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Papers by Constanca Paul

Referência - Revista de Enfermagem, 2008

Projeto acadêmico sem fins lucrativos desenvolvido no âmbito da iniciativa Acesso Aberto II.ª Sér... more Projeto acadêmico sem fins lucrativos desenvolvido no âmbito da iniciativa Acesso Aberto II.ª Série-n.°7-Out. 2008

Current Psychology

During the pandemic, restrictive measures were implemented at Portuguese residential care facilit... more During the pandemic, restrictive measures were implemented at Portuguese residential care facilities (PRCF), such as isolating residents and ceasing collective activities. It is important to understand how PRCF are implementing activities that allow residents to occupy their time and fight isolation. As such, we aim to analyze whether: 1. new activities were implemented for residents (identifying which were carried out); 2. occupation activities were provided to isolated residents in their rooms (identifying which were carried out); 3. the implementation of activities is associated with variables like the amount of staff. This is an exploratory, quantitative, and cross-sectional study. An online questionnaire was sent by email to 2325 PRCF and entities were asked to share it with their workers. The study was also divulged on social networks. Data collection occurred between July 8th and October 18th, 2020. The study had 784 staff members participating and 90.8% reported that new act...

International Journal of Environmental Research and Public Health

Residential care facilities (RCF) for older people are facing high demands due to the COVID-19 pa... more Residential care facilities (RCF) for older people are facing high demands due to the COVID-19 pandemic. The aim of this study was to explore the workers’ perspectives on the changes in work and care dynamics amidst the first wave of the pandemic at Portuguese RCF. This is a descriptive, quantitative, and cross-sectional study. An online questionnaire about pandemic-induced changes in work and care dynamics was sent to 2325 RCF. These entities were then asked to share it with their workers. The participants (n = 784) were mostly women (92.7%) and mostly composed of technical directors (41.6%) and direct-care workers (17.1%). The respondents reported that during the first wave of the pandemic, when compared to the pre-pandemic period, there were greater difficulties in providing care related to the basic necessities of older people (52.7%); direct-care workers were required to work more consecutive hours in each shift (69.95%); direct-care workers had to live at RCF (14.8%), and ther...

Revista Psicologia, Saúde e Doenças: Resumos do 13º Congresso Nacional de Psicologia da Saúde, 2020

PERSON CENTRED HEALTHCARE INTERNATIONAL CONGRESS PROCEEDINGS, Oct 1, 2019

Frontiers in Public Health, 2021

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse... more Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors.Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables.Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for...

SpringerBriefs in Aging, 2020

The widespread need for gerontological care, driven by population ageing, has fostered the prolif... more The widespread need for gerontological care, driven by population ageing, has fostered the proliferation of residential institutions with welfare services focused on procedural efficiency. This standardised care shows signs of wear and has negative impacts on older people, namely in the violation of their rights and devaluation of their self-determination. Compliance with the law(s) is a necessary condition for the promotion of quality gerontological care. However, this is not always the case, and attributing rights their obvious importance, expressly acknowledging them and promoting legal literacy among professionals, clients and the support network

Resumo: O aumento da longevidade veio acompanhado pela evolução de doenças crónico degenerativas ... more Resumo: O aumento da longevidade veio acompanhado pela evolução de doenças crónico degenerativas e mais incapacitantes, especificamente a demência de Alzheimer. O tipo de necessidade de cuidados e a gravidade da situação clínica determinam a frequência e a intensidade dos cuidados a prestar e, consequentemente têm influência na adoção do papel do cuidador, que essencialmente está vinculado à família. Com a evolução tecnológica e a crescente necessidade de cuidados de saúde tem surgido evidência da importância dos Grupos de Ajuda na gestão do sistema de saúde tendo estes de ser incorporados nas práticas de saúde e da área social. No presente estudo, a pergunta: Qual o impacto dos Grupos de Ajuda Mútua em cuidadores informais de pessoas com demência?", delineou o caminho da revisão sistemática da literatura. Este estudo teve como objetivo analisar a produção científica acerca dos Grupos de Ajuda Mútua em cuidadores informais de pessoas com demência. Para o processo de busca de ev...

Revista Ibero-Americana de Saúde e Envelhecimento, 2020

Conceptualização dos cuidados centrados na pessoa idosa: origens e rumos Conceptualization of the... more Conceptualização dos cuidados centrados na pessoa idosa: origens e rumos Conceptualization of the centered care in older people: origins and paths Conceptualización de la atención centrada en la persona mayor: orígenes y direcciones

Geriatrics, Gerontology and Aging, 2021

OBJECTIVE: To identify the evidence on self-reported health and neuroticism in older adults. METH... more OBJECTIVE: To identify the evidence on self-reported health and neuroticism in older adults. METHODS: Indexed literature published in English, Spanish and Portuguese will be systematically searched and retrieved from 10 databases; reference lists from included studies will be manually searched. Two authors will independently screen titles, abstracts, and full texts against the eligibility criteria. A customized data extraction form will be used to perform data extraction of the included studies, which will be: studies written in English, Portuguese, and Spanish; studies of older adults aged 55 years or over (mean age is 60 years at least); studies of community-dwelling older adults; studies that evaluated both self-reported health and personality; studies that evaluated self-reported health and personality with validated instruments; observational, review, and intervention studies. RESULTS: The results will be presented in a tabular format, accompanied by a narrative summary.

SAGE Open Medicine, 2019

Background: In the current context, associated with the increase in longevity, there is a greater... more Background: In the current context, associated with the increase in longevity, there is a greater need for institutionalization of old people in search of formal support. The direct care workers of institutionalized older people, who work at day care centers and residential homes, are at risk of being victims of occupational psychosocial risks. There are several psychological complaints of these workers, highlighting the need to develop a mental health promotion program aiming at job satisfaction of direct care workers, improving their provision of care at work and quality of life. Aim: The StressadaMente program is a mental health promotion program for direct care workers of institutionalized older people in day care centers and residential homes. This article aims to describe the StressadaMente program and to evaluate the level of satisfaction of the direct care workers with the program. Methods: The program was implemented in two day centers/residential homes, enrolling 25 partic...

Kidney International Reports, 2020

Introduction: Chronic Kidney Disease (CKD) and Acute Kidney Injury (AKI) cause significant morbid... more Introduction: Chronic Kidney Disease (CKD) and Acute Kidney Injury (AKI) cause significant morbidity and mortality in developing nations and low resource settings, which are increased due to lack of early diagnosis and treatment. Newer markers have been developed for early identification of renal failure, such as cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) etc, but these are available only in advanced centres. Certain point-of-care devices are developed to measure serum creatinine levels in the community or bedside (e.g. iSTATÒ etc) but most are quite expensive and hence not suitable for low resource settings and larger community screening. Hence, there is a need for simpler and affordable bedside screening methods to detect renal failure. Methods: A pilot study was done on 25 patients to evaluate the diagnostic accuracy of salivary urea for identifying patients with AKI or CKD. The subjects were divided into 4 groups: 5 patients were known case of CKD, 5 patients were on Maintenance haemodialysis (MHD), 5 patients were diagnosed to have Acute kidney injury(AKI), and 10 subjects were normal healthy individuals. Patients serum creatinine and blood urea levels were measured by standard techniques. Semiquantitative estimation of salivary urea was done using dipstick method with an approximate cost of Indian Rupees (INR) 5.00 per test. Results: Among the 25 subjects, 17were males, 8 were females and the mean age was 20-80. There was a significant positive correlation between salivary urea, blood urea and serum creatinine levels. At a cutoff value of 20 mg/dl salivary urea had a sensitivity and specificity of 94 % and 85 % for diagnosing patients with renal failure. Conclusions: Findings of this study suggest that analysis of salivary urea in patients with kidney disease reflects their levels in blood. Hence, salivary urea could be used as screening tool to detect kidney disease on community screening in low resource areas.

International Journal of Advanced Research, 2018

Introduction: Nutritional disorders in older adults are of much concern, especially underweight a... more Introduction: Nutritional disorders in older adults are of much concern, especially underweight and obesity among older adults. This study aimed to evaluate prevalence of underweight and obesity and to identify factors associated with nutritional status in communitydwelling Portuguese elders. Methods: Cross-sectional study involving 337 elders attending day care centers in Lisbon. The data collected included self-perception of health state, chronic diseases, social support and relations as well as sociodemographic variables. Nutritional status was evaluated by Body Mass Index (BMI) classifying participants as underweight (BMI<24 Kg/m 2), normal weight (BMI=24 to<29kg/m 2) and obese (BMI≥29 kg/m 2). Data were compared using chi-square test and multinomial regressions were performed to identify determinants of underweight and obesity, being the normal weight the reference category. Results: Participants were mainly women (210; 62.3%), aged 66 to 99 years old. Overall prevalence of underweight and obesity was 21.7% and 38.3%, respectively. Of the 210 females, 24.3% presented underweight and 44.3% were obese. Of the 127 male participants, 17.3% were underweight and obesity affected 28.3%. Low BMI and obesity were associated with sociodemographic, health, psychosocial and institution attendance variables. Multinomial regressions revealed significant determinants for BMI status. Underweight was positively associated with age, gender and inability to cook and inversely with hypertension and diabetes. Obesity was positively associated with gender, hypertension and alcohol consumption. Conclusion Taking into account that health and nutrition are inherently connected, this research highlights the importance of considering all dimensions of health while managing weight and nutritional status of older adults. Health practitioners should set the focus on the underlying factors of the nutritional condition of this vulnerable population.

Innovation in Aging, 2019

Frailty is a clinical syndrome whose signs and symptoms are predictors of health complications, m... more Frailty is a clinical syndrome whose signs and symptoms are predictors of health complications, making this a major public health problem. FRAILSURVEY, which was considered a good practice by several entities, is a smartphone application that allows an easy assessment of frailty, available in Portuguese, English and Italian, on both iOS and Android stores. Smartphone-based assessment has been proven to be a useful diagnostic tool for patients, although few applications have demonstrated reliability. With this work we aimed to test the reliability of FRAILSURVEY as a tool to assess frailty, and to study people’s preference on which way to assess frailty. FRAILSURVEY is a questionnaire that comprises two sets of questions: 19 about sociodemographic data, social resources, self-perception of health, nutrition, medication, psycho-social and cognitive status, and time occupation, plus a set of 15 used to assess frailty status, the Groningen Frailty Indicator (GFI). Including 427 older ad...

Innovation in Aging, 2019

Frailty is a geriatric multidimensional syndrome whose signs and symptoms are predictors of incre... more Frailty is a geriatric multidimensional syndrome whose signs and symptoms are predictors of increased vulnerability to minor stress events and risk of adverse outcomes such as falls, fractures, hospitalisation, disability and death. In this work, we aimed to update the data of frailty status in European community dwelling population, based on the latest data released (wave 6) of SHARE database, and to study the impact of each criterion on frailty assessment. Frailty status was assessed applying a version of the Fried Phenotype operationalised for SHARE. We included all participants who answered all the questions used in a frailty assessment and who disclosed their gender and, further, whose age was 50 or more. Our final sample was 60816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38497 (56.4%) were female. The overall prevalence of pre-frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia) and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6%...

Geriatrics & Gerontology International, 2019

AimIn the present study, we aimed to update the data of frailty status in the European community‐... more AimIn the present study, we aimed to update the data of frailty status in the European community‐dwelling population of older adults, based on the latest data released (wave 6) of the Survey of Health, Aging and Retirement in Europe database, and to study the impact of each criterion on frailty assessment.MethodsFrailty status was assessed applying a version of the Fried phenotype operationalized for the Survey of Health, Aging and Retirement in Europe. We included all participants who answered all the questions used in a frailty assessment and who disclosed their sex and, furthermore, who were aged ≥50 years. Our final sample was 60 816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38 497 (56.4%) were women.ResultsThe overall prevalence of pre‐frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia), and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6% in Portugal). Pre‐frailty and frailty prevalence increased along with age, and were more freq...

European Journal of Public Health, 2019

females (63.3%) were included. Malnutrition was diagnosed in 26.2%, sarcopenia in 25.0% and frail... more females (63.3%) were included. Malnutrition was diagnosed in 26.2%, sarcopenia in 25.0% and frailty in 61.0%. Mean Body Mass Index (BMI) was 20.7, 25.8 and 26.6 kg/m2 in malnourished, at risk and wellnourished individuals, respectively(p = 0.000); 21.6 and 26.8 kg/m2 in sarcopenic and non-sarcopenic individuals(p = 0.000); and 24.3 and 27.7 kg/m2 in fragile and robust individuals(p = 0.000). Mean Fat Mass Index was 9.6 and 13.3 kg/m2 in sarcopenic and non-sarcopenic individuals (p = 0.007); and 10.3 and 16.0 kg/m2 in fragile and robust individuals (p = 0.000). Mean Free Fat Mass Index was 12.5, 14.9 and 17.0 kg/m2 in malnourished, at risk and wellnourished individuals; 12.0 and 17.0 kg/m2 in sarcopenic and non-sarcopenic individuals(p = 0.000); and 14.7 and 17.1 kg/ m2 in fragile and robust individuals(p = 0.002) Conclusions: BMI, free fat mass and fat mass were significantly lower in older adults with malnutrition, sarcopenia and frailty. BMI is a practical nutritional status marker, however it needs to be interpreted cautiously in older adults, as it seems that a lower value is associated with a worse prognosis and existing cutoffs may not apply. Nutritional screening and assessment of older adults is essential for a prompt intervention, in order to prevent and reverse these conditions

Innovation in Aging, 2018

2), and both social factors (Model 3), and examined the effect of CI and model predictive power. ... more 2), and both social factors (Model 3), and examined the effect of CI and model predictive power. Adding social factors did not substantially change the effect of CI (odds ratio=3.12-3.38, p<0.001, N=831,869 residents,), or predictive power (c-statistic=0.65-0.68). Correlations between risk-adjusted facility-level scores from the current model and Models 1-3 were strong (r=0.997-0.999, p<0.001, N=13,612 facilities). Given slight changes in effect of CI and predictive power between the current model and models including social factors, as well as strong correlations between risk-adjusted facility-level scores, results suggested that additional riskadjustment for available social factors would have little impact on the current specification.

Referência - Revista de Enfermagem, 2008

Current Psychology

International Journal of Environmental Research and Public Health

Revista Psicologia, Saúde e Doenças: Resumos do 13º Congresso Nacional de Psicologia da Saúde, 2020

PERSON CENTRED HEALTHCARE INTERNATIONAL CONGRESS PROCEEDINGS, Oct 1, 2019

Frontiers in Public Health, 2021

SpringerBriefs in Aging, 2020

Revista Ibero-Americana de Saúde e Envelhecimento, 2020

Geriatrics, Gerontology and Aging, 2021

SAGE Open Medicine, 2019

Kidney International Reports, 2020

International Journal of Advanced Research, 2018

Innovation in Aging, 2019

Geriatrics & Gerontology International, 2019

European Journal of Public Health, 2019

Innovation in Aging, 2018

Interdisciplinaria, 2017

The role of the clinical psychologist in the context of genetic counseling includes support for t... more The role of the clinical psychologist in the context of genetic counseling includes support for the process of decision-making for subjects at-risk, regardless of the decision that was made. For this, it is important to know the motivations behind these decisions. What may be considered advantageous and justifiable reasons to perform the PST for genetic diseases from the medical and public point of view, i.e., planning for the future, helping in the choice of a profession, family planning, improving quality of life and contributing to health, may not be recognized as such by the individual seeking the PST.
This study addresses the motivation to perform the presymptomatic testing (PST) of subjects at-risk for 3 diseases, Familial Amyloid Polyneuropathy (FAP), Huntington's disease (HD) and Machado-Joseph disease (MJD), compared with the motivation to perform the PST for Hemochromatosis (HH).
FAP, HD and MJD are three genetic (monogenic) autosomal dominant late-onset diseases (LONDs) with no cure. FAP is a progressive sensorimotor and autonomic neuropathy of adulthood. HD is characterized by a triad of clinical symptoms of chorea (motor, cognitive and psychiatric symptoms), emotional distress and cognitive decline. MJD is characterized by slowly progressive clumsiness in the arms and legs, a staggering lurching gait, sometimes mistaken for drunkenness, difficulty with speech and swallowing, involuntary eye movements, and may be accompanied by double vision or bulging eyes, and lower limb spasticity. HH is a disease in which too much iron accumulates in parenchymal organs, leading to iron overload and subsequent organ toxicity and failure.
The study participants consisted in 213 subjects at genetic risk for FAP, HD and MJD and 31 subjects at genetic risk for HH, that were assessed through an interview to obtain sociodemographic data and the answer to one question about motivation to perform PST: “Which were the reasons that led you to perform the predictive test?" This study was carried out in Center for Predictive and Preventive Genetics (CGPP), Institute for Molecular and Cell Biology (IBMC), Porto, Portugal. This research used a mixed-method, since qualitative and quantitative techniques of data analysis were used.
Before deciding to seek genetic counseling and to know their genetic status, subjects at-risk have naturally considered their motives and it was probably the pro-counseling reasons the ones dictating the motivation to perform the PST. This may suggest that in fact there is a prior self-selection to the test, i.e. only those considering to have emotional skills to go through the process, performing the test.
Seven major categories were obtained. The most significant ones for FAP, HD and MJD were reasons related to the future, reasons related to others and reasons related to curiosity and to the need to know. For HH, the most important ones were reasons related to others and reasons related to the characteristics of the disease.
The motivation of subjects at-risk to perform the PST for FAP, HD and MJD is external and unrelated to the disease, while the motivation of subjects at-risk to perform the PST for HH is related to the disease. Reasons related to others are a common motivation: as subjects at-risk for FAP, HD and MJD, subjects at-risk for HH also chose reasons related to others as one of the most important motivations to carry out the PST. These subjects also care about the fact that they can transmit the disease to their children and care about other family members which are already ill. The category reasons related to others includes subcategories that identify the person and the situation that led to the decision to perform a PST. Subjects at-risk are also concerned about the fact that they have to decide whether or not to have children and its economic implications.

Resumen
El papel del psicólogo clínico en el contexto del consejo genético incluye el apoyo al proceso de toma de decisiones para los sujetos en riesgo, independientemente de la cola se tomó la decisión.
Este estudio aborda la motivación para realizar las pruebas pre-sintomáticas (PPS) de sujetos en situación de riesgo para tres enfermedades, polineuropatía amiloide familiar (PAF), la enfermedad de Huntington (EH) y la enfermedad de Machado-Joseph (EMJ) y comparar con la motivación para realizar la PPS para hemocromatosis (HH).
La muestra consistió en 213 sujetos portugués que tenían riesgo genético para contraer las tres enfermedades y 31 sujetos en situación de riesgo genético para contraer la HH. Ellos fueron evaluados con una entrevista para obtener datos socio-demográficos y debían responder a una pregunta sobre la motivación para llevar a cabo las PPS.
Se obtuvieron siete categorías principales. Las más significativas para PAF, EH y EMJ fueron razones relacionadas con el futuro, razones relacionadas con los demás y razones relacionadas con la curiosidad y la necesidad de conocer. Para HH, las más importantes fueron razones relacionadas con los demás y razones relacionadas con las características de la enfermedad.
La motivación para realizar el PST de la PAF, EH y EMJ es externa y sin relación con la enfermedad, mientras que la motivación de los sujetos en situación de riesgo para la HH está relacionada con la enfermedad. Las razones relacionadas con los demás es una motivación común. Estos sujetos también se preocupan que pueden transmitir la enfermedad a sus hijos.

This study addresses the relation between illness representations, knowledge and motivation to pe... more This study addresses the relation between illness representations, knowledge and motivation to perform the presymptomatic testing (PST) of subjects at-risk for Familial Amyloydotic Polyneuropathy (FAP), Huntington's disease (HD) and Machado-Joseph disease (MJD), compared with subjects at-risk for Hereditary Hemochromatosis (HH). The sample comprised a clinical group of 213 subjects at genetic risk for FAP, HD and MJD, and a comparison group of 31 subjects at genetic risk for HH, that answered three open-ended questions relating illness representations, knowledge about the disease, and motivation to perform PST. People at-risk for FAP, HD and MJD use more metaphors, make more references to the family, are more concerned with the future and feel more out of curiosity and to learn, than for HH. These subjects at-risk correspond to the profile of somatic individual or personhood, wherein the unsubjectivation of the disease can function as a coping mechanism.