Esse estudo elegeu como objeto de investigação a reabilitação psicossocial das pessoas com transtorno mental no contexto da reforma psiquiátrica brasileira. Para aproximação dessa realidade, analisamos as representações dos familiares produzidas a partir da experiência cotidiana nos serviços substitutivos de saúde mental e no domicilio junto ao parente com transtorno mental, explicitando os conflitos e contradições existentes e suas implicações na prática de cuidado da saúde e reabilitação psicossocial. Os sujeitos foram os familiares cuidadores de pessoas com transtorno mental severo e persistente, partícipes do grupo terapêutico de família dos Centros de Reabilitação Psicossocial (CAPS), na cidade de São Paulo (SP) - Brasil. Os achados foram coletados mediante entrevista semi-estruturada, observação e diário de campo e submetidos à Análise do Discurso com esteio no materialismo histórico-dialético mediante a qual foram extraídas as categorias temáticas. Constatamos que as concepções dos familiares acerca do transtorno mental, ainda, fortemente associadas aos signos estigmatizantes, determinam o modo como as famílias organizam o seu cotidiano, influenciando as atividades as relações interpessoais no âmbito familiar e social, os sentimentos, atitudes com relação ao sujeito acometido pelo transtorno, expectativas e perspectivas futuras no que refere à melhoria na qualidade de vida e inclusão social do sujeito acometido pelo transtorno mental e sua família. A maior parte dessas concepções é carregada de adjetivações negativas e adquirem conotação positiva, apenas, quando está presente a possibilidade de ganho secundário e a cura do transtorno mental é representada pela expectativa de retorno a normalidade e adaptação social / The focus of this study is the psychosocial rehabilitation of persons with mental disorders in the context of the Brazilian psychiatric reform. In order to gain insight into this reality, the study sought to perceive the familys representations which were produced from their daily experiences, dealing with substitutive services in mental health, and from the family member with the mental disorder, in the home, making explicit the existing conflicts and contradictions along with their implications in the practical care of psychosocial rehabilitation and health. The subjects were the care givers, being relatives, of those with severe, persistent mental disorder, who participated in the family therapeutic group of the Centers of Psycho-social Rehabilitation (CPR), in the city of Sao Paulo, SP, Brazil. The findings were collected through semi-structured interviews and diary field observation. The findings underwent discourse analysis with support in historical-dialectic materialism through which the thematic categories were extracted. We found that the families conceptions concerning mental disorder, still strongly associated with stigmatic signs, determined the manner in which they organized their daily life. These conceptions influenced the activities, the interpersonal relationships in the social, family context. They influenced the feelings and attitudes regarding the subject who carries the illness, as well as future expectations and perspectives regarding the improvement of the quality of life and the social inclusion of the individual suffering from the mental disorder, as well as of the family. The majority of these conceptions are latent with negative adjectives and acquire positive connotations only when there is a possibility of some secondary gain and when the cure of the mental disorder is represented by the return to normality and social adaptation

Introdução: As doenças articulares, frequentes entre idosos, estão relacionadas ao comprometimento funcional. Objetivo: Avaliar o impacto da doença articular referida no comprometimento funcional em idosos residentes na área urbana do município de São Paulo no período entre 2000 e 2006. Métodos: Este trabalho é parte do Estudo Saúde, Bem-Estar Envelhecimento (SABE). Foram estudados 336 idosos residentes na zona urbana do município de São de Paulo, entrevistados em 2000 e em 2006, representando 162.913 idosos do município. A variável dependente do estudo foi o desenvolvimento de comprometimento funcional e a variável independente foi a doença articular referida entre 2000 e 2006, adicionalmente com as covariáveis sociodemográficas e de saúde. A relação entre as variáveis foi analisada pelo teste de Rao Scot, seguida pelo modelo de regressão logística multinomial e os cálculos do risco atribuível. Considerou-se nível de significância de 5 por cento e intervalos de confiança de 95 por cento . Resultados: No período de 6 anos, observou-se uma incidência de 47,8 por cento de dificuldade de mobilidade e 7,3 por cento de desempenhar atividades de vida diária (AVDs). A doença articular não foi associada ao comprometimento funcional. O sexo feminino foi associado à dificuldade de mobilidade e a idade avançada (70 anos ou mais) e a baixa escolaridade (até 3 anos de estudo) foram associados à dificuldade de desempenho das AVDs. Na população, 9,2 por cento do comprometimento funcional foi atribuído à doença articular. Ainda, entre os idosos que relataram a doença articular, 30,1 por cento do comprometimento funcional foi atribuído a ela. Conclusões: Apesar do impacto da doença articular no comprometimento funcional da população ser representativo, a doença articular não foi associada à incidência de comprometimento funcional nesse estudo / Introduction: The joint disease, common among the elderly, are related to functional impairment. Objective: To evaluate the impact of referred joint disease to functional impairment among elderly living in the urban area of São Paulo between 2000 and 2006. Methods: This study is part of Health Well Being Aging Study (SABE study). We studied 336 elderly residents in the urban area of São Paulo, who were interviewed in 2000 and 2006, representing 162,913 seniors. The dependent variable was functional impairment and the independent variable was joint disease development between 2000 and 2006, in addition to the sociodemographic and health covariates. The association between variables was analyzed using Rao Scot test, followed by multinomial logistic regression model and attributable risk calculations. It was considered a significance level of 5 per cent and confidence interval of 95 per cent . Results: During the 6-year-period, the incidence of mobility impairment was 47.8 per cent and incidence of activities of daily living (ADLs) disability was 7.3 per cent . The joint disease was not associated with functional impairment. Being female was associated with difficulty in mobility difficulties and advanced age (up to 70 years old) and lower education (up to 3 years) were associated with difficulty in performing ADLs. Among population, 9.2 per cent of functional impairment was attributed to joint disease. Still, among the elderly who reported joint disease, 30.1 per cent of functional impairment was attributed to it. Conclusions: despite the expressive impact of joint disease on functional impairment, it was not associated with incidence of disability in this study.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Spinal cord injury can convey constraints to individuals, but a rehabilitation program which evalueates the functional gain allows outpatient care during the rehabilitation process. The aim of the present research was to evaluate results obtained trough the administration of Functional Independence Measure (FIM scale) in paraplegic petients within rehabilitation programs, by connecting such results with the variables: age, gender, time, level and etiology of the lesion, classification of lesion according to the ASIA (American Spinal Injury Association) criterion, time of hosptalization, educational status and complications (pressure sores, heterotopic ossofication, spasticity and neuropathic pain). For such, a transversal quantitative retrospective descriptive study was proceeded by analyzing medical records and the scoresobtained with FIM scale. The investigations were done using spedific tests, through the SPOSS software (statistical Package for the Social Science), version 13 for Windws. Results demonstrated that among the variables there studied variables there is a direct correlation between age, time of lesion, motor level, time of hospitalization and hospitalization wich a companion and the independence gain (P< 0.05). Besides there is an inverse relation between the lession classification (AIS A, B, C, D, or E) and the functional gain (P< 0.05). Functional evaluation of people with spinal cord injury though MIF scale allows to fallow up functional gain in people within a rehabilitation program. / A lesÃo medular pode trazer limitaÃÃes ao indivÃduo, mas um programa de reabilitaÃÃo que avalie o ganho funcional permite o acompanhamento, ao longo do decurso de reabilitaÃÃo. O objetivo desta pesquisa foi avaliar os resultados obtidos com a aplicaÃÃo da Medida de IndependÃncia Funcional (MIF) em pessoas portadoras de paraplegia em programa de reabilitaÃÃo; associando tais achados com as variÃveis: idade, sexo, tempo, nÃvel e etiologia da lesÃo, classificaÃÃo da lesÃo segundo o critÃrio da ASIA (American Spinal Injury Association), tempo de hospitalizaÃÃo, escolaridade e complicaÃÃes (Ãlcera de pressÃo, ossificaÃÃo heterotÃpica, espasticidade e dor neuropÃtica). Para isso foi realizado um estudo quantitativo transversal, de natureza retrospectiva, de carÃter descritivo, com anÃlise de 228 prontuÃrios e da pontuaÃÃo obtida mediante a Escala MIF. As anÃlises foram feitas sob testes especÃficos com auxÃlio do software SPSS (Statistical Package for the Social Science), versÃo 13 para Windows. Os resultados mostraram que, dentre as variÃveis estudadas, hà uma relaÃÃo direta entre a idade, o tempo de lesÃo, nÃvel motor, tempo de internaÃÃo e a internaÃÃo com acompanhante e o ganho de independÃncia (p< 0,05). TambÃm hà uma relaÃÃo inversa entre a classificaÃÃo da lesÃo (AIS A, B, C, D ou E) e o ganho funcional (p< 0,05). A avaliaÃÃo funcional em pessoas portadoras de lesÃo medular, por meio da Escala de Medida de IndependÃncia Funcional, permite o acompanhamento do ganho funcional em pessoas submetidas a um programa de reabilitaÃÃo.

Orientador: Maria Ines Rubo de Souza Nobre / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T06:28:15Z (GMT). No. of bitstreams: 1 Zimmermann_AnaBeatriz_M.pdf: 1435162 bytes, checksum: b4c9ce47e60113462690e7d8723f2d96 (MD5) Previous issue date: 2012 / Resumo: A Medida Canadense de Desempenho Ocupacional (COPM) foi criada para favorecer uma prática centrada no cliente, tendo como foco a autopercepção da pessoa sobre seu desempenho ocupacional. Avaliações padronizadas são cada vez mais utilizadas no âmbito da reabilitação, no entanto, a maioria dos instrumentos buscam favorecer a independência em atividades pré-estabelecidas, baseadas no que é esperado pela sociedade, podendo não contemplar necessidades individuais dos clientes. Atividades e Participação são aspectos centrais da Terapia Ocupacional e os terapeutas ocupacionais reconhecem que o envolvimento e o desempenho ocupacional contribuem e apoiam à saúde. O modelo proposto na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), em 2001, reconhece a influência das atividades e participação, assim como dos fatores contextuais e funções e estruturas do corpo na condição de saúde. Tem-se por objetivo verificar a autopercepção do desempenho ocupacional por meio da COPM em usuários adultos e idosos de um centro de reabilitação no estado do Paraná e classificar os problemas de desempenho ocupacional segundo a CIF. Realizou-se um estudo descritivo com usuários acometidos por lesão medular ou lesão encefálica adquirida em processo de reabilitação entre o período de agosto/2010 a fevereiro /2011. A COPM foi aplicada por meio de entrevista semiestruturada e os problemas de desempenho ocupacional identificados pelos 28 usuários foram classificados segundo a CIF. Entre os 122 problemas classificados, houve maior frequência nos seguintes domínios do componente Atividade e Participação: Mobilidade (36%), Vida Comunitária Social e Cívico (24%) e Cuidado Pessoal (15%). Sugere-se que dificuldades relacionadas a Vida Comunitária, Social e Cívica são mais frequentes dependendo do tempo de lesão e do contexto de tratamento. Percebe-se a abrangência e variedade de problemas identificados por meio da COPM pode colaborar no processo de reabilitação com o estabelecimento de objetivos mais congruentes às demandas e experiências de vida diária dos clientes. Tem-se o desafio de se construir e conduzir práticas de saúde na área de reabilitação à pessoa com deficiência em conjunto com outros setores, ampliando nosso olhar de forma a contemplar as várias dimensões da funcionalidade humana. A classificação dos problemas de desempenho ocupacional de acordo com a CIF pode favorecer a comparação entre estudos que utilizam diferentes instrumentos de avaliação e que por vezes possuem terminologias distintas. Por outro lado, há desafios no processo de codificação no tocante a utilização de categorias abrangentes e inespecíficas para atividades e situações não tão comuns, pois permite interpretações variadas entre os usuários da CIF / Abstract: In the context of rehabilitation, standardized assessments are being more utilized in order to evaluate the impact of the impairment on the individual's daily routine. Most of the assessment instruments focus on favoring the independence on predefined activities, based on what is expected by society, and may not be meeting the client's individual needs. The COPM was created to facilitate a client-centered practice, allowing the client to identify his/her own limitations and restrictions lived on the occupational performance. The model proposed on CIF (International Classification of Functionality, Impairment and Health) in 2001 states that environmental and personal factors, activities and participation, body functions and structures, and health conditions are in dynamic interaction, so that any modifications in one of these components have the potential of generating changes on the others. Activity and participation are core aspects of occupational therapy. Occupational therapists recognize that the involvement and occupational performance contributes and promotes health. One of the goals is to verify self-perception of the occupational performance through COPM on adults and elderly from a rehabilitation center in the state of Paraná and classify the problems of occupational performance in CIF. A descriptive study was performed on users stricken by spinal cord injury or brain injury, obtained during the rehabilitation process between August of 2010 and February of 2011. COPM was applied through semi-structured interviews and the problems of occupational performance identified by 28 participants were classified in CIF. Among the 122 problems of occupational performance classified in CIF, there was a greater frequency on the following domains of the Activity and Participation component: Mobility (36%), Community, Social and Civic Life (24%) and Personal Care (15%). It is suggested that the difficulties related to Community, Social and Civic Life are more frequent depending on the time of injury and on the treatment context. It is noticed that the scope and variety of problems identified through COPM can collaborate in the process of rehabilitation, with the setting of objectives that are more congruent with the demands and experiences of the clients' daily lives. There is a challenge of building and conducting health practices on the area of rehabilitation to the person with disability along with other sectors, expanding our view in order to contemplate the various dimensions of human functionality. The classification of occupational performance problems in CIF can favor the comparison between studies that utilize different evaluation instruments and that sometimes have distinct terminologies. On the other hand, there are challenges related to the selection of codes: comprehensive and non-specific items can facilitate the classification of uncommon and unlikely elements, but at the same time can generate semantic accumulations and increase disagreements on the choice made by the evaluators / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

Orientador: Maria Elena Guariento / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T20:48:43Z (GMT). No. of bitstreams: 1 Paula_AnaFlaviaMarostegande_M.pdf: 1301949 bytes, checksum: 84e772d639f871486a296f94c5c798e7 (MD5) Previous issue date: 2012 / Resumo: O envelhecimento da população brasileira tem ocorrido com grande velocidade. Paralelamente a esse fenômeno observa-se aumento das doenças crônicas que, frequentemente, associam-se a déficits cognitivos, comprometimento do estado de humor e incapacidade funcional. Desta forma, para uma assistência efetivamente integral e integrada desse segmento etário, faz-se necessário detectar essas disfunções nas esferas física, psíquica e cognitiva. Neste sentido, o trabalho em questão tem como objetivo estudar o perfil funcional e cognitivo, bem como o status de humor de idosos atendidos em um Ambulatório de Geriatria, de um hospital universitário que é referência para os serviços de Atenção Primária da Região Metropolitana de Campinas (SP). Os dados foram coletados a partir da Avaliação Geriátrica de 120 prontuários de idosos, considerando as Escalas Adaptadas de Kats, e de Lawton, que permitiu avaliar respectivamente o desempenho nas Atividades de Vida Diária (AVD) e nas Atividades Instrumentais de Vida Diária (AIVD). O desempenho cognitivo, por sua vez, foi avaliado através do Mini-Exame do Estado Mental e a triagem de sintomas depressivos foi feita através da Escala de Depressão Geriátrica. No que se refere à auto-avaliação de memória, esta foi pesquisada através de três perguntas referentes ao estado de memória no ultimo ano e á dificuldade em lembrar fatos antigos e recentes. A maioria relatou ser independente e apresentou idade maior ou igual a 80 anos, (66%) era do gênero feminino e (43%) com escolaridade de 1 a 4 anos. O déficit cognitivo esteve presente em 29% dos idosos e 32% apresentou sintomas depressivos. 41,25% das mulheres apresentaram dependência parcial para as tarefas domésticas; 61,25% dos homens relataram independência para as AIVD. 100% dos idosos com idade entre 71 a 74 anos não referiu dificuldade para lembrar fatos antigos e os idosos com idade maior que 75 anos foram os mais dependentes. Os com escolaridade entre 1 a 4 anos apresentaram pior auto-avaliação de memória. 85,72% dos idosos com déficit cognitivo relataram pouca dependência para AIVD. 57,8% dos idosos com sintomas depressivos apresentaram-se dependentes para AVD e 34,21% desses referiram dificuldades para lembrar fatos antigos. 94,12% dos idosos que consideraram sua memória ruim ou muito ruim referiram dificuldade para lembrar fatos recentes e 32,35% para lembrar fatos antigos. Os resultados destacam a necessidade da avaliação do déficit cognitivo e de comprometimento do estado de humor em idosos assistidos em ambulatório, a fim de prevenir perdas secundárias à incapacidade funcional e garantir melhores condições de qualidade de vida para os mesmos / Abstract: The aging of the population has occurred with great speed. Alongside this phenomenon is observed increase of chronic diseases that often are associated with cognitive deficits, impaired mood and functional disability. Thus, for a comprehensive and integrated care effectively this age group, it is necessary to detect these dysfunctions in the physical, mental and cognitive. In this sense, the work in question is to study the functional and cognitive and mood status of elderly patients in a Geriatric Outpatient Clinic, a teaching hospital that is a reference to the services of Primary Metropolitan Region of Campinas (SP). Data were collected from the medical records of 120 Geriatric Assessment of older people, considering the Scales Adapted Kats, and Lawton, allowing respectively evaluate the performance in Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL). The cognitive performance, in turn, was assessed with the Mini-Mental State Examination depressive symptoms and screening will be done by the Geriatric Depression Scale. With regard to self-assessment of memory, this was investigated through three questions concerning the state of memory in the last year and will trouble remembering facts old and new. Most reported being independent, showed age greater than or equal to 80 years (40%), was the was female (66%), schooling 1-4 years (43%). Cognitive impairment was present in 29% of seniors and 32% had depressive symptoms. 41.25% of women showed partial dependence for household chores; 61.25% of men reported independence for the AIVD. 100% of the elderly aged between 71 and 74 years reported no trouble remembering facts old and the elderly aged over 75 years were the most dependent. The school with between 1 and 4 years had a poorer self-rated memory. 85.72% of the elderly with cognitive impairment reported little dependence for IADL. 57.8% of older people with depressive symptoms presented themselves dependent for ADL and 34.21% reported difficulty remembering these old facts. 94.12% of the elderly who considered his memory bad or very bad reported difficulty remembering recent events and 32.35% for recall old facts. The results emphasize the need for evaluation of cognitive impairment and mood in the elderly assisted outpatient order to prevent loss secondary to functional disability and guarantee better quality of life for them / Mestrado / Gerontologia / Mestre em Gerontologia

Individuals with Traumatic Brain Injury (TBI) often need to be taught independent living skills in order to reintegrate into community settings. This study examined the use of video modeling to teach culinary skills to three individuals with TBI. Video modeling is easily accessible, inexpensive, and not reliant on an additional person to directly teach skills. For all three participants, video modeling resulted in increases in cooking skills using a task analysis created for each food item prepared. For one participant, the skills maintained over two weeks and generalized to a novel food. For another participant video modeling was insufficient in reaching high skills levels therefore a second phase utilizing reinforcement and corrective feedback was implemented. This phase demonstrated with the additional component including reinforcement and corrective feedback, the third participant reached high skill levels.

Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG = 105, IG = 105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P, 0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

The study investigated an organized semantic fluency task, (the Controlled Animal Fluency Task - CAFT) as a measure of executive functioning (EF) in adults, and the relationship with instrumental activities of daily living (IADL). Participants (N = 266) consisted of a clinical sample (n = 142) utilizing neuropsychological assessment data collected at an outpatient psychological center, and a community sample (n = 124). The clinical sample was a heterogeneous mixed neurological group including a variety of health conditions and comorbid anxiety and depression. The CAFT Animals by Size demonstrated a significant positive correlation with Category Fluency (r = .71, n = 142, p < .001) , Animal Fluency (r = .70, n = 142, p < .001), and with other, established neuropsychological measures. The CAFT Animals by Size condition demonstrated a significant moderate negative correlation with IADL for the sample as a whole (r = -.46, n = 248, p < .001), and for the clinical sample (r = -.38, n = 129, p < .001), but not for the community sample. In a hierarchical regression analysis, CAFT Animal by Size explained additional variance in IADL (&#916;R2 = .15). In a hierarchical regression analysis predicting IADL with the control variables entered first, followed by Category Fluency, with CAFT Animal by Size entered last, CAFT Animals by Size did not make a significant additional contribution. A stepwise forward regression indicated Category Fluency, education, and Category Switching are better predictors of IADL than CAFT Animals by Size. Normative data for the CAFT were calculated separately for age groups and education levels. Simple logistic regression indicated CAFT Animal by Size was a significant predictor of clinical or community group membership. A second logistic regression analysis indicated the CAFT Animal by Size condition improved the prediction of membership in the clinical versus the community group, compared to the MMSE alone. Applications of the CAFT are discussed.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-05-24T19:40:59Z No. of bitstreams: 1 Carina Silveira Mariano Nunes.pdf: 797183 bytes, checksum: 9e449a0364075a44c5f95faf739146f3 (MD5) / Made available in DSpace on 2016-05-24T19:40:59Z (GMT). No. of bitstreams: 1 Carina Silveira Mariano Nunes.pdf: 797183 bytes, checksum: 9e449a0364075a44c5f95faf739146f3 (MD5) Previous issue date: 2014-12-15 / Introduction: Physiological responses during activities of daily living (ADLs) have never been studied in adult patients with bronchiectasis (BCT). Aim: To compare the metabolic and ventilatory demands, gas exchange and perception of effort during five ADLs between adults with BCT and healthy subjects. Methods: Thirty-nine subjects [27 women; FEV1 61 ± 26, %pred, MRC 3 (2 – 3)] and twenty healthy subjects (14 women) performed the following five ADL: (1) putting on socks, shoes, and vest, (2) putting away different weights on a rack, (3) sweeping a floor, (4) carrying weight while walking (5Kg), and (5) climbing stairs during a minute. Activities 2, 3, and 4 were performed by five minutes. Pulmonary gas exchange was measured during all ADLs. Results: Patients used a higher proportion of metabolic and ventilatory demands, and had a higher perception of effort when compared with healthy subjects. The distance walked in ADL4 was similar between groups; however patients climbed lower number of steps than control group. Conclusions: Patients with BCT have high metabolic and ventilatory demands, with a higher perception of effort to perform simple daily activities when compared to healthy subjects. / Introdução: As respostas fisiológicas durante atividades de vida diária (AVD) nunca foram estudadas em pacientes adultos com bronquiectasia (BCQ). Objetivo: Comparar as respostas cardiopulmonares, metabólicas, de trocas gasosas e de percepção de esforço durante atividades de vida diária entre pacientes com bronquiectasia e indivíduos saudáveis. Método: 39 pacientes [27 mulheres; VEF1 61 ± 26 %prev; MRC 3 (2 – 3)] e 20 indivíduos saudáveis (14 mulheres) realizaram as seguintes AVD: (1) vestir um par de meias e um par de sapatos sentado em uma cadeira e vestir uma camisa em pé; (2) colocar pesos de 0,5 Kg, 1 Kg, 2 Kg, 3 Kg, 4 Kg e 5 Kg em uma prateleira ao nível da cabeça e depois retornar os mesmos ao nível da cintura; (3) varrer o chão; (4) caminhar carregando 5Kg divididos em duas sacolas; e (5) subir escadas durante um minuto. As atividades 2, 3 e 4 foram realizadas durante cinco minutos. As variáveis metabólicas e ventilatórias foram registradas durante todas as AVD. Resultados: Os pacientes com BCQ tiveram maior demanda metabólica e ventilatória e maior percepção de esforço durante todas AVD quando comparados ao grupo controle (p < 0,05). A distância percorrida na AVD4 não diferiu entre os grupos, mas os pacientes realizaram menor número de degraus na AVD5 em relação ao grupo controle. Análise intra-grupo (BCQ) demonstrou aumento progressivo (p < 0,05) no VO2, VE/VVM e percepção do esforço da AVD1 até a AVD5. Conclusão: Pacientes com BCQ utilizam elevada proporção da capacidade aeróbia e ventilatória máxima para realizarem atividades simples do dia a dia e com maior percepção de esforço (dispneia e fadiga) quando comparados a indivíduos saudáveis.

Objective: The transition to long-term care (LTC) of older adults receiving home care services is preceded by declining functional independence with basic and instrumental activities of daily living (ADL and IADL, respectively). These individual, and group, level time-dependent changes occur within unique provincial and regional policy contexts across Canada, which determine the amount and types of services received by home care recipients during this transition period. It is currently unknown whether activities of daily living (ADL) or IADL (instrumental activities of daily living) exhibit accelerated decline preceding transition to LTC, and if so, whether the onset and rate of decline differs for ADL versus IADL. This dissertation sets out to determine whether such change points exist within longitudinal data gathered from home care recipients in Ontario during the years of 2008 to 2015. Methods: A profile likelihood method was employed to identify the best fitting change points at which the slopes of functional decline in ADL and IADL for those who transition to LTC from home care services depart from the normative age slope of those who remain in community. Data analyzed was collected at approximately 6-month intervals using the International Residential Assessment Instrument – Home Care (RAI-HC) in Ontario, Canada, and was obtained from the Canadian Institutes for Health Information (CIHI) for the period of 2006-2015. A policy review was conducted to determine whether changes had occurred to the amount or type of home care services provided during the data collection period, and subsequently data from 2008 to 2015 were retained. IADL was measured using the 21-point IADL Involvement Scale and ADL was measured using the 28-point ADL Long Form. Best fitting change point models were first identified for ADL and IADL scores in the full sample of participants who remained in community and those who transitioned to LTC and within subgroups stratified by sex. Two additional subgroups were also examined: 1) participants without a primary or secondary caregiver living in the home, and 2) participants with a primary caregiver living in the home. Each caregiver group was also stratified by sex, resulting in a total of 9 groups in which IADL and ADL change points were estimated and compared. Results: In all groups who remained in community with home care services, age-related decline in IADL and ADL were observed. Further, IADL impairment was higher at the time of first assessment and had a greater age-related slope than ADL for those who remained in community. Both measures had discernable change points preceding discharge to LTC and the change point for IADL preceded that of ADL in all groups. Across groups, the change point for ADL had a range of 0.5 years before LTC discharge for men without a primary or secondary caregiver living in the home to 2 years for women with a primary caregiver in the home. IADL change points ranged from 2.5 years before LTC discharge for men with a primary caregiver in the home to 3.6 years for women without a primary or secondary caregiver in the home. Within the full sample, including both men and women, the onset of accelerated IADL decline for those discharged to LTC preceded the onset of home care service by 1.49 years and the time of first assessment by 1.84 years. Women in the full sample, and in both caregiver groups, experienced an earlier IADL change point relative to the availability of home care services and assessment when compared to men. Conclusions: Both IADL and ADL have discernible change points for in the years preceding discharge from home care to LTC. The change point for IADL consistently precedes that of ADL for the entire sample, for those with or without a caregiver in the home and for both men and women. The onset of accelerated IADL decline in the presence of age normative ADL decline may be an early indicator of pending transition from home care to LTC for home care recipients identified in this study. The province of Ontario has committed to providing the right care, at the right time in the right place. This study demonstrates that home care policy in Ontario during this study period, which does not provide for IADL services until after patients first qualify for ADL services, may not be achieving the provinces commitment of ensuring IADL care is provided at the right time for recipients of home care services. Opportunities for early identification and intervention may be available through early monitoring of, and intervention with, IADL function. A stepped care model holds promise for early identification and intervention of IADL impairment in community living older adults. Future research will help to confirm if accelerating decline in IADL function in the absence of appropriate rehabilitation and support services may hasten the onset of accelerated ADL impairment and subsequent admission to LTC. / Graduate / 2022-12-16