?rea de concentra??o: Aspectos f?sico-funcionais e reabilita??o. / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-10-29T20:42:51Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) kaio_cesar_pinhal.pdf: 2523263 bytes, checksum: 1b6ff2e9b6897955304c8b0b2a3cd96b (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-11-10T11:42:50Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) kaio_cesar_pinhal.pdf: 2523263 bytes, checksum: 1b6ff2e9b6897955304c8b0b2a3cd96b (MD5) / Made available in DSpace on 2018-11-10T11:42:50Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) kaio_cesar_pinhal.pdf: 2523263 bytes, checksum: 1b6ff2e9b6897955304c8b0b2a3cd96b (MD5) Previous issue date: 2018 / As mudan?as observadas no perfil de morbimortalidade da popula??o refletem no aumento do n?mero de casos de doen?as cr?nicas n?o transmiss?veis (DCNT). Devido a sua magnitude, ? importante focalizar o debate sobre a epidemia das DCNT no contexto do Diabetes Mellitus (DM). A evolu??o do DM ? marcada pelo surgimento de complica??es e agravos, como tamb?m por um comprometimento da capacidade funcional do indiv?duo. Em 2001, a OMS cria a Classifica??o Internacional de Funcionalidade, Incapacidade e Sa?de (CIF), introduzindo um novo paradigma para se pensar e trabalhar a defici?ncia e a incapacidade. Os dom?nios da CIF s?o descritos com base na perspectiva do corpo, do indiv?duo e da sociedade, sendo divididos estruturalmente em duas partes: funcionalidade/incapacidade e fatores contextuais. A funcionalidade/incapacidade divide-se em dois componentes: estruturas e fun??es do corpo e atividades e participa??o. Os fatores contextuais abrangem os fatores pessoais e os fatores ambientais. Mesmo com a publica??o de pesquisas recentes, estudos que utilizam a CIF de maneira quantitativa ainda s?o escassos. O impacto dos fatores contextuais sobre a atividade e participa??o em indiv?duos om DM e an?lises longitudinais envolvendo os dom?nios da CIF tamb?m carecem de reflex?es mais aprofundadas. Entender a evolu??o das consequ?ncias funcionais do DM ao longo do tempo ? fundamental, n?o s? por compreender os seus determinantes, mas por permitir a??es preventivas antes do surgimento de agravos, al?m de contribuir para a elabora??o de interven??es com vistas a desenvolver mudan?as no autocuidado, qualidade de vida e mobilidade em indiv?duos com DM, aumentando tamb?m o conhecimento e aceita??o sobre a doen?a e incentivando a busca por h?bitos mais saud?veis. Sendo assim, o objetivo geral desse estudo foi realizar uma avalia??o funcional tr?s anos ap?s a linha de base em indiv?duos com Diabetes Mellitus acompanhados nas unidades b?sicas de sa?de do munic?pio de Diamantina, Minas Gerais, Brasil. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Reabilita??o e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2018. / The observed changes in the morbidity and mortality profile of the population reflect the increase in the number of cases of chronic non-communicable diseases (CNCD). Due to its magnitude, it is important to focus the debate on the CNCD epidemic in the context of Diabetes Mellitus (DM). The DM evolution is marked by the appearance of complications and injuries, as well as by a functional capacity compromise of the individual. In 2000, the World Health Organization (WHO) created the International Classification of Functioning, Disability and Health (ICF), introducing a new paradigm for thinking and working on disability. The domains of the ICF are described based on the perspective of the body, the subject and the society, being divided structurally in two parts: functionality/disability and contextual factors. Functionality/disability is divided into two components: structures and functions of the body and activities and participation. Contextual factors encompass personal factors and environmental factors. Even with the publication of recent research, studies that use the ICF quantitatively are still scarce. The impact of the contextual factors on the activity and participation in individuals with DM and longitudinal analyzes involving the domains of the ICF also need to be further investigated. Understanding the evolution of DM functional consequences over time is fundamental not only because it understands its determinants, but also because it allows for preventive actions before the diseases onset, besides contributing to the elaboration of interventions to develop changes in self-care, quality of life and mobility in individuals with DM, also increasing knowledge and acceptance about the disease and encouraging the search for healthier habits. Therefore, the general objective of this study was to perform a functional evaluation three years after the baseline in individuals with DM accompanied at the basic health units of the Diamantina, Minas Gerais, Brazil.

Orientador: Regina Yu Shon Chun / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T00:52:18Z (GMT). No. of bitstreams: 1 Dallaqua_GraziellaBatista_M.pdf: 1572866 bytes, checksum: 28d7900916c3e2caccbdaa7614c39c08 (MD5) Previous issue date: 2014 / Resumo: Nas últimas décadas tem-se observado grandes mudanças em relação ao cuidado e as necessidades das pessoas com determinadas condições de saúde, tais como as doenças crônicas não transmissíveis (DCNT), sendo que as políticas públicas de saúde incluem como aspectos essenciais, questões de atividade, participação e fatores contextuais como preconiza a Organização Mundial de Saúde (OMS). A partir desse ponto de vista, a Classificação Internacional de Funcionalidade, Incapacidade e Saúde ¿ CIF, proposto pela OMS, envolvendo diversos países, surge para abarcar tais questões e auxiliar os profissionais de Saúde na realização de uma avaliação diferenciada, na definição de metas, no gerenciamento da intervenção e na medida de resultados. Desta forma, este estudo volta-se ao cuidado de pessoas com DCNT, mais especificamente, o Acidente Vascular Cerebral (AVC), nos aspectos de fala e linguagem, no âmbito da fonoaudiologia. Trata-se de estudo metodológico, com objetivo de propor um instrumento auxiliar para aplicação da CIF nos domínios de fala e linguagem de acordo com as etapas a seguir: a) Seleção dos domínios da CIF relacionados à fala e a linguagem b) Elaboração das perguntas auxiliares para cada domínio selecionado e dos critérios de qualificação, segundo a CIF c) Avaliação das perguntas auxiliares para validade de conteúdo d) Desenvolvimento das instruções de aplicação e) Aplicação de teste piloto e f) Estimativa da confiabilidade entre observadores. Como resultado obteve-se um instrumento com 35 perguntas para auxiliar na aplicação de 30 domínios da CIF relacionados à fala e a linguagem, de forma mais prática e de fácil entendimento e aplicação. A validade de conteúdo e confiabilidade entre observadores são ótimas demostrando que o instrumento proposto é capaz de auxiliar na avaliação de funcionalidade e participação nos domínios relacionados a fala e linguagem. Espera-se, deste modo, contribuir para a expansão da utilização da CIF nos casos pós-AVC, no âmbito da clínica fonoaudiológica / During the last decades it has been observed great changes regarding care and needs of people with particular health conditions, such as noncontagious chronic diseases (NCCD), since Health Public Policies include as essential aspects, activity issues, participation and contextual factors as stated by World Health Organization (WHO). The International Classification of Functioning, Disability and Health (ICF), proposed by WHO, comes out to comprehend those factors and help health professionals to perform a singular assessment, determine targets, manage intervention and measure results in health assistance. Among the NCCD, this study turns to speech and language aspects, participation and functionality of people who have suffered a stroke, in Speech and Language Pathology field, using ICF as a conceptual foundation. It's important to have a clinical instrument based on human functionality perspective, as proposed by ICF, which integrates language use on the individual's context and relates itself with several environmental and personal aspects regarding language use aiming a differentiated clinical assessment and decision making process centered on the person who has suffered the stroke. It's a methodological study, proposing a clinical instrument to evaluate and classify speech and language needs, participation and functionality after a cerebral vascular disease based on ICF. Therefore we have followed the next stages: a) Selecting speech and language ICF domains, b) Formulating questions for each selected domain and qualification criteria, according to ICF c) Evaluating questions in order to validate their content, d) Developing application instructions, e) Pilot test application and f) Estimation of reliability among observers. The result was a 35 question clinical instrument to evaluation and classification of speech and language aspects, participation and functionality of people who have suffered a stroke, according to ICF. The instrument presented content validation and reliability among observers demonstrating its applicability. The possibility of using several sources of information (subject, family and professional) and the instrument application time are positive and practicable aspects to its utilization in different clinical contexts in a bio-psycho-social approach centered on the subject and not on the pathology. The results confirm the importance of ICF utilization as a conceptual foundation to a differentiated clinical intervention on the perspective of an integral and human attention / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

Orientador: Regina Yu Shon Chun / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T14:23:32Z (GMT). No. of bitstreams: 1 Santana_MariaTerezaMaynard_M.pdf: 859499 bytes, checksum: 64bd889c4f70a131daf590784b96aefe (MD5) Previous issue date: 2014 / Resumo: INTRODUÇÃO: Dentre as doenças crônicas não transmissíveis (DCNT), o AVE (Acidente Vascular Encefálico) trata de um importante problema de Saúde Pública, dado os altos índices de mortalidade e suas sequelas, tais como as alterações de linguagem e suas implicações na participação. Ao longo do tempo, diversas mudanças de paradigmas na saúde levam a ressignificação da clínica, incorporando-se em suas práticas aspectos funcionais e sociais tal como propõe a Organização Mundial da Saúde (OMS) na Classificação Internacional de Incapacidade, Funcionalidade e Saúde ¿ CIF. Este trabalho fundamenta-se em uma visão de linguagem pautada na subjetividade e no cuidado humanizado em fonoaudiologia de pessoas que sofreram AVE, em que a base conceitual da CIF desponta como importante ferramenta por incorporar uma visão positiva da saúde humana. OBJETIVOS: Avaliar e classificar aspectos de linguagem, funcionalidade e participação de pessoas pós AVE com base conceitual da CIF e caracterizar o perfil sociodemográfico dos participantes. MÉTODO: A pesquisa foi aprovada pelo Comitê de Ética da FCM/UNICAMP sob nº 442.958/2013. A amostra é constituída de 50 (cinquenta) participantes com diagnóstico de AVE em atendimento ambulatorial, tempo de íctos acima de 3 (três) meses e de ambos os sexos. A coleta de dados se deu por meio da aplicação de um instrumento clínico para avaliação das necessidades de linguagem, participação e funcionalidade no AVE baseada na CIF. Para classificação dos dados foram consideradas diversas fontes de informação. Os dados foram analisados a partir dos componentes da CIF de Funções do Corpo; Atividade e Participação; Fatores Ambientais, utilizando-se os qualificadores quanto a gravidade do problema e magnitude do nível de saúde. RESULTADOS: A idade dos participantes variou entre 32 e 88 anos, sendo que a maioria (57,8%) é idoso do sexo masculino. Nas funções do corpo, os participantes referiram maior dificuldade nos domínios de "função da memória" e "funções de orientação" (60% em ambos). Em atividade e participação, relataram maior dificuldade em "recreação e lazer" (61,1%), "escrever mensagens" (55,6 %), "andar" (53,1%), "concentrar a atenção" (52%) e "vida comunitária" (51,7%). Nos fatores ambientais, o componente "profissionais de saúde" foi indicado como facilitador para a maior parte do grupo estudado (83,6%), sendo relatado como barreira para uma pequena parcela (14,2%). Quanto ao item "família imediata" foi considerado como facilitador para grande parte dos participantes (79,1%) e como barreira para uma pequena parte (2,3%). O item "família ampliada" foi referido como facilitador para a maioria (70,8%) e como barreira para uma baixa porcentagem (4,2%) dos participantes. CONCLUSÃO: A utilização da CIF como base conceitual possibilitou a análise e classificação dos aspectos de linguagem, funcionalidade e participação das pessoas que sofreram AVE, evidenciando o impacto em suas vidas, em sua percepção, aliada a visão do profissional. Os resultados contribuem para ampliar o olhar do fonoaudiólogo e aprimorar a assistência à saúde desse grupo populacional no atendimento ambulatorial em uma abordagem integral e humanizada / Abstract: INTRODUCTION: Among the chronic non-communicable diseases (NCDs), the CVA (Cerebrovascular Accident) is the most important issue in Public Health, due to its high mortality and after-effects, such as language impairments and implication in participation. Over time, many changes in health paradigms led to the resignification of clinical practice, incorporating in its practices functional and social aspects, as proposed by the World Health Organization (WHO) in The International Classification of Functioning, Disability and Health (ICF). This paper follows a language approach based on the subjectivity and humanized care in Speech and Language Pathology for people that suffered CVA, in which the ICF conceptual basis emerges as an important tool since it embodies a positive vision of human health. OBJECTIVES: To evaluate and classify aspects of language, functionality and participation in post-CVA patients under the ICF conceptual basis and to characterize the sociodemographic profile of the participants. METHOD: The research was approved by the Ethics Committee of FCM/UNICAMP under # 442.958. The sample constitutes 50 (fifty) participants diagnosed with CVA outpatient care, who had the stroke at least 3 (three) months before the research and of both sexes. The data collection was done through the application of a clinical instrument for the evaluation of language, participation and functionality needs in CVA based on ICF. To classify the data, some sources of information were considered in the study. The data were analyzed from ICF components of Body Functions; Activity and Participation; Environmental Factors, using the qualifiers concerning the gravity of the problem and magnitude of health level. RESULTS: The age of the participants varied between 32 and 88 years old, the majority (57, 8%) being elderly men. Among the body functions, the participants reported more difficulties in "memory functions" and "orientation functions" (60% on both). Among activity and participation, were related more difficulties in "recreation and leisure" (61,1%), "writing messages" (55,6%), "walking" (53,1%), "focus the attention" (52%) and "community life" (51,7%). Amongst the environmental factors, the component "healthcare professionals" was indicated as a facilitator to most of the group (83,6%) and reported as a barrier for a small portion (14,2%). As for the item "immediate family", it was considered by a large portion of the participants (79,1%) as a facilitator and as a barrier for a small part (2,3%). The item "extended family" was reported as a facilitator for most (70,8%) and as a barrier for a low percentage of the sample (4,2%). CONCLUSION: The use of ICF as a conceptual basis allowed the analysis and classification of language, functionality and participation aspects in people that had suffered CVA, indicating the impact in their lives and perception, along with the professional view. The results contribute to extend the Speech and Language Pathologist approach and to improve the health assistance to outpatient care in an integral and humanized view / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

Objective: The purpose of this study was to determine speech-language pathologists’ (SLPs’) perceptions regarding the concept of severity of speech sound disorder (SSD). Methods: An online survey of 40 questions was created using REDCap® and disseminated to currently practicing SLPs across the United States. A total of 296 responses were completed, and data were analyzed using descriptive statistics and coding according to grounded theory. Results: The top five factors SLPs consider when determining SSD severity are types of errors, intelligibility, perceptual judgment, normative data, and percentile rankings. Most SLPs were unfamiliar with the International Classification of Functioning, Disability and Health (WHO, 2001), which was reflected in how they prioritized the ICF component of body function over activity/participation and personal factors. Conclusion: SLPs need a standard, biopsychosocial model for rating SSD severity, clinical training and continuing education on the ICF, and exposure to holistic tools for assessing children with SSD.

No description available.

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a leading patient-reported outcome measure of disability. However, patients' perspective of the WHODAS 2.0 self-administered Swedish version have not been sufficiently described. Similarly, knowledge of its construct validity in the general population is missing. This creates a gap because updated norm data to use as reference is also missing. The overall aim of this study was to establish evidence of the measurement properties of the self-administered Swedish version of the WHODAS 2.0. Both qualitative and quantitative methods were adopted. In Study I, interviews with patients (n = 12) with orthopaedic or psychiatric conditions were performed and data were analysed by deductive content analysis. In Study II, a cross-sectional general population survey (n = 3 482) was conducted, and statistical methods based on classical test theory were used in the data analysis. The results show that the items were well understood, acceptable and easy to answer by outpatients, with the exception of six items (Study I).The internal consistency reliability was good or excellent and the construct validity was overall acceptable, with partial support for the factor structure in the general populations (Study II). The self-administered Swedish 36-item version of the WHODAS 2.0 is comparable to other language versions of the instrument. Some of the previous known weaknesses of its construct validity in relation to the item content and insufficient instructions were confirmed. The evidence of overall good content and construct validity together with available norm data supports its use in clinical settings and research.

Background: The prevalence of disability increases with age; therefore with an aging population, interventions to reduce disability are crucial. This thesis adopts a behavioural conceptualisation of disability. The theoretical frameworks of the International Classification of Functioning, Disability and Health (ICF), the Theory of Planned Behaviour (TPB) and the integrated ICF/TPB model are applied to investigate disability and physical activity (PA) behaviours. The thesis aims to: (1) identify the factors involved in the prioritisation of patients for total joint replacement; (2) classify patient pre-operative expectations of total hip replacement (THR) and investigate the relationship between expectations and recovery after surgery, and; (3) test whether the TPB and theory-based interventions can predict and explain PA within individuals. Method: Five studies were conducted. In the first study, health professionals judged whether the items from two prioritisation tools measured each of the ICF constructs. In the second study, surgeons ranked patient vignettes, which differed by constructs from the integrated model, in order of priority for THR. In the third study, a large cohort of THR patients reported expectations of surgery pre-operatively. Health and functioning were also reported pre-operatively and 1-year post-operatively. The fourth and fifth studies were a series of experimental n-of-1 studies using diary methods assessing TPB cognitions and PA behaviours. Results: There is a lack of agreement between judges in relation to the content of many of the items from prioritisation tools. Behavioural and psychological factors can influence prioritisation for THR. The majority of patient expectations of THR addressed activities and social participation; however, the evidence for a relationship between expectations and recovery was limited. The TPB can predict PA within some individuals but the evidence in support of interventions to increase PA was limited. Discussion: The findings provide important clinical and theoretical implications for understanding disability and physical activity behaviours.

Introduction: There has been a continuous development of new technologies in healthcare that are derived from national quality registries. However, this innovation needs to be translated into the workflow of healthcare delivery, to enable children with long-term conditions to get the best support possible to manage their health during everyday life. Since children living with long-term conditions experience different interference levels in their lives, healthcare professionals need to assess the impact of care on children’s day-to-day lives, as a complement to biomedical assessments. Aim: The overall aim of this thesis was to explore and describe the use of instruments about health-related quality of life (HRQOL) in outpatient care for children with long-term conditions on the basis of a national quality registry system. Methods: The research was conducted by using comparative, cross-sectional and explorative designs and data collection was performed by using different methods. The questionnaire DISABKIDS Chronic Generic Measure -37 was used as well as semi-structured interviews and video-recordings from consultations. Altogether, 156 children (8–18 years) and nine healthcare professionals participated in the studies. Children with Type 1 Diabetes (T1D) (n 131) answered the questionnaire DISABKIDS and children with rheumatic diseases, kidney diseases and T1D (n 25) were interviewed after their consultation at the outpatient clinic after the web-DISABKIDS had been used. In total, nine healthcare professionals used the HRQOL instrument as an assessment tool during the encounters which was video-recorded (n 21). Quantitative deductive content analysis was used to describe content in different HRQOL instruments. Statistical inference was used to analyse results from DISABKIDS and qualitative content analysis was used to analyse the interviews and video-recordings. Results: The findings showed that based on a biopsychosocial perspective, both generic and disease-specific instruments should be used to gain a comprehensive evaluation of the child’s HRQOL. The DISABKIDS instrument is applicable when describing different aspects of health concerning children with T1D. When DISABKIDS was used in the encounters, children expressed positive experiences about sharing their results with the healthcare professional. It was discovered that different approaches led to different outcomes for the child when the healthcare professionals were using DISABKIDS during the encounter. When an instructing approach is used, the child’s ability to learn more about their health and how to improve their health is limited. When an inviting or engaging approach is used by the professional, the child may become more involved during the conversations. Conclusions: It could be argued that instruments of HRQOL could be used as a complement to biomedical variables, to promote a biopsychosocial perspective on the child’s health. According to the children in this thesis, feedback on their results after answering to web-DISABKIDS is important, which implies that healthcare professionals need to prioritize time for discussions about results from HRQOL instruments in the encounters. If healthcare professionals involve the child in the discussion of the results of the HRQOL, misinterpreted answers could be corrected during the conversation. Concurrently, this claims that healthcare professionals invite and engage the child.

INTRODUÇÃO: Com o rápido processo de envelhecimento populacional, a incapacidade funcional em idosos tem se tornado um importante problema de saúde pública globalmente. Depressão é uma morbidade bastante prevalente nessa fase da vida e pode estar associada com uma proporção significativa da incapacidade funcional na população de idosos. OBJETIVOS: Avaliar os níveis de incapacidade funcional, os principais fatores associados e o impacto dos transtornos mentais na incapacidade funcional de idosos vivendo na comunidade; examinar os fatores preditores de incapacidade funcional em um período de dois anos. MÉTODO: A presente investigação é parte da coorte prospectiva de base populacional \"São Paulo Ageing & Health Study\" (SPAH), que incluiu idosos com 65 anos ou mais, residentes de uma área economicamente menos favorecida na região Oeste da cidade de São Paulo. Os participantes foram identificados por arrolamento domiciliar e entrevistados em seus domicílios seguindo protocolo padronizado de pesquisa. A avaliação de incapacidade funcional foi realizada com o instrumento \"World Health Organization Disability Assessment Schedule 2.0\", criado para avaliar níveis de incapacidade conforme as definições e critérios da International Classification of Functioning, Disability and Health da Organização Mundial de Saúde, na sua versão com 12 itens. Depressão pelos critérios diagnósticos da CID-10 e sintomas depressivos foram avaliados com o instrumento Geriatric Mental State. Foram examinadas as associações independentes entre os transtornos mentais e incapacidade funcional através de modelos de regressão multivariada e modelos longitudinais multinível. Também foi calculada a Fração Atribuível na População dos transtornos mentais na incapacidade funcional dos idosos. RESULTADOS: Foram incluídos 2.072 idosos no período de 2003 a 2005. Mobilidade, atividades de vida diárias e participação na sociedade foram os domínios de incapacidade funcional mais afetados nessa população. A prevalência de depressão clinicamente significativa foi 26,2% (IC 95% 24,3 - 28,1), sendo 4,8% para depressão CID-10 e 21,4% para sintomas depressivos. Demência, depressão CID-10 e problema em membros apresentaram as associações de maior magnitude com as médias dos escores totais padronizados de incapacidade funcional, seguidos por sintomas depressivos, AVC e DPOC. Sintomas depressivos e depressão CID-10 foram responsáveis por 25,0% do total de incapacidade funcional grave nessa população. Dos idosos incluídos no SPAH, 1.661 foram reavaliados após dois anos. No seguimento, 56,1% dos idosos permaneceram com o mesmo nível de incapacidade funcional, 21,8% melhoraram e 22,1% pioraram. Os idosos que apresentaram sintomas depressivos, depressão CID-10 e demência na inclusão tiveram maior chance de piora da incapacidade funcional após dois anos, independentemente da categoria de incapacidade na inclusão do estudo e das morbidades físicas presentes. CONCLUSÃO: Os transtornos mentais em idosos, principalmente os sintomas depressivos e a depressão CID-10, apresentam associações e impacto importantes na incapacidade funcional. Além disso, são fatores preditores de piora na incapacidade funcional em idosos. Sabe-se que depressão e sintomas depressivos são doenças potencialmente preveníveis e tratáveis, e que sua adequada abordagem em idosos pode culminar com a diminuição da incapacidade funcional, melhora da qualidade de vida e diminuição dos custos em saúde / BACKGROUND: With the fast population aging, functional disability in the elderly has become a major public health issue globally. Depression is a very prevalent morbidity in this life period and may be associated with a significant proportion of functional disability in the elderly population. AIMS: To assess the level of functional disability, the main comorbidities associated and the impact of mental disorders on functional disability in the elderly living in the community; to investigate the predictors of functional disability in a period of two years. METHOD: The present investigation is part of a population-based prospective cohort study \"São Paulo Ageing & Health Study\" (SPAH), which included participants aged 65 or older living in an economically underprivileged area in the western region of São Paulo city. Participants were identified by household enrollment and interviewed in their homes using a standardized research protocol. The assessment of disability was performed with the 12-item version of the \"World Health Organization Disability Assessment Schedule 2.0,\" created to assess levels of disability according to the definitions and criteria of the International Classification of Functioning, Disability and Health of the World Health Organization. ICD-10 depression and depressive symptoms were assessed with the Geriatric Mental State instrument. We examined the independent associations between mental disorders and functional disability through multivariate regression models and longitudinal multilevel models. We also calculated the Population Attributable Fraction of mental disorders on functional disability in elderly. RESULTS: We included 2072 elderly from 2003 to 2005. Mobility, activities of daily living and participation in society were the most affected domains of functional disability in this population. The prevalence of clinically significant depression was 26,2% (CI 95% 24,3 to 28,1), 4,8% for ICD-10 depression and 21,4% for depressive symptoms. Dementia, ICD-10 depression and limb problems were highly associated with the mean of functional disability overall standardized scores, followed by depressive symptoms, stroke and COPD. Depressive symptoms and ICD-10 depression accounted for 25,0% of severe functional disability in this population. Among the elderly included in SPAH, 1661 were reassessed after two years. In this follow-up, 56,1% of the elderly remained with the same level of functional disability, 21,8% improved and 22,1% worsened. The elderly who presented depressive symptoms, ICD-10 depression and dementia at baseline had a higher risk of worsening disability after two years, independently of the category of disability and physical morbidities at baseline. CONCLUSION: Mental disorders in older adults, particularly depressive symptoms and ICD-10 depression, have significant associations and impact on functional disability. Also, they are predictive factors of worsening disability. It is known that depression and depressive symptoms are potentially preventable and treatable diseases and a proper approach may lead to a decreased functional disability, improved quality of life and decreased healthcare costs

Vinte três anos após a sua aprovação pelo Food and Drug Administration (FDA), o Implante Coclear (IC) já deixou de ser uma intervenção de pesquisa e de centros universitários para ser uma opção de tratamento da deficiência auditiva, seja criança ou adulto. A quantidade de evidência científica sobre os resultados positivos proporcionados por essa intervenção é bastante volumosa, não restando mais dúvidas quanto a seus benefícios. Entretanto, especificamente no caso das crianças, poucos estudos têm focado na descrição dos seus efeitos na sua funcionalidade, como o engajamento em atividades sociais, avanço na escolaridade, aspectos psicológicos relacionados com a deficiência e aspectos sociais, como questões ocupacionais dessa população. Ou se investigam, estes aspectos são descritos isoladamente. Esta dificuldade se relaciona principalmente com os instrumentos utilizados na rotina clínica, pois estes geralmente avaliam habilidades específicas de audição e de linguagem, e seus resultados, muitas vezes, não permitem se relacionar com o progresso ou o sucesso da reabilitação. Neste sentido, o uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) com essa população vem sendo sugerido, pois pode ampliar a visão sobre o desenvolvimento da criança usuária de IC. Diante disso, este estudo teve como objetivo construir um checklist da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, versão Crianças e Jovens (CIF-CJ), a partir da investigação de dimensões clínico-terapêuticas e familiares relacionadas à CIF-CJ, para acompanhamento do usuário de Implante Coclear (IC). Tratou-se de um estudo descritivo, desenvolvido no Departamento de Epidemiologia da Faculdade de Saúde Pública, Universidade de São Paulo, Campus São Paulo (FSP/USP-SP) e no Centro de Pesquisas Audiológicas (CPA) do Hospital de Anomalias Craniofaciais da Universidade de São Paulo, campus Bauru (HRAC/ USP-Bauru). Para a construção do checklist, os seguintes estudos foram desenvolvidos: 1) Seleção, a partir da opinião de Fonoaudiólogos que atuam com a população infantil usuária de Implante Coclear (IC), dos códigos da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, versão crianças e jovens (CIF-CJ) para acompanhamento dessa população; 2) Identificação dos aspectos de qualidade de vida considerados importantes pelos pais de crianças e jovens usuários de Implante Coclear e sua correlação com a CIF-CJ e, 3) Levantamento dos códigos da CIF-CJ relacionados/associados aos instrumentos utilizados na rotina clínica para avaliação/acompanhamento de usuários de Implante Coclear com a CIF-CJ. Ao final, os códigos da CIF-CJ selecionados em cada estudo realizado (com os profissionais, familiares e protocolos/instrumentos clínicos) foram comparados e os que não se repetiam, se complementaram para compor o checklist. Assim, após a realização dos três estudos, 71 códigos de segundo nível da CIF-CJ foram selecionados, sendo incluídos 16 códigos do domínio Funções do Corpo, 6 códigos de Estrutura do Corpo, 39 referentes à Atividades e Participação e 10 dos Fatores Ambientais, de um total de 380 códigos iniciais. Dessa forma, a construção do checklist considerou aspectos de todos os domínios da CIF-CJ. Apesar da sua estrutura ser considerada ampla e sua operacionalização como ferramenta nos serviços de saúde ser um desafio, acreditamos que este estudo foi um primeiro passo para a construção de um instrumento baseado na CIF-CJ para ser utilizado com a população infantil usuária de IC. A composição do checklist a partir da avaliação das dimensões clínico-terapêuticas e familiares se mostrou efetiva na busca dos principais aspectos que podem descrever essa população, sendo complementares nas informações para a construção do produto final deste estudo. Como conclusão, para acompanhamento da funcionalidade das crianças e jovens usuários de IC na perspectiva proposta pela CIF-CJ, foi elaborado o Checklist da CIF-CJ para crianças e jovens usuários de Implante Coclear, a partir das especificidades dessa população, sendo selecionados 71 códigos de segundo nível da CIF-CJ / Twenty tree years after its approval for the Food and Drug Administration (FDA), the Cochlear Implant (CI) has already left to be a research intervention in university centers to become a treatment option for the hearing loss, in child or adults. The amount of scientific evidence about the positive results proportioned for this intervention is largely published and there are no more doubts about its benefits. However, specially in child cases, few studies have focused about their functioning results, like social activity engagement, scholarship advance, psychological aspects related to the disability and social aspects like occupational questions of this population. And, in which these questions are investigated, they are isolate researched. This difficult is related mainly with the utilized instruments at the clinics routine, because these instruments evaluate specifics abilities in hearing and language, and its results, many times, do not allow to configure a relationship with the success or rehabilitation progress. In front of this, the aim of this study is to build a checklist using the Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), beginning from the clinics, therapeutics, and familiar opinion dimension investigation related to de ICF-CY to be used for the follow up of the CI users. It was a descriptive study, developed at the Department of Epidemiology of the School of Public Health, University of São Paulo, São Paulo campus (FSP/USP-SP) and at the Center of Audiological Research of the Hospital of Craniofacial Anomalies, University of São Paulo, Bauru campus (HRAC/USP-Bauru). To reach the proposed objective, the checklist building process evolved the following steps: 1) Selection about which codes of the ICF-CY Audiologists and Speech Language Pathologists that work with the child population consider to be important for the following up of this specific young group; 2) Identification of the main life aspects considered important by the Child and Young CI users parents and correlate them with the ICF-CY; and 3) Check the ICF-CY codes that can be linked and related to the instruments utilized at the clinic routine for the evaluation and the follow up of the CI users. At the end, the ICF-CY codes that were previously selected in which one of the research steps (with the professionals, relatives and the clinics protocols/instruments), were compared and the ones not repeated were joined to compose the proposed checklist. Thus, after these tree studies realization, 71 codes of the second level of the ICF-CY were selected, being 16 codes about Body Functions domain, 6 about Body Structure, 39 related to Activities and Participation codes, and 10 about Environment Factors in a whole universe of 380 initial codes. In this way, the checklist building process have considered all the domains that the ICF-CY treats about. Despite its structure could be considered something large, and its operationalization like a tool at the health service be considered a challenge, we do believe that this research was the very first step in order to build an instrument related to the ICF-CY to be used with the CI users young population. The checklist composition, built from the evaluation of the clinics, therapeutics, and familiar opinion dimension, showed to be effective chasing the mainly aspects that can describe this population, and joined particularly well together contributing for the final product built from this study. As conclusion, for the follow up of the young and child CI users functioning, on the ICF-CY bases, it was elaborated the ICF-CY Checklist for children and young Cochlear Implants users, originated from these population specifies, being selected 71 second level codes of the ICF-CY