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- Association between living setting and malnutrition among older adults: The PEN-3S studyPublication . Madeira, Teresa; Peixoto-Plácido, Catarina; Sousa-Santos, Nuno; Santos, Osvaldo; Costa, Joana; Alarcão, Violeta; Nicola, Paulo Jorge; Severo, Milton; Lopes, Carla; Clara, João GorjãoObjectives: Malnutrition is frequent among older adults, especially those living in nursing homes, but the association between residential setting and nutritional status is controversial. The aim of this study was to examine the association between living setting (nursing home versus community) and malnutrition while adjusting for demographic, socioeconomic, health-related, and psychosocial factors. Methods: This cross-sectional study included a randomly selected representative sample of Portuguese adults ≥65 y of age. Interviewers collected data regarding demographic and socioeconomic characteristics, nutritional status, physical activity, energy intake, cognitive function, self-reported general health, functional status, symptoms of depression, and loneliness. Logistic regression models were used to estimate the association between residential setting and malnutrition. Results: Participants were 1186 nursing home residents (72.8% women, 49.2% ≥85 y of age) and 1120 community dwellers (49% women, 21.3% ≥85 y of age). Following Mini Nutritional Assessment (MNA®) criteria, 29.6% of nursing home residents and 14.1% of community dwellers were at risk of malnutrition, whereas 2.3% and 0.3%, respectively, were malnourished. The living setting was not significantly associated with malnutrition after adjusting for functional status, symptoms of depression, and feelings of loneliness (odds ratio, 1.03; 95% confidence interval, 0.67–1.58). Conclusions: Risk of malnutrition and malnutrition are more prevalent among nursing home residents than community dwellers. Physical (functional status) and mental health (symptoms of depression and loneliness) seems more relevant to nutritional status than residential setting by itself. These findings should be taken into account when designing public health policies to tackle malnutrition among older adults.
- Content and Delivery of Physical Therapy in Multiple Sclerosis across Europe: A SurveyPublication . Řasová, Kamila; Freeman, Jenny; Cattaneo, Davide; Jonsdottir, Johanna; Baert, Ilse; Smedal, Tori; Romberg, Anders; Feys, Peter; Alves-Guerreiro, José; Habek, Mario; Henze, Thomas; Santoyo-Medina, Carme; Beiske, Antonie; Asch, Paul Van; Bakalidou, Daphne; Salcı, Yeliz; Dimitrova, Erieta; Pavlíková, Markéta; Štětkářová, Ivana; Vorlíčková, Jana; Martinková, PatriciaBackground: Guidelines and general recommendations are available for multiple sclerosis rehabilitation, but no specific guidance exists for physical therapists. Describing aspects of physical therapy content and delivery in multiple sclerosis and its determinants and analysing whether general recommendations connected with physical therapy are implemented in practice is important for interpreting clinical and research evidence. Methods: An online cross-sectional survey of physical therapists specialized in multiple sclerosis (212 specialists from 26 European countries) was used. Results: There was distinct diversity in service delivery and content across Europe. Perceived accessibility of physical therapy varied from most accessible in the Western region, and least in the Southern region. Sixty-four physical therapists adjusted their approach according to different disability levels, less so in the Eastern region. Duration, frequency and dose of sessions differed between regions, being highest in Southern and Western regions. “Hands on treatment” was the most commonly used therapeutic approach in all apart from the Northern regions, where “word instruction” (providing advice and information) prevailed. Conclusions: The content and delivery of physical therapy differs across Europe. Recommendations concerning access to treatment and adjustment according to disability do not appear to be widely implemented in clinical practice.
- Does Symptom Recognition Improve Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled TrialPublication . Sousa, Joana Pereira; Neves, Hugo; Pais-Vieira, MiguelPatients with heart failure have difficulty in self-care management, as daily monitoring and recognition of symptoms do not readily trigger an action to avoid hospital admissions. The purpose of this study was to understand the impact of a nurse-led complex intervention on symptom recognition and fluid restriction. A latent growth model was designed to estimate the longitudinal effect of a nursing-led complex intervention on self-care management and quality-of-life changes in patients with heart failure and assessed by a pilot study performed on sixty-three patients (33 control, 30 intervention). Patients in the control group had a higher risk of hospitalisation (IRR 11.36; p < 0.001) and emergency admission (IRR 4.24; p < 0.001) at three-months follow-up. Analysis of the time scores demonstrated that the intervention group had a clear improvement in self-care behaviours (βSlope. Assignment_group = −0.881; p < 0.001) and in the quality of life (βSlope. Assignment_group = 1.739; p < 0.001). This study supports that a nurse-led programme on symptom recognition and fluid restriction can positively impact self-care behaviours and quality of life in patients with heart failure. This randomised controlled trial was retrospectively registered (NCT04892004).
- The Fenix reborn: Occupational therapy in the first humanitarian mission in PortugalPublication . Roldão, ElisabeteIn Portugal, June 2017, there was a large fire, which was considered a national disaster. It led to changes in people's daily routines, affecting their occupational performance and making them vulnerable. At the time, the non-governmental organisation, Doctors of the World, implemented the first humanitarian mission in Portugal–The Hope Mission. This mission, which was made up of a nurse, a community mediator, two occupational therapists, four occupational therapy students and a clinical educator, intervened with the population of the entire affected region. Their main objective was to meet the needs of the people; involving them in significant activities, re-organising their roles and routines, re-structuring their daily lives, increasing their quality of life and their wellbeing and avoiding social isolation. Home visits, group activities and projects were implemented in partnership with community institutions. One of the projects was the (Re)Start Project. An initial assessment was made by the occupational therapists in order to plan the intervention. The project consisted of home visits (where an evaluation of the home context was made), group sessions (cognitive stimulation, motion sessions and group dynamics) and individual sessions (focusing on the performance issue and difficulties experienced by each person undertaking their daily routines). To understand the degree of satisfaction of the participants, specifically in relation to the (Re)Start project, a questionnaire was given to all who participated for more than one month. From analysis of the questionnaires, the conclusion was drawn that participants were satisfied with the activities developed in the project and found them meaningful. The presence of occupational therapy in this scenario was found to be important and made a difference. It would be useful to repeat this type of intervention at a national level, if a further humanitarian crisis occurs, especially in areas with ageing population or which are geographically isolated.
- Is olive oil good for you? A systematic review and meta-analysis on anti-inflammatory benefits from regular dietary intakePublication . Fernandes, João; Fialho, Mónica; Santos, Rodrigo; Peixoto-Plácido, Catarina; Madeira, Teresa; Sousa-Santos, Nuno; Virgolino, Ana; Santos, Osvaldo; Carneiro, António VazThe prevalence of non-communicable diseases is rapidly increasing, and evidence shows that diet and lifestyle are key areas of intervention to decrease their burden. Olive oil is considered one of the key nutritional components responsible for the benefits of the Mediterranean diet, which is characterized by the use of olive oil in meals as the main source of fat; a high consumption of water, fruits, nuts, vegetables, legumes, whole grains, spices, and herbs; a moderate consumption of dairy products (mainly cheese and yogurt), fish, poultry, and red wine; and a reduced consumption of red meat and processed foods. The aim of this review was to summarize evidence from randomized controlled trials on the effect of regular dietary intake of olive oil on three inflammatory markers: C-reactive protein, interleukin-6, and tumor necrosis factor-α. Reviewed RCTs reveal beneficial effects of olive oil by reducing levels of inflammation markers. Olive oil taken on a regular basis can be a good dietary fat alternative, especially to manage IL-6. However, further research is required to clarify the effects of olive oil consumption on inflammation, comparing to other fats. Moreover, olive oil daily dosage, different time-lenght intervention and follow-up periods should be taken into consideration.
- Symptom perception management education improves self-care in patients with heart failurePublication . Sousa, Joana Pereira; Oliveira, Cláudia; Pais-Vieira, MiguelBACKGROUND: Patients with heart failure often have difficulty recognizing signs and symptoms of the disease, which delays seeking help, and therefore interferes with patient engagement and self-care management. Early detection of these symptoms could lead to care-seeking and avoid hospitalizations. OBJECTIVE: The purpose of this study was to design a complex intervention through a systematic literature review and qualitative study. METHODS: Our design followed the Medical Research Council's recommendations. To design a complex intervention, we combined a systematic literature review on education, symptom recognition, and self-care management in patients with heart failure, and semi-structured interviews with cardiology healthcare providers and patients with heart failure admitted to a cardiology ward. RESULTS: The systematic literature review identified 582 studies published between 2005 and 2014, of which four were included in the final review. These suggested that patient education focused on symptom recognition, combined with reinforcements, led to better self-care behaviors. Additionally, content analysis of semi-structured interviews revealed three themes: health management, behavior management, and support received. CONCLUSIONS: Combining the findings of the literature review and the themes that emerged from the semi-structured interviews, we proposed the development and implementation of a complex intervention on symptom perception and fluid management.