Fundamento: O crescimento da população idosa é um fenômeno mundial. O envelhecimento aumenta o risco para a ocorrência de doenças crônicas que resultam em graus variáveis de perda da independência funcional. A elevação da idade também pode acarretar a redução da independência funcional, tornando os idosos dependentes para a realização de atividades da vida diária (AVDs) e atividades instrumentais da vida diária (AIVDs). Objetivos: O objetivo desse estudo foi avaliar a capacidade funcional, determinando a prevalência de independência funcional e as características associadas em indivíduos idosos, em uma amostra representativa de Porto Alegre, RS, bem como identificar sua associação com qualidade de vida. Essa pesquisa é um dos braços do estudo da Síndrome de Obesidade e Fatores de Risco – SOFT. Participantes e Métodos: Nesse estudo transversal, de base populacional, de indivíduos idosos com 60 e 90 anos, selecionados através de amostragem por estágios múltiplos de conglomerados, em 106 dos 2157 setores censitários de Porto Alegre. Em entrevistas domiciliares aplicou-se um questionário padronizado, para investigar características socioeconômicas, demográficas, hábitos de vida, fatores de risco para doença cardiovascular, além do índice de independência nas atividades de vida diária, desenvolvido por Katz, em1969, e a escala de independência nas atividades instrumentais da vida diária, criado por Lawton e Brody, em 1983, assim como o questionário de qualidade de vida Short Form-12 (Ware,1994). Utilizou-se o módulo Complex Samples, do SPSS, para as análises dos dados, a fim de ajustar para o efeito da amostragem. Testaram-se diferenças entre proporções utilizando-se o teste do quiquadrado de Pearson, ao analisarem-se as prevalências; análise de variância ou co-variância para compararem-se médias, e análise de regressão logística múltipla, para cálculo da odds ratio e intervalo de confiança de 95%. As análises foram para um nível de significância de 5%. Resultados: A média de idade foi semelhante entre homens e mulheres idosos, e a distribuição de idade e sexo foi similar à do censo do Instituto Brasileiro de Geografia e Estatística. Além de maior escolaridade (8,8 vs. 6,6 anos), os homens referiram estar casados mais freqüentemente (75,7%) do que as mulheres (31,9%), as quais eram predominantemente viúvas ou separadas e residiam sozinhas em maior proporção. Com exceção de cor da pele e de residir sozinho, as demais características associaram-se significativamente com a idade. Identificou-se uma relação inversa entre idade e escolaridade e com o estar casado ou residir com companheiro, e uma associação direta com aposentadoria, separação ou viuvez e o uso de dispositivos para andar. Associação direta e independente de idade e sexo foi observada entre escolaridade e independência para realizar as atividades instrumentais, mas não para as atividades da vida diária. A prática de atividade física regular foi preditora de independência funcional nas AVDs e nas AIVDs. Esse estudo verificou tendência a maior independência entre os homens para o total de domínios das AVDs (94% vs. 89%; p=0,09), assim como das AIVDs (94% vs. 88%; p=0,04). Nos homens, observou-se a redução da independência funcional para realizar a maior parte das AVDs e AIVDs com o avançar da idade. Entre as mulheres, destaca-se, a redução da independência funcional com a idade em todas as atividades, exceto usar o telefone. O sexo masculino esteve associado, independentemente da idade, a maiores escores dos componentes físico e mental da qualidade de vida. A idade associou-se inversamente com o componente físico, enquanto a escolaridade o fez de maneira direta. Entretanto, nenhuma dessas características mostrou relação com o componente mental. Ser ativo fisicamente e possuir menor número de condições crônicas se associaram tanto ao escore do componente físico quanto mental, de maneira fortemente significativa. Conclusão: Os indivíduos idosos investigados no Estudo SOFT, representam a população idosa de Porto Alegre. As diferenças entre homens e mulheres idosos incluem características socioeconômicas, hábitos de vida e independência funcional. Os homens apresentam maior qualidade de vida do que as mulheres, independentemente da idade. / Background: The growth of the elderly population is a worldwide phenomenon. The elderly have chronic diseases that lead to various degrees of incapacity, which increases with age and makes them dependent in their activities of the daily living (ADLs), and in the instrumental activities of the daily living (IADLs). Objectives: the objective of the present study was to assess the functional capacity, verifing the prevalence of functional independence in a representative sample from southern Brazil, as well as to identify its association with life quality. The present research is one of the subprojects of the study of Syndrome of Obesity and Risk Fators (SOFT). Participants and methods: This cross-sectional population-based study of elderly individuals, aged 60 to 90 years old, was selected through a multistage probability sample including participants from 106, out of 2157, census sectors of Porto Alegre. A standard questionnaire was applied in the household in order to investigate socioeconomic and demographic characteristics, life habits, risk factors for cardiovascular disease, as well as the Index of Independence in the activities of the daily living, developed by Katz (1969) and the Instrumental Activities of Daily Living Scale created by Lawton and Brody (1983). The questionnaire Short Form-12 of quality of life (Ware, 1996) was also administered. Complex Samples module of SPSS was used for data analysis in order to take into account the design effect. The differences between proportions were tested by Pearson’s chi-square test; the variance and covariance analyses were used to compare the averages and the multiple logistic regression analysis to calculate the odds ratio and 95% confidence interval. Results: the age average was similar between elderly man and women, and the sex and age distribution was similar to the one of the census of the Brazilian Institute of Geography and Statistics. Besides higher scholarity (8,8 vs. 6,6 years), men referred to being married more frequently (75,7%) than women (31,9%), which were mainly widows or were separated and residing alone more often than men. Except for the color of the skin and the fact of residing alone or not, all the researched characteristics were significantly associated with age. An inverse relationship between age and scholarity and between age and being married or residing with a companion was identified, as well as a direct relationship between age and being retired, being separated or a widow, and needing a walking assistance device. Also, it was observed a direct relationship, regardless of age and sex, between scholarity and independence to perform instrumental activities of the daily living, not however, to the activities of daily living. The practice of regular physical activity was a predicting factor for functional independence in both ADLs and IADLs. This study verified a larger tendency for independence among men for the total of the ADLs (94% vs. 89% for women; p=0,09) and IADLs(94% vs. 88% for women; p=0,04) domains. The reduction of functional independence with age among men was observed in most of the ADLs and IADLs. Among women there was a reduction of functional independence in every activity, except the use of the telephone. The masculine sex was associated, regardless of age, to higher scores on the physical and mental components of quality of life. Age associated inversely with the physical component, while scholarity made it directly, but none of those characteristics showed any relationship with the mental component. Being physically active and possessing a lower number of chronic diseases associated significantly with both mental and physical scores. Conclusion: the elderly individuals investigated in the SOFT study are representative of the elderly population of Porto Alegre. The differences between elderly man and women include: socio-economical characteristics, life habits and functional independence. Men present a higher quality of life than women regardless of age.

Many elderly patients visiting the emergency department for minor injuries are not assessed for functional status and experience functional decline 6 months post injury. Identifying such high-risk patients can allow for interventions to prevent or minimize adverse health outcomes including loss of independence. For the purpose of a planned clinical decision rule to identify elderly patients at high risk of functional decline a survey of physicians was conducted. A random sample of 534 Canadian geriatricians, emergency and family physicians was selected with half randomly selected to receive an incentive. A response rate of 57.0% was obtained with 90% of physicians considering a drop in function of at least 2 points on the 28-point OARS ADL scale as clinically significant. A sensitivity of 90% would meet or exceed 90% of physicians' requirements for a clinical decision rule to identify injured seniors at high risk of functional decline 6 months post injury.

The overall aim was to improve knowledge of the consequences of cognitive dysfunction in everyday life and of instruments to make these assessments. The thesis contains four studies each of different design using different populations. In study I, the relationship between cognitive function, ability to perform activities of daily living and perceived health-related quality of life were investigated in a population of 85-year-old individuals in the community of Linköping (n = 373). The study was part of the Elderly in Linköping Screening Assessment 85 (ELSA 85). Even mild cognitive dysfunction correlated with impaired ability to perform activities of daily living and lower health-related quality of life. In study II, the diagnostic accuracy and clinical utility of Cognistat, a cognitive screening instrument, were evaluated for identifying individuals with cognitive impairment in a primary care population. Cognistat has relatively good diagnostic accuracy with a sensitivity of 0.85, a specificity of 0.79 and a Clinical Utility Index (CUI) of 0.72. The corresponding values were 0.59, 0.91 and 0.53 for the Mini Mental State Examination (MMSE), and 0.26, 0.88 and 0.20 for the Clock Drawing Test (CDT). In study III, the aim was to develop an instrument measuring self-perceived or caregiver reported ability to perform everyday life activities in persons with suspected cognitive impairment or dementia and to perform psychometric testing of this instrument, named the Cognitive Impairment in Daily Life (CID). The CID was found to have good content validity. In study IV, experiences of cognitive impairment, its consequences in everyday life and the need for support in persons with mild cognitive impairment (MCI) or mild dementia and their relatives were explored. Interviews were performed with five people with MCI, eight people with mild dementia and their relatives (n = 13). The main finding was that persons with MCI and dementia experienced cognitive changes that could be burdensome and result in changed activity patterns. In conclusion, the findings support earlier research and show that cognitive dysfunction even at mild stages has an impact on everyday life and reduces perceived quality of life. To improve interventions for persons with cognitive impairment, it is important to assess not only cognitive function but also its consequences in everyday life activities.

Bakgrund: Kronisk obstruktiv lungsjukdom(KOL) är en långsiktig sjukdom som tar tid innan den visar symtom. När patienten kommer och vill ha information och åtgärder för sina symtom har sjukdomsförloppet redan pågått ett tag. Eftersom den är långdragen är omvårdnadsåtgärderna olika beroende på vart i tiden man ligger i sjukdomen. År 2020 kommer denna patientgrupp vara den tredje största i världen, finns det omvårdnadsåtgärder som ökar livskvalitén för denna patientgrupp? Syfte: Syftet med litteraturstudien var att sammanställa resultat avseende forskning om omvårdnad vid kronisk obstruktiv lungsjukdom som leder till förbättrad livskvalité. Metod: Litteratur studie. Resultat: Kunskapsutbytet mellan patient och sjuksköterska: Hur viktigt det är med en klar och tydlig information vid möte mellan sjuksköterska och patient. Att ge stöd och trygghet: Viktigt att sjuksköterskan finns tillgänglig för patienten, underlätta för patienten: Sjuksköterskan har en viktig roll hos patienter med KOL för att förbättra deras förutsättningar för god livskvalité. Slutsats: Viktigt att skapa en tillit mellan sjuksköterskan och patienten, detta skapar trygghet och resulterar till en god fysisk omvårdnad. När trygghet och tillit har byggts upp mellan sjuksköterskan och patienten blir kommunikationen god och man kan tillsammans komma fram till den bästa lösningen för varje enskild patient. / Background: Chronic obstructive pulmonary disease (COPD) is a long term disease that takes time before it shows symptoms. When the patient comes and want information and measures for their symptoms, the disease process has already been going on for a while. Because it is lengthy nursing actions different depending on where in time lying in the disease. In the year of 2020 this will be the third largest patient group in the world, are there any nursing interventions that can increase quality of life? Aim: The purpose of this study was to compile results concerning research on nursing care in chronic obstructive pulmonary disease that leads to improve quality of life. Method: Literature. Results: Knowledge exchange between patient and nurse: How important it is with a clear and transparent information at the meeting between the nurse and patient. To provide support and trust: Important that the nurse is available for the patient. Facilitating patient: The nurse has an important role in patients with COPD to improve their conditions for a god quality of life. Conclusion: Important to create trust between the nurse and patient, this creates confidence and results to good physical care. When trust and confidence has been built between nurse and patient communication becomes good and we can together arrive at the best solution for each individual patient.

Chronic pain is a widespread problem, especially in the older population, and can affect various aspects of daily living. At a time when it has been acknowledged that the population is increasingly ageing, research regarding the effects of chronic pain on the daily living of older adults is essential. Furthermore, the development of innovative technology is changing the way that much research is being conducted, and can lead to the retrieval of novel information, using a fresh approach. The adoption of this technology in the field of chronic pain research has the potential to examine various aspects of the daily living of older adults living with chronic pain using a different approach to previous research. This study is underpinned by a Critical Realist ontology and Hermeneutic epistemology and follows a Generic Qualitative Research methodology (Caelli, et al., 2003). The aim of the study was not to generalise the findings but to gather a deep theoretical description of the outcomes and offer an explanation of these findings based on an analysis of the multiple research methods used within the study. This study had two main aims and was split into two sections according to the aims. Firstly, Part A of this study aimed to explore a range of day-to-day patterns and experiences of functioning in older adults suffering from chronic pain. Part B aimed to explore the usability, acceptance and experience of the technology used to measure functioning as part of the first aim of this study. Part B also aimed to look at the practicalities the participants were faced with when using the technology. A mixed methods design was used for Part A in which 15 older adults (65+) living with chronic pain (pain >3 months) took part in an in-depth study lasting seven days. As well as the 15 core participants that took part in the study, two older adults (65+) without chronic pain and two younger adults (<65) with chronic pain took part in the study in order to provide some insight into the effects of either pain, or age, on functioning. Part A used four data collection techniques to gather data upon the daily functioning of older adults with chronic pain; the Daily Reconstruction Method diary (Kahneman, Krueger, Schkade, Schwarz, Stone, 2004), the Sensecam (also known as the Vicon Revue, Vicon©), the LifeShirt (Vivometrics Inc) and a semi-structured interview. However, although the LifeShirt was validated, as part of this PhD, and used throughout the study, the gathered data was not analysed due to multiple problems with the data. The Daily Reconstruction Method, Sensecam and the semi-structured interview were each analysed separately before the results of the Daily Reconstruction Method and Sensecam were integrated into the themes derived from the semi-structured interviews. The integrated results led to the development of two themes, each with sub-themes; ‘effect on daily living’ and ‘managing pain and functioning’. The themes from Part A highlighted the way in which pain affected functioning and the modifications to daily functioning as a result of chronic pain. The way in which individuals perceived the management of their own pain and functioning, as well as strategies and assistive devices to manage pain and functioning were also discussed. This study has furthered current knowledge due to the idiographic nature of the study, as well as multiple, novel, data collection tools used, adding additional details to how tasks have been modified, reduced, or terminated. Part B of this study used the Unified Theory of Acceptance and Use of Technology (UTAUT, Venkatesh, et al., 2003), the Flow-State Scale (Jackson & Marsh, 1996) and semi-structured interviews to explore participants’ use of both the Sensecam and LifeShirt. The questionnaires and interviews were carried out with all of the individuals that carried out Part A of this research. From the semi-structured interviews two main themes were reported, each with sub-themes; ‘expectations and experiences’ and ‘awareness of equipment’. Two concepts developed from the themes within Part B that were specific to the participants’ experiences of wearing wearable technology in this study, as opposed to ‘typical’ non-wearable technology; specifically, the importance of design and the importance of others. Both of these overarching concepts affected the expectations of the technology, the experiences of using the technology, as well as the awareness of the technology during use. Furthermore, both concepts will remain and are long-lasting, despite the development of the technology in this field, but there are specific details that are contemporary and are specific to either the Sensecam or the LifeShirt as used in this study.

Introdução: As órteses são recursos terapêuticos auxiliares indicados para alívio da dor, melhora do padrão funcional ou aplicação de forças para correção de deformidades. Existe uma carência de estudos que analisem as alterações biomecânicas promovidas pelas órteses no padrão funcional do membro superior. O objetivo do presente estudo foi analisar os efeitos biomecânicos do ombro e do cotovelo com o uso de órteses funcionais em pacientes com disfunções decorrentes de traumas do sistema musculoesquelético. Métodos: O estudo analisou as alterações do padrão de movimento com o uso das órteses dinâmicas e estáticas por meio da análise cinemática e eletromiográfica do membro superior durante a realização de uma tarefa funcional padronizada, sendo que os controles serão os próprios pacientes. Os movimentos analisados foram flexão-extensão de ombro, abdução-adução de ombro, rotação interna-rotação externa de ombro, flexão-extensão de cotovelo, pronação-supinação. Na eletromiografia foi analisada a integral normalizada dos músculos trapézio superior, bíceps braquial e tríceps braquial. Além disso foi realizada dinamometria isométrica de preensão e pinças, bem como a aplicação do questionário QuickDASH sobre sintomatologia e funcionalidade. Foram incluídos 6 pacientes, maiores de 18 anos, com disfunções decorrentes de lesões nervosas periféricas e deformidades musculoesqueléticas decorrentes de artrite reumatóide, que tiveram indicação do uso de órtese. Resultados: embora as órteses estáticas sejam indicadas para correção de desvio ulnar e para bloqueio de garra mista, de acordo com os resultados deste estudo, não agregaram em termos de funcionalidade. Neste último modelo, um voluntário apresentou diferença clinicamente importante de 22,7 pontos, sinalizando piora da função na situação com órtese. Além disso, as órteses para bloqueio de garra mista demandaram maior recrutamento de trapézio superior e bíceps braquial. As órteses dinâmicas para lesão do nervo radial parecem favorecer a força de preensão estática, porém, promoveram compensações proximais durante a execução de tarefas dinâmicas, que envolveram elevação e deslocamento do membro superior, em termos de amplitude de movimento de abdução de ombro, flexão e pronação de cotovelo / Introduction: Orthoses are therapeutic resources that are indicated for pain relief, improvement of the functional pattern and / or to correct deformities. There is a lack of studies that analyze the biomechanical alterations promoted by the orthoses in the functional pattern of the upper limb. The aim of the present study was to analyze the biomechanical effects in shoulder and elbow promoted by orthoses in patients with upper extremity dysfunctions due to trauma of the musculoskeletal system. Methods: The range of motion and muscle activation was collected simultaneously during the performance of a standardized functional task with and witho no orthosis. The movements analyzed were shoulder flexion-extension, shoulder abduction-adduction, shoulder internal-external rotation, elbow flexion-extension, pronation-supination and the integrated electromyography signal of the upper trapezius, brachial bíceps and brachial triceps muscles were analyzed. In addition, isometric dynamometry of gripping and pinch, besides the application of the questionnaire QuickDASH about symptomatology and functionality. Were included six patients, older than 18 years, with peripheral nerve dysfunction and musculoskeletal deformities due to rheumatoid arthritis, who had indication of the use of orthosis. Results: although the static orthosis are indicated for correction of ulnar deviation and MCP extension-blocking, according to the results of this study, they did not add in terms of functionality. MCP extension-bloking orthosis promoted a clinically important difference of 22,7 points, suggesting worsing of the funtion. In addition, this model demanded greater proximal muscular recruitment of upper trapezius and brachial biceps. Dynamic orthoses for radial nerve injury seem to favor static grip strength, but they promoted proximal compensations during the execution of dynamic tasks, that involved elevation and displacement of the upper limb in terms of shoulder abduction, flexion and pronation of elbow

É de extrema importância estudar a relação entre capacidade funcional e saúde bucal relacionado à qualidade vida, para auxiliar nos fatores intervenientes tanto no cuidado odontológico como em outras áreas de atenção à saúde do idoso, além de adequar planos de tratamento as reais necessidades de cada indivíduo, proporcionando melhor qualidade de vida. O objetivo desse estudo foi investigar a capacidade funcional e saúde bucal relacionada à qualidade de vida do idoso. Foram incluídos na pesquisa idosos acima de 65 anos que residem em área de cobertura da Estratégia Saúde da Família de Bauru. Foram investigadas, através de entrevistas, as variáveis capacidade funcional (Índice de Katz), saúde bucal relacionada à qualidade de vida (OHIP-14), condições socioeconômicas e comorbidades. Foram excluídos da pesquisa idosos que apresentavam alterações de compreensão e expressão da comunicação, Para a realização da análise estatística foi utilizado o Teste de Pearson ao nível de significância de 0,05 e a Regressão Linear Multivariada, ao nível de significância de p 0,01. Participaram da pesquisa 238 idosos com 65 anos ou mais, sendo que 56,3% tinham entre 65 e 74 anos e 43,7% tinham 75 anos ou mais, a média geral de idade foi 74,5 anos. Quanto ao sexo, 55,5% eram mulheres, houve predominância da raça branca (65,1%). Quanto a variável capacidade funcional, 8,8% apresentaram incapacidade funcional intermediária ou severa. Sobre os aspectos socioeconômicos, 61,3% dos idosos apresentaram renda mensal de até dois salários mínimos, 88,2% eram aposentados ou pensionistas, 68,9% tinham algum grau de escolaridade e 57,1% eram casados ou mantinham uma união estável. Quanto a saúde bucal relacionada à qualidade de vida, 20,6% dos entrevistados se sentiram desconfortáveis para mastigar alguns tipos de alimentos. A hipertensão arterial foi a comorbidade mais relatada pelos entrevistados (75,6%). As dimensões dificuldade para mastigar (0,21; p<0,05) e necessidade de parar as refeições (0,21; p<0,05) do instrumento OHIP-14 apresentaram correlação estatisticamente significante com o Índice de Katz. Através da análise multivariada, foi observado que quanto maior a incapacidade menos o idoso se preocupa com a saúde bucal. A alimentação é um aspecto importante da vida diária de qualquer pessoa, especialmente o idoso que apresenta doenças crônicas em maior quantidade e severidade conforme o envelhecimento acontece. Além disso, a incapacidade apresentou tendência de aumento com a idade, no entanto a literatura não permite concluir que o envelhecimento em si seja causa da incapacidade funcional. A maior limitação do estudo se relaciona ao próprio desenho epidemiológico, pois o estudo transversal não permite inferências de causalidade, no entanto a amplitude do grupo etário nesta pesquisa permite observar tendências sobre a capacidade funcional e a saúde bucal relacionada à qualidade de vida em idosos. A incapacidade funcional aumentou com a idade e apresentou tendência de maior impacto negativo na saúde bucal relacionada a qualidade de vida dificultando a realização de refeições. / It is extremely important to study the relation between functional capacity and oral health related quality of life, to assist in intervening factors both in dental care as in other areas of health care for the elderly, and adequate treatment plans the real needs of each individual providing better quality of life. The aim of this study was to investigate the functional capacity and oral health related quality of life of the elderly. They were included in the survey, seniors over 65 residing in the Family Health Strategy coverage area of Bauru. Variables functional capacity (Katz Index), oral health related quality of life (OHIP-14), socioeconomic conditions and comorbidities were investigated through interviews. There were excluded from the research elders that presented understanding and communication expression changes for the statistical analysis we used the Pearson Test at the 0.05 significance level and Multivariate Linear Regression, at a significance level of p <0, 01. The participants were 238 elders aged 65 or more, wherein 56.3% were between 65 and 74 years and 43.7% were 75 years or older, the overall mean age was 74.5 years. As to gender, 55.5% were women, with predominance of Caucasians (65.1%). As for the functional capacity variable, 8.8% had intermediate or severe disability. On socio-economic aspects, 61.3% of seniors had incomes up to twice the minimum wage, 88.2% were retired or pensioners, 68.9% had some degree of schooling and 57.1% were married or maintained a stable relationship. As for oral health related quality of life, 20.6 % of respondents feel uncomfortable to chew some foods. Arterial hypertension was the most reported comorbidity by respondents (75.6 %). The dimensions \"difficulty chewing\" (0.21; p < 0.05) and \"the need to stop meals\" (0.21; p < 0.05) of the OHIP -14 instrument showed a statistically significant correlation with the Katz index. Through multivariate analysis, it was observed that the higher the inability least the elderly care about oral health. Food is an important aspect of daily life for anyone, especially the elderly people who present chronic diseases in greater quantity and severity as aging occurs. Furthermore, the inability showed increased with age, but the literature does not suggest that aging itself is the cause of disability. The major limitation of the study relates to own epidemiological design, as the cross-sectional study does not allow causal inferences; however the extent of the age group in this study allows us to observe trends on the functional status and oral health related quality of life in the elderly. Functional disability increased with age and tended to higher negative impact on oral health related quality of life hindering the realization of meals.

A neuropatia diabética é umas das principais complicações crônicas da Diabetes Mellitus que causa prejuízo nos sistemas somatossensorial e motor resultando em alterações biomecânicas nos padrões de locomoção. Atividades de locomoção da vida diária que provocam maior desafio mecânico e de estabilidade podem ser consideradas como um fator de risco para formação de ulcerações em diabéticos neuropatas. Assim, para o real entendimento da interferência da neuropatia diabética na realidade do paciente diabético, torna-se essencial avaliar a biomecânica de membro inferior durante a execução de tarefas motoras da vida real do paciente. O objetivo deste estudo foi investigar a influência da neuropatia diabética nas características discretas e das séries temporais do padrão de ativação muscular, por meio da EMG de superfície, e da cinemática sagital de membro inferior, por meio de eletrogoniômetros, de diabéticos neuropatas (GD) e não diabéticos (GC) (n=46, GC=23, GD=23). Na análise discreta foram analisadas variáveis discretas dos envoltórios lineares dos músculos VL, GM e TA e da variação angular sagital de quadril, joelho e tornozelo. Estas variáveis foram comparadas entre grupos, em cada tarefa motora, por testes t independentes (=0,05). A análise das séries temporais eletromiográficas e de variação angular sagital foi realizada por meio da correlação cruzada de cada série entre os grupos. Também se avaliou a força da relação de fase entre a atividade muscular de VL, TA e GM com a variação angular de joelho e tornozelo, em cada grupo. Os coeficientes de correlação dessas relações foram comparados entre grupos por testes t independentes (=0,05). Os resultados demonstraram que durante o subir, os diabéticos apresentaram menor extensão de tornozelo ao final do apoio e, ao se projetarem para frente na primeira metade do apoio, fletiram menos o tornozelo. Em decorrência disto, houve um prejuízo no posicionamento ideal de tornozelo, indispensável para a ação inicial eficiente de VL. A desvantagem mecânica de VL observada no GD no início do apoio no degrau desencadeou uma ativação aumentada deste músculo ao final da fase de apoio na perna contralateral. No descer, o GD apresentou menor extensão de tornozelo no início do apoio, mas não apresentou alterações na EMG. Nos resultados da análise das séries temporais das EMG houve alta similaridade entre os grupos tanto no subir quanto no descer. A correlação entre a atividade muscular e a variação angular em todas as relações avaliadas foram significativamente mais fracas para o GD no subir para o VL joelho e GM tornozelo (relações fracas em ambos os grupos), exceto para a relação TA e tornozelo, em que o GD obteve relação moderada, enquanto o GC obteve relação fraca. No descer, as correlações foram similares entre os grupos (moderada para VL - joelho e GM - tornozelo, e fraca para TA - tornozelo). Aparentemente, o subir parece exacerbar mais os déficits motores da neuropatia diabética tanto na análise discreta quanto nas séries temporais. Apesar da similaridade temporal das séries no descer escada, qualitativamente houve diferenças na forma, sugerindo uma estratégia de recrutamento motor alterada. Em resumo, diabéticos neuropatas apresentam o padrão cinemático de tornozelo e muscular de vasto lateral e tibial anterior alterados durante estas atividades cotidianas, assim como uma alterada coordenação da ativação muscular de joelho e tornozelo com o correspondente movimento articular. Estes fatos, associados aos maiores impactos verticais do subir e descer escada podem aumentar o risco de ulceração no dia-a-dia de diabéticos neuropatas / The diabetic neuropathy is one of the main chronic complications of Diabetes Mellitus which causes damage to somatosensory and motor control systems resulting in biomechanical alterations in locomotion patterns. Locomotion activities with greater mechanical and balance demands might be considered a risk factor for ulcer formation in diabetic neuropathic patients. Therefore, to have a better understanding of the diabetic neuropatic interference in the daily life of these individuals, it is essential to evaluate the biomechanics of lower limbs during real life activities. The aim of this study was to investigate the influence of the diabetic neuropathy in the discrete characteristics and in time series of muscle activation patterns, using superficial EMG, and sagittal kinematics, using electrogoniometers, of lower limbs during stair management in diabetics (n=23) and non-diabetic individuals (n=23). The discrete analyses were done by discrete variables of VL, GM and TA linear envelopes and the sagittal angular variation of hip, knee and ankle. These variables were compared between groups in each motor task, by t test for independent samples ( = 0.05). The analyses of electromyographic and sagittal angular variation time series were performed by cross-correlation of each serie between groups. Moreover, the strength of the phase relationship between muscle activity of VL, TA and GM with the angular variation of knee and ankle was assessed in each group. The correlation coefficients of these relationships were compared between groups by independent t tests ( = 0.05). The main findings showed that during the stair ascent, diabetics had lower ankle extension at the end of stance phase, and while projecting their body forward during the first half of stance, their ankle flexion angle was also smaller. Because of that, there was a worse ankle positioning in the beginning of the stance, necessary for an efficient action of VL. The mechanical disadvantage of VL observed in diabetic neuropathic patients at the beginning of the stance phase may have triggered an increased activation in the same muscle at the end of stance in the contralateral leg. In the stair descent, diabetics had lower ankle extension at the beginning of stance, but did not show significant alterations in EMG. In the time series analysis, the EMG signals of all muscles presented higher similarities in timing across time series between groups for stair ascent and descent. The correlation obtained between groups for the muscle activity and angular variation amongst all evaluated relationships were statistically lower in the diabetic group for stair ascent (for VL-knee and GM-ankle (both groups presented weak relation), except for the relation between TA and ankle joint variation, which was moderate for the diabetic individuals and weak for controls. In the stair descent, the correlations were similar between groups (moderate relation for VL- knee and GM - ankle, and a weak relation for TA - ankle). Apparently, the stair ascent explicited motor deficits caused by diabetic neuropathy in the discrete analysis and also in the time series analysis. Although the similarities in the time series in the stair descent, qualitative shape differences were observed, suggesting a impaired pattern of motor recruitment in neuropathic patients. In summary, diabetic neuropathic individuals presented an altered ankle kinematic and VL and TA muscles activities patterns during these real life activities, and also altered coordination between muscle activity of knee and ankle and adjacent joint motion. These facts, combined to higher vertical impacts of stair ascent and descent might raise the plantar ulceration risks in the daily activities of diabetic neuropathic individuals

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

As transformações demográficas e epidemiológicas do século anterior trouxeram significativas modificações sociodemográficas e de saúde, em todo o mundo, com o aumento de idosos na população. Ao processo de envelhecimento pode estar associado às doenças crônicas não transmissíveis, dentre elas a doença pulmonar obstrutiva crônica (DPOC), um problema de saúde pública, parcialmente reversível, progressivo e incapacitante. Assim, os objetivos do estudo foram caracterizar os idosos com diagnóstico de DPOC nos estádios I a IV, atendidos no Ambulatório de Pneumologia Geral do HCFMRP/USP, segundo as variáveis sociodemográficas, história de tabagismo e condição de saúde; identificar o grau de independência funcional; identificar a presença de sintomas de depressão; analisar a correlação entre o grau de independência funcional, idade, número de morbidades, tempo e grau de DPOC e a associação entre a presença de sintomas de depressão, as variáveis sociodemográficas, o grau de DPOC e as comorbidades. Trata-se de um estudo descritivo, transversal e correlacional. A coleta dos dados ocorreu no período de março a maio de 2010. Utilizou-se um instrumento para caracterização da amostra, a Medida da Independência Funcional (MIF) e a Escala de rastreamento de sintomas depressivos (CES-D). Foram estudados 84 idosos, média de idade 70,4 anos (s=7,3); 61,9% homens; 51,2% casados; 36,9% viúvos; 36,9% sabiam ler e escrever informalmente/analfabetos; 82,8% eram aposentados; 73,2% recebiam um salário mínimo; 54,8% moravam com a família; 75% deixaram de fumar, 20,2% ainda fumavam e 4,8% nunca fumaram; a carga tabágica foi superior para os homens, sendo a diferença significativa (p<000,1); 100% tinham DPOC, 51,2% pressão alta, 39,3% problemas para dormir e 33,3 problemas cardíacos; a média de morbidades foi de 3,4(s=2,4); 41,7% referiram internação nos últimos 12 meses; 34,5% por exacerbação da DPOC e 34,3% por pneumonia. Houve predomínio da DPOC nos estádios III (40,5%) e II (35,7%), verificou-se prevalência de homens (79,5%) no estádio III e de mulheres (56,7%) no II; os homens apresentaram níveis de DPOC mais elevados que as mulheres, sendo a diferença estatisticamente significativa (p=0,05); tempo médio de DPOC foi 8,3 anos (s=6,4). O escore médio da MIF total foi 117,0 pontos; 96,4% com nível de Independência completa/modificada; a correlação de Pearson entre número de morbidade e MIF (total e motora) foi inversa e significativa (p=0,02). A CES-D classificou 71,4% com sintomas de depressão. Houve diferenças significativas entre presença de sintomas de depressão e as variáveis, sexo (p=0,01), estado conjugal (p=0,02) e problemas para dormir (p=0,01). O estudo revelou que a maioria dos idosos apresentava independência completa/modificada e presença de sintomas de depressão. Apesar de não ter encontrado diferenças significativas na correlação entre os escores da MIF e as variáveis, idade, tempo e grau de DPOC, bem como entre a associação de sintomas depressivos com idade, grau de DPOC e comorbidades, os resultados são relevantes para discussões entre os profissionais da área da saúde, uma vez que a identificação correta de fatores que podem influenciar no tratamento, reabilitação e qualidade de vida do idoso com DPOC torna efetiva as praticas assistenciais voltadas para as necessidades dos mesmos. / The demographic and epidemiological transformations of the previous century brought significant sociodemographic and health changes, globally, with an increase of the elderly population. The aging process can be associated to non transmissible chronic diseases, among them the chronic obstructive pulmonary disease (COPD), which is a partially reversible, progressive and debilitating public health problem. Thus, this descriptive, cross-sectional and correlational study aimed to characterize the elderly with diagnosis of COPD at stages I to IV, who receive care at the Outpatient Clinic of General Pneumology of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School (HCFMRP/USP), according to sociodemographic variables, history of smoking and health conditions; to identify the degree of functional independence; to identify the presence of symptoms of depression; to analyze the correlation among the degree of functional independence, age, number of morbidities, time and stage of COPD and the association between the presence of symptoms of depression, the sociodemographic variables, the stage of COPD and the comorbidities. Data collection was carried out between March and May 2010. An instrument was used for the characterization of the sample, as well as the Measure of Functional Independence (MFI) and the Center for Epidemiologic Studies Depression Scale (CES-D). In total, 84 elderly adults were studied, with average age of 70.4 years (sd=7,3); 61.9% men; 51.2% married; 36.9% widower; 36.9% could read and write and were informally illiterate; 82.8% were retired; 73.2% received one minimum wage monthly; 54.8% lived with the family; 75% quit smoking, 20.2% still smoked and 4.8% never smoked; the tobacco load was higher for men, with significant difference (p<0.001); 100% had COPD, 51.2% had high blood pressure, 39.3% problems to sleep and 33.3 heart problems; the average of reported morbidities was 3.4 (sd=2.4); 41.7% reported being hospitalized in the last 12 months; 34.5% for aggravation of COPD and 34.3% pneumonia. There was predominance of COPD at stages III (40.5%) and stage II (35.7%), with prevalence of men (79.5%) at stage III and women (56.7%) at stage II; men presented higher levels of COPD than women, with statistically significant difference (p=0.05); average time of COPD was 8.3 years (sd=6.4). The average score of total MIF was 117.0 points; 96.4% with level of complete/altered independence; Person correlation between number of morbidity and MIF (total and motor) was inverse and significant (p=0.02). CES-D classified 71.4% of the participants with symptoms of depression. There were significant differences between the presence of symptoms of depression and the variables gender (p=0.01), marital status (p=0.02) and problems to sleep (p=0.01). The study revealed that most elderly adults presented complete/altered independence and presence of symptoms of depression. Although there were no significant differences between the correlation of the scores of MIF and the variables age, time and stage of COPD, as well as the association of depressive symptoms with age, stage of COPD and comorbidities, results are relevant for discussions among health professionals, once the correct identification of factors that can influence on the treatment, rehabilitation and quality of life of the elderly with COPD make care practices targeting the needs of the elderly more effective.