A Organização Mundial de Saúde (OMS) definiu a qualidade de vida como a percepção do indivíduo sobre si, no contexto de valores em que vive e em relação a: metas, expectativas, parâmetros e relações sociais. O objetivo do estudo foi realizar a equivalência dos instrumentos de qualidade de vida (University of Washington - Quality of life (UW-QOL), Brief Core Set Questionnaire - Head and Neck - BCSQ H&N), em pacientes com câncer de boca, diagnosticados na Liga de Neoplasia Bucal (LINB) e o Oral Health Impact Profile (OHIP-14) para pacientes que buscaram por atendimento de urgência, com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Foram entrevistados 50 pacientes atendidos pela Liga de Neoplasias da FOUSP e 100 pacientes do Setor de Urgências da Clínica Odontológica da FOUSP. Os escores de cada instrumento foram pontuados e, em seguida, verificou-se a frequência de ocorrência dos domínios. As categorias mais frequentes nos instrumentos de qualidade de vida UW-QOL, foram: b152 (Ansiedade - Funções Emocionais), b510 (Funções de ingestão - saliva), b250 (Função gustativa). No questionário BCSQ H&N, as categorias mais frequentes foram: b510 (Funções de ingestão), b310 (Funções da voz) e b152 (Funções emocionais). No questionário OHIP-14, as categorias mais pontuadas foram: b280 (Sensação de dor), b152 (Funções emocionais) e b130 (Funções da energia e dos impulsos - Atividade). Foi observada equivalência entre os domínios dos instrumentos de qualidade de vida e a CIF. Assim, a CIF constitui instrumento útil para avaliar a real situação de saúde do paciente, além dos aspectos clínicos. / The World Health Organization (WHO) defined quality of life as the perception of the individual in his life, in the context of values in which they live and in relation to their goals, expectations, parameters and social relations. The objective of the study was to perform the equivalence of quality of life instruments, University of Washington - Quality of Life (UW-QOL), Brief Core Set Questionnaire - Head and Neck (BCSQ H&N) in patients with diagnosed oral cancer in the League of Oral Neoplasms (LINB); and the Oral Health Impact Profile (OHIP-14) for patients who sought for emergency care, with the International Classification of Functioning, Disability and Health (ICF). Fifty patients from the Oral Neoplasms League and 100 patients from the Urgency Clinic at FOUSP were interviewed. Each instrument\'s scores were registered and the occurrence frequency of each domain was verified. The most frequent categories of instruments in quality of life UW-QOL were: b152 (Anxiety - Emotional functions), b510 (Ingestion functions - saliva), b250 (Taste function). At BCSQ H&N the most frequent categories were: b510 (Ingestion functions), b310 (Voice functions) and b152 (Emotional functions). In the OHIP-14 questionnaire, the highest scoring categories were: b280 (Sensation of pain), b152 (Emotional functions) and b130 (Energy and drive functions - Activity). Equivalences was observed among the instruments´ domains and ICF. Thus, ICF is a useful tool to perform real evaluations on the patients´ health, adding information to the clinical aspects.

Orientador: Maria Ines Rubo de Souza Nobre / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T06:28:15Z (GMT). No. of bitstreams: 1 Zimmermann_AnaBeatriz_M.pdf: 1435162 bytes, checksum: b4c9ce47e60113462690e7d8723f2d96 (MD5) Previous issue date: 2012 / Resumo: A Medida Canadense de Desempenho Ocupacional (COPM) foi criada para favorecer uma prática centrada no cliente, tendo como foco a autopercepção da pessoa sobre seu desempenho ocupacional. Avaliações padronizadas são cada vez mais utilizadas no âmbito da reabilitação, no entanto, a maioria dos instrumentos buscam favorecer a independência em atividades pré-estabelecidas, baseadas no que é esperado pela sociedade, podendo não contemplar necessidades individuais dos clientes. Atividades e Participação são aspectos centrais da Terapia Ocupacional e os terapeutas ocupacionais reconhecem que o envolvimento e o desempenho ocupacional contribuem e apoiam à saúde. O modelo proposto na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), em 2001, reconhece a influência das atividades e participação, assim como dos fatores contextuais e funções e estruturas do corpo na condição de saúde. Tem-se por objetivo verificar a autopercepção do desempenho ocupacional por meio da COPM em usuários adultos e idosos de um centro de reabilitação no estado do Paraná e classificar os problemas de desempenho ocupacional segundo a CIF. Realizou-se um estudo descritivo com usuários acometidos por lesão medular ou lesão encefálica adquirida em processo de reabilitação entre o período de agosto/2010 a fevereiro /2011. A COPM foi aplicada por meio de entrevista semiestruturada e os problemas de desempenho ocupacional identificados pelos 28 usuários foram classificados segundo a CIF. Entre os 122 problemas classificados, houve maior frequência nos seguintes domínios do componente Atividade e Participação: Mobilidade (36%), Vida Comunitária Social e Cívico (24%) e Cuidado Pessoal (15%). Sugere-se que dificuldades relacionadas a Vida Comunitária, Social e Cívica são mais frequentes dependendo do tempo de lesão e do contexto de tratamento. Percebe-se a abrangência e variedade de problemas identificados por meio da COPM pode colaborar no processo de reabilitação com o estabelecimento de objetivos mais congruentes às demandas e experiências de vida diária dos clientes. Tem-se o desafio de se construir e conduzir práticas de saúde na área de reabilitação à pessoa com deficiência em conjunto com outros setores, ampliando nosso olhar de forma a contemplar as várias dimensões da funcionalidade humana. A classificação dos problemas de desempenho ocupacional de acordo com a CIF pode favorecer a comparação entre estudos que utilizam diferentes instrumentos de avaliação e que por vezes possuem terminologias distintas. Por outro lado, há desafios no processo de codificação no tocante a utilização de categorias abrangentes e inespecíficas para atividades e situações não tão comuns, pois permite interpretações variadas entre os usuários da CIF / Abstract: In the context of rehabilitation, standardized assessments are being more utilized in order to evaluate the impact of the impairment on the individual's daily routine. Most of the assessment instruments focus on favoring the independence on predefined activities, based on what is expected by society, and may not be meeting the client's individual needs. The COPM was created to facilitate a client-centered practice, allowing the client to identify his/her own limitations and restrictions lived on the occupational performance. The model proposed on CIF (International Classification of Functionality, Impairment and Health) in 2001 states that environmental and personal factors, activities and participation, body functions and structures, and health conditions are in dynamic interaction, so that any modifications in one of these components have the potential of generating changes on the others. Activity and participation are core aspects of occupational therapy. Occupational therapists recognize that the involvement and occupational performance contributes and promotes health. One of the goals is to verify self-perception of the occupational performance through COPM on adults and elderly from a rehabilitation center in the state of Paraná and classify the problems of occupational performance in CIF. A descriptive study was performed on users stricken by spinal cord injury or brain injury, obtained during the rehabilitation process between August of 2010 and February of 2011. COPM was applied through semi-structured interviews and the problems of occupational performance identified by 28 participants were classified in CIF. Among the 122 problems of occupational performance classified in CIF, there was a greater frequency on the following domains of the Activity and Participation component: Mobility (36%), Community, Social and Civic Life (24%) and Personal Care (15%). It is suggested that the difficulties related to Community, Social and Civic Life are more frequent depending on the time of injury and on the treatment context. It is noticed that the scope and variety of problems identified through COPM can collaborate in the process of rehabilitation, with the setting of objectives that are more congruent with the demands and experiences of the clients' daily lives. There is a challenge of building and conducting health practices on the area of rehabilitation to the person with disability along with other sectors, expanding our view in order to contemplate the various dimensions of human functionality. The classification of occupational performance problems in CIF can favor the comparison between studies that utilize different evaluation instruments and that sometimes have distinct terminologies. On the other hand, there are challenges related to the selection of codes: comprehensive and non-specific items can facilitate the classification of uncommon and unlikely elements, but at the same time can generate semantic accumulations and increase disagreements on the choice made by the evaluators / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

There are many tools available for the study of post-translational modifications. The majority of these tools is specific towards the individual modification and involves separation of modified proteins from non-modified ones. The drawback of using a modification specific method is that there is a lack of flexibility in its usage for other modifications. The goal of these studies was to investigate the possibility of obtaining a similar separation effect by fractionating post-translationally modified proteins based on the physical properties of proteins. The post-translational modification chosen to be the basis of this study was the O-GlcNAc modification. Using the C2C12 mouse myoblast cell line, it was determined that the optimal conditions for producing lysates containing increased yields of O-GlcNAc modified proteins was to treat differentiated C2C12 cells with 10nM insulin, 12g/L glucose and 2mM of the O-GlcNAcase inhibitor Streptozotocin for 24 hours. Using the optimized lysis buffer, it was shown that protein separation by surface charge using standard anion exchange separation did not provide enough resolution or material to obtain any identifications of modified proteins. However, when a chromatofocusing method which separates proteins on the basis of their isoelectric points was used, a separation scheme with larger capacity and higher resolution was possible. Using this separation method followed by gel electrophoresis of individual fractions, proteins which are potentially O-GlcNAc modified were identified by mass spectrometry. It was evident from the number of protein bands observed per fraction on the Coomassie stained gels and the number of proteins identified per protein band by mass spectrometry that further reduction in sample complexity was required to assist in the positive identification of O-GlcNAc modified proteins. Among the identified proteins, 32 percent were metabolic proteins, 21 percent were protein processing proteins, 16 percent were structural proteins and the remainder a mix of other proteins. Unfortunately, it was not possible to validate the presence or absence of the O-GlcNAc modification on these proteins using available methodologies such as immunoprecipitation. As such, further work is required to optimize the separation strategy and to verify the usefulness of this separation strategy in identifying O-GlcNAc/post-translationally modified proteins. / Medicine, Faculty of / Medicine, Department of / Experimental Medicine, Division of / Graduate

Falls are the primary cause of injuries among older adults, and accidents that result from falls can lead to personal suffering and extensive societal burdens. The overall aims of this thesis were to explore and describe falls and fall prevention strategies in community-dwelling older adults and to evaluate a fall prevention home exercise program, the Otago Exercise Program (OEP), with or without motivational interviewing (MI). Methods: Qualitative and quantitative research methods were uses. The designs were as follows: a cross-sectional, descriptive and comparative study (study I); a descriptive feasibility investigation (study II) and a randomized controlled trial (RCT) with two interventions, the OEP and OEP+MI, as well as a control group, with a 12-month follow-up (study III); and a prospective and descriptive study (study IV). The four studies comprised community-dwelling individuals aged 75 years or older. Study I included 262 individuals and studies II-IV had 175 participants who needed walking aids or home support. Study II also included 12 physical therapists.  Data collection was performed via self-reported questionnaires, fall calendars, exercise diaries, physical performance tests and a semi-structured questionnaire.  Results and conclusions: Suggested actions to prevent falls significantly differed between high and low active older adults (study I). Support for self-directed behavioral strategies could be important for preventing falls in older adults who have low physical activity levels. The study protocol for the RCT had acceptable feasibility (study II), and only minor changes of the protocol were needed. There were no benefits for OEP or OEP+MI with personal support implemented nine times over the 12-month period. However, all groups maintained physical functioning and activity (study III). To increase physical functioning and reduce falls in this sub-group of older adults, more frequent personal support and/or an alternative delivery format may be required for efficient intensity and challenge in home exercises. Over 12 months, falls and fall-related injuries in the RCT sample were the most common when moving around within the home and transitioning from sitting to standing (study IV). Special attention to these activities might be important for preventing falls in community-dwelling older adults who need walking aids or home support.

Les propriétés radiatives sont d'une importance cruciale lors de l'étude des plasmas astrophysiques et de fusion, particulièrement dans des conditions hors équilibre thermodynamique local (hors-ETL). C'est pourquoi nous avons développé un modèle collisionnel-radiatif, capable de calculer les propriétés radiatives en toutes conditions de température et de densité. Nous avons intégré à ce modèle de nouveaux facteurs de Gaunt développés par nous-mêmes. Ces facteurs permettent d'obtenir des sections efficaces des processus atomiques plus précis que les formules classiques et semi-empiriques, nécessaires au calcul des populations atomiques. Ils ont été obtenus en utilisant des méthodes sophistiquées, telles que les méthodes distorted-wave et generelized-line-strength, à l'aide du code FAC. Dans le but de valider nos résultats, nous les avons comparés dans un premier temps, aux calculs de Hill et Rose d'un plasma composé d'un mélange de carbone et de 5% de silicium, dans des conditions ETL et hors-ETL. Les résultats sont très satisfaisants, aussi bien à l'ETL qu'hors-ETL. Nous avons aussi comparé nos résultats à la transmission mesurée par Xiong et al. d'un plasma de silicium à Te = 72 eV et Ne = 1.3 x 10²¹ cm⁻³. Là encore, nous obtenons un bon accord. Cependant, on constate la présence de quelques écarts au niveau du décalage spectral de certaines raies, ainsi que l'absence de certaines transitions. Cette absence peut s'expliquer par certaines configurations électroniques manquantes dans le calcul de structure atomique. Nous nous sommes aussi intéressés à l'absorption d'un mélange de carbone et de 5% de germanium avec un nombre restreint de configurations électroniques. Nous avons exploré l'effet d'interaction de configurations ainsi que l'effet d'un champ radiatif. Nous avons également déduit des lois permettant de calculer rapidement les lois de Planck et de Rosseland. Ces lois concernent pour le moment le carbone, le silicium et le germanium, pour Te entre 250 et 350 eV et Ne entre 2 et 8 x 10²³ cm⁻³. / The radiative properties are of utmost importance when studying astrophysical and ICF plasmas, particularly in non local thermodynamic equilibrium conditions. This is the reason why we have developed a collisional-radiative model that enables us to calculate the radiative properties of plasmas under any temperature and density conditions. We developed and implemented new Gaunt factors to the CR model. These factors greatly improve the precision when calculating the cross sections of the microscopic processes. These cross sections are required to calculate the populations of the atomic levels. We obtained these new factors by using the distorted-wave and generalized line strength methods of the Flexible Atomic Code (FAC).In order to validate our new-developed CR model, we compared our results to those of Hill and Rose, of a plasma composed of carbon and 5% silicon, in LTE and NLTE conditions. We obtained satisfactory results in both conditions. We also compared our results to the experimental transmission measured by Xiong et al., of a pure silicon plasma, with Te = 72 eV et Ne = 1.3 x 10²¹ cm⁻³. Again, we obtained results that are in good agreement with the measured spectrum. However, we noticed some discrepancies in the line shift of some lines, and some missing transitions. This can be explained by the absence of certain electronic configurations in the calculation of the atomic structure with the Cowan atomic code.We also explored the absorption of a plasma composed of carbon and 5% germanium with a restricted number of electronic configurations. We investigated the effect of configuration interaction and the effect of the radiative field. We also developed new laws that predict the Planck and Rosseland mean opacities very quickly. For the time being, these laws work for carbon, silicon and germanium, with Te between 250 and 350 eV, and Ne between entre 2 et 8x10²³ cm⁻³.

It is widely acknowledged that a team approach is preferred practice and contributes to optimizing the surgical, dental, speech and psychosocial outcomes for individuals with cleft lip and palate (CLP).Young adulthood often marks the transition from child-centered interdisciplinary care to adult-centered care. There is a paucity in literature relating to the transition of care for young adults with CLP. The purpose of this survey research is therefore to explore the CLP team practices regarding young adults with CLP. An exploratory, descriptive design with quantitative analysis was used to explore what services are provided by CLP teams to young adults with CLP. An exploratory design was deemed appropriate due tolimited research available on the provision of team services for young adults with CLP. An online survey was used as the method of data collection to determine the number of teams providing services to this population, the types of services provided, and the perceived needs of young adults receiving CLP team services. 71 participants of (18.4%) responded to the survey. The low response rate is typical of survey research, despite three invitations to participate. However, the topic elicited global responses, from North America, South America, Europe, Asia and Australia, which is indicative of the importance of transition of care for young adults with CLP. 46 Participants responded to the question regarding their perceived needs of young adults with CLP. It appears that the characteristics of young adults with CLP (i.e., appearance, self-acceptance, social attitudes, social experiences, employment, starting a family, hearing and speech) are perceived to occur universally and that concerns about appearance is most frequent, followed by speech were important needs recognized by the teams. 56% of teams that responded to that they discharge young adults between 18-22 years, which confirms the expected results. However, an unexpected finding is that 37% of team’s complete treatment or never discharge patients. 35.5% of the respondents described the services provided, which existed of plastic and reconstructive surgery (98%), oral and maxilla facial surgery (86%), orthodontics (90%) and speech therapy (78%) with 50% indicating that they also provided other services. This confirms the perceptions of the needs of young adults with CLP since the high frequency of surgery and orthodontics address the concerns regarding appearance and speech therapy addresses the frequently perceived concern regarding speech. Continued team care is crucial for young adults with CLP to address their adult needs and improve their QoL.The results from this survey research will increase awareness of the importance of the transition from child to adult team care. Recommendations for further research will be discussed.

Bakgrund: Personer Cerebral pares är en heterogen grupp med skilda upplevelser av att leva med en kropp som inte fungerar som andras. Forskning har utförts på vad personer med Cerebral pares i olika åldrar har för erfarenhet av fysioterapi och fysisk aktivitet. Däremot saknas det en litteraturöversikt inom området som skulle kunna ge en djupare insikt i vad personer med Cerebral pares anser om fysioterapi och fysisk aktivitet samt faktorer som motiverar eller hindrar till detta.  Syfte: Syftet med den systematiska litteraturöversikten var att var att sammanställa tidigare utförda kvalitativa studier som undersöker vad personer med Cerebral pares har för erfarenhet av fysioterapi och fysisk aktivitet, för att beskriva faktorer som motiverar eller hindrar utförandet av fysioterapi och fysisk aktivitet, enligt ICF:s ramverk. Metod: Studien genomfördes i form av en systematisk litteraturöversikt med stöd av ENTREQ guidelines. Sökningar utfördes i databaserna PubMed och CINAHL. Inkluderade studier analyserades, kvalitetsgranskades och sammanställdes slutligen med hjälp av en deskriptiv analys, för att beskriva faktorer som motiverar eller hindrar utförandet av fysioterapi och fysisk aktivitet enligt ICF:s ramverk.  Resultat: Sökningarna resulterade i sex vetenskapliga artiklar med kvalitativ ansats. Faktorer som personer upplevde vara hinder i samband med fysioterapi och fysisk aktivitet kunde vara att leva i en kropp som inte fungerar som andras eller att inte bli accepterad av personer utan funktionsnedsättning. Samtidigt kan fysioterapi och fysisk aktivitet bidra till en känsla av frihet, självständighet och förverkligande av personliga mål. Bland unga kan det vara diffust att förstå vikten av den fysioterapeutiska interventionen, då det av föräldrar och vårdprofession ofta sätts i en komplex kontext. I vuxen ålder kan det vara lättare att ha förståelse för behovet av kontinuerlig träning och behandling. Konklusion: Resultatet visar delade åsikter om vad som motiverar eller hindrar utförandet av fysioterapi och fysisk aktivitet. Bristande underlag inom forskningsfrågan gör att det här är ett relativt outforskat område. Vidare forskning bör därför fokusera ytterligare på undersökning av vad personer med CP har för erfarenheter av fysioterapi och fysisk aktivitet, vilket kan underlätta samt förbättra utformning av fysioterapeutisk intervention och patientmöte

Les personnes amputées de membre inférieur (PAMI) sont très diversifiées. Ils’agit d’une population hétérogène, tant par ses origines que par ses niveaux d’amputation, ses capacités et ses projets de vie. A ces profils variés s’ajoutent une multitude de composants prothétiques ainsi que les différentes combinaisons possibles entre ces composants. Il est également important de prendre en compte les différents environnements auxquels la PAMI est confrontée quotidiennement. La Classification Internationale du Fonctionnement (CIF 2001) a été créée par l’Organisation Mondiale de la Santé et repose sur un modèle multidimensionnel. Elle est constituée de deux grandes parties : le fonctionnement d’une part et les facteurs contextuels d’autre part. Ce modèle est capable de décrire de manière globale les modifications de fonctionnement (handicap) à partir d’un problème de santé quelconque. Ainsi, une grande quantité d’informations peut être obtenues à partir du modèle de la CIF. Néanmoins, il demeure nécessaire de développer de nouveaux outils pour mieux exploiter ce modèle afin de le rendre plus intelligible et utilisable en pratique clinique courante. Pour cela, nous nous proposons d’utiliser l’Extraction de Connaissances à partir des Données (ECD). L’ECD est un processus non trivial d'identification des structures inconnues, valide et potentiellement exploitable dans les bases de données, qui permet de transformer un maximum d’informations en connaissances facilement exploitables. A partir du modèle de la CIF et conjointement avec des méthodes d’ECD, l’objectif de cette thèse est de caractériser un groupe de PAMI expertes en termes de capacités locomotrices. Ce groupe et sa liste d’indicateurs pertinents reposant sur le modèle de la CIF ont été déterminés. Ils servent de référence pour la comparaison d’autres PAMI et peuvent guider la prise en charge de cette population particulière. / The subjects with a lower-limb amputation (LLA) compose a heterogeneouspopulation, by their amputation origins, by their amputation levels, by their abilities and by their life projects. To these various LLA’s profiles we could add a multitude of prosthetic components and the combination of these components. It is also important to take into account the different environments, which the LAA are confronted daily. The International Classification of Functioning, Disability and Health (ICF 2001) was created by the Word Heath Organization and is based on a multidimensional model. The ICF is constituted by two domains: the functioning on one hand and the contextual factors on the other hand. This comprehensive-global model is able to describe the functioning (disability) from any health problem. However it remains necessary to develop new tools to better use the ICF model making it more intelligible and useful in clinical practice. For this, we proposed to use the Knowledge Discovery in Database (KDD). KDD is a non-trivial process of identification of unknown, valid and potentially-exploitable structures in database. KDD permits to transform a maximum of information in easy-exploitable knowledge. From the ICF model conjoint with KDD methods, the aim of this thesis was to characterize an expert group of LLA in terms of locomotion capacity. This group and its list of relevant indicators, based on the ICF model, were determined. They can be used as a reference to compare with others LLA improving making decision of this particular population.

Heute werden gleiche Themen durch verschiedene Nutzer bearbeitet, deshalb entstehen unterschiedliche Darstellungen desselben Sachverhalts. Um eine einheitliche Repräsentation von Daten zu ermöglichen, werden Ontologien verwendet. Ontologien stellen einen strukturierten gerichteten Graphen dar, dessen Knoten und Kanten jeweils die Konzepte und Beziehungen innerhalb einer Domäne repräsentieren. In den Lebenswissenschaften existieren zahlreiche große Ontologien wie z.B. CHEBI, NCI Thesaurus (The National Cancer Institute Thesaurus), GO (Gene Ontology). Da die Ontologien weiterentwickelt und wiederverwendet werden sollen, ist es wichtig, eine einheitliche und verständliche Syntax zu verwenden.

Die Kürzung einer Rang-k-Matrix ist ein wichtiger Bestandteil der Technik der Hierarchischen Matrizen. In dieser Arbeit untersuchen wir zwei verschiedene Kürzungsalgorithmen auf ihre Parallelisierbarkeit. Zuerst werden wir die sequentiellen Versionen der Algorithmen einführen, ihre Komplexitat untersuchen und diese Ergebnisse in numerischen Experimenten validieren. Danach parallelisieren wir beide Algorithmen und untersuchen ihr Laufzeitverhalten theoretisch und anhand von numerischen Experimenten auf Rechensystemen mit verteiltem und geteiltem Speicher. Es zeigt sich, dass beide Algorithmen gut parallelisierbar sind, wobei wir bei Rechensystemen mit verteiltem Speicher die Anzahl der verwendeten Prozessoren an die Groesse der zu kuerzenden Matrix anpassen sollten, damit wir einen linearen Speedup erreichen.