abstract: Parkinson's disease, the most prevalent movement disorder of the central nervous system, is a chronic condition that affects more than 1000,000 U.S. residents and about 3% of the population over the age of 65. The characteristic symptoms include tremors, bradykinesia, rigidity and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients' motor performance but often leads to levodopa-induced complications, such as dyskinesia and motor fluctuation. With the disease progress, clinicians must closely monitor patients' progress in order to identify any complications or decline in motor function as soon as possible in PD management. Unfortunately, current clinical assessment for Parkinson's is subjective and mostly influenced by brief observations during patient visits. Thus improvement or decline in patients' motor function in between visits is extremely difficult to assess. This may hamper clinicians while making informed decisions about the course of therapy for Parkinson's patients and could negatively impact clinical care. In this study we explored new approaches for PD assessment that aim to provide home-based PD assessment and monitoring. By extending the disease assessment to home, the healthcare burden on patients and their family can be reduced, and the disease progress can be more closely monitored by physicians. To achieve these aims, two novel approaches have been designed, developed and validated. The first approach is a questionnaire based self-evaluation metric, which estimate the PD severity through using self-evaluation score on pre-designed questions. Based on the results of the first approach, a smart phone based approach was invented. The approach takes advantage of the mobile computing technology and clinical decision support approach to evaluate the motor performance of patient daily activity and provide the longitudinal disease assessment and monitoring. Both approaches have been validated on recruited PD patients at the movement disorder program of Barrow Neurological Clinic (BNC) at St Joseph's Hospital and Medical Center. The results of validation tests showed favorable accuracy on detecting and assessing critical symptoms of PD, and shed light on promising future of implementing mobile platform based PD evaluation and monitoring tools to facilitate PD management. / Dissertation/Thesis / Ph.D. Biomedical Informatics 2013

Esta pesquisa investiga os determinantes e a evolução recente no Brasil do trabalho remunerado feminino exercido no próprio domicílio ou simplesmente trabalho domiciliar. Quase 10% da população feminina ocupada, aproximadamente 4,5 milhões de mulheres, tem esse tipo de ocupação. Constatando a inexistência de estudos sobre o tema com dados quantitativos abrangentes, a presente pesquisa utiliza informações da Pesquisa Nacional por Amostras Domiciliares (PNAD) de 1992 a 2005 para analisar como evoluiu a proporção de trabalhadoras domiciliares no total da população ocupada. As mais importantes hipóteses delineadas na literatura a partir de estudos de caso são discutidas pela confrontação com os dados. Sob a ótica da demanda por essa forma de trabalho, analisa-se os setores que mais fazem uso do trabalho domiciliar feminino e as mudanças nessa composição, bem como sua relação com as transformações no mundo do trabalho decorrentes da reestruturação empresarial. Quanto à oferta por trabalho domiciliar, investiga-se como atributos individuais e familiares afetam as chances da mulher estar nesse tipo de condição de ocupação. É debatido como as transformações na inserção produtiva feminina afetaram a importância relativa do trabalho domiciliar. Constrói-se um modelo Logit Multinomial no Stata a partir dos dados da PNAD para comparar como mudou no tempo o impacto de cada atributo sobre a probabilidade de que uma mulher seja trabalhadora domiciliar. / This research investigates the determinants and recent developments of female home-based work in Brazil. Almost 10% of the occupied female population, approximately 4.5 million women, has this kind of occupation. Noting the lack of studies on the topic with comprehensive quantitative data, the present research uses information from PNAD beginning on 1992 until 2005 to evaluate how the proportion of female home-based workers on occupied population evolved. The most important assumptions outlined in the literature from case studies are discussed by confrontation with the data. From the perspective of demand for this type of work, sectors that intensively use female home-based work are analyzed, as well as its relationship with the changes in the labor market resulting from firms restructuring. On the supply of home-based work, it is investigated how individual and family attributes affect the chances of a woman to be in this work condition. It is discussed how the changes on female\'s productive insertion affected the relative importance of home-based work. A Multinomial Logit model is built on Stata using the data from PNAD to compare how the impacts of each attribute on the probability of a woman being home-based worker changed over time.

A estimulação somatossensitiva através da estimulação repetitiva de nervos da mão parética é uma abordagem promissora na recuperação motora do membro superior de pacientes com acidente vascular cerebral (AVC) na fase crônica e habitualmente é realizada em ambiente hospitalar. A dificuldade de comparecimento frequente de pacientes com AVC ao hospital pode prejudicar a implementação desta estratégia terapêutica em nosso meio. A reabilitação domiciliar pode ser uma alternativa interessante, além de ser menos dispendiosa do que a reabilitação hospitalar. O atual estudo teve como objetivo principal verificar a melhora em desempenho na função do membro superior parético após uma intervenção de estimulação somatossensitiva associada a treino motor, em ambiente domiciliar. Foi realizado um ensaio clínico aleatorizado, com mascaramento duplo e dois tipos de intervenção: ativa ou controle. Os pacientes do grupo ativo foram instruídos a utilizar um dispositivo de estimulação elétrica do nervo mediano, por duas horas. Os pacientes do grupo controle também foram instruídos a usar o dispositivo durante duas horas, porém sem que houvesse estimulação do nervo. Imediatamente após a utilização do dispositivo, todos os pacientes foram orientados a realizar um treino motor baseado no teste de Jebsen-Taylor. O tratamento foi realizado diariamente, ao longo de um mês. O desfecho primário foi o efeito da estimulação somatossensitiva (ativa versus controle) associada a treino motor sobre a melhora da função do membro superior parético avaliada pelo teste de Jebsen-Taylor. Os desfechos secundários foram: 1) melhora na independência funcional, avaliada pela Medida de Independência Funcional (MIF); 2) aderência às intervenções propostas, avaliada através de registros em uma agenda, e de relatos orais dos pacientes; 3) eventos adversos decorrentes dessas intervenções. O desempenho no teste de Jebsen-Taylor e na Medida de Independência Funcional (MIF) foi avaliado antes das intervenções (D0), ao seu término (D30) e quatro meses após o seu término (D150). Para a comparação da melhora em desempenho no teste de Jebsen-Taylor e da melhora em pontuação na MIF no grupo ativo e no grupo controle, foi utilizada análise de variância com medidas repetidas (ANOVAMR) com fatores grupo (ativo e controle) e tempo (D30 e D150). Foi observado um efeito significativo de grupo (F=5,02; p=0,038) na ausência de efeitos significativos de tempo ou interação grupo*tempo (p>0,05) em relação à melhora em desempenho no teste de Jebsen-Taylor. Não houve diferenças estatisticamente significantes entre os grupos em relação à pontuação na MIF após o tratamento. O grupo ativo apresentou maior aderência ao tratamento do que o grupo controle, porém esta conclusão foi baseada em informações fornecidas pelos pacientes, sem observação direta da pesquisadora. Não observamos eventos adversos relevantes. Este estudo é pioneiro por demonstrar efeitos benéficos, em longo prazo, da estimulação somatossensitiva associada a treino motor realizado em ambiente domiciliar, sem a supervisão de um terapeuta. Para a realização de estudos futuros, sugerimos algumas modificações em relação ao protocolo de estimulação somatossensitiva e treino motor, assim como combinações da técnica utilizada a outras técnicas de neuroestimulação / Somatosensory stimulation in the form of peripheral nerve stimulation is a promising strategy to improve motor function of the upper limb in chronic stroke patients and is usually administered in research laboratories. The usual difficulty in commutting to and from the hospital in a regular basis at short intervals of time is an obstacle for implementation of this therapeutic approach in our country. Home-based rehabilitation may be an interesting alternative, in addition to being less expensive than hospital-based rehabilitation. The current study aims to evaluate the improvement in performance of the paretic upper extremity after an experimental intervention consisting of somatosensory stimulation associated with motor training, performed at home. This study is a randomized, double-blind clinical trial, with two different types of interventions: active or control. Patients in the active group were instructed to use a device of electrical stimulation of the median nerve, for two hours. Patients in the control group were also instructed to use the device for two hours, and sham stimulation was administered. Immediately after the use of the device, all patients were instructed to train tasks that are part of the Jebsen-Taylor test. Treatment was performed daily, for one month. The primary outcome was improvement in performance of the paretic hand, evaluated by the Jebsen-Taylor test. Secondary outcomes were: 1) improvement in the Functional Independence Measure (FIM); 2) compliance with the proposed interventions, assessed through a daily written log, and oral reports of the patients; 3) possible adverse events from these interventions. Performance in the Jebsen-Taylor test and FIM scores were assessed before the interventions (D0), immediately after its end (D30) and four months after its end (D150). Analysis was performed with repeated- measures ANOVA (ANOVARM) with factors GROUP (active and control) and TIME (D30 and D150). Regarding Jebsen-Taylor test improvement, there was a significant effect of GROUP (F=5.02; p=0.038) in the absence of significant effects of TIME or interaction GROUP*TIME (p>0.05). There were no significant differences in FIM scores in either group after treatment. Compliance with treatment was greater in the active than in the control group, but conclusions about this finding are limited because data were collected solely based on information provided by patients. No relevant adverse events were observed. This study pioneered home-based somatosensory stimulation combined with motor training, without direct supervision of a therapist. We suggest changes to be made in the protocol in future studies, as well as investigation of effects of somatosensory stimulation combined with other neurostimulation techniques

Magister Human Ecology - MHE / In many developing countries including South Africa, there is an overwhelming number of people infected with HIV/AIDS in the hospitals, which the health care workers are unable to cope with. Therefore, an urgent need to develop alternative community based activities such as support groups, home based care programs and placement of orphans, for the provision of social health care services to the HIV client, arises. However, a deeper understanding of the challenges facing community organizations when providing home based care is crucial and necessary in order to formulate effective and relevant care services. The aim of the study was to explore the challenges faced by Umtha elanga Community Organization (UWCO) in the provision of HIV/AIDS home based care. The objectives of the study were to assess the current home based care of the UWCO and to explore the challenges that community based organizations have to face when providing care services to people being infected and affected by HIV/AIDS. The research design undertaken was the case study of UWCO. The qualitative approach with in-depth interviews with the management staff and home based caregivers was utilized. Data analysis began immediately after the interviews by transcribing and translating the audio-taped data. Thematic analysis was used in which data was coded and categorized. The findings of the research indicated that the home based care programme assists PLWHA clients in their natural home setting. All home based carers work voluntary and get supported by the organization as ell as by the department of social development and health such as the social workers. Finances appear to be, both for the organization and the home based carers, a huge hindrance. Research indicated that the organization experiences various challenges to provide the service to their community. It is recommended that Government must ensure that home based care workers get recognition, credit and support for their valuable contribution. Training for HBC employers needs to be extended to expose and add more skills. This will ensure that they are equipped for their tasks. Home based care workers must become registered and paid better salaries by the government. / South Africa

Bien que l’innocuité de la pratique de l’activité physique (AP) ait été acceptée dans les myopathies y compris dans les dystrophies, il existe très peu de preuve de pertinence dans la littérature. Ce travail de thèse a permis d’apporter pour la première fois les preuves confirmées de l’innocuité et des effets bénéfiques de la thérapie par l’exercice dans le cadre de la dystrophie facio scapulo humérale. Ceci à travers une vision intégrée de ces bénéfices potentiels émanant d’évaluations conjointes fonctionnelles, tissulaires et de qualité de vie. Deux groupes ont été formés par randomisation : groupe contrôle (CG : 44 ± 10ans) et groupe entraîné (TG : 40 ± 13ans). Au terme de 24 semaines d’un entraînement mixte adapté, supervisé et coaché à domicile, les bénéfices fonctionnels importants ont été rapportés notamment en terme de capacité aérobie (VO2pic, PMA), de force (MVC) suivi d’une augmentation de la surface de section (CSA) des fibres musculaires, de fonction musculaire (endurance musculaire, TM6) et de fatigue ressentie par les patients. L’absence de dommages musculaires et la forte tendance à l’amélioration de la qualité de vie confortent l’idée de l’innocuité de notre programme d’AP. La biologie du muscle révèle aussi des améliorations de l’activité de certains enzymes du métabolisme oxydatif (CS et CK). En somme, ce programme d’entraînement mixte, supervisé et coaché à domicile a permis d’aboutir à des améliorations fonctionnelles, tissulaires et de qualité de vie, ce qui ouvre des perspectives d’application à d’autres types de myopathies / Although it is now accepted that physical activity (PA) is not deleterious in myopathies, including muscular dystrophies, there is very little evidence of relevance in the literature. This thesis has allowed to provide for the first time, confirmed evidence of safety and beneficial effects of exercise therapy in FSHD, through an integrative view of the potential benefits of such programs on functional, biological and quality of life. Two groups were randomly formed: control group (CG: 44 ± 10 years) and trained group (TG: 40 ± 13 years). After 6-month of adapted and home-based training, benefits have been reported particularly in terms of aerobic capacity (VO2pic, PMA), strength (MVC) followed by an increase in cross-sectional area (CSA) of muscle fibers, muscle function (muscle endurance, 6MWT) and fatigue experienced by patients. The lack of muscle damage (HES analysis & plasma CK values) and the strong tendency to improving the quality of life, support the idea that our training program is safe. Muscle biology also shows improvements in the activity of some oxidative enzymes (CS and CK). In short, this home-based mixed training program has allowed to achieve functional, tissue and quality of life improvements, which opens perspectives for application to other types of myopathies

Due to the COVID19-pandemic many companies and organisations in Sweden have changed their ways of working from location dependent to teleworking. It has been discussed if flexible working conditions benefits or disadvantages workers possibilities to balance work life and family life. Previous research show that women and men traditionally have been responsible for different parts of the unpaid work at home. Studies also show that women tend to spend more time on unpaid work than men. The purpose of this study is to examine if and how the increase of teleworking, as a result of the pandemic, is perceived to have changed the boundaries between work life and family life. The purpose is also to examine whether the experience of the conflict between work and family life has changed due to the pandemic. The aim of the study is also to examine if the distribution of unpaid work is perceived to have changed. The results of the study are based on the answers from qualitative interviews of four women and three men who were teleworking as a result of the pandemic. The results of the study indicate that the responsibility for the boundaries between work life and family life has shifted from the employer to the employee. The conflict between work life and family life is expressed in different ways and has to some extent changed as a result of teleworking. When and how the unpaid work is performed has changed but the distribution between the sexes seems to be the same as before. The social aspect seems to be an important factor for the wellbeing and is lacking in this new way of working. / Till följd av COVID-19-pandemin har många företag och organisationer i Sverige ändrat sin verksamhet från platsberoende till arbete på distans. Det har diskuterats huruvida flexibla arbetsförhållanden gynnar eller missgynnar arbetstagarens möjligheter att balansera arbetsliv och familjeliv. Tidigare forskning visar att kvinnor och män traditionellt sett har ansvarat över olika delar av det oavlönade arbetet i hemmet. Samtidigt visar studier att kvinnor lägger mer tid på oavlönat arbete än män. Syftet med denna studie är därför att undersöka om och hur det ökade distansarbetet till följd av pandemin upplevs ha förändrat gränsdragningen mellan arbetsliv och familjeliv. Syftet är även att undersöka om upplevelsen av konflikten mellan arbete och familj har förändrats till följd av pandemin. Syftet med studien är dessutom att undersöka om fördelningen av det oavlönade arbetet upplevs ha förändrats. Studiens resultat baseras på svaren från kvalitativa intervjuer med fyra kvinnor och tre män som arbetar på distans till följd av pandemin. Studiens resultat tyder på att ansvaret för gränsdragningen mellan arbetsliv och familjeliv har förflyttats från arbetsgivaren till arbetstagaren. Konflikten mellan arbetsliv och familjeliv tar sig i uttryck på olika sätt och har till viss del förändrats till följd av distansarbetet. När och hur det oavlönade arbetet utförs har förändrats, men fördelningen mellan könen verkar vara densamma som innan. Den sociala aspekten verkar vara en viktig faktor för välbefinnandet som saknas i och med det nya arbetslivet.

The low literacy levels achieved by deaf children are of ongoing concern to educators and researchers alike. The present research considered emergent literacy as one aspect to consider in the acquisition of literacy skills in deaf children. The aim of this research was to describe the home-based literacy experiences of severely to profoundly deaf pre-schoolers as provided by their hearing parents. Parents of twenty-nine pre-school deaf children from schools for the deaf were selected to complete a questionnaire. The questionnaire was developed based on the four identified literacy contexts: the physical and functional context, the language context, the affective context and the educational context. The results obtained indicate that the deaf children in this survey are exposed to literacy-rich home environments where they are able to observe literate adult role models. Limitations in the quantity and quality of text-based interaction between the deaf pre-schoolers, their hearing parents and older siblings were identified. The results also indicated that the parents who participated in this research regarded the development of language and communication as more important than the early acquisition of literacy skills. The parents assigned the greatest responsibility in teaching literacy skills to teachers. This study highlights the sensitive nature of early literacy and language learning in young deaf children. Suggestions for further research are presented. / Dissertation (M(Augmentative and Alternative Communication))--University of Pretoria, 2005. / Centre for Augmentative and Alternative Communication (CAAC) / unrestricted

Background The Parent-Infant Home Visiting Programme (PIVHP) is a home-based parenting programme targeted at new and expectant mothers, characterised as vulnerable. Participants are recruited from low-income communities situated on the Cape Flats, in Cape Town, South Africa. The programme consists of antenatal and postnatal sessions, facilitated by trained Parent Infant Attachment Counsellors (PIACs) recruited from target communities. There are two programme cycles per year: one from January to June, and a second one from July to December. The overarching goal of PIHVP is to contribute towards the prevention of child abuse, abandonment and neglect; and to promote positive infant growth and development. The programme has to date not been guided by an explicit theory of change (TOC). There was no Monitoring and Evaluation (M&E) system in place, at the time of the evaluation, either. The programme engages in extensive data collection for administrative purposes. This data, however, is not captured nor analysed systematically to monitor progress or measure impact. This formative evaluation aims to capitalise on the existing data. Evaluation Focus This evaluation focused on the first 2019 programme cycle. The main objective of this evaluation was to determine the extent to which the PIHVP had been implemented with fidelity. As such, a process evaluation was conducted to address the following evaluation questions: 1. Did the PIHVP beneficiaries recruited for the first 2019 programme cycle meet the eligibility criteria specified by programme? 2. What proportion of participants completed and dropped out of the PIHVP during the first programme cycle of 2019? What are the reasons provided for programme dropout? questions: 3. To what extent did the PIHVP meet its targeted number of participants? What are the reasons for over/under coverage? 4. Did the participants receive the home-visiting sessions at the duration and frequency prescribed by the programme model? 5. Did PIACs complete and conduct all programme activities, developmental screenings and demonstrations as intended? 6. How did participants perceive PIACs in terms of the support they provided and their preparation level, knowledge, and reliability? 7. To what extent do PIACs implement the skills acquired through their training into their sessions? 8. Are the participants satisfied with the service they received? What are the strengths and limitations they identified? 9. To what extent did participants engage with the PIACs (around the content) during home-visit sessions? Methodology The evaluator first extracted and refined the programme's TOC through structured consultations with the programme manager. The plausibility of the PIHVP's programme theory was then assessed through an extensive literature review. The evaluator then proceeded with the process evaluation. A mixed methods approach was used, as combination of both primary and secondary data sources, and quantitative and qualitative data analysis were used to systematically answer the evaluation questions.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Child abuse remains a serious health problem in the U.S. Yet, there are preventative programs that can significantly improve the parenting experienced by very young children and result in lower incidence of maltreatment. Home visitation is the most prevalent and successful form of primary prevention. These programs are staffed by home visitors who empower parents and are the lynchpin of home visitation programs. What makes some home visitors excel at this work is the focus of this research. A small, non-random, purposive sample of excellent home visitors and their administrators was used to learn about the personal characteristics of outstanding home visitors. The mixed methods design of this research included qualitative interviews, home visiting situational vignettes, and quantitative tests of personality attributes. The results indicated that this group of outstanding home visitors possessed important similarities. First, the home visitors were effective at forming and maintaining empathic relationships. The variables that facilitate the formation of the therapeutic relationships between home visitor and client include: (a) “good enough empathy” (need not be extraordinarily empathic but at least averagely so), (b) positive regard (showing respect to the families and recognizing that the parent is the expert on their child), and (c) congruence. Secondly, the home visitors possessed self-awareness allowing for reflective practice and forming and maintaining better client relationships. Thirdly, the excellent home visitors possessed an attitude of lifelong learning. Fourthly, the home visitors strongly believed in the ability of their clients to change. This was accomplished by focusing on client strengths. Finally, in order for the home visitors to assist parents in therapeutic change, they had a belief in and understanding of systems theory and the impact that the environment can or has had on those clients. Without an ecological approach, home visitors are likely to blame the families with which they work for their unfortunate situations such as poverty. Each of the five characteristics can be taught and improved, but entrenched beliefs are less easily manipulated. The five characteristics are ordered with the first (effective at forming relationships) the most amenable to change and the last (an ecological approach) the least.