Thesis (MSc) Stllenbosch University, 2001. / ENGLISH ABSTRACT: A prospective study was conducted in 1999 to establish the incidence and nature of acute poisonings in the Cape Town / Western Cape region. This study was based on an analysis of Poison Centre queries and acute poisoning admissions to Tygerberg Hospital over a period of 1 year (1999). Summary of findings for Hospital admissions (1010 cases): Acute poisonings were more common in adults (83%) than in children (17%) and drug overdose was by far the most common clinical entity in adult Hospital admissions (89% of cases). Most overdoses in adults were intentional (97%). Seventy five percent of these cases were female, predominantly in the 20-40 year age group. The incidence of non-drug chemical exposures in adults was relatively low (11%). In children, on the other hand, there was much less of a discrepancy between drug and non-drug chemical exposures (41% and 59% respectively). Paracetamol was the drug most commonly used in overdose in both adults and children. In adults ethanol featured in 17% of cases. Ingestion of paraffin and related volatile hydrocarbons were the most important cause of acute poisoning in children. Acute poisoning admissions due to drugs of abuse, excluding ethanol, were minimal in both age groups (1%). Toxic exposures to non-drug chemicals in the agricultural and industrial settings were low (3%). The number of exposures to biological toxins was also minimal (2%). Summary of findings for Poison Centre inqueries (3744 consultations): In 1999 the Tygerberg Poison Information Centre received 3744 calls, of which 2690 were related to acute human exposures to poisonous substances. The remainder of the calls (1054) was either about drug therapy, or general non-patient related toxicological matters. There were more calls regarding poisoning in adults (61%) than in children (39%). Most of the paediatric poisonings were accidental (97%), whereas in adults 55% were deliberate and 45% accidental. Forty four percent of the children and 52% of adults were female. In children, inqueries about exposures to potentially harmful non-drug household chemical products comprised 56% of poison calls, while drug overdose was 28% and exposures to biological toxins 16%. In adults 44% of inqueries were with regard to household products, 40% about drugs and 16% biological toxins. A comparison of Hospital admissions versus Poison Centre consultations: In order to make a valid comparison between Hospital admissions and Poison Centre consultations, acute poisoning cases originating from the same area were compared. Eight hundred and thirty four (90%) of patients admitted to Tygerberg Hospital and 592 (25%) of Poison Centre consultations originated from the same region, the Tygerberg catchment area. Several differences were noted when comparing poisoning cases reported to the Poison Centre and Hospital admissions. Six hundred and eighty eight (83%) adults and 145 (17%) children were admitted to Hospital in contrast to Poison Centre inqueries, where 322 (54%) were adults and 270 (46%) children. In adults, 99% of Hospital admissions versus 59% of Poison Centre consultations were regarded as self-inflicted. Ninety three percent of adults admitted to Hospital were drug overdoses, whereas only 48% of adult Poison Centre consultations involved ingestion of medicines. In adult overdoses with paracetamol and other analgesics, tricyclic antidepressants, antiepileptics, theophylline and ethanol were significantly higher in Hospital admissions than in Poison Centre consultations. In contrast, exposures to pesticides e.g. pyrethroids, misuse of recreational drugs e.g. cannabis and biological toxin exposures e.g. spider bites, were significantly higher in Poison Centre consultations than in Hospital admissions. In children, poisoning exposures to volatile hydrocarbons, especially paraffin, were significantly higher in Hospital admissions compared to Poison Centre enqueries. As is evident from the disparity in the results above, inqueries to the Tygerberg Poison Information Centre cannot be regarded as a reflection of the true incidence of acute poisonings in the community. Poison Information Centre statistics are distorted because of two factors: 1. Under-reporting to the Poison Information Centre. Healthcare providers are familiar with how to manage drugs commonly used in overdose (e.g. paracetamol) and certain household non-drug chemicals (e.g. paraffin), and often do not consult the Poison Centre for poison cases involving these substances. The number of inqueries received by the Poison Information Centre regarding these substances is, therefore, an under representation of actual incidence. 2. Over-reporting to the Poison Information Centre. The Tygerberg Poison Information Centre is well known for its expertise in biological toxins (e.g. spider and snake bites, scorpion stings, plant and mushroom ingestions, and marine toxins). Therefore, the number of inqueries received by the Centre with regard to these exposures is far higher than actual incidence of exposures. It is clear from this study that one cannot use data derived from a poison centre alone as an indicator of true incidence of poisoning in the community. A more accurate estimate of incidence of acute poisoning could be obtained by including data from hospital admissions, as well as those from primary health care facilities. Another prominent finding in this study was the high incidence of self-inflicted drug overdose in adult females, with paracetamol being the drug of choice. Poison prevention should therefore not be limited to children. Adult prevention programs need urgent attention. / AFRIKAANSE OPSOMMING: ‘n Prospektiewe studie om die insidensie en aard van akute vergigtigings in die Wes-Kaap vas te stel, is gedurende 1999 in Tygerberg Hospitaal uitgevoer. Die studie is gebaseer op ‘n analise van oproepe wat deur die Tygerbergse Vergifinligtingsentrum ontvang is en pasiente wat gedurende dieselfde tydperk met ‘n diagnose van akute vergiftiging by die Hospitaal toegelaat is. Qpsomming van Hospitaal toelatinqs (1010 qevalle): Toelatings van akute vergiftigings was meer algemeen by volwassenes (83%) as by kinders (17%). Die meeste hospitaal toelatings (83%) by volwassenes is a.g.v. geneesmiddeloordoseing. By 97% van volwassenes was gifstowwe doelbewus ingeneem, met vroue in die meerderheid (75%). Die insidensie van vergiftigings met nie-geneesmiddel verwante gifstowwe by volwassenes was laag (11%). By kinders was daar egter ‘n meer eweredige verspreiding tussen geneesmiddel (41%) en nie-geneesmiddel verwante (59%) gifstowwe. By beide volwassenes en kinders, was parasetamol die middel wat by die meeste oordoserings betrokke was. Alkohol was by 17% van vergiftigings by volwassenes betrokke. Paraffien en verwante vlugtige substanse was die belangrikste gifstowwe betrokke by akute vergiftigings by kinders. Akute vergiftigings as gevolg van die gebruik van dwelmmiddels was laag in alle ouderdomsgroepe (1%). Vergiftigings in die landbou en industriele sektore was laag (3%). Dit was ook die geval ten opsigte van blootstelling aan biologiese toksienes (2%). Opsomminq van Tyqerberq Verqifinliqtinqsentrum konsultasies (3744 qevalle): Gedurende 1999 het die Tygerberg Vergifinligtingsentrum 3744 oproepe ontvang waarvan 2690 as gevolg van akute vergiftigings was. Die ander 1054 oproepe het gehandel oor geneesmiddel terapie of algemene, nie-pasient verwante navrae. Daar is aangetoon dat oproepe ten opsigte van akute vergiftigings by volwassenes meer algemeen was as by kinders (61% en 39% respektiewelik). By kinders was die meeste vergiftigings per ongeluk (97%), terwyl by volwassenes die meeste doelbewus (55%) was. By kinders was 44% van die vroulike geslag teenoor 52% by volwassenes. By kinders was nie-geneesmiddel gifstowwe by 56% van akute vergiftigings betrokke en geneesmiddels by 44%. By volwassenes was dit 60% en 40%, respektiewelik. ‘n Verqelvkinq ten opsigte van Hospitaal toelatinqs en Verqifsentrum konsultasies: Om ‘n geldige vergelyking tussen Hospitaal toelatings en Vergifinligtingsentrum konsultasies te maak is gevalle van akute vergiftigings afkomstig uit dieselfde geografiese gebied.vergelyk. Toelatings tot Tygerberg Hospitaal 834 (90%) en 592 (25%) oproepe wat deur die Tygerbergse Vergifsentrum ontvang is, kom uit dieselfde opvangsgebied, naamlik die Tygerbergse substruktuur. Verskeie verskille tussen die twee instansies ten opsigte van die tipe vergiftigings is aangetoon. Volwassenes 688 (83%) en 145 (17%) kinders is met ‘n diagnose van akute vergiftiging by Tygerberg Hospitaal toegelaat in teenstelling met die Inligtingsentrum konsultasies waar 322 (54%) volwassenes en 270 (46%) kinders by betrokke was. By volwassenes was 99% van die toelatings die gevolg van doelbewuste vergiftiging (paraselfmoord), terwyl dit 59% van die Inligtingsentrum se navrae was. Drie en negentig persent van die volwassenes was in die Hospital toegelaat met geneesmiddel oordosering. Heelwat minder geneesmiddel oordosering (48%) was deur die Inligtingsentrum hanteer. Parasetamol en ander analgetika, trisikliese antidepressante, anti-epilepsie middels, alkohol en teofillien oordoserings by volwassenes was beduidend hoer by Hospitaal toelatings as by Vergifsentrum konsultasies. Akute vergiftiging deur paraffien en verwante vlugtige substanse by kinders was beduidend hoer by Hospitaal toelatings as wat gevind is by Inligtingsentrum navrae. Navrae ten opsigte van pestisied vergiftiging, gebruik van dwelmmiddels en blootstelling aan biologiese toksiene was beduidend hoer as by Hospitaal toelatings. Hierdie duidelike kontrasterende data dui daarop dat die tipe navrae wat deur die Tygerberg Vergifinligtingsentrum hanteer word nie noodwendig ‘n weerspieeling van die ware insidensie van akute vergiftiging in die gemeenskap is nie. Daar is 2 hoofredes hiervoor. 1. Onderrapportering by die Inligtingsentrum. Gesondheidverskaffers (dokters, verpleegsters, aptekers ens.) is vertroud met die behandeling van sekere algemene vergiftigings soos byvoorbeeld parasetamol oordosering en paraffien inname. Hulle ag dit derhalwe onnodig om die Sentrum hieroor te konsulteer. Dit lei dus tot onderrapportering. 2. Oorrapportering by die Inligtingsentrum. Die Tygerbergse Vergifinligtingsentrum is bekend vir sy vakkundigheid ten opsigte van blootstelling aan biologiese toksiene (spinnekopbyte, slangbyte, skerpioensteke, plante-en sampioen vergiftigings, ens). Dit is om hierdie rede dat vergiftigings deur biologiese agense, geraporteer aan die Sentrum, ‘n hoer syfer verteenwoordig as wat die werklike insidensie ten opsigte van die vergiftigings is. Hierdie studie toon dat vergifinligtingsentrum data nie noodwendig ‘n indikator van die ware insidensie van akute vergiftigings in die gemeenskap is nie. Dit is dus belangrik dat hospitaaltoelatingsdata asook data van primere gesondheidsklinieke ingesluit word om sodoende ‘n beter beeld te verkry van die ware insidensie van akute vergiftigings. ‘n Opmerklike bevinding tydens die studie was die hoe insidensie van doelbewuste geneesmiddel oordosering by volwasse vroue, met veral parasetamol as die middel van keuse. Programme wat fokus op die voorkoming van akute vergiftigings in volwassenes het dringende aandag nodig.

Background: Stroke survivors often have persistent neural deficits related to motor function and sensation, which increase their risk of falling, most of which occurs at home or in community settings. The use of wearable technology to monitor fall risk and gait in stroke survivors may prove useful in enhancing recovery and/or preventing injuries. Objective: Determine the feasibility of using wearable technology (PAMSys (TM)) to objectively monitor fall risk and gait in home and community settings in stroke survivors. Methods: In this feasibility study, we used the PAMSys to identify fall risk indicators (postural transitions: duration in seconds, and number of unsuccessful attempts), and gait (steps, speed, duration) for 48 hours during usual daily activities in stroke survivors (n=10) compared to age-matched controls (n=10). A questionnaire assessed device acceptability. Results: Stroke survivors mean age was 70 +/- 8 years old, were mainly Caucasian (60%) women (70%), and not significantly different than the age-matched controls (all P-values >0.20). Stroke survivors (100%) reported that the device was comfortable to wear, didn't interfere with everyday activities, and were willing to wear it for another 48 hours. None reported any difficulty with the device while sleeping, removing/putting back on for showering or changing clothes. When compared to controls, stroke survivors had significantly worse fall risk indicators and walked less (P<0.05). Conclusion: Stroke survivors reported high acceptability of 48 hours of continuous PAMSys monitoring. The use of in-home wearable technology may prove useful in monitoring fall risk and gait in stroke survivors, potentially enhancing recovery.

INTRODUÇÃO: Frente ao aumento gradativo de quedas da própria altura com o avançar da idade, torna-se imprescindível conhecer os fatores de risco implicados na sua ocorrência em mulheres na transição e após menopausa, com o intuito de contribuir com estratégias de prevenção e promoção da saúde no cotidiano. OBJETIVO: Estimar a prevalência de quedas referidas e caracterizar a associação entre as quedas com variáveis clínicas e epidemiológicas das mulheres da Estratégia de Saúde da Família do Município de Pindamonhangaba, SP. MÉTODOS: Em estudo com delineamento observacional do tipo transversal vinculado ao Projeto de Saúde de Pindamonhangaba (PROSAPIN), foram utilizados dados secundários randomizados de 875 mulheres com idade entre 35 a 65 anos e investigadas por meio de um inquérito domiciliar e medidas antropométricas. A variável queda foi incluída como dependente, enquanto que as independentes foram representadas pela idade, estado civil, renda, escolaridade, raça, ocupação, histórico ginecológico, doenças crônicas referidas e mensuradas, medicamentos, obesidade (índice de massa corpórea), hábito alimentar, consumo de bebidas alcoólicas, tabagismo, sono, depressão e atividade física habitual. RESULTADOS: Participaram do estudo 749 mulheres com média de 47,7 anos (com desvio padrão de 8,1); a prevalência de quedas da própria altura foi de 17,6 por cento (IC de 14,9 - 20,5), sendo a maioria (54,6 por cento) na pós menopausa. Das mulheres que caíram, a prevalência de recorrência foi de 45,2 por cento. As principais causas foram escorregões (29,4 por cento) e tropeços (19,8 por cento). Após análise multivariada constatou-se associação das quedas com a idade (p=0,018), qualidade do sono ruim (0,007) e comorbidades como a hipertensão arterial (p=0,032) e depressão (p=0,003). As comorbidades hipertensão arterial (p=0,055) e depressão (p=0,001) associaram-se também as quedas recorrentes, bem como restrições às atividades de vida diária (p=0,000). CONCLUSÃO: A maior prevalência de quedas ocorreu após a menopausa e entre os principais fatores associados à sua gênese emergiram a idade, hipertensão arterial, depressão e sono ruim / INTRODUCTION: Faced the gradual increase of falls from height with advancing age, it becomes essential to know the risk factors of the falls on women in transition and after menopause, in order to contribute with strategies for prevention and health promotion in their daily routine. OBJECTIVE: To estimate the prevalence of referred falls and characterize the association between falls and clinical and epidemiological variables of women of the Family Health Strategy of Pindamonhangaba City, SP. METHODS: In a study with observational design of the type cross-sectional linked to Health Project of Pindamonhangaba (PROSAPIN), it was used secondary randomized data from 875 women from 35 to 65 years old and they were investigated through a household survey and anthropometric measurements. The falls were included as a dependent variable and age, marital status, income, education, race, occupation, gynecologic history, chronic disease and those measured, medicines, obesity (body mass index), dietary habits, alcohol consumption, smoking, sleep, depression and physical activity. RESULTS: There were 749 women investigated with average age of 47.7 years (standard deviation 8.1); the prevalence of falls from height was 17.6 percent (95 percentCI: 14.9 - 20.5), the majority (54.2 percent) of the fallers were in the post menopausal. Of the women who fell, the prevalence of recurrence was 45.2 percent. The main causes were slipping (29.4 percent) and setbacks (19.8 percent). After multivariate analysis, it was found an association of falls with age (p=0.018), poor sleep quality (p=0.007) and comorbidities as hypertension (p=0.032) and depression (p=0.003). The comorbidities hypertension (p=0.055) and depression (p=0,001) associated too with recurrent falls, as well restricted the activities of daily living (p=0.000). CONCLUSION: The highest prevalence of falls occurred after the menopause and among the main factors associated its genesis emerged the age, hypertension, depression and bad sleep

Made available in DSpace on 2016-04-26T20:20:33Z (GMT). No. of bitstreams: 1 Diogo Lopes Vilela Berbel.pdf: 862471 bytes, checksum: ab140484793c5a31974541cdda77c3d0 (MD5) Previous issue date: 2011-10-24 / It's about a master's thesis which investigates the accidental disability. The investigation begins in the Previdenciary context analysis, which is understood as a phenomenon inherent in Social Security. Once the contextualization of research is won, the second step is to analyse the meaning of the social risk as an object of social welfare protection. Although identified, the paper does not analyze all the risks admitted by Brazilian law. The research focuses on disability and, above all, the disability caused by work accident, occupational disease and work disease. The related concepts to the subject are defined. At this stage, it is verified the conceptual divergence between the branches of law, which noting its own principles establish regarded definitions of the phenomenon. Characterized the meaning of disability, the paper goes into the harvest of its characterization; generally it is identified two methods of measurement: i) casual links; ii) technical connection, while the former checks the relation of cause and effect in reality, the latter uses statistics to characterize this logical connection. Before the conclusions, the disability is analyzed in the light of the its effects, be it under the labor law, be it in the macro social security law. This duality ratifies the relativity of the definition, because each part, without connection, defines disability through its values. In the end, the paper presents specific findings on the investigation / Trata-se de dissertação de mestrado que investiga a invalidez acidentária. A investigação inicia-se na análise do contexto previdenciário, que é compreendido como fenômeno inerente à Seguridade Social. Vencida a contextualização da investigação, passa-se a análise do significado do risco social enquanto objeto da proteção previdenciária. Apesar de identificados, a dissertação não analise todos os riscos admitidos pela legislação brasileira. A investigação foca a invalidez e, sobretudo, a invalidez decorrente do acidente do trabalho, da doença profissional e da doença do trabalho. Os conceitos interessantes ao tema são definidos. Nessa etapa verificasse divergência conceitual entre os ramos do direito, que observando princípios próprios firmam definições relativas do fenômeno. Caracterizado o significado da invalidez, a dissertação adentra à seara da sua caracterização; genericamente, identifica-se dois métodos de aferição: i) nexo de causalidade; ii) nexo técnico; enquanto o primeiro verifica a relação de causa e efeito na realidade, o segundo se utiliza da estatística para caracterizar essa vinculação lógica. Antes das conclusões, a invalidez é analisada em face dos seus efeitos, seja no âmbito do direito do trabalho, seja na esfera macro do direito previdenciário. Essa dualidade ratifica a relatividade da definição, porque cada âmbito, sem vinculação, conceitua a invalidez por meio dos seus valores. No final, a dissertação apresenta conclusões pontuais sobre a investigação

Background: Fear of falling is now recognized as an independent fall risk factor due to its prevalence in older adults. Objectives: The purpose of this study was to gain a better understanding of fear of falling levels in community-dwelling older adults before and after attending a fall prevention clinic. Methods: An explanatory sequential mixed methods design was used. The Falls Efficacy Scale-International (FES-I) tool assessed fear of falling levels before and after attending a fall prevention clinic (n=32). Semi-structured interviews were then conducted in a sample of these participants (n=12). Results: There was no statistically significant difference in the before (M=30.44, SD=9.8) and after (M=31.72, SD=8.3) FES-I scores. Three themes emerged from the qualitative analysis: 1. Concerns about falling, 2. Decreased concerns about falling and 3. An increased self-awareness of fall risks. Conclusion: Further use of cognitive-behavioural therapy should be considered in falls risk reduction interventions for community-dwelling older adults with fear of falling.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Este estudo teve como objetivo validar o resultado de enfermagem Comportamento de prevenÃÃo de queda, apresentado pela Nursing Outcomes Classification (NOC). O processo de validaÃÃo focalizou pessoas acometidas por acidente vascular cerebral (AVC) e seus cuidadores, com foco no contexto domiciliar. Estudo do tipo metodolÃgico, realizado em duas etapas (validaÃÃo de conteÃdo e clÃnica) a partir de um instrumento proposto por Vitor (2010), o qual apresentou para o resultado 28 indicadores e definiÃÃes operacionais direcionadas inicialmente à populaÃÃo em geral. Estes foram revistos e organizados em 22 indicadores voltados ao ambiente domiciliar, local onde acontece o tipo mais comum de queda, a da prÃpria altura. A etapa de validaÃÃo de conteÃdo foi iniciada com avaliaÃÃo do instrumento por juÃzes quanto à aparÃncia. Em seguida, 22 especialistas avaliaram os tÃtulos e definiÃÃes de cada indicador, segundo os critÃrios psicomÃtricos de simplicidade, clareza, precisÃo e adequaÃÃo. ApÃs atendimento Ãs sugestÃes dos especialistas, procedeu-se à validaÃÃo clÃnica, precedida por um teste piloto para ajustes à populaÃÃo. Etapa realizada por duas duplas de profissionais treinados, no ambulatÃrio de dois hospitais de referÃncia ao atendimento a pacientes com AVC, com participaÃÃo de 106 pacientes e/ou cuidadores. Uma dupla aplicou o instrumento com as definiÃÃes operacionais e outra aplicou o instrumento contento apenas tÃtulos e escala da NOC. Os dados foram organizados em planilhas e analisados com o software SPSS 22. Para a etapa de validaÃÃo de conteÃdo foi calculado teste binomial, enquanto que, para a etapa clÃnica, utilizaram-se os testes de Friedman para verificar diferenÃa entre avaliadores, anÃlise da diferenÃa mÃnima significante (DMS), Alfa de Cronbach e Coeficiente de CorrelaÃÃo Intraclasse (CCI) para comparaÃÃo das avaliaÃÃes. O projeto foi apreciado por Comità de Ãtica em Pesquisa, aprovado sob os Pareceres n 49.912 e n 392.531; todos os participantes foram orientados quanto aos objetivos e assinatura do Termo de Consentimento. Na validaÃÃo de conteÃdo, a maioria dos especialistas foi de mulheres, mÃdia de 33,1 anos, 9,5 anos de formaÃÃo, doutores, profissionais de InstituiÃÃes de Ensino Superior. Os indicadores que se apresentaram estatisticamente significantes, pelo teste binomial, foram: Prende pequenos tapetes e Controla a inquietaÃÃo, e todos apresentaram-se apropriados ao paciente com AVC (100% e p=1,000). Na etapa clÃnica, houve discreta predominÃncia de homens participantes (51,9%), na maioria idosos, casados, aposentados, com baixa escolaridade e renda, residindo com a famÃlia e com sequelas fÃsicas do AVC, implicando a necessidade de um cuidador. O teste de Friedman indicou diferenÃas entre avaliaÃÃo das duplas em doze indicadores (p <0,05), destes, cinco demonstraram diferenÃas nas mÃdias de postos maiores que a DMS. Todos os indicadores apresentaram-se estatisticamente significantes (p<0,001) e satisfatÃrios segundo o (CCI). Esta etapa foi importante para constataÃÃo da manutenÃÃo ou nÃo de indicadores, que totalizaram 18 ao final. Assim, de forma geral, observou-se que houve maior concordÃncia entre a dupla que utilizou o instrumento com as definiÃÃes de cada indicador. Destaca-se a eficÃcia do processo de construÃÃo de referentes empÃricos e adequaÃÃo a populaÃÃes especÃficas, bem como a necessidade contÃnua de estudos nesta linha de conhecimentos. / This study aimed to validate the nursing outcome Fall prevention behavior from the Nursing Outcomes Classification (NOC). The validation process focused on people with stroke and their caregivers in the home context. This is a methodological study performed in two stages (content and clinical validation) by a tool proposed by Vitor (2010) who presented 28 indicators and operational definitions related to the general population. The tool was revised and organized in 22 indicators towards to the home environment which is the most common place where falls from height happen. The content validity stage was started with assessment by judges about the appearance. Then, 22 specialists evaluated the titles and definitions of each indicator according to psychometric criteria of simplicity, clearness, precision and suitability. After perform the changes suggested by the specialists, the clinical validation was performed at first by a pilot test in order to adjust the tool to the population. This stage was developed with 106 patients and/or caregivers interviewed by two pairs of trained professionals in the ambulatory service of two hospitals that are reference in the care of people with stroke. One pair of evaluators applied the form with the operational definitions while the other pair applied the form with only the titles and NOC scale. The data were organized in sheets and analyzed by the SPSS 22 program through the calculation of the binomial test. The clinical validation stage applied the Friedman test to verify differences among the evaluators, the calculation of the minimum significant difference (MSD), Cronbach alpha and intraclass correlation coefficient (ICC) to compare the evaluatorsâ assessment. The study was approved by an Ethical Committee by the nÂ49.912 and nÂ392.531; all the participants (specialists, patients and caregivers) were oriented about the goals and the Consent Term. At the content stage, the specialists were most female, with age average of 33.1 years old, 9.5 years of graduation, PhD, working in Post-secondary Institutions. The indicators statistically significant by the Binomial test were: Attaches small rugs and Controls restlessness and all of them were appropriated to the patient with stroke (100% and p=1.000). Most participants were male (51.9%), elderly people, married, retired, with low school grade and low income, living with family and with physical sequelae from the stroke, which requires the need of a caregiver. The Friedman test showed differences in the evaluations of the pairs of professionals for twelve indicators (p<0.05), five of them showed difference in the mean rank higher than the MSD. All the indicators showed statistical significance (p<0.001) and the ICC. This stage was important to realize the need of keeping or not the indicators, which were 18 at the end. Thus, it is noted that the tests showed more agreement between de pair that used the tool with the indicators for each definition. It is possible to highlight the efficiency of empirical references construction and its suitability to specific populations, besides the need of continuous researches in this field of study.

This thesis investigates walking patterns in healthy young people and in people with an increased risk of falling, and determines the physiological contributions to walking stability. First, a review of the relevant literature on techniques for assessing walking stability, age-related changes in balance and gait, and the contributions of vision, vestibular function, peripheral sensation and strength was undertaken. In response to a critical analysis of these findings, a new technique and protocol for the assessment of walking stability was developed. This involved measuring and analysing head and pelvis accelerations while subjects walked on a level surface and an irregular surface. Gait patterns were studied in 30 young healthy subjects and two groups known to be at increased risk of falling - 100 subjects over the age of 75, and 30 subjects with diabetic peripheral neuropathy. A series of vision, sensation, strength, reaction time and balance tests were also undertaken to identify subjects??? physiological abilities and risk of falls. Acceleration patterns of the head and pelvis differed according to physiological risk of falling, particularly when walking on the irregular surface. Those with a high risk of falling walked with a reduced velocity, cadence and step length, and exhibited less rhythmic acceleration patterns at the head and pelvis. Gait patterns were significantly associated with leg strength, peripheral sensation and reaction time. It is concluded that subjects with a high physiological risk of falling exhibit characteristic patterns of walking that indicate an impaired ability to control the movement of the pelvis and head, which may predispose to loss of balance.

We discuss a strategy for visual recognition by forming groups of salient image features, and then using these groups to index into a data base to find all of the matching groups of model features. We discuss the most space efficient possible method of representing 3-D models for indexing from 2-D data, and show how to account for sensing error when indexing. We also present a convex grouping method that is robust and efficient, both theoretically and in practice. Finally, we combine these modules into a complete recognition system, and test its performance on many real images.

Purpose: The primary purpose of this project was to determine the effect of aquatic exercise and aquatic exercise combined with an education group program on decreasing both psychosocial and physical fall risk factors in community-dwelling older adults with hip osteoarthritis (OA). Secondary purposes were to 1) describe fall risk, history and nature of falls and near-falls in older adults with hip OA, 2) determine the association of the timed up and go test (TUG) to history of falls and near-falls, 4) explore the relationship of both psychosocial and physical factors to history of falls and near-falls, and 5) evaluate the role of falls-efficacy in predicting balance performance. Methods: Participants were recruited from the community and screened for presence of hip osteoarthritis and fall risk. Baseline fall history and a battery of measures for balance, muscle strength, functional ability and falls-efficacy were administered. Participants were then randomly assigned to one of three groups: Aquatic Exercise, Aquatic Exercise and Education or a Control Group. The interventions were twice per week for 11 weeks. Fall risk factors were measured after 11 weeks. Study 1 described history of falls and near-falls and evaluated the association of the TUG screening test with fall and near-fall history. Study 2 summarized the relationships of physical and psychosocial fall risk factors and identified the primary predictors of fall risk, based on associations with fall history. Study 3 evaluated the randomized controlled clinical trial comparing the impact of the interventions (aquatic exercise and education) on fall risk outcomes. Results: Older adults with hip OA reported a high frequency of falls and near-falls. The TUG, using a cut-off score of 10 sec., was associated with frequent near-fall history. There was a strong association of frequent near-falls to history of actual falls, with the association increasing 7-fold if lower falls-efficacy was present. Falls-efficacy was also an independent predictor of balance impairment. Screening for history of near-falls and falls-efficacy may be important in predicting risk of future falls. The combination of Aquatic Exercise and Education improved falls-efficacy and functional mobility compared to Aquatic Exercise only or no intervention. Aquatic Exercise on its own was not effective in decreasing fall risk factors or improving falls-efficacy. Significance of Findings: The accumulation of both physical and psychosocial risk factors in older adults with hip OA increases their vulnerability to falls and injury. Fall prevention programs for this population should be designed to include both exercise and education to address falls-efficacy and physical fall risk factors.

Purpose: The primary purpose of this project was to determine the effect of aquatic exercise and aquatic exercise combined with an education group program on decreasing both psychosocial and physical fall risk factors in community-dwelling older adults with hip osteoarthritis (OA). Secondary purposes were to 1) describe fall risk, history and nature of falls and near-falls in older adults with hip OA, 2) determine the association of the timed up and go test (TUG) to history of falls and near-falls, 4) explore the relationship of both psychosocial and physical factors to history of falls and near-falls, and 5) evaluate the role of falls-efficacy in predicting balance performance. Methods: Participants were recruited from the community and screened for presence of hip osteoarthritis and fall risk. Baseline fall history and a battery of measures for balance, muscle strength, functional ability and falls-efficacy were administered. Participants were then randomly assigned to one of three groups: Aquatic Exercise, Aquatic Exercise and Education or a Control Group. The interventions were twice per week for 11 weeks. Fall risk factors were measured after 11 weeks. Study 1 described history of falls and near-falls and evaluated the association of the TUG screening test with fall and near-fall history. Study 2 summarized the relationships of physical and psychosocial fall risk factors and identified the primary predictors of fall risk, based on associations with fall history. Study 3 evaluated the randomized controlled clinical trial comparing the impact of the interventions (aquatic exercise and education) on fall risk outcomes. Results: Older adults with hip OA reported a high frequency of falls and near-falls. The TUG, using a cut-off score of 10 sec., was associated with frequent near-fall history. There was a strong association of frequent near-falls to history of actual falls, with the association increasing 7-fold if lower falls-efficacy was present. Falls-efficacy was also an independent predictor of balance impairment. Screening for history of near-falls and falls-efficacy may be important in predicting risk of future falls. The combination of Aquatic Exercise and Education improved falls-efficacy and functional mobility compared to Aquatic Exercise only or no intervention. Aquatic Exercise on its own was not effective in decreasing fall risk factors or improving falls-efficacy. Significance of Findings: The accumulation of both physical and psychosocial risk factors in older adults with hip OA increases their vulnerability to falls and injury. Fall prevention programs for this population should be designed to include both exercise and education to address falls-efficacy and physical fall risk factors.