesity has been less studied. The aim of this study was to characterise the nutritional status of community-dwelling older adults (≥ 65 years old) living in Portugal. The study included a nationally representative sample of randomly selected community-dwelling older adults. Trained nutritionists collected data through face-to-face structured interviews regarding sociodemographic characteristics, nutritional status and anthropometric measures (namely, weight and height), among other variables of the PEN-3S study. Nutritional status was assessed by the 18-item Mini Nutritional Assessment (full MNA®), in which a lower score indicates worse nutritional status. The World Health Organisation’s (WHO) BMI cut-offs for adults were followed (obesity: BMI ≥ 30Kg/m2 ). MNA and BMI categories estimates (95% CI) were obtained using Complex Samples analysis (SPSS® 24.0). Non-difference between sexes was analysed with Chi-square tests. Complete information was available for 1110 community-dwelling participants (mean age: 75.9 ± 8.1 years; 48.9% women; 71.4% attended school for < 5 years). According to the MNA, 0.5% (95%CI: 0.2–1.7) were classified as malnourished and 16.0% (12.9–19.7) were at risk of malnutrition. Following WHO’s BMI criteria, 0.6% (0.2–1.5) had a BMI ≤ 18.5Kg/m2 , 41.9% (37.9–46.0) had a BMI between 25–30Kg/m2 , and 36.7% (32.8–40.9) presented a BMI ≥ 30Kg/m2 . The prevalence of risk of malnutrition was significantly higher for women (20.1%, 95% CI: 15.4–25.9) than men (10.4%, 7.6–14.1; p < 0.001). The prevalence of obesity was also significantly higher for women (42.2%, 35.9–48.7 versus 29.3%, 24.8–34.2; p = 0.007). Moreover, 13.9% (9.2–20.4) were simultaneously at risk of malnutrition and had a BMI ≥ 30Kg/m2 , while no one in this BMI category was classified as malnourished. Although appropriate BMI cut-offs for older adults are still uncertain, these results highlight that a high BMI does not exclude the risk of malnutrition, particularly in women. Therefore, health professionals should routinely screen for malnutrition using multi-component, validated screening tools, irrespective of the BMI. In fact, malnutrition is preventable if detected on time and effective interventions exist. The concomitant presence of malnutrition and obesity may pose additional challenges to the treatment.
- The patients’ perspective : what causes hospitalizations for ambulatory care sensitive conditions?Publication . Siopa, Margarida; Sarmento, João; Santos, Rodrigo; Lopes, Sílvia; Dias, Sónia; Guerreiro, António Sousa; Panarra, António; Nascimento, Paula; Rodrigues, Ana; Santana, RuiIntroduction: In Portugal, the hospitalizations for ambulatory care sensitive conditions (ACSH) account for 12% of all hospitalizations with an estimated financial impact of up to 450 million€. Therefore, understanding the determinants of avoidable hospitalizations is important to develop policies and interventions that reduce the ACSH. Analyzing the patient’s perspective brings an angle relevant to explain the ACSH. Despite patients are the most qualified to express the social and individual context of their experience, few studies have investigated the patients’ perspective about what causes ACSH. The aim of this study is to compare the perspective of patients on the determinants of the ACSH.
- Saúde mental e desemprego : integração da evidênciaPublication . Virgolino, Ana; Ambrósio, Sara; Carreiras, Joana; Heitor, Maria João; Santos, OsvaldoIntrodução: Um dos efeitos da crise económica com início em 2008 foi o aumento exponencial das taxas de desemprego em vários países, incluindo Portugal. A associação entre crise económica e agravamento do estado de saúde mental tem sido documentada por vários estudos, com foco particular no suicídio1,2 e em sintomas de depressão 3,4. Por outro lado, existe literatura que aponta para uma relação entre desemprego e agravamento de saúde mental, o que sugere um efeito moderador daquela variável enquanto componente da crise financeira5,6. Importa integrar, de forma sistemática, a evidência disponível para compreender melhor a associação entre desemprego e saúde mental no contexto de flutuações macroeconómicas.
- Promotion of mental health literacy and mental well-being in a Portuguese unemployed population sample : effectiveness assessment of a capacity building community-based intersectoral interventionPublication . Santos, Maria João Heitor dos; Moreira, S.; Dinis, A.; Virgolino, Ana; Carreiras, Joana; Rosa, R.; Ambrósio, S.; Lopes, E.; Fernandes, T.; Santos, OsvaldoIntroduction: Economic crises have consequences on labor market, with impacts on mental health (MH) and psychological well-being (PWB). We describe the effectiveness of an intervention among unemployed, performed within EEA Grants Healthy Employment project.Objectives Evaluate the effectiveness of an intervention for MH literacy, PWB and resilience among unemployed. Aims MH and PWB promotion, common mental disorders prevention and inequalities reduction linked to unemployment.Methods A five modules intervention (life-work balance; impact of unemployment on PWB and MH; stigma; depression and anxiety; health promotion) distributed by 20 hours was developed based on literature reviews and a Delphi panel. It was delivered to unemployees from two public employment centers (PECs).Inclusion criteria: 18–65 years old; registration in PEC for less than a year; minimum of nine years of formal education. Control groups from the same PECs received the care-as-usual. Measures of psychological WB, MH self-reported symptoms, life satisfaction,resilience and mental health literacy were collected through an online survey before and one week after intervention.Results Overall, 87 unemployed participated,48% allocated to the intervention group (IG); 56% women (21–64 years old), average education was 15 years. Mixed measures ANOVA showed that the interaction between time and group was significant for PWB and MH literacy measures. The IG showed better self-reported PWB and improved MH literacy after intervention, compared to controls. No significant interactions were found for MH symptoms, life satisfaction and resilience.Conclusions This study shows the contribution of short-term community-based interventions in increasing MH literacy and PWB among unemployed.
- Avaliação de impacto na saúde : determinantes biopsicossociais no empregoPublication . Santos, Maria João Heitor dos; Carreiras, Joana; Godinho, M.; Reis, Fátima; Miguel, José PereiraIntrodução: Emprego e conciliação trabalho-família têm impacto na saúde e bem-estar dos trabalhadores. Presentismo e absentismo, ligados a diminuição da qualidade de trabalho e produtividade, relacionam-se com problemas de saúde física e mental. De acordo com o centro de Sainsbury para a Saúde Mental, a percentagem de casos de ausência ao trabalho, devido a problemas de saúde mental, ascende a 40%. A percentagem de trabalhadores na Europa que afirma sofrer de stresse no trabalho chega a atingir 28%. A resposta individual ao stresse pode estar associada à resiliência e a exposição crónica ao stresse pode afetar a saúde. Menos de metade da população adulta em Portugal tem uma auto-perceção de saúde global boa ou muito boa ao contrário de outros países. São necessárias intervenções para melhorar condições psicossociais laborais. A identificação de preditores de absentismo prolongado e presentismo, relacionados com ambiente psicossocial em meio laboral, e intervenções para redução do absentismo por causa psiquiátrica e do presentismo são áreas de investigação prioritárias. Políticas públicas de setores fora da saúde têm impacto positivo ou negativo na saúde mental das populações e uma boa ou má saúde mental repercute-se nos diferentes ambientes de vida. Iniciativas para diminuir fatores de stresse no trabalho promovem desenvolvimento económico. Promoção da saúde mental e prevenção da doença mental abrangem múltiplos determinantes, ao reforçarem fatores protetores e ao diminuírem fatores de risco. Os locais de trabalho, onde as pessoas passam muito do seu tempo, são áreas prioritárias de ação. Enquanto uma boa saúde mental estimula a capacidade de trabalho e a produtividade, más condições de trabalho conduzem a sofrimento psicológico, baixas por doença e aumento de custos. Políticas e medidas de diferentes setores, nomeadamente do emprego, têm impacto potencial na saúde, saúde mental e bem-estar dos indivíduos, nos sistemas de saúde e na equidade em saúde.
- Do we know what really works? A systematic review about using video games for cognitive trainingPublication . Brito, F.; Virgolino, Ana; Fialho, Mónica; Miranda, A. C.; Peixoto, J.; Neves, I.; Camolas, J.; Reis, M. F.; Carriço, L.; Santos, Osvaldo