The purposes of this qualitative descriptive study were to describe the perceptions of rural, older Appalachian women who live alone regarding systems of informal and formal care and to understand if traditional cultural norms influence attitudes and decisions to access these two systems. Older Appalachian women in this study defined themselves and their health in terms of their homes and as women who care for themselves informally and value independence and privacy. Five major themes emerged from the data for informal care, and three related to formal care or use of it. The findings support a reconceptualization of informal and formal care and point out reasons why these women chose to use or not use these two systems of care. Furthermore, they reveal how changes in the formal care system could support health promotion and prevention strategies grounded in everyday ways of maintaining health within the context of home.

OBJECTIVE: To investigate the cross-cultural validity of international Dutch-English comparisons when using the Dutch Rivermead Mobility Index (RMI), and the intra-test reliability and construct validity of the Dutch RMI. METHODS: Cross-cultural validity was studied in a combined data-set of Dutch and English patients undergoing rehabilitation after stroke, who were assessed with the Dutch version of the RMI and the original English RMI, respectively. Mokken scale analysis was used to investigate unidimensionality, monotone homogeneity model fit, and differential item functioning between the Dutch and the English RMI. Intra-test reliability and construct validity were studied in the Dutch patients by calculating the reliability coefficient and correlating the Dutch RMI and the Dutch Barthel Index. RESULTS: The RMI was completed for Dutch (n = 200) and English (n = 420) patients after stroke. The unidimensionality and monotone homogeneity model fit of the RMI were excellent: combined Dutch-English data-set (coefficient H = 0.91); Dutch data-set (coefficient H = 0.93); English data-set (coefficient H = 0.89). No differential item functioning was found between the Dutch and the English RMI. The intra-test reliability of the Dutch RMI was excellent (coefficient rho = 0.97). In a sub-sample of patients (n = 91), the Dutch RMI correlated strongly with the Dutch Barthel Index (Spearman's correlation coefficient rho = 0.84). CONCLUSION: The Dutch RMI allows valid international Dutch-English comparisons, and has excellent intra-test reliability and construct validity.

Bakgrund: En stomi är en kirurgisk åtgärd där tarmen läggs upp och bildar en öppning på magen. Denna åtgärd resulterar i att elimination sker via denna öppning, och ändrar därför kroppsfunktionen. Det finns många orsaker till varför en stomi anläggs och det är inom sjuksköterskans arbetsområde att stödja patienten. Syfte: Syftet var att beskriva vuxnas upplevelse av att leva med stomi. Metod: En litteraturöversikt genomfördes där både kvalitativa och kvantitativa artiklar från två olika databaser, PubMed och CINAHL Complete användes. En granskning och analys av artiklarna utfördes utifrån Friberg. Resultat: Efter tematiseringen identifierades två huvudteman en förändrad vardag och psykisk hälsa med två underteman i varje. I resultatet framkom det att en stomi påverkade vardagen både fysiskt och psykiskt samt att personer med stomi upplevde ökat behov av stöd från vården efter stomioperationen. Slutsats: En stomi kan innebära både fysiska och psykiska konsekvenser. Avsaknad av stöd och information kan upplevas, vilket i sin tur kan påverka vardagen negativt. / Background: An ostomy is an intestinal opening placed on the abdomen through a surgical procedure. This procedure results in elimination passing through the opening and changes bodily functions. There are many reasons why a stoma is placed and it is within the field of nursing to support the patient. Aim: To describe adults’ experiences of living with a stoma Method: A literature review was performed using both qualitative and quantitative articles found on PubMed and CINAHL Complete. The articles were examined and analyzed to then form a base for the result. The control was performed with the support of Friberg. Results: When the thematization was completed, two main headings were formed; a changed everyday life and mental health. Each theme had two subheadings. In the results it appeared that the ostomy has both physical and psychological effects and that people with a stoma are in need of support from the healthcare, after the surgery.​ Conclusions: An ostomy can result in both physical and psychological consequences. An absence of support and information can be experienced and this can have a negative influence in daily life.

In this bachelor’s thesis, the development and construction of a soft exoskeleton for a human hand is described.The purpose of the project includes evaluating what type of exoskeleton that is most suitable for aiding the user inactivities of daily living and how this exoskeleton can be constructed in order to increase grip strength in the human hand. In addition, the prototype should be portable and not inflict any harm on the user. The necessary theoretical research is thoroughly conducted followed by the construction of the final prototype. The purpose of the project is achieved, resulting in a flexible, portable and safe exoskeleton which with satisfaction can aid the user in its activities of daily living. However, this prototype is limited to exclusively include the thumb and index finger, and in further work the prototype can be developed to include all five fingers of the human hand. / I detta kandidatexamensarbete behandlas utvecklingen och konstruktionen av ett mjukt exoskelett för den mänskliga handen. Syftet med projektet är att undersöka vilken typ av exoskelett som passar bäst för att hjälpa användaren med aktiviteter i det dagliga livet, samt hur detta exoskelett kan konstrueras för att förstärka greppet i handen. Prototypen ska även vara bärbar och inte skada användaren. Den nödvändiga teorin presenteras, följt av konstruktionen av den slutgiltiga prototypen. Syftet med projektet uppfylls och resulterar i ett flexibelt, portabelt och säkert exoskelett som kan hjälpa användaren med aktiviteter i det dagligalivet. Dock är denna prototyp begränsad till att endast inkludera styrning av tummen och pekfingret, och prototypenkan således i framtida arbeten utvecklas till att inkludera samtliga fem fingrar på den mänskliga handen.

Syfte: Syftet med litteraturöversikten var att sammanställa kunskapsläget av arbetsterapeutiska interventioner för vuxna med postcovid.  Metod: En systematisk sökning utfördes i databaserna CINAHL, Scopus, Swepub, APA Psycinfo, Science Citation Index Expanded, Pubmed och Google Scholar. Efter analys av kvalitativa, kvantitativa och mixade metodartiklar selekterades elva artiklar som överensstämde med litteraturöversiktens syfte.  Resultat: I analysen framkom att interventionerna fokuserar på hanteringen av trötthet och fatigue. Tre kategorier identifierades: Interventioner med ett individanpassat tillvägagångssätt för hantering av trötthet och fatigue som omfattades av kartläggning, utbildning och strategier. Gruppanpassade interventioner som riktas mot rehabiliteringsprogram för energihantering och socialt stöd i grupp. Arbetsmiljöinterventioner och återgång till arbete med interventioner som aktivitetsprofil och rehabiliteringsprogram.  Konklusion: Arbetsterapeutiska interventioner utgör en central del av rehabiliteringen för patienter med postcovid. Genom att ge patienten anpassade verktyg främjas självinsikt, vilket leder till ökad livskvalitet. Det finns ett stort behov för fortsatt forskning inom området för att stärka kunskap och evidensläget. / The aim: The aim of this literature review was to compile the state of knowledge of the occupational therapy interventions for adults with post-covid. Method: A systematic search was performed in the databases CINAHL, Scopus, Swepub, APA Psycinfo, Science Citation Index Expanded, Pubmed and Google Scholar. After the analysis of qualitative, quantitative and mixed method articles, eleven articles were selected that align to the purpose of the literature review. Results: The analysis showed that the interventions focus were on the management of weariness and fatigue. Three categories were identified: Interventions with an individualized approach to manage fatigue and weariness that included mapping, education and strategies. Group-adapted interventions were directed toward rehabilitation programs for energy management and social support in groups. Workplace environment interventions and return to work with interventions such as activity profile and rehabilitation programs. Conclusion: Occupational therapy interventions are a central part of rehabilitation for patients with post-covid. By providing the patient with adapted tools, self-awareness is promoted and leads to increased quality of life. There is a great need for continued research in the field to strengthen knowledge and the state of evidence.

Résumé : Pour assister efficacement les personnes en perte d'autonomie dans le contexte des habitats intelligents, il est essentiel d'identifier les difficultés auxquelles ces personnes sont confrontées dans leur quotidien. L'objectif de ce travail est d'observer les processus exécutifs durant les activités de la vie quotidienne, ainsi que leur dysfonctionnement lors du vieillissement cognitif (normal ou lié à la maladie d'Alzheimer), puis d'élaborer un modèle théorique et informatique capable de simuler les comportements observés. Une phase d'observation et de qualification des processus de contrôle exécutif (capacités de régulation de l'action, de correction et d'adaptation lors de situations imprévues) a d'abord été réalisée, dornnant lieu à la spécification d'un modèle théorique fondé sur le modèle de contrôle attentionnel de l'action de Norman et Shallice. Le modèle théorique a ensuite été implémenté informatiquement et permet de simuler une activité quotidienne spécifique. // Abstract : In order to assist patients who are loosing their autonomy, smart homes and cognitive assistance systems have to be based on a good knowledge of people's disorders and on the difficulties they are likely to encounter in daily life. The specific objective of this PhD is to observe executive processes involved in the completion of daily activities and their impairment during ageing and dementia of the Alzheimer's type, and then to design both theoretical and computational models which are able to generate the observed behaviours. An observation and a qualification phase, allowing to observe executive control processes (action regulation, correction and adaptation when unexpected situations occur) have been first realized, leading to the specification of a theoretical model based on the Norman and Shallice model. This theoretical model has then been implemented to obtain a computational model, which allows the simulation of a specific activity of daily living.

<p>Svetska&nbsp; zdravstvena&nbsp; organizacija&nbsp; defini&scaron;e kvalitet&nbsp; života kao&nbsp; percepciju&nbsp; pojedinca&nbsp; o sopstvenom&nbsp; položaju&nbsp; u&nbsp; životu&nbsp; u&nbsp; kontekstu kulture i sistema vrednosti u kojima živi kao i prema&nbsp;&nbsp; svojim&nbsp;&nbsp; ciljevima,&nbsp;&nbsp; očekivanjima, standardima&nbsp; i&nbsp; interesovanjima.<br />To&nbsp; je&nbsp; &scaron;irok koncept&nbsp; koga&nbsp; čine:&nbsp; fizičko&nbsp; zdravlje&nbsp; pojedinca, psiholo&scaron;ki&nbsp;&nbsp; status,&nbsp;&nbsp; materijalna&nbsp;&nbsp; nezavisnost, socijalni&nbsp; odnosi&nbsp; i&nbsp; njihovi&nbsp; odnosi&nbsp; prema značajnim karakteristikama spolja&scaron;nje sredine. Procenjuje&nbsp; se&nbsp; da&nbsp; preko&nbsp; bilion&nbsp; ljudi&nbsp; živi&nbsp; sa<br />nekim&nbsp; oblikom&nbsp; invaliditeta,&nbsp; &scaron;to čini oko 15% svetske&nbsp; populacije. Prisustvo bilo&nbsp; kakvog telesnog invaliditeta kod osobe može&nbsp; značajno da utiče na njen psihofizički i socijalni razvoj. Procenjivanje&nbsp; uticaja&nbsp; fizičkog&nbsp; invaliditeta&nbsp; na svakodnevni&nbsp;&nbsp; život&nbsp;&nbsp; odslikava&nbsp;&nbsp; kakvo je funkcionisanje i blagostanje te osobe iz dana u dan i u različitim domenima života, &scaron;to&nbsp; zapravo predstavlja procenu kvaliteta života. Istraživanje&nbsp; predstavlja&nbsp; studiju&nbsp; preseka&nbsp; na uzorku&nbsp; od&nbsp; 227&nbsp; odraslih&nbsp; osoba&nbsp; sa&nbsp; motornim invaliditetom&nbsp; u&nbsp; Vojvodini,&nbsp; koji&nbsp; su&nbsp; članovi udruženja osoba sa invaliditetom. Kao instrument istraživanja kori&scaron;ćen je posebno kreiran&nbsp; upitnik&nbsp; za&nbsp; procenu&nbsp; kvaliteta&nbsp; života osoba sa invaliditetom. Osnovni cilj istraživanja je bio da se proceni kvalitet života osoba sa invaliditetom u odnosu na fizičko, socijalno i emocionalno funkcionisanje kod odraslih osoba sa motornim invaliditetom na teritoriji Vojvodine, kao i da se utvrdi postojanje&nbsp; razlike&nbsp; u&nbsp; kvalitetu&nbsp; života u odnosu na nivo obrazovanja,&nbsp; zaposlenost&nbsp; i bračno stanje. Podaci prikupljeni tokom ankete su kontrolisani&nbsp; na validnost, kodirani&nbsp; i&nbsp; uno&scaron;eni&nbsp; u posebno&nbsp; kreiranu&nbsp; bazu&nbsp; podataka.&nbsp; Odabrana&nbsp; su pitanja&nbsp; i&nbsp; formirani&nbsp; domeni/skale&nbsp; (fizičkog, emocionalnog i&nbsp; socijalnog&nbsp; funkcionisanja&nbsp; i samoprocene&nbsp; zdravlja)&nbsp; na&nbsp; osnovu matrica korelacija,&nbsp; ICC&nbsp; i&nbsp; vrednosti Kronbah&nbsp; alfa. Aritmetička&nbsp; vrednost,&nbsp; mediana,&nbsp; standardna devijacija,&nbsp; minimalna&nbsp; i&nbsp; maksimalna&nbsp; vrednost&nbsp; i 95%&nbsp; interval poverenja&nbsp; su&nbsp; izračunate&nbsp; za&nbsp; svaki domen kvaliteta života. Dobijene vrednosti domena i sumarnih skala su komparirane u odnosu na pol i bračno stanje ispitanika,&nbsp; (t-test, Mann-Whitney&nbsp; test),&nbsp; a ANOVA&nbsp; metodom&nbsp; i&nbsp; Kruskal -Wallis&nbsp; testom&nbsp; je vr&scaron;ena komparacija srednjih vrednosti u odnosu na&nbsp; nivo&nbsp;&nbsp; obrazovanja&nbsp; i status zaposlenosti ispitanika. Za&nbsp; sve&nbsp; testove&nbsp; su&nbsp; navedeni&nbsp; nivoi statističke značajnosti (p vrednosti). Studija je uključila 227 osoba sa motornim invaliditetom&nbsp; u&nbsp; Vojvodini,&nbsp; 120&nbsp; mu&scaron;karaca (52,9%) i 107 žena (47,1%). Prosečna&nbsp; starost ispitanika je bila<br />47 godina. U najvećem broju slučajeva uzrok invaliditeta je povreda (33,0%),<br />zatim&nbsp; neurolo&scaron;ko &nbsp; oboljenje&nbsp; (26,0%), urođena bolest&nbsp; (20,7%), te&scaron;ko&nbsp; reumatsko&nbsp; oboljenje (13,7%),&nbsp; cerebrovaskularni&nbsp; inzult &nbsp; (2,6%) i ostala&nbsp; stanja &nbsp; (4%). U pogledu ortopedskih pomagala,&nbsp; invalidska&nbsp; kolica&nbsp; koristi 30,4% ispitanika, &scaron;tap 37, 0%, &scaron;etalicu 3,1%, aparat za podizanje&nbsp; stopala &nbsp; 3,5%,&nbsp; dok&nbsp; ostatak&nbsp; navodi ostalo (&scaron;take, antidekubitusni krevet...). Psihometrijska analiza je pokazala da je za definisanje domena fizičkog funkcionisanja bilo moguće uključiti 5 pitanja iz upitnika, za domen emocionalnog&nbsp; funkcionisanja 10 pitanja&nbsp; a&nbsp; za domen&nbsp; socijalnog&nbsp; funkcionisanja&nbsp; 3&nbsp; pitanja. Skala za svaki domen se kretala u intervalu od 0 do 100. Set od 5 pitanja uključenih u skalu fizičkog funkcionisanja&nbsp; definisali&nbsp; su&nbsp; kapacitet&nbsp; fizičkih sposobnosti. Prosečna vrednost domena fizičkog&nbsp; funkcionisanja&nbsp; za&nbsp; sve&nbsp; ispitanike&nbsp; je iznosila 85, 0&nbsp; (SD=18.9) sa 95%&nbsp; CI u&nbsp; rasponu od 82,6 do 87,5. Utvrđena je statistički značajna razlika za ovaj domen u odnosu na zaposlenost (p=0.067) dok u odnosu na nivo obrazovanja&nbsp; i bračno stanje nema statistički značajne razlike. Set&nbsp; od 10 pitanja&nbsp;&nbsp; uključenih u skalu emocionalnog funkcionisanja definisali su emocionalni&nbsp;&nbsp; status ispitanika. Prosečna vrednost&nbsp; domena emocionalnog &nbsp; funkcionisanja za sve ispitanike je iznosila 62,5 (SD=20,0) sa 95% CI u rasponu od 59,9 do 65,1. Utvrđena je statistički&nbsp; značajna&nbsp; razlika&nbsp; za&nbsp; ovaj&nbsp; domen&nbsp; u odnosu&nbsp; na nivo&nbsp; obrazovanja (p=0.048) dok&nbsp; u odnosu&nbsp; na&nbsp; zaposlenost&nbsp; i&nbsp; bračno&nbsp; stanje nemastatistički značajne razlike. Set od 3&nbsp; pitanja&nbsp; uključenih u skalu socijalnog funkcionisanja definisali su kapacitet socijalnih aktivnosti. Prosečna vrednost domena socijalnog funkcionisanja&nbsp; za&nbsp; sve&nbsp; ispitanike&nbsp; je iznosila 72,0 &nbsp; (SD=27,6)&nbsp; sa&nbsp; 95% CI u&nbsp; rasponu od 68,4 do 75,6. Utvrđena je statistički značajna razlika za ovaj&nbsp; domen&nbsp; u&nbsp; odnosu na nivo obrazovanja (p=0.067)&nbsp; dok u odnosu na zaposlenost i bračno stanje nema statistički značajne razlike.</p> / <p>The&nbsp; World&nbsp; Health&nbsp; Organization&nbsp; defines quality&nbsp; of&nbsp; life&nbsp; (QoL)&nbsp; as&nbsp; &ldquo;an&nbsp; individual&#39;s<br />perception of their position in life in the context of the culture and value systems where they live and&nbsp; in&nbsp; relation&nbsp; to&nbsp; their&nbsp; goals,&nbsp; expectations,&nbsp;standards&nbsp; and concerns.&nbsp; It&nbsp; is&nbsp; a&nbsp; broad&nbsp; concept affected in a complex way by a person&#39;s physical health, &nbsp;psychological&nbsp; state,&nbsp; personal&nbsp; beliefs, social&nbsp; relationships&nbsp; and&nbsp; their&nbsp; relationship&nbsp; to salient features of their environment.&rdquo;<br />Over&nbsp; a&nbsp; billion&nbsp; people&nbsp; are&nbsp; estimated&nbsp; to&nbsp; live with&nbsp; some&nbsp; form&nbsp; of&nbsp; disability.&nbsp; This&nbsp; corresponds to&nbsp; about&nbsp; 15%&nbsp; of&nbsp; the&nbsp; world&#39;s&nbsp; population.&nbsp; The presence&nbsp; of&nbsp; any&nbsp; sort&nbsp; of&nbsp; physical&nbsp; disability&nbsp; in person can significantly influence their physical,<br />mental and social development. The assessment of&nbsp; the&nbsp; effects&nbsp; of&nbsp;a&nbsp; disability&nbsp; on&nbsp; every&nbsp; day,&nbsp; life reflects&nbsp; on&nbsp; the&nbsp; functioning&nbsp; and&nbsp; wealth&nbsp; of&nbsp; a&nbsp;person on daily basis and in various segments of life,&nbsp; that&nbsp; actually&nbsp; represents&nbsp; the&nbsp; assessment&nbsp; of their quality of life. The&nbsp; research&nbsp; represents&nbsp; a&nbsp; cross-sectional&nbsp;study of the sample of 227 adults with motoric disability&nbsp; in&nbsp; Vojvodina,&nbsp; who&nbsp; are&nbsp; registered&nbsp; in associations of people with disability. Especially created questionnaire was used to assess quality of life. The&nbsp; aim&nbsp; of&nbsp; this&nbsp; study&nbsp; was&nbsp; to&nbsp; investigate&nbsp; the&nbsp;relationship&nbsp; between&nbsp; physical&nbsp; (PF),&nbsp; emotional (EF) and social functioning&nbsp;(SF) domain of QoL and education level, employment and having life&nbsp;partner of disabled persons.<br />The&nbsp; data&nbsp; collected&nbsp; during&nbsp; the&nbsp; survey&nbsp; were checked for validity, then coded and entered into a specially created database. Тhe questions were&nbsp;selected,&nbsp; four&nbsp; scales&nbsp; / domains&nbsp; (physical, emotional,&nbsp;&nbsp; social&nbsp;&nbsp; functioning&nbsp;&nbsp; and&nbsp;&nbsp; self assessment of health) were formed based on the correlation&nbsp; matrices,&nbsp; intercorrelation&nbsp; cofficient (ICC) and Crombach alpha values. Mean value,&nbsp;median,&nbsp; standard&nbsp; deviation,&nbsp; minimum&nbsp; and maximum values and 95% of confidence interval wаs calculated for all domain of QoL. The values obtained in the field of physical, emotional and social functioning were compared as&nbsp; per&nbsp; gender&nbsp; and&nbsp; marital&nbsp; status&nbsp; of&nbsp; the participants,&nbsp; using&nbsp; t-test,&nbsp; Mann-Whitney&nbsp; test, ANOVA&nbsp; method&nbsp; and&nbsp; Kruskal&nbsp; Wallis&nbsp; test&nbsp; were used&nbsp; to&nbsp; compare&nbsp; the&nbsp; mean&nbsp; values&nbsp; in&nbsp; respect&nbsp; to level of education and employment status of the respondents.&nbsp; For&nbsp; all&nbsp; the&nbsp; tests,&nbsp; the&nbsp; levels&nbsp; of statistical significance (p) were provided. The study involved 227 adults with motoric disability&nbsp; in&nbsp; Vojvodina,&nbsp; 120&nbsp; men&nbsp; (52.9%)&nbsp; and 107&nbsp; women&nbsp; (47.1%).&nbsp; Average&nbsp; age&nbsp; of&nbsp; the participants&nbsp; was&nbsp; 47&nbsp; years&nbsp; of&nbsp; age.&nbsp; The&nbsp; cause&nbsp; of disability&nbsp; in&nbsp; the&nbsp; largest&nbsp; number&nbsp; of&nbsp; the interviewees&nbsp; were&nbsp; the&nbsp; injury&nbsp; (33.0%),&nbsp; then neurological&nbsp;&nbsp; conditions&nbsp;&nbsp; (26.0%),&nbsp;&nbsp; inborn condition&nbsp; (20.7%),&nbsp; serious&nbsp; rheumatic&nbsp; disease (13.7%), cerebrovascular insult (2.6%) and other (4%).&nbsp; As&nbsp; for&nbsp; the&nbsp; orthopedic&nbsp; tools,&nbsp; wheelchairs are&nbsp; used&nbsp; by&nbsp; 30.4%&nbsp; participants,&nbsp; stick&nbsp; 37.0%, walker&nbsp; is&nbsp; used&nbsp; by&nbsp; 3.1% &nbsp; and&nbsp; the&nbsp; orthoses&nbsp; for elevating&nbsp; feet&nbsp; 3.5%,&nbsp; whereas&nbsp; the&nbsp; rest&nbsp; of&nbsp; the interviewees&nbsp; state&nbsp; other&nbsp; (different&nbsp; orthopedic tools such as crutches, anti decubitus mattresses etc). Psychometric&nbsp; analysis&nbsp; showed&nbsp; that&nbsp; in&nbsp; order to&nbsp; define&nbsp; the&nbsp; domain&nbsp; on&nbsp; physical&nbsp; functioning from the questionnaire applied it was possible to include&nbsp;&nbsp; the&nbsp;&nbsp; 5&nbsp;&nbsp; questions,&nbsp;&nbsp; for&nbsp;&nbsp; emotional functioning domain 10 questions and for domain on social functioning 3 questions. The sum of all selected questions&nbsp; for&nbsp; every&nbsp; domain&nbsp; forms&nbsp; the scale in the range from 0 to 100. The set of five questions stated for the scale of physical&nbsp;&nbsp; functioning&nbsp; indicate the capacity of physical&nbsp; functioning. The&nbsp; average&nbsp; value&nbsp; of PF domain&nbsp; for&nbsp; all&nbsp; the&nbsp; interviewees&nbsp; is 85.0 (SD=18.9) with 95% CI in the range of 82. 6 to 87.5. The&nbsp; difference&nbsp; in&nbsp; regard&nbsp; to employment status (p=0.067) is&nbsp; statistically&nbsp; significant&nbsp; but there&nbsp; is&nbsp; not&nbsp; satisticlly&nbsp; significant&nbsp; difference&nbsp; in regard level of education and marital status. The set of ten questions stated for the scale of emotional&nbsp; functioning. The average&nbsp; value of EF&nbsp; domain&nbsp; for&nbsp; all&nbsp; the&nbsp; interviewees&nbsp; is 62.5 (SD=20.0) with 95% CI in the range of 59.9 to 65.1.&nbsp; The&nbsp; difference&nbsp; in&nbsp; regard&nbsp; to level&nbsp; of education (p=0.048)&nbsp; is&nbsp; statistically&nbsp; significant but there&nbsp; is&nbsp; not satisticlly&nbsp; significant difference in&nbsp; regard&nbsp; to employment&nbsp; status and&nbsp; marital status. The set of three questions stated for the scale of&nbsp; social&nbsp; functioning&nbsp; indicate&nbsp; the&nbsp; capacity&nbsp; of social&nbsp; interaction.&nbsp; The&nbsp; average&nbsp; value&nbsp; of&nbsp; SF domain&nbsp; for&nbsp; all&nbsp; the&nbsp; interviewees&nbsp; is&nbsp; 72.0 (SD=27.6) with 95% CI in the range of 68.4 to 75.6. The&nbsp;&nbsp; difference&nbsp; in&nbsp; regard&nbsp; to the&nbsp; level&nbsp; of education&nbsp; is&nbsp; statistically&nbsp; significant&nbsp; (p&lt;&nbsp; 0.001) but there&nbsp; is&nbsp; not satisticlly&nbsp; significant difference in&nbsp; regard&nbsp; to&nbsp; employment&nbsp; status&nbsp; and marital status.</p>

<p>Uvod: Akutni apendicitis predstavlja jedno od najče&scaron;ćih abdominalnih hirur&scaron;kih oboljenja u dečjem uzrastu. Lečenje je operativno, primenom otvorene hirurgije ili primenom minimalno invazivne hirurgije tj. laparoskopske apendektomije. Iako je laparoskopska apendektomija, zbog svojih prednosti, stekla popularnost kod mnogih hirurga, jo&scaron; uvek nije &scaron;iroko primenjena metoda na na&scaron;im prostorima. Prednost izvođenja laparoskopske apendektomije u odnosu na otvorenu metodu u dečjem uzrastu je i dalje nedovoljno definisana i predmet je mnogih istraživanja. Cilj istraživanja je da se utvrdi da li je dužina hospitalizacije kod dece operisane laparoskopski zbog akutnog apendicitisa kraća u odnosu na otvorenu metodu, kao i da se utvrdi da li postoji razlika u pojavi postoperativnih komplikacija između ove dve hirur&scaron;ke metode. Pored toga, cilj istraživanja je i da se utvrdi uticaj obe metode lečenja na kvalitet života i brzinu uspostavljanja svakodnevnih aktivnosti. Metodologija: Na Klinici za dečju hirurgiju, Instituta za zdravstvenu za&scaron;titu dece i omladine Vojvodine, sprovedena je prospektivna, kontrolisana randomizirana studija, u trajanju od deset meseci, u koju su bili uključeni svi pacijenti sa akutnim apendicitisom, kod kojih je planirana apendektomija, a čiji roditelji su dali pismeni pristanak za uče&scaron;će u istraživanju. Svi ispitanici su podeljeni u dve osnovne grupe u odnosu na operativnu tehniku: otvorena i laparoskopska apendektomija. Potom su svi ispitanici podeljeni u tri podgrupe, u zavisnosti od stepena upaljenosti crvuljka (negativni, nekomplikovani i komplikovani apendicitis). Svaki ispitanik je imao svoj individualni protokol istraživanja gde su preoperativno zabeleženi: uzrast, pol, simptomi (vrsta i dužina), fizikalni pregled, laboratorijske analize (broj leukocita, hematokrit), ultrazvučni nalaz, procena op&scaron;teg stanja, udružena oboljenja, vreme od prijema do operacije, preoperativna antibiotska terapija. Intraoperativno je analizirano: vrsta hirurgije, nalaz na apendiksu, prisustvo peritonitisa, udružena patologija, dužina operacije i trajanje pneumoperitoneuma (kod laparoskopske apendektomije), patohistolo&scaron;ki nalaz apendiksa, bakteriolo&scaron;ki bris abdomena. Postoperativno su analizirani: antibiotska terapija (vrsta i dužina), započinjanje peroralnog unosa, utvrđivanje postoperativnog bola, febrilnost, uspostavljanje peristaltike creva, izgled rane, postoperativne komplikacije (infekcija rane, intraabdominalni apscesi, ileus) i dužina hospitalizacije. Posebno su analizirani kvalitet života pacijenata nakon operacije pomoću modifikovanog upitnika SF 10 za dečji uzrast, kao i uspostavljanje svakodnevnih aktivnosti pomoću Activity Assessment Scale (AAS), modifikovane za dečji uzrast, nakon svakog postoperativnog dana, prvih sedam dana, nakon mesec dana, tri i &scaron;est meseci od operacije. Svi pacijenti su operisani u uslovima op&scaron;te anestezije. Klasična, otvorena apendektomija je vr&scaron;ena kroz naizmenični rez u desnoj ilijačnoj jami. Po otvaranju peritoneuma, cekum je izvučen i načinjena je klasična apendektomija. Laparoskopska apendektomija je vr&scaron;ena kroz tri 5 mm porta. Pneumoperitoneum je kreiran otvorenom metodom po Hasson-u, kroz infraumbilikalnu inciziju, a preostala dva porta su postavljena desno i levo ilijačno. Mezenteriolum je zbrinut pomoću ultrazvučnih makaza. Postavljene su intrakorporalne ligature i apendiks je odstranjen kroz desni port. Rezultati: Tokom perioda od deset meseci operisano je ukupno 125 pacijenata uzrasta od 2 do 18 godina, zbog akutnog apendicitisa. Laparoskopskom tehnikom je operisano 60 pacijenata (48%), a otvorenom metodom 61 (48,8%). Kod 4 pacijenta je načinjena konverzija, tj. promena operativne tehnike iz laparoskopske u otvorenu metodu. Nije bilo statistički značajne razlike između terapijskih grupa u odnosu na stepen upaljenosti apendiksa, vrstu i dužinu trajanja simptoma, u dijagnostičkim procedurama, kao ni u vremenu proteklom od prijema u bolnicu do operacije. Srednje operativno vreme je iznosilo 65 minuta (25-185 min) za laparoskopsku grupu i 45,49 minuta (25-90 min) za otvorene apendektomije (razlika je statistički značajna, p&lt;0,001). Crevna peristaltika, kao i započinjanje peroralnog unosa, se statistički značajno ranije uspostavljaju u grupi laparoskopsko operisanih. U grupi laparoskopskih apendektomija, postoperativne komplikacije (infekcija rana i formiranje intraabdominalnih apscesa) su se javile kod 8,33% ispitanika (5/60), a u otvorenoj grupi kod 4.91%, (3/61), &scaron;to nije bilo statistički značajno (c2 = 0,152; df = 1; p = 0,696). Dužina hospitalizacije kod dece operisane laparoskopski je iznosila 5,95 } 1,21 dana, a otvoreno 6,43 } 1,09 dana, &scaron;to je statistički značajna razlika (t = -2,206; p = 0,029). Rezultati Man-Vitnijevog U testa su pokazali statistički značajno bolji ukupni skor svakodnevnih aktivnosti za grupu laparoskopskih apendektomija (Z = -7,608; p = 0,000). U svim ispitivanim indikatorima kvaliteta života, deca laparoskopske grupe su imala veći skor. Deca sa akutnim apendicitisom operisana laparoskopski značajno ranije postižu visok stepen kvaliteta života (t = 2,407; p = 0,018). Zaključak: Prednost minimalno invazivne hirurgije u terapiji akutnog apendicitisa u dečjem uzrastu ogleda se u bržem uspostavljanju ponovnog funkcionisanja gastrointestinalnog trakta, kraćoj hospitalizaciji, a samim tim i bržem sveukupnom oporavku, vraćanju svakodnevnim aktivnostima i dobrom kvalitetu života. Postoperativne komplikacije se podjednako javljaju, kako kod otvorene, tako i kod laparoskopske operativne tehnike.</p> / <p>Introduction: Acute appendicitis is one of the most common abdominal surgical diseases in children. Operative treatment means open surgery or minimally invasive surgery (laparoscopic appendectomy). Although laparoscopic appendectomy, gained popularity among many surgeons, it is still not widely accepted in our region. The advantage of laparoscopic appendectomy compared to the open method in children is still not sufficiently defined and is the subject of further research. The aim of the research was to determine whether the length of hospital stay after laparoscopic surgery in children with acute appendicitis is shorter compared to the open method, as well as to determine whether there is a difference in the occurrence of postoperative complications after these two operative techniques. In addition, the aim of the research was to determine the effect of both methods of treatment on quality of life and everyday functioning. Methodology: This prospective, randomized controlled study was performed at the Clinic for Pediatric Surgery, Institute of Children and Youth Healthcare of Vojvodina, during a period of ten months. All patients with acute appendicitis, whose parents have given written consent, were included in research. All patients were divided into two basic groups, in relation to the surgical technique: open or laparoscopic appendectomy. Then, all of them were divided into three groups, depending on the degree of appendicitis (negative, uncomplicated and complicated appendicitis). Each participant had their own individual research protocol where we recorded preoperatively: age, sex, symptoms (type and length), physical examination, laboratory tests (white blood cell count, hematocrit), ultrasound finding, general state (ASA classification), associated diseases, time from admission to surgery, preoperative antibiotic therapy. During the operation we analyzed: type of surgery, degree of the appendicitis, the presence of peritonitis, associated pathology, length of surgery and duration of pneumoperitoneum (in laparoscopic appendectomy), hystopathologic findings of the appendix, a bacteriology. Postoperatively we analyzed: antibiotic therapy (type and length), oral intake, postoperative pain, fever, establishing peristalsis, the appearance of postoperative complications (wound infections, intra-abdominal abscesses, ileus) and length of hospitalization. Especially, we analyzed the quality of life of patients after surgery using the modified questionnaire SF 10 for children; and the establishment of daily activities using Activity Assessment Scale (AAS), modified for children; after each postoperative day, the first seven days, one month, three and six months after surgery. All patients were operated under general anesthesia. Open appendectomy was performed through incision in the right iliac fossa. Peritoneum was opened, the cecum was pulled out and classic appendectomy was made. Laparoscopic appendectomy is performed through three 5 mm ports. Pneumoperitoneum was created by the Hasson techique, through the infraumbilical incision, and the remaining two ports are set at right and left iliac region. Mezenteriolum was ligated by ultrasonic scissors. After putting intracorporal ligature, appendix was removed through the right port. Results: Over a period of ten months we operated 125 patients , aged 2 to 18 years, due to acute appendicitis. Laparoscopic technique was performed in 60 patients (48%), and the open method in 61 (48,8%). In 4 patients the conversion was made (operative technique changed from laparoscopic to open method). There were no statistically significant differences between the treatment groups with respect to the degree of appendix inflammation, the type and duration of symptoms, the diagnostic procedures, as well as the time from hospital admission to the surgery. Medium operative time was 65 minutes (25-185 min.) for laparoscopic group and 45,49 minutes (25-90 min.) for open appendectomy (the difference is statistically significant, p&lt;0,001). Intestinal peristalsis, as well as the initiation of oral intake was significantly sooner established in the laparoscopic group. Postoperative complications (wound infections and intra-abdominal abscess formation In laparoscopic appendectomy) occurred after laparoscopy in 8,33% of patients (5/60), and in the open group in 4,91% (3/61), which was not statistically significant (c2 = 0,152, df = 1; p = 0,696). Length of hospital stay in children operated by laparoscopy was 5,95 } 1,21 days and by open technique 6,43 } 1,09 days, which is significantly longer (t = -2,206; p = 0,029). Results of the Mann-Whitney U test showed significantly better overall record of daily activities for a group of laparoscopic appendectomy (Z = -7,608; p = 0,000). In all tested indicators of quality of life, children from laparoscopic group had a higher score. Children with acute appendicitis treated by laparoscopic surgery achieved a high level of quality of life, significantly earlier (t = 2,407; p = 0,018). Conclusion: The advantage of minimally invasive surgery in the treatment of acute appendicitis in children is reflected in the faster re-establishment of functioning of the gastrointestinal tract, shorter hospitalization and therefore, a faster overall recovery, resuming normal activities and a good quality of life. Postoperative complications occur equally in both, open as well as in laparoscopic operative techniques.</p>

Introdução: A sarcopenia é caracterizada pela redução da força e massa muscular (MM), e acompanhada pelo declínio da capacidade funcional, em idosos, e sua associação com dependência para realização das atividades básicas da vida diária (ABVD) tem sido relatada na literatura internacional, entretanto, há escassez de informações sobre o tema no Brasil. Objetivo: Estimar a associação entre sarcopenia e dependência para a realização das ABVD, em idosos domiciliados no município de São Paulo, segundo sexo. Casuística e métodos: Foram analisados idosos ( 60 anos), de ambos os sexos, do Estudo SABE, longitudinal, epidemiológico e de base domiciliar, realizado no município de São Paulo, em 2000 e 2006, e que, em 2000, não apresentaram dependência. A variável sarcopenia foi definida por meio de três componentes: desempenho no teste de sentar e levantar de uma cadeira (SeL), categorizado em baixo (tempo percentil 75, segundo sexo), e normal (< percentil 75); pela força de preensão manual (FPM), categorizada em baixa (força percentil 25, segundo índice de massa corporal e sexo) e normal (> percentil 25); e massa muscular (MM), categorizada em baixa ( percentil 20, segundo sexo) e normal (> percentil 20), sendo diagnosticados sarcopênicos, idosos que apresentaram, simultaneamente, baixo desempenho e baixa MM, ou, então, desempenho normal, mas, baixas FPM e MM. A dependência para a realização das ABVD foi referidas pelos idosos, em 2006, sendo considerando dependentes, aqueles que responderam positivamente, para, pelo menos uma questão referente à dependência. As variáveis de controle foram sexo, grupos etários (60-74 e 75 anos), etnia (caucasianos, asiáticos, outros), número de doenças referidas (1 ou > 1). Resultados: Dos idosos sobreviventes, 799 apresentaram todos os dados necessários ao estudo (60,3 por cento mulheres, 85,6 por cento < 75 anos). Foram identificados como sarcopênicos, em 2000, 8,9 por cento dos idosos (homens = 8,3 por cento ; mulheres = 9,3 por cento ), e dependentes para a realização das ABVD, em 2006, 7 por cento (homens = 6,5 por cento ; mulheres = 7,3 por cento ). Idosos sarcopênicos apresentaram chance 3,13 vezes maior, para dependência (IC 95 por cento 1,67-5,87), em 2006, ajustado pelas demais variáveis, em relação aos não sarcopênicos. Quanto ao sexo, os homens sarcopênicos apresentaram chance 4,12 vezes maior (IC 95 por cento 1,28-13,30), para dependência, em 2006, enquanto as mulheres sarcopênicas apresentaram chance 2,77 vezes maior (IC 95 por cento 1,23-6,24). Conclusão: Aproximadamente 9 por cento dos idosos do município de São Paulo foram identificados como sarcopênicos, em 2000. Idosos sarcopênicos apresentaram chance maior de dependência para a realização das ABVD, em 2006, em particular, os homens / Introduction: Sarcopenia is characterized by reduced muscle mass (MM) and strength, and it is accompanied by a decline in functional capacity in elderly. Its association with dependence to perform activities of daily living (ADL) has been reported in international literature, however,there is limited information about the theme, in Brazil. Purpose: To estimate the association between sarcopenia and dependence to perform ADL, in elderly domiciled in the city of São Paulo, according to gender. Methodology: Elderly ( 60 anos) of both genders, who were not dependent in 2000, from the SABE Survey, a home-based, longitudinal and epidemiologic study, performed in the city of São Paulo, in 2000 and 2006, were analyzed. Sarcopenia was defined by three components: performance in the sit and rise from a chair test (S&R), categorized as low (time 75th percentile according to sex) and normal (<75th percentile); by handgrip strength (HS), categorized as low (strength 25 percentile, according to body mass index and gender) and normal (> 25th percentile); and muscle mass (MM), categorized as low ( 20th percentile, by sex) and normal (> 20th percentile); where diagnosed sarcopenic elderly who had both poor performance and low MM , or normal performance, but low HS and MM. Dependence to perform ADL, referred by the elderly, in 2006, being considered dependents those who answered, positively, for at least, one question related to dependence. Control variables were: sex, age groups (60-74 e 75 anos), ethnicity (caucasian, asian, others), number of referred diseases (1 ou > 1). Results: Of the survivors, 799 presented all data for the study (60.3 per cent women, 85.6 per cent < 75 years old). It was identified as sarcopenic, in 2000, 8.9 per cent of the elderly (men = 8.3 per cent ; women = 9.3 per cent ), and dependents to perform ADL, in 2006, 7 per cent (men = 6.5 per cent ; women = 7.3 per cent ). Those diagnosed with sarcopenia, in 2000, presented an odds ratio 3.13 times higher, for dependence (CI 95 per cent 1.67-5.87), in 2006, adjusted for other variables. According to gender, sarcopenic men presented an odds ratio 4.12 times higher (CI 95 per cent 1.28-13.30), for dependence, in 2006, while sarcopenic women present odds ratio 2.77 times higher (CI 95 per cent 1.23-6.24). Conclusion: Approximately 9 per cent of the elderly in São Paulo were identified as sarcopenic, in 2000. Sarcopenic elderly presented higher chance of dependency to perform ADL in 2006, particularly men

Made available in DSpace on 2016-01-26T12:51:16Z (GMT). No. of bitstreams: 1 marielza_dissert_parte 1.pdf: 600568 bytes, checksum: 0107e3e73118e6ec5de58894e7163c10 (MD5) Previous issue date: 2004-04-27 / Technological improvements in dialysis have contributed for the increased survival of chronic renal patients, however, undergoing dialysis treatment for an indeterminate time might interfere in the quality of life of these patients. This study was aimed at evaluating the quality of life of chronic renal patients undergoing hemodialysis and identifying the activities that might have a negative impact on their quality of life. This is a descriptive and exploratory study, including 125 chronic renal patients undergoing hemodialysis (74 men and 51 women), mean age 53.1±14.6 years, mean time on hemodialysis 28.5±23 months. The generic SF-36 quality of life questionnaire and a semi-structured interview were used as data collection instruments. Data was subject to a descriptive statistical analysis, the chi-squared test, Pearson s correlation coefficient and the proportion comparison test, with a significance level of 5%. The results showed impaired quality of life of the patients, with lower scores for physical aspects dimensions (32.3±11.3), emotional aspects (46.1±16.3) and vitality (48.7±7.3). Quality of life variables regarding genders did not have a significant difference. There was a negative correlation between time on hemodialysis and physical component (r=-0.75, p<0.001), indicating that the longer the time on hemodialysis the lower are the scores found for this component and there was no significant correlation between time on hemodialysis and mental component (r=-0.29). Physical and recreational activities were the most affected in the global sample and in the sample stratified by gender. There was a negative correlation between time on hemodialysis and daily activities: work (p=0.0014), domestic activities (p=0.0014) and practical activities (0.0459). Data have shown impairment in several of the analyzed quality of life aspects in chronic renal patients undergoing hemodialysis and have pointed out that daily physical and recreational activities were the most affected ones. Our results have allowed the conclusion that there were no evidences of statistically significant differences in quality of life compared to gender; time on hemodialysis correlated with quality of life and daily activities had a negative correlation with physical component and work, domestic and practical activities. These results are important predictive factors to improve quality of life parameters in these patients. / Os avanços tecnológicos na área de diálise contribuíram para o aumento da sobrevida dos renais crônicos, entretanto, a permanência por tempo indeterminado em tratamento dialítico pode interferir na qualidade de vida destes pacientes. Este estudo teve como objetivo avaliar a qualidade de vida de pacientes renais crônicos em tratamento de hemodiálise e identificar as atividades cotidianas, que podem comprometer na qualidade de vida. Trata-se de estudo descritivo e exploratório, onde foram pesquisados 125 pacientes renais crônicos em tratamento de hemodiálise (74 homens e 51 mulheres), com média de idade 53,114,6 anos, tempo médio de hemodiálise de 28,523 meses. Utilizou como instrumentos de coleta de dados o questionário genérico de qualidade de vida SF-36 e a entrevista semi-estruturada. Os dados foram submetidos a análise estatística descritiva, o teste qui-quadrado, o coeficiente de correlação de Pearson e o teste de comparação de proporções, efetuados ao nível de 5% de significância. Os resultados constataram prejuízo na qualidade de vida dos pacientes, demostrando menores escores nos domínios dos aspectos fisicos (32 3+11 3), aspectos emocionais (46,11 6,3) e vitalidade (48,77,3). As variáveis de qualidade de vida em relação ao sexo não apresentou diferença significante. Verificou-se correlação negativa entre tempo de hemodiálise e componente físico (r = -0,75, p< 0,001), indicando que quanto maior o tempo de hemodiálise mais baixos são os valores encontrados deste componente e não houve correlação sígnificante entre tempo de hemodiálise e componente mental (r = -0,29). As atividades corporais e recreativas foram as mais comprometidas tanto na amostra global quanto na estratificada por sexo. Observou-se correlação negativa entre tempo de hemodiálise e as atividades cotidianas: trabalho (p=0,001 4), atividades domésticas (p= 0,0014) e atividades práticas (0,0459). Nota de Resumo Os dados evidenciaram o comprometimento em vários domíníos analisados da qualidade de vida dos renais crônicos em hemodiálise e identificaram que as atividades cotidianas corporais e recreativas foram as mais afetadas. Os resultados permitiram concluir: que não houve evidências de diferença estatisticamente significantes da qualidade de vida em relação ao sexo; houve diferença estatisticamente significante quanto as atividades cotidianas; o tempo de hemodiálise correlacionado com a qualidade de vida e atividades cotidianas apresentou correlação negativa no componente físico e nas atividades do trabalho, domestica e prática respectivamente Estes valores são importantes fatores preditivos para a melhora dos parâmetros de qualidade de vida destes pacientes.