<p>The aim in the study is to search for a deeper understanding of how parents experience a neurological diagnose of the child and how this affects the parenthood. Parenthood was seen in a systemtheoretical perspective as a social construction. The narrative method was used in two lifestory parentinterviews. The analysis was made from parenthood. The result formed stories about parenthood with children having neuropsyciatric functional disability who even came to be a woman’s struggle. Two stories became central, one about righteousness and commonship and one against diagnosis and network. The struggle for support and understanding from the surrounding network was central. There was also a fight between the network and the parent of the authority to decide the child’s normality. The parent and child early experience a segregation in society based on diagnose. Parents experienced insecurity and difficulties regarding dose and sideeffects in medication the child. The networks reception was central for the acceptance of diagnosis and for keeping the parentcompetence. The public debate of inherent or environment created doubt and insecurity. In the stories there was a tendency that the struggle went beside the child and parenthood and instead became a struggle for righteousness against society.</p>

The aim in the study is to search for a deeper understanding of how parents experience a neurological diagnose of the child and how this affects the parenthood. Parenthood was seen in a systemtheoretical perspective as a social construction. The narrative method was used in two lifestory parentinterviews. The analysis was made from parenthood. The result formed stories about parenthood with children having neuropsyciatric functional disability who even came to be a woman’s struggle. Two stories became central, one about righteousness and commonship and one against diagnosis and network. The struggle for support and understanding from the surrounding network was central. There was also a fight between the network and the parent of the authority to decide the child’s normality. The parent and child early experience a segregation in society based on diagnose. Parents experienced insecurity and difficulties regarding dose and sideeffects in medication the child. The networks reception was central for the acceptance of diagnosis and for keeping the parentcompetence. The public debate of inherent or environment created doubt and insecurity. In the stories there was a tendency that the struggle went beside the child and parenthood and instead became a struggle for righteousness against society.

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system that has high association with chronic pain syndromes such as fibromyalgia, migraine disorders, and chronic abdominal pain in adolescents with the diagnosis. Many of these disorders are characterized as central sensitization disorders, or pathological pain memory mediated by neural plasticity. Ehlers Danlos Syndrome Type 3 (EDS-3), also called joint hypermobility syndrome (JHS) is a genetic disorder of the connective tissue that causes joint laxity and is also highly associated with chronic pain syndromes as well as POTS. Methods: This study proposed to characterize POTS as a disorder of central sensitization. The hypothesis, presented within the proposed theoretical model, demonstrates that JHS leads to chronic pain that results in central sensitization and autonomic nervous system dysfunction (POTS). Other factors that were evaluated were anxiety and function. A sample size of 40 adolescents between the ages of 12 and 19 years were recruited from the cardiology and pain clinics at Children’s National Medical Center. Analysis of data utilizing Wilcoxon, Chi square, Pearson correlation, and logistic regression tests were completed using SAS 9.3. Results: In comparison to those without POTS, there were no significant associations found between having the diagnosis of POTS and any other variable studied in the model. JHS had a stronger correlation with anxiety, central sensitization, both subjectively, and objectively with hyperalgesia on Aδ sensory nerve fiber when compared to those without JHS. Subjective central sensitization was highly correlated with anxiety, function, age, and female gender. Function and central sensitization had a significant association even when removing anxiety as a covariate. Conclusions: These findings suggest that joint hypermobility may be a factor that contributes to the development of central sensitization in individuals with chronic pain. Dysautonomia is likely not a disorder of central sensitization, but rather a variable related to joint hypermobility and chronic pain in ways yet to be discovered. As previously discussed in other literature, anxiety has strong associations with central sensitization and functional disability in chronic pain syndromes, and when treated effectively may increase function in those that suffer with these disorders.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Low back pain is one of the most frequent health problems and also one of the most prevalent musculoskeletal disorders. It’s the leading reason for activity limitation and job absenteeism which leads to huge economic burden on persons, society, industry and governments. Women are more susceptible to low back pain due to hormonal effects, differences in reporting of somatic symptoms and greater sensitization of pain. The aim of this study was to determine the impact of low back pain on activities of daily living and quality of life of adult women attending Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. The following objectives were addressed, namely to determine pain intensity, functional disability and quality of life of adult women as well as to explore the activities of daily living that may contribute to low back pain. A sequential explanatory mixed method approach, comprising of a cross-sectional descriptive and explorative design for the quantitative and qualitative phases respectively, was employed in the study. A self-administered questionnaire consisting of four sections (socio-demographic information, the Nordic Musculoskeletal Questionnaire, the Oswestry Disability Index Questionnaire and World Health Organization Quality of Life Tool) was completed by two hundred and thirty-four adult women with a mean age of 38.54 years (SD=9.40). Twenty-six women participated in the focus group discussions. Results of the study indicate that 94.6% of the women had experienced low back pain in the past year while 90.1% had low back pain in the past seven days. In addition, more than half of the women (52.3%) experienced moderate pain intensity. Almost three quarters (68.1%) of the participants who experienced pain in the past year reported that low back pain prevented them from carrying out their activities of daily living. Half of the participants (50.2%) had moderate disability. A significant positive correlation was found between pain and disability (r = 0.426; p = 0.000) while a non-significant negative correlation was found between low back pain and quality of life (r = -0.058; p = 0.390). The qualitative results showed that women have difficulty in performing certain activities of daily living i.e. personal hygiene, sitting, standing and housework due to low back pain. A significant correlation was found between pain intensity, disability and quality of life. Such correlations advocate towards the bio-psychosocial model in management of low back pain. There is a need to invest in primary-based health care to include low back pain and its related risk factors, in order to advise the affected population on appropriate and essential prevention strategies. Future interventions should focus on enhancing physical health and psychosocial stress in women with low back pain.

MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009 / The use of reliable and valid outcome measures in clinical research as well as clinical practice is very important. Self reported questionnaires are widely used as outcome measures to assess the subjective perception of disability caused by low back pain (LBP). The Roland Morris Disability Questionnaire (RMDQ), Quebec Disability Scale (QDS) and Waddell Disability Index (WDI) have been identified as reliable and valid instruments for assessing disability caused by LPB in English speaking patients. The three questionnaires were translated, back-translated and tested in a final version for use with Tswana speaking subjects. The questionnaires were tested on one hundred respondents, who met the inclusion criteria, at five hospitals in Tswana speaking areas. Of the one hundred respondents 31 were retested 24 hours later. No significant floor or ceiling effects were found for all three questionnaires. There was moderate correlation between the RMDQ, WDI and the DRI (0.74 and 0.63, respectively). The correlation between the QDS and the Disability Rating Index (DRI) was strong (0.85). The RMDQ, QDS and WDI correlated moderately with the VAS (pain) (0.63, 0.68 and 0.74, respectively). The RMDQ, QDS and WDI appeared to be internally consistent scales with Cronbach’s alpha values of 0.92, 0.95 and 0.75, respectively. The RMDQ, QDS and WDI showed excellent test-retest reliability with intra-class correlation coefficient values of 0.93, 0.91 and 0.84, respectively. The results suggest that the Tswana versions of the RMDQ, QDS and WDI validated in this study are easy to understand, valid and reliable instruments for the measurement of functional disability caused by LBP in a Tswana speaking population. Therefore, these translated instruments may be useful clinical methods for collecting standardised data on activity limitations resulting from LBP in a Tswana speaking population.

A atenção domiciliar (AD) é uma modalidade de atenção à saúde que visa reorganizar o processo de trabalho das equipes de diferentes serviços, reduzir a demanda por atendimento hospitalar, ampliar a autonomia dos usuários e de seus familiares, além de proporcionar a integralidade da atenção. No âmbito do sistema único de saúde, a AD é operacionalizada, na atenção primária, por meio da Estratégia de Saúde da Família (ESF) e do programa Agentes Comunitários de Saúde (PACS) e pelo programa Melhor em Casa que organiza os Serviços de Atenção Domiciliar (SAD). O estudo teve como objetivo caracterizar os indivíduos assistidos pela equipe multiprofissional de atenção domiciliar (EMAD) do município de Ribeirão Preto, SP. Trata-se de um estudo epidemiológico descritivo que utilizou um formulário e o domínio motor da Medida de Independência Funcional (MIF) para obter o perfil e a incapacidade funcional, respectivamente. Participaram do estudo 58 indivíduos maiores de 18 anos, residentes na área de abrangência e cadastrados na EMAD entre o período 1 de janeiro à 12 de agosto de 2013. Para a realização da análise dos dados, utilizou-se o aplicativo Stata 9.0. Além da análise descritiva, realizou-se o teste de comparação de médias entre os grupos por meio do teste t de Student e ANOVA one way. Os indivíduos caracterizam-se pelo discreto predomínio do sexo masculino (51%), idosos (79,4%), sendo que 91,4% estão inseridos na modalidade de atenção domiciliar AD2 e 87,9% receberam a visita domiciliar do enfermeiro. Houve o predomínio do acesso à atenção domiciliar por demanda espontânea (48,2%) e 41,4% dos participantes realizavam fisioterapia, no momento da entrevista, no SUS (79,2%). Além disso, 37,6% necessitavam usar fraldas e equipamentos (91,4%), sendo este a cadeira de rodas (39,6%) e a maioria foi adquirido por meio do SUS (51%). Quanto aos diagnósticos, os mais frequentes são o acidente vascular encefálico (11%) e a doença pulmonar obstrutiva crônica (11%). Em relação aos cuidadores, 80,4% são do sexo feminino, idosos (41%), com o grau de parentesco esposa (37,6%). Entre aqueles que cuidam de indivíduos que fazem ou fizeram fisioterapia, 90% receberam orientações. No que tange à MIF, a média do domínio motor foi de 50,5 pontos. A maior categoria foi alimentação, sendo que 43,1% apresentaram independência completa, e a menor foi escadas, com 58,6% de indivíduos que necessitaram de ajuda total. O perfil dos indivíduos assistidos pela EMAD e a utilização de uma ferramenta que avalia a incapacidade funcional dos mesmos evidenciaram aspectos propositivos para potencializar o planejamento e a operacionalização da assistência e do processo de trabalho da EMAD. / Home care (AD) is a type of health care that aims to reorganize the work process of the different services teams, reduce the demand for hospital attendance, increase the autonomy of the users and of their family members, in addition to providing comprehensive care. Within the framework of the public health system, AD is operationalized, in the primary care, by means of the Family Health Strategy (ESF), of the Community Health Agents (PACS) program and by the Better Home program which organizes the Homecare Services (SAD). The study aimed at characterizing the individuals assisted by the multidisciplinary team of home care in the city of Ribeirão Preto, Brazil. This is a descriptive epidemiological study which made use of a form and of the motor domain included in the Functional Independence Measure (MIF) to get the profile and the functional disability, respectively. The study included 58 patients over 18 years old living in the area covered and enrolled in the EMAD in the period between January 1 to August 12, 2013. For carrying out the data analysis, Stata 9.0 application was used. In addition to the descriptive analysis two variables or more were compared using the t Student and ANOVA one way test. Individuals are characterized by a slight predominance of males (51%), elderly (79.4%), and 91.4% are inserted into the modality of home care AD2 and 87.9% received home visits of the nurse. There was a predominance of access to home care by spontaneous demand (48.2%) and 41.4% of the participants performed physical therapy at the time of interview, in the SUS (79.2%). Furthermore, 37.6% needed to wear diapers and equipment (91.4%), these being the wheelchair (39.6%) and most had been obtained through the SUS (51%). With regard to diagnosis, the most frequent are the stroke (11%) and the chronic obstructive pulmonary disease (11%). Regarding caregivers, 80.4% are female, elderly (41%), with the degree of relationship wife (37.6%). Among those who took care of individuals who are undergoing or underwent physical therapy, 90% received guidance. Concerning the MIF, the average of motor domain was of 50.5 points. The largest category was feeding, and 43.1% had complete independence, and the lowest was stairs, with 58.6% of individuals requiring total assistance. The profile of the individuals assisted by the EMAD and the use of a tool that evaluates their functional disability highlighted propositive aspects so as to enhance the planning and the operationalization of the assistance and of the EMAD working process.

Made available in DSpace on 2016-08-10T10:54:48Z (GMT). No. of bitstreams: 1 SUELY MARIA SATOKO MORIYA INUMARU.pdf: 2947140 bytes, checksum: fc012d0c0b255e373ed6c0ac70bb9cfa (MD5) Previous issue date: 2015-09-25 / The dissertation was built on the scientific paper mode and consists of two articles. The first, entitled "Back School Program in the physical and functional performance in patients with chronic nonspecific low back pain.", Aimed to analyze the effects of Back School Program in the physical and functional performance in patients with chronic nonspecific low back pain. The second article entitled. "Quality of life of individuals with unspecific low back pain after Postural School Program" aimed to evaluate the effects of Back School Program on quality of life of patients with nonspecific low back pain. The two articles are the product of the same type of study, experimental, with analytical and quantitative design, with a sample of 70 patients with chronic low back pain in Clinica Escola of the State University of Goiás. The subjects were divided into two groups randomly by lot : an intervention group (GI) of 34 participants with 10 meetings for the application of Back School Program and another group without intervention (GSI), with 36 participants. Assessment tools used in the first article: Epidemiological Survey, Functional Disability Questionnaire on Low Back Pain (Oswestry) Visual Analogue Scale (VAS), Sitting Test and Lift (TSL), flexibility test (Wells Bench), sixminute walk test ( 6MWT) and the second article the Quality of Life Questionnaire SF-36. They were applied in three stages: Initial Assessment (AI), Final Evaluation of Postural School (AFEP) and Monitoring Assessment (AA) after 30 days of intervention. As for the results of the first article, the average age of the group participants was 47.85 years, most overweight. It was observed that the GI increased flexibility (p = 0.027) reduced the failure (p = 0.001) and pain (p = 0.002) in AFEP compared with GSI. In the analysis between assessments, GI, statistical differences were found in significant variables: flexibility, disability, pain, ability to sit and stand and cardiorespiratory fitness, to compare the AI. In the second article, the comparison between the groups was most significant difference in GI compared with GSI, the AI only in the vitality domain (p = 0.037). The AFEP showed significant differences in the domains: role limitations due to physical appearance with value (p = 0.019), pain with (p = 0.010), vitality with (p = 0.022), general health status with (p = 0.009) and social aspect with (p = 0.003). In AA, the statistical differences were greater in areas: limitations due to physical aspect with (p = 0.003) and general health care (p = 0.028). The most significant changes in GI in relation to quality of life occurred the moment of AI to the time of AFEP and, from this, remained constant until the time of AA. This it can be seen that the application of Back School Program should be considered good treatment option because this technique has contributed directly to the improvement of the physical and functional performance and quality of life in patients with chronic nonspecific low back pain. It is an educational - therapeutic program that meets all health care levels. / A dissertação foi construída na modalidade de artigo cientifico e consta de dois artigos. O primeiro, intitulado Programa de Escola Postural no desempenho físico e funcional em indivíduos com lombalgia crônica inespecífica. , teve como objetivo analisar os efeitos do Programa de Escola Postural no desempenho físico e funcional de indivíduos com lombalgia crônica inespecífica. O segundo artigo intitulado. Qualidade de Vida de indivíduos com lombalgia inespecífica após Programa de Escola Postural objetivou avaliar os efeitos do programa de Escola Postural na qualidade de vida de indivíduos com lombalgia inespecífica. Os dois artigos são produto do mesmo tipo de estudo, experimental, com delineamento analítico e quantitativo, constando de uma amostra de 70 indivíduos com lombalgia crônica da Clínica Escola da Universidade Estadual de Goiás. Os indivíduos foram divididos em dois grupos aleatoriamente por meio de sorteio: um grupo de intervenção (GI) de 34 participantes com 10 encontros para aplicação do Programa Escola Postural e outro grupo sem intervenção (GSI), com 36 participantes. Os instrumentos de avaliação no primeiro artigo foram: Questionário Epidemiológico, Questionário de Incapacidade Funcional na Lombalgia (Oswestry) Escala Visual Analógica (EVA), Teste Sentar e Levantar (TSL), Teste de flexibilidade (banco de Wells), Teste de Caminhada de seis minutos (TC6) e no segundo artigo o Questionário de Qualidade de Vida SF-36. Foram aplicados em três momentos: Avaliação Inicial(AI), Avaliação Final da Escola Postural (AFEP) e Avaliação de Acompanhamento (AA) pós 30 dias da intervenção. Quanto aos resultados do primeiro artigo, a idade média das participantes dos grupos foi de 47,85 anos, a maioria com sobrepeso. Observou-se que o GI aumentou a flexibilidade (p=0,027), diminuiu a incapacidade (p=0,001) e a dor (p=0,002) na AFEP, quando comparados com o GSI. Na análise entre as avaliações, no GI, foram encontradas diferenças estatísticas significativas nas variáveis: flexibilidade, incapacidade, dor, destreza para sentar e levantar e condicionamento cardiorrespiratório, ao comparar a AI. No segundo artigo, na comparação entre os grupos houve diferença significativa maior para GI quando comparado com GSI, na AI somente no domínio vitalidade (p=0,037). Na AFEP apresentou diferenças significativas nos domínios: limitação por aspecto físico com valor de (p=0,019), dor com (p=0,010), vitalidade com (p=0,022), estado geral da saúde com (p=0,009) e aspecto social com (p=0,003). Na AA, as diferenças estatísticas foram maiores nos domínios: limitação por aspecto físicos com (p=0,003) e estado geral de saúde com (p=0,028). As mudanças mais significativas no GI em relação à qualidade de vida ocorreram do momento da AI para o momento da AFEP e, a partir deste, mantiveram-se constantes até o momento da AA. Assim, pode-se perceber que a aplicação do Programa Escola Postural deve ser considerado boa opção de tratamento, pois essa técnica contribuiu diretamente na melhora do desempenho físico e funcional e na Qualidade de Vida em portadores de lombalgia crônica inespecífica. Trata-se de um programa educativo-terapêutico que atende todos os níveis de atenção a saúde.

Introdução: A dor lombar crônica pode ser definida como dor ou desconforto persistente por mais de 12 semanas nos níveis lombar e sacral da coluna vertebral. Cerca de 5% dos pacientes apresentam comprometimento de raiz nervosa, e uma razão comum é a herniação discal. Os músculos multífido lombar (ML) e transverso do abdome (TrA) são preferencialmente acometidos frente a episódios de dor lombar. Contudo, há escassa literatura que tenha avaliado a fadiga do ML e a capacidade de ativação do TrA em indivíduos com e sem hérnia de disco lombar. Objetivo: Avaliar a fadiga do músculo multífido lombar e a capacidade de ativação do transverso do abdome em indivíduos com hérnia de disco e dor lombar crônica, e controle. Métodos: Participaram do estudo 60 indivíduos com idade entre 20 a 50 anos, divididos em dois grupos: Hérnia Lombar (GHL) com dor há mais de três meses (n=30) e Grupo Controle (GC) sem dor (n=30). A fadiga do multífido lombar foi avaliada com a eletromiografia de superfície durante a realização do teste de esforço de Sorensen e a capacidade de ativação do TrA pela Unidade de Biofeedback Pressórico (UBP). A dor foi avaliada com a escala visual analógica - EVA e questionário McGill de Dor, a incapacidade funcional pelo Índice de incapacidade de Oswestry e o relato de esforço percebido pela escala de Borg. O nível de significância adotado foi de 5%. Na análise dos dados de frequência mediana quanto menor o valor maior a fadiga. Resultados: Houve aumento da fadiga nos dois grupos, porém mais intensa no GHL (p=0,0001) proporcionando a instalação da fadiga em menor tempo (163 s). Na capacidade de ativação do TrA, o GHL apresentou ativação insuficiente (-0,9 mmHg) e GC próximo a valores ideais ( -3,9 mmHg). Na escala de Borg, houve diferença entre os grupos para o esforço inicial (p=0,0002), contudo não foi observado diferença para o esforço final (p=0,0611). O GHL apresentou dor moderada (6,4 cm) quando avaliada pela EVA e pelo Questionário McGill de dor nas categorias sensorial (19,2) afetiva (8,6) e total (36,3) e incapacidade funcional mínima. Conclusão: Os indivíduos com hérnia de disco e dor lombar crônica apresentam maior fadiga do músculo multífido lombar e ativação do transverso do abdome insuficiente quando comparados aos controles. / Introduction: Chronic low back pain can be defined as pain or discomfort lasting more than 12 weeks in the lumbar and sacral levels of the spine. About 5% of patients have nerve root impairment, and the more common etiology is the disc herniation. The lumbar multifidus (LM) and transversus abdominis (TrA) muscles are often affected in low back pain. However, the literature on the fatigue assessment of ML and the ability of TRA activation in individuals with and without lumbar disc herniation is scarce. Objective: To evaluate the lumbar multifidus muscle fatigue and transversus abdominis activation in individuals with disc herniation and chronic low back pain, and control. Methods: The study included 60 subjects aged 20 to 50 years, divided into two groups: lumbar herniated group (GLH) with pain for more than three months (n = 30) and control group (CG) without pain (n = 30). The fatigue of the lumbar multifidus was measured with surface electromyography during the Sorensen test and ability of activation of TRA with Unit Biofeedback pressure (PBU). Pain was assessed by visual analog scale - VAS and McGill pain questionnaire, functional disability by Oswestry Disability Index, and the reporting of perceived exertion with Borg scale. The significance level was established in 5%. Results: We found increased fatigue in both groups however more intense in GLH (p=0.0001) providing the onset of fatigue in less time (163 s). The ability to activate the TrA, the GLH showed insufficient activation (-0.9 mmHg) and CG near the ideal values (-3.9 mmHg). In Borg scale, difference was observed between groups for the initial effort (p = 0.0002), however no difference was observed for the final effort (p = 0.061). The GLH had moderate pain (6.4 cm) when assessed by the VAS and the McGill Pain Questionnaire in sensory (19.2), affective (8.6) and total (36.3) categories and minimal functional disability. Conclusion: Individuals with disc herniation and chronic low back pain have higher fatigue of lumbar multifidus and insufficient transversus abdominis muscle activation when compared to controls.

A atenção domiciliar (AD) é uma modalidade de atenção à saúde que visa reorganizar o processo de trabalho das equipes de diferentes serviços, reduzir a demanda por atendimento hospitalar, ampliar a autonomia dos usuários e de seus familiares, além de proporcionar a integralidade da atenção. No âmbito do sistema único de saúde, a AD é operacionalizada, na atenção primária, por meio da Estratégia de Saúde da Família (ESF) e do programa Agentes Comunitários de Saúde (PACS) e pelo programa Melhor em Casa que organiza os Serviços de Atenção Domiciliar (SAD). O estudo teve como objetivo caracterizar os indivíduos assistidos pela equipe multiprofissional de atenção domiciliar (EMAD) do município de Ribeirão Preto, SP. Trata-se de um estudo epidemiológico descritivo que utilizou um formulário e o domínio motor da Medida de Independência Funcional (MIF) para obter o perfil e a incapacidade funcional, respectivamente. Participaram do estudo 58 indivíduos maiores de 18 anos, residentes na área de abrangência e cadastrados na EMAD entre o período 1 de janeiro à 12 de agosto de 2013. Para a realização da análise dos dados, utilizou-se o aplicativo Stata 9.0. Além da análise descritiva, realizou-se o teste de comparação de médias entre os grupos por meio do teste t de Student e ANOVA one way. Os indivíduos caracterizam-se pelo discreto predomínio do sexo masculino (51%), idosos (79,4%), sendo que 91,4% estão inseridos na modalidade de atenção domiciliar AD2 e 87,9% receberam a visita domiciliar do enfermeiro. Houve o predomínio do acesso à atenção domiciliar por demanda espontânea (48,2%) e 41,4% dos participantes realizavam fisioterapia, no momento da entrevista, no SUS (79,2%). Além disso, 37,6% necessitavam usar fraldas e equipamentos (91,4%), sendo este a cadeira de rodas (39,6%) e a maioria foi adquirido por meio do SUS (51%). Quanto aos diagnósticos, os mais frequentes são o acidente vascular encefálico (11%) e a doença pulmonar obstrutiva crônica (11%). Em relação aos cuidadores, 80,4% são do sexo feminino, idosos (41%), com o grau de parentesco esposa (37,6%). Entre aqueles que cuidam de indivíduos que fazem ou fizeram fisioterapia, 90% receberam orientações. No que tange à MIF, a média do domínio motor foi de 50,5 pontos. A maior categoria foi alimentação, sendo que 43,1% apresentaram independência completa, e a menor foi escadas, com 58,6% de indivíduos que necessitaram de ajuda total. O perfil dos indivíduos assistidos pela EMAD e a utilização de uma ferramenta que avalia a incapacidade funcional dos mesmos evidenciaram aspectos propositivos para potencializar o planejamento e a operacionalização da assistência e do processo de trabalho da EMAD. / Home care (AD) is a type of health care that aims to reorganize the work process of the different services teams, reduce the demand for hospital attendance, increase the autonomy of the users and of their family members, in addition to providing comprehensive care. Within the framework of the public health system, AD is operationalized, in the primary care, by means of the Family Health Strategy (ESF), of the Community Health Agents (PACS) program and by the Better Home program which organizes the Homecare Services (SAD). The study aimed at characterizing the individuals assisted by the multidisciplinary team of home care in the city of Ribeirão Preto, Brazil. This is a descriptive epidemiological study which made use of a form and of the motor domain included in the Functional Independence Measure (MIF) to get the profile and the functional disability, respectively. The study included 58 patients over 18 years old living in the area covered and enrolled in the EMAD in the period between January 1 to August 12, 2013. For carrying out the data analysis, Stata 9.0 application was used. In addition to the descriptive analysis two variables or more were compared using the t Student and ANOVA one way test. Individuals are characterized by a slight predominance of males (51%), elderly (79.4%), and 91.4% are inserted into the modality of home care AD2 and 87.9% received home visits of the nurse. There was a predominance of access to home care by spontaneous demand (48.2%) and 41.4% of the participants performed physical therapy at the time of interview, in the SUS (79.2%). Furthermore, 37.6% needed to wear diapers and equipment (91.4%), these being the wheelchair (39.6%) and most had been obtained through the SUS (51%). With regard to diagnosis, the most frequent are the stroke (11%) and the chronic obstructive pulmonary disease (11%). Regarding caregivers, 80.4% are female, elderly (41%), with the degree of relationship wife (37.6%). Among those who took care of individuals who are undergoing or underwent physical therapy, 90% received guidance. Concerning the MIF, the average of motor domain was of 50.5 points. The largest category was feeding, and 43.1% had complete independence, and the lowest was stairs, with 58.6% of individuals requiring total assistance. The profile of the individuals assisted by the EMAD and the use of a tool that evaluates their functional disability highlighted propositive aspects so as to enhance the planning and the operationalization of the assistance and of the EMAD working process.

Att inte veta om att man har en psykisk funktionsnedsättning kan påverka individens självbild, vilket även kan resultera i utanförskap i samhället. Detta kan ha lett till att man aldrig fått kontakt med arbetsmarknaden eller brytt sig om att ta kontakt med Arbetsförmedlingen. Syftet med denna uppsats var att utforska om det fanns en gemensam nämnare till att personer med psykisk funktionsnedsättning som deltog i projektet Unga till Arbete i Gävle fick ett arbete, samt att öka förståelsen för hur de upplevde mötet med myndigheter generellt och med Arbetsförmedlingen i synnerhet.  Fyra intervjuer med personer som hade diagnosen psykisk funktionsnedsättning, varav två av dem kvinnor och två män genomfördes och bearbetades med induktiv tematisk analys. Ur analys av intervjumaterialet genererades följande övergripande teman: bristande uppmärksamhet, oförståelse samt undermålig samverkan mellan myndigheter och professionella, vilka gällde och följt deltagarna från tidig skolgång fram till vuxen ålder. Resultatet visade att projektet Unga till Arbete i Gävle hjälpt respondenterna att få stöd och därmed ett arbete. Studiens resultat visade även att deltagarna redan i tidig ålder stämplats som avvikare och känt utanförskap. Detta har i sin tur påverkat dem negativt och lett till att de saknat möjlighet till att ha arbete och egen ekonomi för att känna social trygghet. / Not knowing whether you have a mental functional disability may have an affect on an individual’s self-image, which in turn can result to exclusion in society. This could lead to not ever being able to work or caring to take contact with any type of employment agency. The purpose of this study was to explore if there was common denominators that lead to participants of the project Unga till Arbete i Gävle receive work, and also to increase the understanding for how people with mental functional disability experience the meeting with authorities. Four interviews with people, who had the diagnosis mental functional disability, out of which two were women and two were men, was processed with inductive thematic analysis. Out of the analysis there was an overarching theme; lack of attention, incomprehension and poor interaction between authorities and professionals, who had studied the participants from an early childhood to adulthood. The results showed that the project Unga till Arbete i Gävle had helped the participants to receive support, witch thereby lead to them being able to find work. The result of the study also showed that the participants had been labelled as deviant and felt exclusion at an early age. This had in turn lead to a negative impact on the participants, who felt a lack of opportunity to having a job and personal finance, in order for them to be able to feel social safety