Realizing the need on the part of the general public for a better background for selection of useful household objects that combine utility and beauty of line, the author planned an exhibition in an attempt to develop a community awareness to good design in useful objects available in Wichita Falls, Texas.

As the population ages, prediction of falls risk is becoming an increasingly important research area. Due to built-in inertial sensors and ubiquity, smartphones provide an at- tractive data collection and computing platform for falls risk prediction and continuous gait monitoring. One challenge in continuous gait monitoring is that signi cant signal variability exists between individuals with a high falls risk and those with low-risk. This variability increases the di cultly in building a universal system which segments and labels changes in signal state. This paper presents a method which uses unsu- pervised learning techniques to automatically segment a gait signal by computing the dissimilarity between two consecutive windows of data, applying an adaptive threshold algorithm to detect changes in signal state, and using a rule-based gait recognition al- gorithm to label the data. Using inertial data,the segmentation algorithm is compared against manually segmented data and is capable of achieving recognition rates greater than 71.8%.

This study assessed falls efficacy and confidence-related changes among participants attending the a Matters of Balance/Volunteer Lay Leader (AMOB/VLL) falls prevention program for older adults, based on their residential location. Data were examined from 431 older Texans enrolled in AMOB/VLL during a two-year period, and assessed at baseline and post-intervention. Results indicate that participants significantly increased falls efficacy, reduced activity interference due to their health, and decreased the number of days limited from usual activity. Regression models show that participants, despite entering the program with lower reported health status, reported greater rates of positive change for falls efficacy and health interference compared with their baseline pre-intervention counterparts. Overall program attendance and attendance at major sessions showed the greatest influence. Findings contribute to the understanding of cognitive restructuring and strengthening variations with falls prevention program outcomes.

Orientador: Ibsen Bellini Coimbra / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-07T23:17:03Z (GMT). No. of bitstreams: 1 Ricci_NataliaAquaroni_M.pdf: 749854 bytes, checksum: 6d38565ef0ceed8c74de281e2e869d5b (MD5) Previous issue date: 2006 / Resumo: O processamento do controle postural tem início com a comunicação entre o ambiente e corpo, feita por meio dos sistemas sensoriais. Com o envelhecimento, estes sistemas são afetados pela diminuição da reserva funcional e/ ou doenças, predispondo o idoso à instabilidade e quedas. Objetivo: Analisar a influência das informações sensoriais no equilíbrio estático de idosos, comparando-os, em grupos, quanto ao histórico de quedas (sem queda, uma queda e quedas recorrentes) no último ano. Método: Pesquisa descritiva comparativa de corte transversal. Amostra constituída por idosos da comunidade cadastrados em unidade de saúde da família, selecionados e divididos por grupos em consulta ao banco de dados de pesquisa populacional sobre envelhecimento no município de Amparo (SP). Cada grupo foi reduzido a 32 sujeitos por filtro de gênero e faixa etária. O protocolo de avaliação incluiu dados sociodemográficos, clínicofuncionais, psicocognitivos e de equilíbrio estático. O equilíbrio foi avaliado pelo CTSIB que analisa a capacidade de manutenção da estabilidade frente a seis condições de conflitos sensoriais. Foi realizada análise descritiva e inferencial dos dados por meio dos testes de Qui-quadrado, ANOVA, Teste-T e Correlação de Pearson; todos com nível de significância a 5%. Resultados: Houve maior número de casos anormais ao CTSIB para o Grupo de quedas recorrentes em relação ao Grupo sem quedas nas condições 4 (p=0,012) e 5 (p=0,017); e ao Grupo de uma queda na condição 4 (p=0,052). Quanto ao tempo despendido, o Grupo de quedas recorrentes permaneceu menos tempo do que o Grupo sem quedas nas condições 4 (p=0,043), 5 (p=0,042) e 6 (p=0,052). Na progressão do CTSIB, os Grupos sem quedas e uma queda apresentaram menor tempo despendido da condição 4 para a 5 (p=0,016 e p=0,012, respectivamente) e o Grupo de quedas recorrentes teve menor desempenho da condição 1 para a 2 (p=0,039) e da 4 para a 5 (p=0,001). A idade foi a variável de maior associação com a informação sensorial nos três grupos. Conclusão: Os resultados revelam que a interação sensorial nos idosos difere quanto ao histórico de quedas e que no Grupo de quedas recorrentes há maior dependência no sistema somatossensorial e visual. Com esses dados, é possível direcionar o processo de reabilitação e prevenção por meio do treinamento e/ou compensação das estratégias deficitárias e diminuição da dependência sensorial / Abstract: The processing of postural control starts with the environment and body communication, through sensorial systems. Because of the ageing, these systems are affected by the functional decrease and/or diseases, predisposing the elderly to instability and falls. Objective: This work is aimed at analyzing the influence of sensorial information in the elderly¿s static balance comparing them in groups, according to the report of falls (without fall, one fall and recurrent falls) in the last year. Method: A transversal descriptive comparative research. The sample was composed by community-dwelling elderly, which were registered in the Health Family Unit. They were selected and divided into groups by means of consultation of the database on a population research about aging in the Municipal District of Amparo (SP). Each group was reduced to 32 subjects by gender and age filter. The evaluation protocol included socialdemographic, health, physical, psychological and cognitive status, and static balance performance data. The balance was evaluated by CTSIB, which analyzes the stability maintenance capacity according to six sensorial conflicts conditions. The descriptive and inferential analysis was accomplished by means of the tests: Qui-squared, ANOVA, T-Test and Pearson Correlation; with significance level of 5%. Results: There was a larger number of CTSIB abnormal cases for the Group of recurrent falls in comparison to the Group without falls in the conditions 4 (p=0.012) and 5 (p=0.017); and to the Group of one fall in the condition 4 (p=0.052). As for the time performance, the Group of recurrent falls remained less time than the Group without falls in the conditions 4 (p=0.043), 5 (p=0.042) and 6 (p=0.052). In relation to the CTSIB progression, the Groups without falls, and one fall presented less time from the condition 4 to 5 (p=0.016 and p=0.012, respectively); and the Group of recurrent falls had a worse performance from the condition 1 to 2 (p=0.039) and from the condition 4 to 5 (p=0.001). The variable age was presented the largest association with the sensorial information for all the groups. Conclusion: The results showed that the sensorial interaction in the elderly varies according to the history of falling. They also revealed that there is a larger dependence on the visual and somatosensory systems for the Group of recurrent falls. In this way, it is possible to guide the rehabilitation process and prevention with training and/or compensation of deficient strategies and decrease the sensorial dependence / Mestrado / Mestre em Gerontologia

Orientador: Maria Filomena Ceolim / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T15:12:15Z (GMT). No. of bitstreams: 1 Pereira_AlexandreAlves_M.pdf: 1520399 bytes, checksum: 72e63b6e3cf94505105d6ffd2c213b81 (MD5) Previous issue date: 2011 / Resumo: Objetivo: Descrever a influência da atividade física, da velocidade da marcha, da capacidade funcional, dos sintomas de insônia, do cochilo diurno e dos sintomas depressivos sobre a ocorrência de quedas em idosos residentes na comunidade. Métodos: Estudo retrospectivo, de corte transversal. Dos 900 idosos recrutados em domicílio na cidade de Campinas, foram incluídos nesse estudo 689 idosos selecionados por desempenho superior à nota de corte no Mini-Exame do Estado Mental. Os instrumentos incluíram questionários para avaliação dos sintomas de insônia, cochilo diurno e ocorrência de quedas nos últimos 12 meses; medida observacional de velocidade da marcha; as versões brasileiras da Geriatric Depression Scale e do Minnesota Leisure Activity Questionnaire; 13 atividades avançadas de vida diária (AAVDs) e sete atividades instrumentais de vida diária (AIVDs). Resultados: A idade média foi 72,19 (dp = 5,33). Dos entrevistados, 68,8% eram do sexo feminino; 49,93% queixaram-se de um ou mais sintomas de insônia e 62,94% referiram o hábito de cochilar; 19,61% apresentaram sintomas depressivos; 56% eram sedentários, contudo a maioria mostrou-se independente funcionalmente (AAVDs, AIVDs e velocidade da marcha); a prevalência de quedas foi de 26,2%, sendo 11,87% a freqüência de quedas recorrentes. Dentre as variáveis investigadas, sexo feminino, idade igual ou acima de 80 anos, limitação funcional em AIVDs, uso de medicamentos para dormir, sintomas de insônia, cochilo diurno e sintomas depressivos apresentaram associação significativa com quedas recorrentes. No modelo multivariado de análise permaneceram associados a quedas recorrentes o sexo feminino, cochilos diurnos, sintomas depressivos e idade igual ou acima de 80 anos. Conclusões: os achados desse estudo mostraram que os sintomas de insônia e cochilo diurno estão associados ao risco aumentado de quedas em idosos da comunidade. As estratégias de prevenção de quedas em idosos da comunidade devem focar na intervenção dos fatores de risco modificáveis. Deste modo, os resultados dessa pesquisa indicam a necessidade de avaliação da qualidade do sono e suas conseqüências nessa população / Abstract: Objective: to describe the influence of physical activity, walking speed, functional performance, insomnia symptoms, daytime napping and depressive symptoms on the incident of fall in community-dwelling elderly people. Methods: Retrospective, cross-sectional study. Of the 900 elderly people recruited at home in Campinas, 689 were selected from those who scored above the cutoff point for the Mini-Mental State Examination. The instruments included questionnaires to assess insomnia symptoms, daytime napping and falls in the previous 12 months; walking speed; the Brazilian versions of the Geriatric Depression Scale and Minnesota Leisure Activity Questionnaire; 13 advanced activities of daily living (AAVDs) and seven instrumental activities of daily living. Results: Of the respondents, 68% were female; 49,93% complained one or more insomnia symptoms and the most of the sample reported napping; 19,61% had depressive symptoms; 56% were sedentary, although most proved to be functionally independent; the prevalence of falls was 26.2% and 11.87% frequency of recurrent falls. Among the variables investigated, female, age above 80 years, functional limitation in IADL, use of sleep medications, insomnia symptoms, daytime nap and depressive symptoms were significantly associated with recurrent falls. In multivariate analysis, female, age above 80 years, daytime napping and depressive symptoms remained associated with recurrent falls. Conclusion: the findings of this study showed that insomnia symptoms and daytime napping are associated with greater risk of falls in community elderly people. The strategies to prevent falls in community elderly people should aim to the intervention in the modifiable risk factors. Thus, the results of this survey indicate the need for assessment of sleep quality and its consequences in this population / Mestrado / Gerontologia / Mestre em Gerontologia

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13293号 / 論社医博第14号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 松田 秀一, 教授 今中 雄一, 教授 古川 壽亮 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

Background: Healthcare workers are ranked among one of the top occupations for musculoskeletal disorder (MSD) injuries that affect the muscles, the bones, the nervous system and due to repetitive motion tasks (Centers for Disease Control and Prevention, 2017). Numerous high-risk patient handling tasks such as lifting, transferring, ambulating and repositioning of patients cause injuries that can be prevented when evidence-based solutions are used for safe patient handling and mobility (SPHM) tasks. Purpose: The purpose of this quality improvement project was to evaluate the knowledge and attitudes of orthopedic nurses regarding the use of SPHM algorithms as the standard of care when transferring patients. Theoretical Framework. Lewin’s Theory of Change Methods. A quasi-experimental pretest-post-test design was utilized in this evidenced-based practice project. Results. Descriptive statistics that evaluated pre and post questionnaires of the orthopedic nurses noted nurses displayed behavioral and attitudinal intent to use the SPHM algorithms as the standard of care to improve patient outcomes by decreasing falls. Although the behavioral beliefs and attitudes reflected acknowledgement of SPHM skills and knowledge, nursing did not improve in their documentation of SPH fall risk as two separate tools were required on each patient. Conclusions: SPHM evidenced-based standards do guide staff to critically examine how to safely transfer and mobilize a patient. Patient fall rates did decrease during educational sessions, prompting the need for on-going education of all staff on the unit that transfers patients. The findings from this quality project may encourage future practice approaches to use of the safe patient handling (SPH) fall risk assessment tool for all patients to prevent patient falls.

Occasionally healthy older adults trip over stationary objects even when seen well in advance. These are known as “inadvertent” trips. The purpose of this study was to determine the prevalence of inadvertent trips in older males and older females under conditions of normal vision with good lighting. We also determined their relationship with unobstructed gait measures and other risk factors associated with falls during everyday activities. Forty-one subjects stepped over an obstacle (height set to 25% of leg length) 100 times. The obstacle was contacted by 15 participants (37%) in a total of 29 trials (0.7% of all trials). Of the 29 obstacle contacts, 52% occurred with lead limb. There was no difference in the frequency of contacts between males and females. Slower stride speed, shorter stride length, and increased gait cycle time variability during unobstructed walking were associated with contacts during the obstacle crossing trials (p <u><</u> 0.041). Inadvertent trips were also associated with the number of prescription medications taken by participants (p = 0.019) and participants’ maximum reported rating-of-fatigue (p = 0.022<u>)</u>. Fatigue was an important factor and 36 subjects (88%) reported an increase in their fatigue across trials highlighting the importance of considering fatigue in all obstacle crossing studies using older adults. We conclude that inadvertent trips are not uncommon in older adults and point to useful future areas of research and risk factors that could be targeted by fall intervention programs

Falls among hospitalized elderly patients are a safety concern for health care organizations and the patients they serve, but falls can be prevented through the team effort of nurses and other health care professions to promote safety within the organization. The project site was experiencing an increase in the number of patients falls and identified the need for staff education related to assessment and intervention to prevent patient falls in the elderly population. Thus, the practice-focused question for this project was whether an educational program on evidence-based fall prevention strategies using the American Medical Directors Association clinical guidelines would improve staff nurse ability to assess fall risk and apply intervention strategies for elderly patients in an acute care setting compared to standard practice. Lewin's change theory was used as the theoretical foundation for this project. A total of 29 cardiac unit staff nurses who participated in the educational program were provided information on recognizing risk factors for falls, conducting an accurate fall risk assessment using the Morse Fall Scale, and developing individualized care plan for managing fall risk. The Agency for Healthcare Research and Quality 2E Fall Knowledge Test was used in a pre- and posttest design to assess the efficacy of the educational program. The results showed a statistically significant increase (p < 0.001) in staff members' knowledge in recognizing, assessing, and managing falls. This project can improve nurse's knowledge with evidence-based recommendations in practice, which promotes positive social change through improved staff competency that may result in decreased patient falls and adverse patient outcomes.

Seniors are a growing segment of the population of the United States. By 2030 they will make up nearly 20% of the general population. Senior citizens face many health challenges as they age. Injury due to falling is a major concern for many in this age group. Research shows that approximately one third of seniors will fall each year. Injuries that result from falls have been identified as the number one cause of accidental death in this age group each year. While falls have been studied by researchers for a number of years, and some progress has been made in finding ways to improve balance in seniors, the high incidence of falls continues to plague this demographic. Many of the current treatments to improve balance are too expensive, not accessible, or not motivating for seniors. This research project explored the effect of using a readily available video-game system to address these barriers. The Wii Fit gaming system was used with participants three times each week for 30 minutes and the resulting changes were documented. The Berg Balance Scale and Timed Up and Go test, both frequently used by professionals to assess balance in seniors, were used to document balance change. Every participant showed improvement. The Activities-specific Balance Confidence scale, which is used to measure a person's fear of falling, was also used to assess the participant's confidence in their balance as well as the level of fear associated with falling. The results of this test were positive but not to the extent of the balance tests. Finally, each participant was interviewed to assess how easy to use the participants felt the Wii Fit was as well as the motivational qualities of the Wii Fit as a balance tool. Answers given by the participants in the interview were generally positive. These results indicate that the Wii Fit gaming system may be beneficial for improving balance in seniors.