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Background. Long-term sick leave is one of the main risk factors for permanent exit out of the labour market. The longer the duration of sickness absence, the less likely sick leave conclusion. Objectives and Methods. The aims were to analyse possible determinants of sick leave conclusion and their relative impacts, to analyse the properties of two models for the assessment of sick leave conclusion, to study the impact of a multidisciplinary vocational intervention for sick leave conclusion in a high-risk group for long-term sick leave compared to a matched-control group, and to compare the patients’ own assessment on chance to sick leave conclusion within 6 months with the assessment of a team of rehabilitation professionals. A prospective cohort study of 943 patients aged 18 to 63 years, sickness certified at a Primary Health Care Centre in Sweden during 8 months in 2004, and follow-up for three years. Results. Significant determinants increasing time to sick leave conclusion were number of sick leave days the year before baseline, age and a psychiatric diagnosis (F in ICD-10). Concordance between actual sick leave conclusion and that predicted by a computer-based model was 73-76% during the first 28-180 days in a manual model, and approximately 10% units higher in a computer based model. Three nomograms provided detailed information on the probability on sick leave conclusion. Before intervention started, the rehabilitation group had a 73% higher sick leave conclusion rate than the control group but during the rehabilitation programme period, a 51% lower conclusion rate, and after there were no significant differences between the groups. The patients’ and the rehabilitation teams’ assessment scores were highly correlated (r=0.49).   Conclusions. Previous sick leave was the most influential variable associated with sick leave conclusion. A computer- based assessment model gave more detailed information on sick leave conclusion than a manual model. A multidisciplinary intervention declined sick leave in a high-risk group for long-term sick leave but after intervention there was no difference between groups. Patients’ own view on sick leave conclusion was highly correlated to the assessment of professionals’.

Made available in DSpace on 2016-08-10T10:53:54Z (GMT). No. of bitstreams: 1 FLAVIO JOSE TELES DE MORAIS.pdf: 1122456 bytes, checksum: 159a6ab066ac93cad0aa91f4249b2987 (MD5) Previous issue date: 2012-03-14 / In children and adults obesity is normally associated with an inadequate diet, low physical activity and environmental or genetic factors. Individuals in this condition have a higher prevalence of cardiovascular risk factors, shown by their clinical history, physical exams or biochemical parameters, in addition to loss of quality of life. Ten multidisciplinary intervention sessions were conducted, involving 26 overweight families, chosen from an elementary school in Goiânia, Brazil. This investigation was divided in three studies. The first and second studies evaluate the quality of life of caregivers and children, the effect of the intervention on the Body Mass Index (BMI) and on the quality of life (QL), and the relationship between the QL and the BMI. The third study investigated the biochemical parameters of the 10 families with the higher BMIs before the multidisciplinary intervention, and the relationship between the results for caregivers and children. The children had average scores of 53.15 in the QV AUQEI scale before the intervention, with 15.38% having decreased QL. The effect of the intervention on the children s BMI ranged from 23.38 to 22.97kg/m² (p=0.07). Though all domains of the AUQEI improved after the intervention, there was no statistically significant change before and after the intervention (52.23 and 54.38). Significant correlations between the BMI and the QL were not found. In the caregivers, the obese had smaller averages before the interventions in the QL domains (functional capacity, general state of health and mental health), comparing to the caregivers with overweight in the SF-36. After the multidisciplinary intervention the caregivers showed statistical improvement in the QL domains (SF-36): vitality, social aspects and mental health. A statistical improvement was also found in the environmental domain through the WHOQOL-BREF tool. The relationship between QL and BMI showed that the psychological domain stood out, in which obese caregivers had lower averages than the overweight caregivers. The biochemical parameters measured were: glucose, insulin, reactive ultrasensitive protein C (PCR-US), lipidogram and hepatic transaminases. As result, 95% of the caregivers and children showed at least one alteration, with PCR-US and the HOMA/IR index being the most altered, calculated from glucose and basal insulin. The PCR-US was increased in 85% of the caregivers and children, and the HOMA/IR was above normality in 35% of the sample, emphasizing that an increase in the PCR-US levels were increased in 95% of the participants. 90% of caregivers had an increase in the abdominal circumference, 20% in the blood pressure and 10% in metabolic syndrome. No statistically significant relationships between the biochemical alterations of the caregivers with the children were found; though an increase in the PCR-US was found in 70% of the families in which the caregiver and the child had increased. We conclude that the multidisciplinary intervention contributed with a reasonable improvement in the QL of the participants, and the biochemical alterations signaled that the family unity is an indispensable tool for acquiring better habits and potential beneficial changes. / A obesidade em crianças e adultos tem sido associada a uma dieta inadequada, gasto físico diminuído com participação de fatores genéticos e ambientais. Indivíduos nesta condição possuem uma maior prevalência de fatores de riscos cardiovasculares evidenciados em história clínica, exame físico ou nos parâmetros bioquímicos (PB), além de prejuízos na qualidade de vida (QV). A presente investigação foi dividida em três estudos, mediante dez sessões de intervenção multidisciplinar envolvendo 26 famílias acima do peso de uma escola do ensino fundamental de Goiânia. Os objetivos do 1º e 2º estudos foram: avaliar a QV de cuidadores e crianças, o efeito da intervenção no índice de massa corporal (IMC) e na QV, além da relação entre QV e IMC. Os objetivos do 3º estudo foram investigar os PB das 10 famílias com maior IMC, antes da intervenção multidisciplinar, e a relação entre os resultados de cuidadores e crianças. Os resultados das crianças mostraram escores médios de 53,15 na escala de QV AUQEI antes da intervenção. Antes da intervenção, 15,38% das crianças apresentaram QV prejudicada. O efeito da intervenção no IMC das crianças foi de 23,38 a 22,97kg/m2 (p=0,07). Apesar da melhora em todos os domínios do AUQEI após a intervenção, não houve diferença estatisticamente significativa antes e após intervenção (52,23 e 54,38). Também não foram encontradas correlações significativas entre IMC e QV. Nos cuidadores, os resultados mostraram obesos com menores médias antes da intervenção, nos domínios da QV (capacidade funcional, estado geral de saúde e saúde mental), em comparação aos cuidadores com sobrepeso ao analisar o instrumento Short Form-36 (SF-36). Após o programa, os cuidadores apresentaram melhoria estatisticamente significativa nos domínios de QV (SF-36): vitalidade, aspectos sociais e saúde mental. Foi observada, também, melhoria estatisticamente significativa no domínio meio ambiente quando utilizado o instrumento WHOQOL-BREF. Na análise da relação entre QV e IMC, destacou-se o domínio psicológico, em que cuidadores obesos apresentaram médias menores que cuidadores com sobrepeso. Quanto aos PB, antes da intervenção foram mensurados: glicemia de jejum, insulina, proteína C reativa ultrassensível (PCR-US), lipidograma e transaminases hepáticas. E, como resultados, observou-se que 95% dos cuidadores/crianças apresentaram pelo menos uma alteração, sendo que a PCR-US e o índice HOMA/IR, calculado a partir da glicemia e insulina basal, foram os mais alterados. A PCR-US esteve aumentada em 85% dos cuidadores/crianças e o HOMA/IR esteve acima da normalidade em 35% da amostra, destacando-se que, em 95% dos participantes em que este índice esteve aumentado, concomitantemente, foi detectado aumento dos níveis da PCR-US. Observou-se, antes do programa, nos cuidadores, que 90% apresentaram aumento da circunferência abdominal, 20% aumento da pressão arterial e 10% de síndrome metabólica. Não foram encontradas relações estatisticamente significativas entre as alterações bioquímicas dos cuidadores com as crianças; entretanto, em 70% das famílias em que o cuidador apresentava aumento da PCR-US, esse aumento foi também observado na sua criança. Conclui-se que a intervenção multidisciplinar contribuiu com melhoria sensível na QV dos participantes, e as alterações bioquímicas evidenciadas apontaram a unidade familiar como ferramenta indispensável a melhores hábitos e potenciais mudanças benéficas.

The increasing prevalence of childhood obesity worldwide is viewed as a global epidemic (World Health Organization, 2010). It is associated with a variety of health problems as well as physical– (cardio–respiratory endurance, flexibility, muscular strength, muscular endurance, and body composition), and motor proficiency (fine manual control, manual coordination, body coordination, and strength–and–agility) (Asayama et al., 2003:644; Okely et al., 2004:242; Tokmakidis et al., 2006:870). As far as the South African context is concerned, there is little research examining these relationships and the effect of physical intervention there upon, in nine– to 12–year old children. The first and second objectives of this study were to determine whether obesity would influence the physical– and/or the motor proficiency of nine– to 12–year–old South African children. The third and fourth objectives of this study were to determine the effect of a multidisciplinary intervention on the physical– and the motor proficiency of nine– to 12–year–old obese children. For objectives one and two, a cross–sectional study was performed on 280 children (128 boys and 152 girls), with an average age of 10.6 years (±1.05). Anthropometric–, physical– and motor measurements were obtained by the 'Fitnessgram' (Meredith & Welk, 1999) and the 'Bruininks–Oseretsky Test of Motor Proficiency–II' (Bruininks & Bruininks, 2005). Body mass index (BMI) cut–off points were used to classify the children as normal, overweight, or obese (Cole et al., 2000). The data was analysed with regard to the above–mentioned objectives with the Statistica computer program, by means of descriptive statistics, Spearman rank correlations, and variance analyses. The results show that the physical fitness variables, cardio–respiratory endurance and muscular strength, particularly leg muscular strength, showed significant decreases with an increase in BMI. A progressive, but insignificant, decrease was found in muscular endurance with an increase in BMI, while flexibility showed the weakest relationship to BMI. The motor variables strength–and–agility weakened significantly with an increase in BMI, while fine manual control, manual coordination, and body coordination showed the weakest relationships to BMI. Variance analysis showed further significant relationships among BMI, cardio–respiratory endurance, muscular strength, and running speed–and–agility (p<0.05). It can be concluded that health–promoting physical fitness and the motor proficiency of young South African children are negatively influenced by obesity and intervention strategies are recommended to promote the quality of life of such children. For objectives three and four, an availability random sample of 37 experimental subjects, with an average age of 11 years (±0.99) was taken, where 20 subjects (seven boys and 13 girls) took part in a multidisciplinary intervention programme, and 17 subjects (six boys and 11 girls) formed part of a control group. Body composition, physical–, and motor proficiency were analysed by the 'Fitnessgram' (Meredith & Welk, 1999) and the 'Bruininks–Oseretsky Test of Motor Proficiency–II' (Bruininks & Bruininks, 2005) during baseline measurements, on completion of the intervention programme, and after a follow–up period of three months. The results, which were analysed with a repeated–measures analysis, Bonferroni–post–hoc analysis, and dependent and independent t–tests, show that the intervention programme brought about a significant change in all the body composition variables, excluding body height. Flexibility, muscular strength, and abdominal muscular endurance, as well as one of the four fine manual control test items (folding paper), two of the 12 body coordination test items (tapping feet and fingers - opposite sides synchronised, and standing on one leg on a line - eyes closed), and six of the seven strength and agility test items (shuttle run, stepping sideways over a balance beam, one–legged stationary hops, one–legged side hops, two–legged side hops, and sit–ups), showed significant differences from the control group on completion of the intervention programme. The results indicate that the intervention brought about differences in body composition and physical– and motor proficiency and also showed a sustainable effect over a period of three months on body fat percentage, subscapular skinfold and leg muscular strength. From this, it can be deduced that young obese children need sustained guidance to be able to maintain the lifestyle adaptations that are required by obesity interventions. It can be concluded that the physical– and motor proficiency of children is negatively influenced by obesity, that a multidisciplinary intervention programme improves the body composition profile of obese children and has a positive effect on the physical– and the motor proficiency of obese nine– to 12–year old South African children, although the effect is not sustainable without ongoing, controlled intervention. / Thesis (Ph.D. (Kinderkinetics))--North-West University, Potchefstroom Campus, 2012.

The increasing prevalence of childhood obesity worldwide is viewed as a global epidemic (World Health Organization, 2010). It is associated with a variety of health problems as well as physical– (cardio–respiratory endurance, flexibility, muscular strength, muscular endurance, and body composition), and motor proficiency (fine manual control, manual coordination, body coordination, and strength–and–agility) (Asayama et al., 2003:644; Okely et al., 2004:242; Tokmakidis et al., 2006:870). As far as the South African context is concerned, there is little research examining these relationships and the effect of physical intervention there upon, in nine– to 12–year old children. The first and second objectives of this study were to determine whether obesity would influence the physical– and/or the motor proficiency of nine– to 12–year–old South African children. The third and fourth objectives of this study were to determine the effect of a multidisciplinary intervention on the physical– and the motor proficiency of nine– to 12–year–old obese children. For objectives one and two, a cross–sectional study was performed on 280 children (128 boys and 152 girls), with an average age of 10.6 years (±1.05). Anthropometric–, physical– and motor measurements were obtained by the 'Fitnessgram' (Meredith & Welk, 1999) and the 'Bruininks–Oseretsky Test of Motor Proficiency–II' (Bruininks & Bruininks, 2005). Body mass index (BMI) cut–off points were used to classify the children as normal, overweight, or obese (Cole et al., 2000). The data was analysed with regard to the above–mentioned objectives with the Statistica computer program, by means of descriptive statistics, Spearman rank correlations, and variance analyses. The results show that the physical fitness variables, cardio–respiratory endurance and muscular strength, particularly leg muscular strength, showed significant decreases with an increase in BMI. A progressive, but insignificant, decrease was found in muscular endurance with an increase in BMI, while flexibility showed the weakest relationship to BMI. The motor variables strength–and–agility weakened significantly with an increase in BMI, while fine manual control, manual coordination, and body coordination showed the weakest relationships to BMI. Variance analysis showed further significant relationships among BMI, cardio–respiratory endurance, muscular strength, and running speed–and–agility (p<0.05). It can be concluded that health–promoting physical fitness and the motor proficiency of young South African children are negatively influenced by obesity and intervention strategies are recommended to promote the quality of life of such children. For objectives three and four, an availability random sample of 37 experimental subjects, with an average age of 11 years (±0.99) was taken, where 20 subjects (seven boys and 13 girls) took part in a multidisciplinary intervention programme, and 17 subjects (six boys and 11 girls) formed part of a control group. Body composition, physical–, and motor proficiency were analysed by the 'Fitnessgram' (Meredith & Welk, 1999) and the 'Bruininks–Oseretsky Test of Motor Proficiency–II' (Bruininks & Bruininks, 2005) during baseline measurements, on completion of the intervention programme, and after a follow–up period of three months. The results, which were analysed with a repeated–measures analysis, Bonferroni–post–hoc analysis, and dependent and independent t–tests, show that the intervention programme brought about a significant change in all the body composition variables, excluding body height. Flexibility, muscular strength, and abdominal muscular endurance, as well as one of the four fine manual control test items (folding paper), two of the 12 body coordination test items (tapping feet and fingers - opposite sides synchronised, and standing on one leg on a line - eyes closed), and six of the seven strength and agility test items (shuttle run, stepping sideways over a balance beam, one–legged stationary hops, one–legged side hops, two–legged side hops, and sit–ups), showed significant differences from the control group on completion of the intervention programme. The results indicate that the intervention brought about differences in body composition and physical– and motor proficiency and also showed a sustainable effect over a period of three months on body fat percentage, subscapular skinfold and leg muscular strength. From this, it can be deduced that young obese children need sustained guidance to be able to maintain the lifestyle adaptations that are required by obesity interventions. It can be concluded that the physical– and motor proficiency of children is negatively influenced by obesity, that a multidisciplinary intervention programme improves the body composition profile of obese children and has a positive effect on the physical– and the motor proficiency of obese nine– to 12–year old South African children, although the effect is not sustainable without ongoing, controlled intervention. / Thesis (Ph.D. (Kinderkinetics))--North-West University, Potchefstroom Campus, 2012.

Le syndrome confusionnel postopératoire (SCPO) chez la personne âgée (PA) est une complication fréquente et potentiellement grave. Sa prévention constitue donc un axe de travail essentiel dans une démarche globale et multidisciplinaire d’amélioration de la prise en soin des PA en chirurgie. Après une revue de la littérature, nous avons élaboré un programme multidisciplinaire de prévention du SCPO et sa méthodologie d’évaluation. Ce programme est actuellement en cours d’évaluation grâce à une étude interventionnelle, contrôlée, randomisée en stepped wedge (étude CONFUCIUS, financée par le Programme de Recherche en Qualité Hospitalière) au sein de trois services de chirurgie (orthopédie, digestif, urologie). À ce jour, 51 patients (âge moyen = 81,6 ans et 45% de femmes) ont été inclus. Le programme de prévention sera déployé à partir de novembre 2012 dans le service de chirurgie orthopédique en collaboration avec l’équipe mobile de gériatrie de l’établissement. Préalablement, nous avons évalué les connaissances et la perception des soignants relatives au SCPO grâce à une approche quantitative et qualitative. Celles-ci sont insuffisantes, tout particulièrement concernant les signes cliniques et le diagnostic. En effet, seuls 4% des soignants connaissaient la forme hypoactive et aucun l’outil diagnostique de référence, la Confusion Assessment Method. Une banalisation du SCPO a été mise en évidence, des croyances et des représentations persistent. Cela montre qu’il est nécessaire de lutter contre les idées reçues avant d’engager toute action de prévention. Nos travaux s’inscrivent dans une démarche globale et multidisciplinaire d’amélioration de la qualité et de la sécurité des soins en chirurgie et seront poursuivis, notamment par une étude permettant de déterminer le rôle prédictif des biomarqueurs du liquide céphalo-rachidien dans la survenue de SCPO et d’une démence 12 mois après l’intervention chirurgicale chez la PA / Postoperative delirium is common in elderly and is associated with a significant increase in mortality, complications, length of hospital stay and admission in long care facility. Although several interventions have proved their effectiveness to prevent it, the Cochrane advises an assessment of multifaceted intervention using rigorous methodology bases on randomized study design. After a review of literature, a multifaceted program of delirium prevention coordinated by a mobile geriatric team (MGT) was created. This program is currently being evaluated in a randomized, controlled, interventional, stepped wedge study (the CONFUCIUS study funding by the National French Program of Hospital Quality Research) within three surgical departments (orthopedics, gastroenterology, and urology). To date, 51 patients (mean age of 81.6 years; 45% female) have been included. The program will be rolled out from November 2012 in the department of orthopedic surgery in collaboration with the hospital’s MGT. Prior to the implementation of the prevention program, the knowledge base in older postoperative delirium. Only 4% of nursing staff knew the hypoactive form and none of nursing staff knew the Confusion Assessment Method. In addition, some stereotypes persist. This work is part of a comprehensive and multidisciplinary approach to improving quality and safety in surgical care. It will be followed by a study aiming to determine the capacity of cerebrospinal fluid biomarkers in predicting the onset of POD and dementia 12 months after surgery