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Efeitos do tempo de hospitalização na ocorrência de delirium e transição de fragilidade física em idosos hospitalizados
No full textOrientadora: Profa. Dra Maria Helena LenardtCoorientadora: Profa. Dra Maria Angélica BinottoTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Defesa : Curitiba, 03/12/2024Inclui referênciasResumo: Trata-se de estudo quantitativo de coorte prospectivo, com o objetivo de analisar os efeitos do tempo de hospitalização na ocorrência de delírium e condição de fragilidade física em idosos hospitalizados. O estudo foi desenvolvido em hospital da Região Sul do Brasil, com amostra de seleção n=547 formada a partir de idosos hospitalizados, com idade maior ou igual a 60 anos, classificados quanto à condição de fragilidade física e ausência de delirium (n=427). Distribuiu-se em duas coortes de acordo com a exposição tempo de hospitalização menor ou igual que três dias (n=245) e maior que três dias (n=182). Utilizou-se análises descritivas, testes de associação, curvas de sobrevivência de Kaplan-Meier e regressão de riscos proporcionais. Houve predomínio de idosos na condição de pré-frágeis em ambas as coortes (54,29%; 48,35%). No tempo de hospitalização menor ou igual que três dias, 68,75% dos frágeis permaneceram frágeis, 31,25% transicionaram para pré-frágeis; dos pré-frágeis 86,60% permaneceram pré-frágeis; dos não frágeis 84,90% permaneceram não frágeis. Na hospitalização maior que três dias, 72,41% dos frágeis permaneceram frágeis; dos pré-frágeis 50% permaneceram pré-frágeis, 30,56% alteraram para frágeis; dos não frágeis 30,77% permaneceram não frágeis, 69,23% transicionaram para pré-frágeis. Quanto à transição da condição de fragilidade não houve diferença significativa nas duas coortes, p=0,285. A ocorrência geral de delirium foi 14,05%, sendo 5,31% na coorte menor ou igual que três dias, 25,83% na maior que três dias de hospitalização. Dos pacientes que desenvolveram delirium, 74,17% eram frágeis, 25,83% pré-frágeis, p<0,0001. Na coorte menor ou igual que três dias a presença de delirium foi observada em 15,55% dos frágeis, 3,75% pré-frágeis e 1,47% não frágeis; na coorte maior que 3 dias, 44,77% dos frágeis, 15,9% pré-frágeis e 11,1% não frágeis. Idosos frágeis (p<0,001) com idade superior a 80 anos (p=0,0007), viúvos (p=0,0142), em cuidados paliativos (p=0,0001), baixo peso (p=0,0002), com demência (p=0,0001) tendem a apresentar delirium após um tempo menor de hospitalização. Idosos mais longevos (p=0,0005), em cuidados paliativos (p=0,0001), com sobrepeso (p=0,0022) tendem ao óbito após um tempo maior de hospitalização. Apresentaram tempo maior de hospitalização os idosos frágeis (p=0,0001), mais idosos (p=0,003), viúvos (p=0,0287), com renda 0-1 salário-mínimo (p=0,0091), em cuidados paliativos (p=0,0001), sem histórico de quedas (p=0,0033), com sobrepeso (p=0,0012), sem demência (p=0,0019). Destaca-se que, a metade dos idosos nas coortes eram préfrágeis e os idosos com tempo hospitalização superior a três dias exibiram cinco vezes mais chance de ocorrência de delirium. Mesmo não havendo diferença estatisticamente significativa nas transições da condição da fragilidade entre as coortes, dois terços dos idosos não frágeis com mais de quatro dias hospitalizados progrediram para pré-fragilidade. O tempo de hospitalização se mostrou capaz de influenciar a ocorrência de delirium incidente, sendo mais preocupante nos internamentos prolongadosAbstract: This is a quantitative prospective cohort study aimed at analyzing the effects of hospitalization time on the occurrence of delirium and physical frailty in hospitalized elderly individuals. The study was developed in a hospital located in the southern region of Brazil, with a selection sample of n=547 formed by hospitalized elderly individuals, aged 60 years or older, classified according to their physical frailty and absence of delirium (n=427). It was divided into two cohorts according to the exposure to a hospitalization time of less than or equal to 3 days (n=245) and more than 3 days (n=182). Descriptive analyses, association test, Kaplan-Meier survival curves and proportional hazards regression were used. There was a predominance of elderly individuals in the pre-frail condition in both cohorts (54.29%; 48.35%, respectively). In hospitalizations of less than or equal to 3 days, 68.75% of the frail individuals remained frail, 31.25% transitioned to pre-frail; of the pre-frail, 86.60% remained pre-frail; of the non-frail, 84.90% remained non-frail. In hospitalizations more than 3 days, 72.41% of the frail individuals remained frail; of the pre-frail, 50% remained pre-frail, 30.56% transitioned to frail; of the non-frail, 30.77% remained non-frail, 69.23% transitioned to pre-frail. Regarding frailty transition, there was no significant difference between the two cohorts, with p=0.285. The overall occurrence of delirium was 14.05%, with 5.31% in the cohort less than or equal to 3 days, and 25.83% in hospitalizations longer than 3 days. Of the patients who developed delirium, 74.17% were frail, 25.83% pre-frail, with p<0.0001. In the cohort less than or equal to 3 days, the presence of delirium was observed in 15.55% of the frail individuals, 3.75% of the pre-frail and 1.47% of the nonfrail; in the cohort greater than 3 days, it was observed in 44.77% of the frail, 15.9% of the pre-frail and 11.1% of the non-frail. Frail elderly individuals (p<0.001) aged over 80 years (p=0.0007), widowed (p=0.0142), in palliative care (p=0.0001), underweight (p=0.0002), with dementia (p=0.0001) tend to present delirium after a shorter hospitalization time. Older elderly individuals (p=0.0005), in palliative care (p=0.0001), overweight (p=0.0022) are more prone to death after a longer hospitalization time. The elderly who were frail (p=0.0001), older (p=0.003), widowed (p=0.0287), with an income of 0-1 minimum wage (p=0.0091), in palliative care (p=0.0001), without a history of falls (p=0.0033), overweight (p=0.0012), without dementia (p=0.0019) had a longer hospital stay. It is noteworthy that half of the elderly individuals in the cohorts were pre-frail, and those hospitalized for more than three days were five times more likely to develop delirium. Although there was no statistically significant difference in the frailty transitions between the cohorts, two-thirds of the non-frail elderly individuals with more than four days of hospitalization progressed to pre-frailty. The length of hospitalization proved to be capable of influencing the occurrence of incident delirium, being more concerning in prolonged hospitalization
A condição de fragilidade física de idosos e apitidão para a direção veicular
Full text linkOrientadora: Profª Drª Maria Helena LenardtCo-orientadora: Profª Drª Mariluci Hautsch WilligDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Defesa: Curitiba, 11/12/2015Inclui referências : f. 98-124Área de concentração: Prática profissional de enfermagemResumo: Trata-se de estudo quantitativo de corte transversal, cujo objetivo foi investigar a associação entre a condição de fragilidade física de idosos e a aptidão física e mental para a direção de veículos automotores. O estudo foi realizado nas clínicas de trânsito na cidade de Curitiba/PR. A escolha das clínicas ocorreu por sorteio e a inclusão delas no estudo foi vinculada a critérios determinados pelos pesquisadores. Estabeleceram-se os seguintes critérios de inclusão do idoso no estudo: ter idade igual ou superior a 60 anos; estar agendado para os testes de habilitação em uma das clínicas de realização da pesquisa e apresentar capacidade cognitiva e física para realização dos testes. A amostra foi constituída por 172 idosos durante o período amostral de 31 de janeiro de 2015 a 31 de julho de 2015, perfazendo seis meses de coleta de dados diários, em dias úteis. Os dados foram coletados por meio de instrumento estruturado, aplicação de escalas e realização de testes físicos, que compõem a avaliação da fragilidade física. Realizou-se a codificação e organização dos dados no programa computacional Excel® 2007 e no Statistical PacKage for Social Sciences (SPSS) versão 20.0, após a digitação com dupla checagem. Os dados foram analisados por meio de estatística descritiva, distribuição de frequência absoluta e percentual, média e desvio padrão, e análises univariadas por meio do teste de qui-quadrado e Cochran - houve significância estatística quando o valor de p<0,05 e análises multivariadas por regressão logística, com método forward stepwise, que resultou em modelos preditores de aptidão para direção veicular em idosos. Os resultados mostram idosos com idade média de 67,73 ± 6,55, sendo 70,67% do sexo masculino, e a distribuição dos grupos foi 0 (0%) para os frágeis, 97 (56,40%) pré-frágeis e 75 (43,60%) não frágeis. Houve associação significativa entre fragilidade física e o estado civil (p=0,0327), uso de bebidas alcóolicas (p=0,0417), quantidade de quilômetros rodados (p=0,0222), acidentes (p=0,0165) e às restrições impostas na carteira de habilitação (p=0,0313). Quanto ao resultado da habilitação veicular 43 (25%) eram aptos, 118 (68,60%) aptos com restrição e 11 (6,40%) inaptos temporários. Não houve associação estatística entre fragilidade física e o resultado final do teste de habilitação (p=0,8934). O modelo preditor de aptidão para direção veicular eleito para este estudo foi o Modelo 2, idade, estado civil, consumo de álcool e fragilidade. Embora a prevalência seja de idosos motoristas na faixa etária idoso-jovem, os dados mostram que 66% se encontram na condição de pré-fragilidade. Essa condição aponta para a importância de gestão da fragilidade física nesse grupo de motoristas, já que a gerência da mesma contribui para retardar e atenuar o declínio funcional e consequentemente para uma direção mais segura. Palavras-chave: Idoso, Idoso fragilizado; Aptidão física; Exame para habilitação de motoristas; Condução de veículo.Abstract: It is a quantitative cross-sectional study, which objective was to investigate the association between elderly physical frailty condition and the physical and mental fitness for driving motor vehicles. The study was conducted in the transit clinics in Curitiba / PR.The clinics were chosen at random, and its inclusion were based on established criteria. The elderly inclusion criteria in the study: the person must be 60 years of age or older; being scheduled for the rehab tests in one of the research performing clinics and present cognitive and physical abilities to perform the tests. The sample consisted of 172 elderly, in the sample period from 31 January 2015 to 31 July 2015, resulting six collecting months of daily data on weekdays. The data were collected through structured instruments, ranges application and physical tests, which compose the physical frailty evaluation. Held encoding and organization of data in computer program Excel® 2007 and the Statistical Package for Social Sciences (SPSS) version 20.0, after entering double check. Data were analyzed using descriptive statistics, distribution of absolute frequency and percentage, mean and standard deviation, and more univariate analysis using the chi-square test and Cochran considering the level of statistical significance p <0.05. The results show elderly people with an average age of 67.73 ± 6.55, and (70.67%) were male, and the distribution of the groups was 0 (0%) fragile, 97 (56.40%) pre-frail and 75 (43.60%) did not fragile. There was a significant association between physical frailty and marital status (p = 0.0327), use of alcohol (p = 0.0417), number of kilometers traveled (p = 0.0222), accidents (p = 0.0165) and restrictions imposed in the license (p = 0.0313). As the result of vehicular license 43 (25%) were able 118 (68.60%) fit with restraint and 11 (6.40%) temporary unfit. There was no statistical association between physical fragility and the outcome of the license test (p = 0.8934). The fitness predictive model for vehicular direction chosen for this study was the Model 2, age, marital status , alcohol consumption and fragility. Although the prevalence of elderly drivers in the older-younger age group, the data show that 66% is in pre-fragility condition. This condition points to the indispensability of management of physical frailty in this group of drivers, as its management contributes to delay and mitigate the functional decline and consequently to a safer direction. Keywords: Elderly, Frail elderly; Physical fitness; Automobile driver examination; Automobile driving
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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