Introdução: A morte do cônjuge representa diversos desafios a serem enfrentados por mulheres, especialmente nos primeiros seis meses. O enfrentamento deste processo, comumente predispõe a declínios da saúde e impacta a vida cotidiana. Para sua compreensão, destaca-se o \"Modelo do Processo Dual do Luto\", o qual pressupõe que um dos fatores estressores que os viúvos precisam lidar são os orientados para a restauração. Estes incluem o engajamento em atividades cotidianas que não se relacionam diretamente à perda, sendo singular e dependente do significado atribuído pela pessoa a estas atividades. Objetivo: Conhecer os significados atribuídos às atividades cotidianas relacionadas ao enfrentamento orientado para a restauração de mulheres após a morte por câncer, em até seis meses, do cônjuge idoso. Metodologia: Trata-se de estudo qualitativo, do tipo exploratório e descritivo. Constitui-se como população alvo do estudo, viúvas: do sexo feminino; que mantinham relacionamento com o falecido por meio de casamento ou união estável; residentes no Estado de São Paulo; cujos cônjuges, falecidos de 2 a 6 meses em decorrência de câncer, tinham acima de 60 anos e foram atendidos pela equipe do Núcleo de Cuidados Paliativos do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de maio a outubro de 2015. As viúvas que aceitaram participar do estudo foram convidadas para uma entrevista individual, que ocorreu entre outubro e dezembro de 2015. Para sua condução, foi utilizado um roteiro semi-estruturado que buscava conhecer se os participantes realizavam ou pensavam em realizar atividades cotidianas relacionadas ao enfrentamento orientado para a restauração, e quais os significados que atribuíam a seu desempenho. O conteúdo das entrevistas foi gravado, transcrito e posteriormente analisado pelo processo de codificação, gerando temas abrangentes. Resultados: Identificou-se um primeiro tema nos resultados que se relacionou aos fatores que influenciavam no significado das atividades cotidianas relacionadas ao enfrentamento orientado para a restauração, os quais foram: a) sofrimento decorrente da percepção da ausência do marido no cotidiano; b) desempenho do papel de cuidadora; c) percepção negativa sobre a qualidade do relacionamento prévio com o cônjuge; d) participação nas circunstâncias que envolveram o óbito e nos processos decisórios de tratamento no período de adoecimento do cônjuge; e) apoio da rede informal e a presença de animais de estimação; f) espiritualidade. O segundo tema que emergiu dos resultados se referiu ao relato das entrevistadas sobre sua participação nas entrevistas conduzidas nesta tese. Discussão: O reconhecimento dos fatores que influenciavam no significado das atividades cotidianas favorece a reflexão sobre o apoio prestado às viúvas após a morte do cônjuge, especialmente ao se considerar que as mulheres se beneficiam mais de intervenções com ênfase no enfrentamento orientado para restauração. Entende-se que estudos que utilizam entrevistas como procedimento de coleta de dados podem beneficiar o enfrentamento do processo de luto dos participantes, pois potencialmente os auxiliam a elaborarem as experiências vivenciadas. Conclusão: Acredita-se que esta tese represente avanços na compreensão acerca do engajamento em atividades cotidianas no processo de luto, o que favorece a abordagem em Cuidados Paliativos prestada aos familiares após o óbito do paciente / Introduction: The death of the spouse represents several challenges to be faced by bereaved widows, mainly during the first six months. It commonly predisposes to health decline with impact in daily life. To understand the grieving process the \"Dual Process Model of Coping with Bereavement\" is highlighted. To this theoretical model, one of the types of stressor that the widows have to deal with is the restoration-oriented. It includes the involvement in daily activities that are not related to loss. This involvement is unique depending on the meaning given by the person to daily activities. Objective: To know the meaning attributed to daily activities focused on restoration by women after the death of their elderly spouse due to cancer, up to six months after death. Method: It is a qualitative exploratory and descriptive study. Its target population is constituted by widows: a) female; b) who had a relationship with the deceased exclusively through marriage or stable union; c) residing in São Paulo state; d) whose spouses have died within the past 2-6 months due to cancer and were over the age of 60; e) and whose spouses had been attended by the Palliative Care Service of The Hospital das Clínicas of the University of São Paulo Medical School during the period May- October 2015. The spouses that agree to participate in the study were invited to a private interview, which occurred from October to December 2015. To its conduction a semi-structured guideline was used which aimed to know if the participants took part or thought about taking part in restoration-oriented daily activities, and the meaning they attribute to them. The content of the interviews were recorded, transcribed and analyzed using the coding process. Comprehensive themes emerged from this process. Results: A first theme was identified on the results related to the influencing factors upon the meaning of daily activities focused on restoration which were: a) distress resulting from the perception of the husband\'s absence in daily life; b) caretaker role performance; c) negative perception about the quality of the previous relationship with the spouse; d) participation in the circumstances that involved the spouse\'s death and in the decisionmaking procedures of treatment during his illness; e) support from the informal network and the presence of pet animals; f) spirituality. The second theme that emerged from the results referred to the interviewees\' report about their participation in the interviews conducted in this thesis. Discussion: The recognition of the influencing factors upon the meaning attributed to daily activities gives opportunity for reflection on the support given to widows after their spouses\' death, especially taken into account that women benefit more from interventions focused on restoration. It is understood that studies using interviews as data collecting procedure can benefit the participants facing the bereavement, since it can potentially help them to elaborate their experiences. Conclusion: It is believed that this thesis represents advances in the understanding about the involvement in daily activities during bereavement, what helps the Palliative Care provided to the family after the patient death

Introdução: Na Doença de Alzheimer, o comprometimento no desempenho nas Atividades de Vida Diária (AVD) impacta diretamente a autonomia e independência do indivíduo. A capacidade funcional determina o nível de auxílio que uma pessoa irá necessitar no cotidiano para uma vida em segurança e com autonomia. Dentre os domínios cognitivos, a Função Executiva tem sido relatada como a mais associada com o desempenho de funcionalidade. Há a necessidade de instrumentos válidos para avaliar os déficits das funções executivas no desempenho de tarefas de mundo real em pacientes com doença de Alzheimer (DA) no Brasil. Objetivo: Validar a versão brasileira do teste Executive Performance Test (EFPT) em pacientes com doença de Alzheimer (DA). Métodos: Adaptação cultural do EFPT para o português do Brasil. Os estudos de confiabilidade e validade foram realizados com três grupos de idosos: controles, DA leve e DA moderada. Este estudo examinou a estabilidade do instrumento, a consistência interna (alfa de Cronbach), a validade de constructo e de critério e análises de precisão. Resultados: A amostra foi composta de 83 participantes com 60 anos ou mais, distribuídos em três grupos: controle, DA leve e DA moderada. A confiabilidade inter examinadores foi alta (ICC = 0,985), com alta consistência interna (Cronbach ? = 0,967). Houve forte correlação entre EFPT-Br Total e DAFS-BR (r = -0.762), correlação fraca a moderada com a bateria cognitiva e correlação moderada a forte com a bateria funcional. Foi realizado o cálculo da da ROC multiclasse área sob a curva de 0,8933, a pontuação sugerida para diferenciar os grupos : menor que 8 para controles; entre 9 e 27 para DA leve; e acima de 28 para DA moderada, para discriminar grupos. Conclusão: O EFPT-BR é um teste válido, com parâmetros psicométricos satisfatórios, para discriminar pacientes saudáveis, com DA leve e DA moderada na realização de tarefas instrumentais. O teste fornece informações consistentes para auxiliar a compreensão do desempenho de pacientes com DA na realização de atividades de vida diária com mais autonomia e segurança / Background: In Alzheimer\'s disease, the impairment in performing Activities of Daily Life (ADL) directly affects the autonomy and independence of the individual. The functionality determine a person needs for a safe and autonomous life. Among the cognitive domains, Executive Function has been reported as the most associated with functionality performance. There is a need for valid assessments to evaluate the deficits of executive functions in performing of real world tasks with patients with Alzheimer\'s disease (AD) in Brazil. Objective: To validate to Brazilian Portuguese version of the Executive Function Performance Test (EFPT) in Alzheimer disease (AD) patients. Methods: Cultural adaptation of EFPT to Brazilian Portuguese. The reliability and validity studies were performed with three groups of elderly: controls, mild AD and moderate AD. This study examines instrument stability, an internal consistency (Cronbach\'s alpha), a construct and criterion validity, and precision analyzes. Results: The sample consisted of 83 participants aged 60 years and over, divided into three groups: control, mild AD and moderate AD. The inter-examiner reliability was high (ICC = 0.985), with high internal consistency (Cronbach ? = 0.967). There was a strong correlation between EFPT-Br Total and DAFS-BR (r = -0.762), weak to moderate correlation with a cognitive battery and moderate to strong correlation with the functional battery. We performed the calculation of the ROC multiclass area under the curve of 0.8933, a score suggested to differentiate the groups: less than 8 for controls; between 9 and 27 for mild AD; and above 28 for moderate AD, to discriminate groups. Conclusion: EFPT-BR is a valid test with satisfactory psychometric parameters to discriminate healthy patients with mild AD and moderate AD in performing instrumental tasks. The test provides consistent information to assist in understanding the performance of AD patients in carrying out more autonomous and safe daily life activities

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

Aim: The aim of diploma thesis was clinical utility of the Czech version of Canadian Occupational Performance Measure (COPM) in both parts. Utility in performance of activities of daily living and utility in satisfaction with performance of activities of daily living for physically disabled adults persons. Methods: The pre-research consisted of 40 persons with physical disability after stroke. For data collection was used Canadian Occupational Performance Measure, Barthel index and Subjective QUAlity of Life Analysis (SQUALA). Hypotheses were vitrificated by correlation analysis using Spearman's Rank Correlation Coefficient. Results: P-value (p = 0,00001) from the test of dependence of measured values by COPM in performance of activities of daily living and BI was lower than level of significance α = 0,05; 0,00001 < 0,05. P-value from the test of dependence of measured values by COPM in satisfaction with performance of activities of daily living and SQUALA questionnaire was lower than level of significant α = 0,05; 0,041 < 0,05. Conclusion: The results of the statistical analysis did not confirm the independence of the measured values by the Czech version COPM, BI and the SQUALA questionnaire. It was supported the using COPM in both parts, in performance of activities of daily living and in satisfaction...

Contexte. La schizophrénie (SCZ) est associée à des troubles cognitifs qui entravent les capacités fonctionnelles des patients. En particulier, les déficits des fonctions exécutives handicapent la réalisation des Activités de la Vie Quotidienne (AVQ), et altèrent l’adhésion au traitement. Des Assistants Technologiques pour la Cognition (ATC), initialement conçus pour les maladies neurologiques, pourraient être utilisés comme outils de remediation cognitive pour compléter les traitements conventionnels dans la SCZ.Objectifs. Notre objectif clinique était d’améliorer l'autonomie et l'adhésion au traitement de patients SCZ grâce à deux ATC : Mobus et DoPill. Notre objectif technologique était de vérifier que ces ATC étaient adaptés aux besoins et aux capacités des patients SCZ.Méthodes. Des personnes ayant un diagnostic de SCZ selon les critères du DSM-IV ont testé Mobus au cours de trois études. Il s’agit d’un logiciel installé dans des smart phone qui offre un rappel des AVQ. De plus, l’utilsateur a la possibilité d’exprimer son vécu quotidien (symptômes, émotions...). Dans la troisième étude, un autre ATC a été testé : le DoPill. Ce pilulier intelligent avertit l’utilisateur lorsqu’il est temps de prendre son médicament. Des capteurs détectent la prise médicamenteuse. Les informations sur la réalisation des AVQ, le vécu des patients et l’adhésion au traitement, enregistrées de manière écologique par Mobus et DoPill, sont accessibles aux aidants à distance via Internet.Résultats. Nos trois études ont permis d’optimiser Mobus et DoPill. De plus, Mobus aurait amélioré certaines capacités de planification des utilisateurs, et DoPill aurait facilité l’adhésion au traitement. Cependant, ces résultats doivent être reproduits car leur significativité est faible.Conclusion. Le développement d’ATC ne peut se faire qu'en étroite collaboration entre le patient, son aidant et le programmeur, par étapes successives permettant d'améliorer le produit afin qu'il réponde au mieux aux besoins des utilisateurs. Cette collaboration est nécessaire sur le plan technique, mais aussi éthique. En effet, il ne s'agit pas d'isoler le patient dans un environnement technologique impersonnel, mais bien de l’accompagner quotidiennement dans sa réinsertion sociale. / Background. Cognitive impairments in schizophrenia (SCZ) lead to a negative functional outcome. Especially, executive deficits are associated with difficulties in achieving Activities of Daily Living (ADL) and treatment adherence. Assistive Technologies for Cognition (ATC), first concieved for neurological disease, could be used as tools of cognitive remediation in SCZ, to complete the action of antipsychotics.Objective. Our clinical aim was to enhance the autonomy and adherence of SCZ people with the use of two ATCs: Mobus and DoPill. Our technological aim was to investigate whether SCZ patients would be able to use such ATCs.Methods. Outpatients diagnosed with SCZ according to DSM-IV criteria tested Mobus in three studies. This application, implemented in smart phones, provides ADL recall. In addition, patients can report self-experiences anywhere at anytime. In the third study, another ATC, the DoPill, was tested. This smart pill dispenser alerts the patient when it’s time to take medication. Sensors detect when pills are taken out. Information about ADL’s execution, self-experiences and adherence, are ecologically registered by Mobus and DoPill and remotely available for caregivers via Internet.Results. Our three studies allowed to improve Mobus and DoPill in order to make them the most suitable to the needs of SCZ people. Furthermore, Mobus enhanced some planning skills of the participants, whose adherence as well progressed with the use of DoPill. Nevertheless, these findings have to be reproduced, as we found only weak significance. Conclusion. A close collaboration between the patient, the caregiver and the programmer is essential for developing ATC. This teamwork is necessary for technical issues, but also for ethical concerns. Indeed, ATC are not meant to isolate people by replacing the human element of relatives and caregivers by a machine. On the contrary, they offer a sense of security and are aimed at accompanying the patient in his/her social rehabilitation.

No description available.

The general aim of this thesis was to classify and describe long-term pain two years after a stroke and to describe the experiences of pain, and the consequences it has on the persons’ lives. The studies were conducted from a multidimensional perspective on pain, combining quantitative and qualitative methods. Three types of long-term pain were classified and described among the 43 participants included, aged 33-82 years. These were central post-stroke pain, nociceptive, mainly shoulder pain, and tension-type headache. Pain onset, within one to six months in most of the cases was after discharge from the hospital. Continuous pain or pain almost every day was reported by nearly two-thirds. The pain was mostly described as troublesome, annoying and tiring in all pain groups. The rating of pain intensity revealed individual differences among the participants within the pain groups. In addition to long-term pain, the participants suffered several impairments and nearly half of them were dependent on others, and two-thirds on assistive devices. Several coping strategies were described, most often problem-focused. Their health-related quality of life was decreased, mostly related to their long-term pain and physical impairments. Their experiences of caring revealed the need of improvements in knowledge about longterm pain, attention and understanding among the professionals, and continuity in the contacts. / On the day of the public defence the status of article III was: Accepted for publication and the status of article IV was: In press.

Background People with rheumatic or neurologic conditions are commonly referred for occupational therapy because of decreased ability to perform ADL tasks. Upon referral, occupational therapists use a client-centred, occupationfocused approach when evaluating a person's perceived and observed quality of ADL task performance to clarify the nature and extent of the person’s problems, plan interventions and determine effectiveness of interventions. Evaluation of the extent of problems and change following intervention require the use of linear measures of ADL. The aim of this doctoral thesis was to develop and validate linear measures of perceived and observed quality of ADL task performance for occupational therapy clinical praxis and research. Methods To develop linear measures of observed quality of ADL task performance based on Rasch measurement methods, clients with ABI (n=70) were evaluated using a 3-category rating scale and the ADL Taxonomy. Similarly, to develop linear measures of perceived quality of ADL task performance women with rheumatic diseases (n=118) reported their ability on a questionnaire and in an interview based on the ADL Taxonomy and a 4- category rating scale. To further validate the ADL ability measures of the Assessment of Motor and Process Skills (AMPS) data were collected in two samples. In a sample of women with chronic widespread pain (CWP) or fibromyalgia (FM) (n=50) the ADL ability measures were validated with regard to discrimination, stability and sensitivity to changes. Discrimination was examined by comparing AMPS data from women with CWP/FM to those of healthy women. Stability and sensitivity to change were examined based on repeated AMPS observations pre and post intervention. In addition, sensitivity to change was examined in a sample of clients with ABI (n=36) using a pre- and post-test design. Finally, the validity of the AMPS ADL ability measures in relation to perceived ADL ability was examined in women with rheumatic diseases (n=118) and women with CWP/FM (n=50). Results Based on the results of the four studies in this thesis, we were able to conclude that it was possible to obtain linear measures of observed quality of ADL task performance based on a revised version of the ADL Taxonomy (ADL-O). It was also possible to obtain linear measures of perceived quality of ADL task performance based on revised versions of the ADL Taxonomy using the formats of questionnaires (ADL-Q) and interviews (ADL-I). Moreover, it was possible to establish further evidence of validity of the ADL ability measures of the AMPS. Thus, the AMPS ADL ability measures could discriminate between women with CWP/FM and healthy women. The ADL ability measures of remained stable when no intervention was provided and the ADL motor ability measures were sensitive to change among women with CWP/FM. Moreover, the ADL ability measures were sensitive to change among clients with low ADL ability following ABI. Finally, only low to moderate correlations were found between measures of perceived and observed ADL ability. Conclusions Rasch analyses of revised versions of the ADL Taxonomy suggest that the majority of the ADL tasks and rating scales focused on quality of ADL task performance can be used to obtain linear measures of quality of ADL task performance based on methods of questionnaire, interview or observation. Furthermore, the studies provided evidence of validity of the ADL ability measures of the AMPS in relation to discrimination, stability and sensitivity to change and relation to perceived ADL ability. The results may, therefore, enhance the use of ADL instruments that provide linear measures of perceived and observed quality of ADL task performance in occupational therapy clinical praxis and research.

Background: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed. Methods: Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits. Results: Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication. Conclusion: Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.