OBJETIVO. A religiosidade està presente na sociedade humana, independentemente de Ãpoca ou local. No Brasil, 95% da populaÃÃo declara ter religiÃo. A partir do advento da metodologia cientÃfica no campo, a religiosidade, em saÃde mental, vem sendo objeto de intensa investigaÃÃo. Hoje, sabe-se que a religiosidade, na maioria das vezes, atua como fator de proteÃÃo em saÃde mental e fÃsica. O presente estudo utilizou a ciÃncia psicomÃtrica para desenvolver e validar um instrumento breve para mensurar religiosidade intrÃnseca (InventÃrio de Religiosidade IntrÃnseca - IRI) em duas amostras brasileiras e comparar com medidas de saÃde mental e qualidade de vida. MÃTODO. A versÃo inicial (14 itens) foi baseada na revisÃo de literatura e em sugestÃes de especialistas. Estudantes universitÃrios (amostra 1; n=323) e pacientes psiquiÃtricos (amostra 2; n=102) preencheram os seguintes instrumentos: IRI, Escala de Religiosidade Duke (DUREL), uma medida de espiritualidade (WHOQOL-SRPB), uma medida de qualidade de vida (WHOQOL-BREF), bem como medidas de sintomas ansiosos e depressivos (InventÃrio de DepressÃo de Beck - BDI, InventÃrio de Ansiedade de Beck - BAI e Escala Hospitalar de Ansiedade e DepressÃo - HADS). RESULTADOS. O IRI apresentou consistÃncia interna adequada nas amostras 1 (&#945; de Cronbach=0,96; IC95%; 0,87-0,98) e 2 (&#945; = 0,96; IC95%; 0,85-0,99). AnÃlises de componentes principais com rotaÃÃo varimax indicaram um Ãnico fator que explicou 73,7% e 74,9% da variÃncia nas amostras 1 e 2, respectivamente, apÃs a retirada dos itens de menor carga fatorial. Foram observadas fortes correlaÃÃes entre o IRI e a sub-escala de religiosidade intrÃnseca da DUREL (r de Spearman de 0,87 a 0,73 nas amostras 1 e 2, respectivamente, p<0,001). O IRI apresentou boa validade teste-reteste em ambas as amostras (coeficientes de correlaÃÃo intraclasse > 0,70). DISCUSSÃO. O IRI apresentou boas propriedades psicomÃtricas. Observou-se associaÃÃes significativas entre medidas de religiosidade intrÃnseca e depressÃo e qualidade de vida na amostra de estudantes, bem como associaÃÃes significativas entre religiosidade intrÃnseca e depressÃo e ansiedade, na amostra de pacientes psiquiÃtricos. CONCLUSÃO. Os dados indicam que o IRI à um instrumento vÃlido e pode contribuir para estudar religiosidade intrÃnseca em diferentes amostras brasileiras. / OBJECTIVE. Religiousness is present in mankind regardless of period or place. In Brazil, 95% of the population said to have religion. Since the entrance of scientific methodology in the field, religiousness, in mental health, has been increasingly investigated. Nowadays, is well known that religiousness, in many ways, acts as a buffer in mental and physical health. The present study employed psychometric science to develop and validate a brief instrument to assess intrinsic religiousness (Intrinsic Religiousness Inventory - IRI) in two Brazilian samples and to correlate with mental health and quality of life measures. METHOD. The initial version (14 items) was based on literature review and experts suggestion. University students (sample 1; n=323) and psychiatric patients (sample 2; n=102) filled the following instruments: IRI, the Duke Religiosity Index (DUREL), a spirituality measure (WHOQOL-SRPB), a quality of life measure (WHOQOL-BREF) as well as measures of anxiety and depressive symptoms (Beck Depression Inventory - BDI, Beck Anxiety Inventory - BAI and Hospital Anxiety and Depression Scale - HADS). RESULTS. The IRI showed adequate internal consistency reliability in sample 1 (Cronbachâs &#945; = 0.96; 95% CI; 0.87-0.98) and sample 2 (&#945; = 0.96; 95% CI; 0.85-0.99). Principal component analyses with varimax rotation of the IRI indicated a single factor, which explained 73.7% and 74.9% of variance in samples 1 and 2, respectively, after the exclusion of items with small factor loadings. Strong correlations between the IRI and the intrinsic subscale of the DUREL were observed (Spearmanâs r ranging from 0.87 to 0.73 in samples 1 and 2, respectively, p<0.001). The IRI had good test-retest reliability in both samples (intraclass correlation coefficients > 0.70). DISCUSSION. The IRI showed good psychometrical properties. Significantly associations were observed between intrinsic religiousness and depression symptoms and quality of life measures in the student sample, as well as significantly associations between intrinsic religiousness and depression and anxiety symptoms measures in the psychiatric sample. CONCLUSION. These data indicate that the IRI is a valid instrument and may contribute to study intrinsic religiosity in Brazilian samples.

Orientador: Sônia Regina da Cal Seixas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica / Made available in DSpace on 2018-08-16T04:24:29Z (GMT). No. of bitstreams: 1 Conceicao_AndreLuizda_M.pdf: 6490563 bytes, checksum: 0ed173b723361183980fbcbd4fa308be (MD5) Previous issue date: 2010 / Resumo: O presente trabalho aborda de maneira crítica e reflexiva o jogo de interesses e os principais atores envolvidos na questão que diz respeito à possibilidade de construção e operação da UHE Tijuco Alto, no alto curso do rio Ribeira de Iguape entre São Paulo e Paraná, na região do Vale do Ribeira. Entre os principais atores, é dado maior destaque a Companhia Brasileira de Alumínio (CBA), ao Movimento dos Ameaçados por Barragens do Vale do Ribeira (MOAB) e os municípios que serão os mais afetados pelas obras. Tal empreendimento afetará diretamente os municípios de Ribeira-SP, Itapirapuã Paulista-SP, Cerro Azul-PR, Doutor Ulysses-PR e Adrianópolis-PR. Dessa forma, definiu-se como objetivo central da pesquisa a análise da qualidade de vida da população do município de Ribeira-SP, diante da possibilidade da implantação da hidrelétrica. Assim, foi realizada pesquisa de campo no município e entrevista com os moradores, onde foi possível observar, entre outros aspectos, a precariedade das condições econômicas, sociais, urbanas e culturais da comunidade local. Outro aspecto constatado foi o fato da maioria dos entrevistados se posicionarem a favor da construção da UHE Tijuco Alto, alegando principalmente a necessidade de desenvolvimento local e maior oferta de empregos. Aqueles contrários a usina, destacaram questões ambientais, sobretudo, motivos relacionados à perda da tranquilidade e segurança local. Independentemente daqueles que são contra ou a favor, chegou-se a conclusão da inevitabilidade da implantação da UHE Tijuco Alto, até mesmo porque ela é representativa do poder econômico que se sobressai em relação às demais dimensões e interesses, sejam eles ambientais, sociais ou culturais / Abstract: The present work approaches in critical and reflexive way the game of interests and the main involved actors in the question that says respect to the construction possibility and operation of the UHE High Tijuco, in the high course of the river Ribeira de Iguape between São Paulo and Paraná, in the region of the Valley of the Ribeira. Between the main actors, the Brazilian Alumínio Company is given to bigger prominence (CBA), to the Movement of Threatened for Barrages of the Valley of Ribeira (MOAB) and the cities that will be affected by the workmanships. Such enterprise will directly affect the cities of Ribeira-SP, Itapirapuã Native of São Paulo, Cerro Blue, Doctor Ulysses and Adrianópolis-PR. Of this form, the analysis of the quality of life of the population of the city of Ribeira-SP was defined as objective central office of the research, ahead of the possibility of the implantation of the plant. Thus, research of field in the city and interview with the inhabitants was carried through, where it was possible to observe, among others aspects, the precariousness of economic, social, urban and cultural the conditions of the local community. Another evidenced aspect was the fact of the majority of the interviewed ones if to locate in favor of the construction of the UHE High Tijuco, alleging the necessity of local and bigger development mainly offers of jobs. Those contrary the plant, had detached ambient questions, over all, reasons related to the loss of the tranquilidade and local security. Independently of that they are against or the favor, she arrived it conclusion of inevitability of implantation of UHE Tijuco High, even though because it is representative of the economic power that if detaches in relation to the too much dimensions and interests, is ambient, social or cultural they / Mestrado / Mestre em Planejamento de Sistemas Energéticos

Orientador: Eduardo Hebling / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-05T11:26:16Z (GMT). No. of bitstreams: 1 Rodrigues_CathleenKojo_M.pdf: 413345 bytes, checksum: 15e4256c2a1c26f926f58d44a363014a (MD5) Previous issue date: 2005 / Resumo: A avaliação das condições de saúde bucal em pacientes idosos é essencial para o desenvolvimento de políticas de saúde específicas. A prevalência de doenças bucais é alta nessa população. A autopercepção das condições de saúde bucal influencia a procura por cuidados bucais e a qualidade de vida dos idosos. O objetivo desse estudo foi avaliar a autopercepção das condições de saúde bucal em 184 idosos, de ambos os sexos, com idade de 60 anos ou mais (média de 77,6 anos), institucionalizados, funcionalmente independentes ou parcialmente dependentes, sem alterações cognitivas significantes, de Piracicaba, Brasil. Foram aplicados questionários sobre as características sócio-demográficas e a saúde sistêmica. A autopercepção de saúde bucal foi avaliada com uso do Geriatric Oral Health Assessment Index (GOHAI). O estado emocional da amostra foi avaliado pela Escala de Depressão Geriátrica. Os dados foram avaliados pelos testes de Mann-Whitney e Kruskal-Wallis (a=0,05). A autopercepção de saúde bucal da amostra foi baixa, com média do GOHAI de 28,03. Não foram observadas diferenças estatisticamente significantes do GOHAI considerando a faixa etária, gênero, renda, grau de instrução, saúde geral ou última visita ao dentista. O índice foi maior nos casados ou com companheiros e nos viúvos do que nos solteiros (p<0,05). As pessoas que residiam sozinhas apresentaram menores valores do GOHAI do que as que residiam com esposo, demonstrando a influência de um acompanhante ou esposo na autopercepção de saúde bucal. O tipo de moradia também influenciou nos valores desse índice; com pontuação maior para os residentes em habitação própria. Com relação ao estado emocional, houve uma predominância entre GOHAI baixo e estado depressivo (p<0,05). Os fatores de risco para baixa autopercepção de saúde bucal foram ser solteiro e residir em habitação coletiva / Abstract: The assessment of oral health status in elderly patients is essential to the development of specific oral health politics. The prevalence of oral diseases is high in this population. The self-perception of oral health status influences the search for oral cares and the quality of life in elderly. The aim of this study was assessed the self-perception of oral health status in 184 elderly people, both gender, 60 years or older (mean age = 77,6), institutionalized, functionally independent or partially dependent, without significant cognitive alterations, from Piracicaba, Brazil. A questionnaire with questions about the sociodemographic and systemic health characteristics was applied. The self-perception of oral health was assessed using the Geriatric Oral Health Assessment Index (GOHAI). The emotional status was assessed using the Geriatric Depression Scale. The data were analyzed using Mann-Whitney test and Kruskal-Wallis test (a=0.05). The oral health self-perception of the sample was low, with mean scores of GOHAI of 28.03. No significant statistics differences were found in GOHAI considering age, gender, income, education level, systemic health or the last visit to the dentist. The index was higher among married, those who lived with their partners and widowed than among single (p<0.05). Those who lived alone had lower GOHAI values than those who lived with their spouses, showing the importance of a companion or spouse for self-perception of oral health. The kind of dwelling has also influenced the index values; those who lived in their own residence had higher punctuation. About emotional state, there was predominance between low GOHAI and depressive state (p<0.05). The GOHAI showed satisfactory psychometric properties to assess the oral health self-perception in elderly / Mestrado / Saude Coletiva / Mestre em Odontologia

Orientador: Gustavo Luis Gutierrez / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Fisica / Made available in DSpace on 2018-08-13T09:55:36Z (GMT). No. of bitstreams: 1 Desiderio_Andrea_M.pdf: 719743 bytes, checksum: fd85709ac8a0290e62c393d764c3ff47 (MD5) Previous issue date: 2009 / Resumo: O presente trabalho versa sobre a qualidade de vida, suas definições, visões, certezas e incertezas, sua história construída a partir da saúde e muito além dela, seus mecanismos de validação e possíveis encontros com a área da educação física. Com o intuito desta aproximação escolhemos a ginástica geral como prática corporal que na atualidade pode, ou não, ser promotora de qualidade de vida. A tal ginástica geral apresenta-se como prática corporal específica e focalizada no indivíduo pertencente a um grupo e também como espetáculo, como arte, arte corporal. Também buscamos informações históricas para entendermos a ginástica geral que temos hoje, vimos o que se é realizado sob esta nomenclatura e projetamos algumas aproximações entre estes dois universos, a qualidade de vida e a ginástica geral. A pesquisa partiu sempre do enfoque social, tendo na história uma grande base. Para tanto esta se caracteriza por uma pesquisa qualitativa que utilizou os seguintes métodos para sua realização: revisão bibliográfica, a fim de conhecer e problematizar as relações entre os objetos; análise dos depoimentos de 13 ginastas de ginástica geral presentes na pesquisa de Souza (1997), com base na análise de discurso de Bardin (1977) e, pesquisa de campo com visitas a diferentes grupos de ginástica geral. O documento de avaliação de qualidade de vida produzido pela Organização Mundial de Saúde serviu de base para a criação de itens de análise dos depoimentos pesquisados, assim como, para as visitas de observação aos grupos. Definições de qualidade de vida, atuais e fundamentadas no social, e de ginástica geral com esta mesma perspectiva deram o diferencial do olhar para tal problemática. Esta pesquisa justifica-se por apresentar uma forma de ginástica, contemporânea e de vanguarda, que corrobora com definições de qualidade de vida ampliadas, podendo ser uma prática corporal muito mais significativa. / Abstract: The current job talks about Quality of Life, its definitions, an overall view, certainties and uncertainties, its history built from health and far beyond it, its validity mechanisms and enforcement in the physical activity reality. For such consideration the General Gymnastic has been chosen as a corporal practice which might be responsible for Quality of Life nowadays. Such General Gymnastic introduces itself as a specific corporal practice that is focused on the individual belonging to a group and mainly as a show, as art itself and body art. We?ve also searched for historical information as well, in order to understand the General Gymnastic existing nowadays, we?ve kept an eye on what is done under this term and projected some approaches between these two distinct universes, Quality of Life and General Gymnastic. The research has always started by the social focusing, having a great basis in history. Nevertheless, this one characterizes by a qualitative research which has used the following methods for its realization: bibliographical review, in order to recognize and take the relationships among the objects as a problem, analyze the statements of 13 general gymnastic gymnasts present in Souza's research (1997), based on Bardin's (1972) deposition content analysis and also having field trips, visiting several different general gymnastic groups. The quality of Life evaluation document made by the World Health Organization (WHO) has been the basis for the creation of the items checked like the statements previously analyzed, as well as the field trips to the groups. Current Quality of Life definitions based on the social and the General Gymnastic with the same perspective have given the different point of view for such problem. This study justifies by introducing a new kind of gymnastic, contemporary and vanguard, which is in accordance with extended Quality of Life definitions, being also a more significant corporal practice. / Mestrado / Atividade Fisica, Adaptação e Saude / Mestre em Educação Física

Orientador: Agricio Nubiato Crespo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T05:24:30Z (GMT). No. of bitstreams: 1 Spina_AnaLucia.pdf: 396844 bytes, checksum: 5539ff9f308e6cec8023d63bdaf5f554 (MD5) Previous issue date: 2009 / Resumo: A percepção vocal é um debate ativo da neurociência e um desafio para pesquisadores na atualidade. Este estudo verificou se a auto-avaliação vocal feita pelo paciente disfônico é concordante com a avaliação vocal feita pelo fonoaudiólogo e se essa concordância sofre influência das variáveis: idade, sexo, uso profissional da voz, diagnóstico laringoscópico clínico ou diferentes avaliadores. Correlacionou a avaliação vocal feita pelo fonoaudiólogo e a auto-avaliação feita pelo sujeito disfônico ao protocolo QVV. Verificou também, a habilidade para perceber variação de freqüência em sons vocais e som instrumental. Comparou a habilidade perceptiva entre sujeitos com disfonia funcional, sujeitos com voz normal e cantores. Correlacionou a habilidade de percepção às variáveis: sexo, idade, escolaridade, experiência preliminar com canto, avaliação da qualidade vocal feita pelo fonoaudiólogo e auto-avaliação vocal feita pelo sujeito. O estudo contou com dois grupos distintos. Grupo I: 245 sujeitos submetidos a avaliação perceptiva da voz feita pelo fonoaudiólogo, auto-avaliação da voz e aplicação do protocolo QVV. No Grupo II: foi realizada, em 242 sujeitos, avaliação da percepção de variação de freqüência de sons vocais, feita por meio do som /a/ prolongado, emitido por voz masculina e feminina; e avaliação da percepção de variação de freqüência com som instrumental por meio de teclado virtual. No grupo I: a concordância da avaliação vocal entre fonoaudiólogos e auto-avaliação vocal foi baixa e não sofreu influência das variáveis estudadas. O protocolo QVV revelou sensibilidade tanto para a qualidade vocal avaliada pelo fonoaudiólogo, como para a qualidade vocal avaliada pelo próprio sujeito disfônico. No grupo II: em relação à percepção de variação de freqüências nos sons vocais e som instrumental, cantores apresentaram habilidade superior de percepção para voz e instrumento; sujeitos disfônicos tiveram maior dificuldade em perceber variações de freqüência em voz e instrumento do que sujeitos com voz normal; sexo e idade não influenciaram na habilidade de percepção; sujeitos com maior grau de escolaridade e experiência preliminar com canto mostraram melhor habilidade percepção; quanto pior a classificação da qualidade vocal nas disfonias pior a percepção. / Abstract: Voice perception has been actively debated by neuroscientists and is a challenge for researchers nowadays. This study compared the auditory voice-perception assessments of experienced speech therapists and patients (self-assessment). The influence of age, gender, professional voice use, clinical diagnosis and evaluation by different professionals were also determined. A correlation between vocal assessment performed by the speech-therapist and self-assessment performed by the dysphonic subject was carried out through the VRQOL protocol. The study also observed the ability to perceive pitch variation in vocal and instrumental sounds. A comparison was made between the perceptive ability of subjects with functional dysphonia, subjects with normal voice and singers. A correlation between perceptive ability and gender, age, educational level, previous singing experience, perceptive vocal quality assessed by speech-therapists and self-perception of vocal quality. The study considered two groups. Group I: 245 subjects with voice-perception assessment carried out by the speech-therapist, patients self-assessment and results obtained from the V-RQOL protocol. Group II: 242 subjects evaluated for their perception of pitch variation for vocal sounds that was a sustained /a/ performed by female and male voices and perception of pitch variation for instrumental sounds performed by a virtual keyboard. Group I: levels of agreement between the speech-therapist vocal assessment and patients self-assessment were low and were not influenced by the age, gender, professional voice use, clinical diagnosis and evaluation by different professionals. The V-RQOL protocol was sensitive both to vocal quality as assessed by the speech-therapist and the dysphonic patient. Group II: singers showed better ability in perceiving vocal and instrumental sounds, dysphonic subjects had more difficulty in perceiving pitch variation for vocal and instrumental sounds than subjects with normal voices. Age and gender did not influence perception ability. Subjects with higher educational levels and previous singing experience had better perceptive ability. In the dysphonic group the worse the voice quality the worse the perception. / Universidade Estadual de Campi / Ciencias Biomedicas / Doutor em Ciências Médicas

Made available in DSpace on 2015-04-11T13:41:25Z (GMT). No. of bitstreams: 1 Dissertacao Final Erika Almeida.pdf: 704330 bytes, checksum: ae54e1f47e0111c00993b46699defb34 (MD5) Previous issue date: 2008-01-30 / FAPEAM - Fundação de Amparo à Pesquisa do Estado do Amazonas / One searched to analyze the conditions of life and work of aged inhabitants of the south zone of Manaus. The study had a quantitative and qualitative boarding as methodology, using form application of interviews with 36 aged ones that frequently attend the CAIMI (Best Age Full Assistance Center).The research points that the majority of them is inserted in informal works, without assurance of social welfare and health service. In addition to it, relating to life conditions of these aged ones, is verified that the same ones are found in a poverty situation, low education level, the condition of the domicile is unsatisfactory for their necessities, which inhabit with relatives and people who became part of the aged family, that in fact are the ones who inhabits with the aged ones, depending, many times, of the pension of these aged ones and the income of their work also. In this manner, we can assume that the conditions of life of the interviewed ones are in accordance with its conditions of work, being the same one in state of poverty, being this main segment the responsible one for the sustenance of the family, either through the pension or income of his work. In this manner, we verify that the Social Politics established in a society centered in the work aiming at the right to the citizenship, are weakened front to the destabilization of the work market and omission by the state and society to assure this right. / Buscou-se analisar as condições de vida e trabalho de idosos moradores da zona sul de Manaus. O estudo teve como metodologia uma abordagem qualitativa/ quantitativa, utilizando-se aplicação de formulários de entrevistas junto aos 36 idosos que freqüentam assiduamente o CAIMI (Centro de Atendimento Integral à Melhor Idade). A pesquisa aponta que a maioria deles está inserido em trabalhos informais, sem que seja assegurados a previdência social e serviço de saúde. Ademais, em relação as condições de vida desses idosos, é verificado que os mesmos se encontram em uma situação precarizada, possuem baixa escolarização, a condição do domicílio (habitação) é insatisfatória para as suas necessidades, os quais residem com familiares e agregados, que na verdade são eles quem residem com os idosos, dependendo, muitas vezes, da aposentadoria desses idosos e ainda da renda de seu trabalho. Desse modo, podemos sinalizar que as condições de vida dos entrevistados estão de acordo com suas condições de trabalho, estando a mesma precarizada, sendo esse segmento o principal responsável pelo sustento de sua família, seja através da aposentadoria ou do seu trabalho. Dessa forma, verificamos que as Políticas Sociais fundadas numa sociedade centrada no trabalho, visando o direito à cidadania, ficam fragilizadas frente à desestruturação do mercado de trabalho e do não envolvimento do Estado e sociedade para assegurar esse direito.

nÃo hà / O transplante renal à a terapia que oferece maior sobrevida e melhor qualidade de vida (QV) para pacientes com doenÃa renal crÃnica (DRC). Entretanto, mundialmente observa-se carÃncia de ÃrgÃos para realizaÃÃo de transplantes ocasionando grande tempo de permanÃncia dos pacientes em terapia dialÃtica. Objetivos: Identificar mudanÃa de nÃvel de QV e verificar associaÃÃo de variÃveis com nÃvel inicial e mudanÃa de QV em portadores de DRC submetidos à hemodiÃlise (HD) durante seguimento de 24 meses. Materiais e mÃtodos: A amostra foi formada pelos pacientes em HD regular na Ãnica unidade de diÃlise da regiÃo norte do CearÃ, Brasil. Foram incluÃdos maiores de 18 anos, nunca submetidos a transplante renal e com pelo menos trÃs meses sob terapia dialÃtica. Cento e sessenta e quatro pacientes foram submetidos a uma avaliaÃÃo e tiveram seus dados analisados de forma transversal. Noventa e dois foram submetidos a pelo menos duas avaliaÃÃes e foram analisados longitudinalmente. Ao serem incluÃdos no estudo os pacientes tiveram seus dados demogrÃficos, clÃnicos e laboratoriais coletados; foram classificados de acordo com grau de comorbidade pelo Ãndice de Khan; e foram submetidos ao instrumento de medida de QV SF-36. Anualmente os pacientes eram re-avaliados laboratorialmente e submetidos à nova avaliaÃÃo pelo instrumento SF-36. RegressÃo linear pelo mÃtodo stepwise foi utilizada para estimar a correlaÃÃo entre as variÃveis e o nÃvel inicial de QV. A mudanÃa de nÃvel de QV foi determinada pela anÃlise de variÃncia para medidas repetidas com uso de co-variÃveis (ANCOVA) considerando pontuaÃÃo inicial e final, e pelo cÃlculo da taxa de variaÃÃo mensal (pontuaÃÃo final menos pontuaÃÃo inicial com divisÃo do resultado pelos meses de seguimento). As variÃveis contÃnuas foram testadas quanto a sua associaÃÃo com mudanÃa de QV por regressÃo linear, e as variÃveis categÃricas pela estratificaÃÃo da amostra de acordo com a taxa de variaÃÃo mensal em trÃs grupos: melhora, piora, e sem mudanÃa. Resultados: O nÃvel de QV apresentou melhora em relaÃÃo Ãs dimensÃes Aspectos sociais (63,8 vs. 75,0; p=0,001), Aspectos emocionais (39,7 vs. 63,1; p<0,001) e SaÃde mental (63,1 vs. 69,0; p=0,009). Entre os pacientes com baixo grau de comorbidade, alÃm das dimensÃes citadas, houve melhora das dimensÃes Capacidade funcional (56,7 versus 63,5; p=0,014) e Dor (56,7 vs. 66,5; p=0,009). Idade e albumina foram as principais variÃveis correlacionadas com nÃvel inicial de QV. A idade se associou negativamente com as oito dimensÃes de QV: Capacidade funcional (r=-0,312; p<0,001), LimitaÃÃo por aspectos fÃsicos (r=-0,262; p<0,001), Dor (r=-0,157; p=0,049), Estado geral de saÃde (r=-0,232; p=0,003), Vitalidade (r=-0,298; p<0,001), Aspectos sociais (r=-0,293; p=<0,001), LimitaÃÃo por aspectos emocionais (r=-0,260; p=0,001) e SaÃde mental (r=-0,217; p=0,006). O nÃvel de albumina se correlacionou positivamente com Capacidade funcional (r=0,218; p=0,006), Dor (r=0,276; p<0,001), Estado geral de saÃde (r=0,268; p<0,001), Vitalidade (r=0,270; p<0,001) e Aspectos sociais (r=0,250; p=0,001). A idade e o nÃvel de creatinina se correlacionaram com mudanÃa do nÃvel de QV estimada pela taxa de variaÃÃo mensal. A idade se associou negativamente com Dor (r=-0,031; p=0,024), explicando 9,0% da variaÃÃo, e creatinina se correlacionou positivamente com Estado geral de saÃde (r=0,096; p=0,040), explicando 4,6% da variaÃÃo. Mais mulheres do que homens evoluÃram com piora da Capacidade Funcional [19 (50,0%) vs. 11 (21,2%); p=0,006]. ConclusÃes: Houve melhora dos aspectos mentais de qualidade de vida entre os pacientes. Essa melhora deve ser encarada como fator favorÃvel para implementaÃÃo de intervenÃÃes sobre os aspectos fÃsicos de qualidade de vida, com especial atenÃÃo aos pacientes do sexo feminino e com maior grau de comorbidade. O avanÃar da idade e nÃveis baixos dos marcadores do estado nutricional (albumina e creatinina) devem ser considerados indicadores de risco para pior nÃvel de QV. / Kidney transplantation is the therapy that offers longest lifetime and best quality of life (QL) in patients with chronic kidney disease (CKD). However, worldwide there is lack of organs to transplant, causing the need for long-term dialysis therapy. Objectives: To identify changes in QL level and verify the association between variables and initial level and changes in QL in CKD patients undergoing hemodialysis (HD) during a follow-up of 24 months. Materials and methods: The sample consisted of patients undergoing regular HD in the only renal unit in the north of Cearà state, Brazil. We included those older than 18 years who never had kidney transplant and had been under dialysis at for least three months. Hundred and sixty-four patients were submitted to one evaluation and their data composed a transversal analysis. Ninety-two were submitted at least to two evaluations and were studied by longitudinal analysis. At baseline we collected demographic, clinical and laboratory data; classified the patients according to comorbidity by the Khan index; and submitted them to the SF-36 questionnaire in order to measure QL. Every year the patients were re-evaluated with laboratory tests and submitted again to the SF-36. Linear regression by the stepwise method was used to estimate the correlation between variables and initial level of QL. Change in QL level was detected by analysis of variance using co-variables (ANCOVA), considering the initial and final scores, and by the monthly variation rate (final minus initial score divided by number of months of follow-up). Continuous variables were tested for their association with change in QL by linear regression, and the categorical variables were stratified according to monthly variation rate into three groups: improving, worsening, and no change. Results: QL level improved with respect to Social functioning (63.8 vs. 75.0; p=0.001), Role-emotional (39.7 vs. 63.1; p<0.001) and Mental health (63.1 vs. 69.0; p=0.009). Among low comorbidity patients, besides improvement in these dimensions, there was improvement in Physical functioning (56.7 vs. 63.5; p=0.014) and Bodily pain (56.7 vs. 66.5; p=0.009). Age and albumin were strong correlators due to the initial QL level. Age was negatively associated with all eight QL dimensions: Physical functioning (r=-0,312; p<0,001), Role-physical (r=-0,262; p<0,001), Bodily pain (r=-0,157; p=0,049), General health (r=-0,232; p=0,003), Vitality (r=-0,298; p<0,001), Social functioning (r=-0,293; p=<0,001), Role-emotional (r=-0,260; p=0,001) and Mental health (r=-0,217; p=0,006). Albumin was positively associated with: Physical functioning (r=0,218; p=0,006), Bodily pain (r=0,276; p<0,001), General health (r=0,268; p<0,001), Vitality (r=0,270; p<0,001) and Social functioning (r=0,250; p=0,001). Age and creatinine level were associated with changes in QL estimated by monthly variation rate. Age was negatively associated with Bodily pain (r=-0,031; p=0,024), responsible for 9.0% of its variation, and creatinine was positively correlated with General health (r=0,096; p=0,040), responsible for 4.6% in its variation. More women than men worsened in Physical functioning [19 (50.0%) vs. 11 (21.2%); p=0.006]. Conclusions: There was improvement in mental aspects of QL among the patients. This improvement should be seen as a favorable factor to implement interventions aimed at the physical aspects of QL, with special attention to women and high-grade comorbidity patients. Ageing and low level of the laboratory markers related to nutritional status (albumin and creatinine) should be considered as risk markers of poorer QL level.

The cognitive aging literature contains abundant evidence of the natural vulnerability of the frontal areas of the brain and the associated impact on higher-order cognition. Namely, Executive Functions (EFs) have been repeatedly shown to decline steadily after 60 (Schaie, 2013). These age-related changes are said to impact most aspects of everyday life including quality of life (QoL; Davis et al., 2010), a key variable with regards to health, social service interventions and evidence-based clinical practices. Deepening our understanding of potential moderators of cognitive aging such as QoL is crucial to promoting well-being in the growing older adult population. The overarching aim of this study was to investigate the moderating role of QoL over age-related EFs differences. A seminal taxonomy of EFs (Miyake et. al, 2000, 2012) and the work of the World Health Organization (WHO) on QoL (Power et al., 2005) inspired this endeavor. Six tasks of EFs related to Shifting, Updating, and Inhibiting and self-reported QoL based on the WHOQOL-BREF and -OLD were utilized with 102 community-dwelling, healthy older adults (M = 73.11 years; age range: 60 - 94). A moderation analysis was used to assess if QoL (moderator) buffers the relationship between age (IV) and EFs indicators (DV). Regression and MANCOVA analyses were conducted to evaluate age-related differences in EFs and the following prominent theories: the processing speed theory (Salthouse, 1996), inhibition deficit theory of cognitive aging (Hasher & Zacks, 1988), and dedifferentiation hypothesis (Garrett, 1946). As predicted, age significantly contributed to task performance for most EFs indicators, above and beyond processing speed. As expected, statistically significant moderation interactions were found for several executive indicators and QoL domains, illustrating the buffering role of QoL over age-related differences in EFs. Specifically, QoL items related to the environment, sensory abilities, and social engagement domains, and EFs indicators related to Inhibiting, showed the most notable moderating effects. Implications for these results and the role of covariates were discussed. An emphasis was placed throughout on the importance of investigating QoL variables and other moderating factors of cognitive aging, for the development of prevention and intervention endeavors with older adults. / Graduate

Dementia is a progressive condition that can profoundly affect the lives of individuals and their families. With no known cure for the disease, the focus has shifted towards promoting well-being and enabling individuals to maintain an optimum quality of life. Understanding of the perspectives of both people with dementia and their carers in this area will provide greater insight into to the provision of dementia care services. The first paper systematically reviewed the literature exploring the level of agreement between self and family-proxy ratings of patient quality of life. Twenty-six studies were identified for review. The overall level of agreement between ratings was low. Patients were found to consistently rate their quality of life as higher, compared to family-proxy ratings. A range of factors influencing this discrepancy were identified: neuropsychiatric symptoms, cognition, awareness of disease, caregiver burden and stress, relationship factors, activities of daily living and sociodemographic characteristics. The need for further interventions to address these factors is highlighted, as well as implications for future research. The second paper aimed to explore people with dementia and their carers lived experience of social interaction and communication after attending a Cognitive Stimulation Therapy (CST) group. Interpretative Phenomenological Analysis revealed six superordinate themes. These captured the difficulties faced by people with dementia in accessing social opportunities and the positive experience of being in the CST group. Several challenges experienced by carers were highlighted and the subsequent impact this had on their emotional well-being. Improvements for people with dementia were noticed in areas of social communication, confidence and emotional wellbeing, with no noticeable change in memory. Carers expressed a desire for on-going support and intervention following the group. These findings have important implications for future research, dementia care and increased carer support.

Magister Chirurgiae Dentium (MChD) / Introduction:Hereditary Epidermolysis bullosa (EB) is a group of rare mechanobullous dermatological disorders in which blisters develop following gene mutations. These genes encode structural proteins that anchor the epidermis to the underlying dermis.There are four main types of Epidermolysis bullosa, with more than 20 subtypes. The medical, physical and psychosocial aspects of Epidermolysis bullosa are well documented (Lucky et al, 2005; Mellerio et al, 2005). Many studies have documented case reports of associated oral lesions (Silva et al, 2004; Pacheco and de Sousa Araugio 2008; Siqueira et al, 2008). However, no assessment of the impact of these oral lesions on the affected person's everyday life has been made. The morbidity of the oral lesions associated with EB is expected to have an impact on the quality of life of these patients.Aim:To assess the prevalence and impact of oral lesions on daily activities in persons with Epidermolysis bullosa in Cape Town, South Africa, utilizing the Oral Impact on Daily Performance (OIDP) measure. Research Design and Methodology A case-controlled, descriptive analysis of the way in which oral lesions impact on quality of life in persons with Epidermolysis bullosa was carried out using semi-structured interviews. Fourteen persons with a confirmed diagnosis of hereditary Epidermolysis bullosa who attended the dermatology clinics at the Red Cross and Groote Schuur hospitals participated in the study. The control group comprised eighteen persons closely matched for gender, age, and dental status. Three persons with EB were unavailable for inclusion in the study.Results and Discussion Fourteen persons with Epidermolysis bullosa and eighteen controls were included in the study. Epidermolysis bullosa Simplex comprised the largest sub-group (n=9). Two persons had Junctional Epidermolysis bullosa, two had recessive Dystrophic Epidermolysis bullosa and one person had Kindler syndrome. The oral manifestations observed were consistent with those reported in the literature(Chimenos et al, 2003; Silva et al, 2004; Pekinar et al, 2005). No significant oral lesions (other than tooth decay) were seen in persons in the Epidermolysis bullosa Simplex group. Oral ulcers, atrophy of the dorsal surface of the tongue and gingival erythema were seen in persons with Junctional Epidermolysis Bullosa. The two individuals with Dystrophic Epidermolysis bullosa had a maximal oral opening of 15mm and 24mm. Ankyloglossia, depapillation of the dorsal tongue, absence of palatal rugae and poor oral hygiene was seen in these two persons. The patient with Kindler syndrome presented with erythematous and inflamed gingiva and cratering in the maxillary anterior interdental area. The gingiva appeared desquamative, fragile and bled with even the slightest provocation. Healing peri-oral blisters and angular cheilitis was also seen. His mouth opening was restricted to a maximal oral aperture of 13mm and his tongue extrusion was limited to only the tip of the tongue passing over the lower anterior incisor teeth.Defects in the tooth enamel was recorded in both participants with Junctional Epidermolysis bullosa and one person with dystrophic Epidermolysis bullosa, as well as excessive occlussal tooth wear (attrition), which may have been secondary to enamel hypoplasia. The dental caries status of the Epidermolysis bullosa and control groups varied according to age. The dmf for persons with Epidermolysis bullosa (all of whom had Epidermolysis bullosa Simplex), was lower than in the control group. The DMF in EB persons (15.3) was higher than in the control group (10.1).Toothache and tooth decay were the most common perceived complaints in both the Epidermolysis bullosa and control participants, accounting for the high overall OIDP score in both groups (87.5%). No statistically significant difference was found between the two groups (85.7% and 88.9% for Epidermolysis bullosa and control group persons respectively).Conclusion:The results of the study show that oral lesions (particularly tooth decay and toothache) in persons with Epidermolysis bullosa do affect their daily activities and the impact thereof is high. Other oral manifestations, irrespective of the subtype, had little impact on the OIDP score. This may be because the EB persons become tolerant of and “learn to cope” with them.Recommendations:Epidermolysis bullosa is a rare condition and not all persons with EB will present with lesions. However, all health personnel (including oral health profession) must be cognizant of this condition, in order to manage these persons safely, without incurring harm inadvertently. Thus, the overall management of persons with Epidermolysis bullosa must encompass ways to minimize and prevent trauma; provide an optimum wound healing environment; provide pain management and judicious checks for the development of premalignant lesions. This necessitates a multidisciplinary and holistic approach, with emphasis on patient involvement. To this end, an oral health care programme should form an integral part of their management because of the risk of dental disease. Periodic recall visits will enable the monitoring of home care and minimize the need for advanced restorative procedures. In this way, one may reduce the impact any oral problems may have, so that they do not further influence the patients well being.