[pt] O Comprometimento cognitivo vascular subcortical (CCVs) caracteriza-se, do ponto de vista cognitivo, por déficits em funções executivas em seus estágios iniciais, levando a dificuldades funcionais precoces na população acometida. Contudo, dados da literatura indicaram que a condição é frequentemente subdiagnosticada, o que pode ser atribuído, dentre outras razões, à falta de instrumentos de rastreio acurados para a condição, cujas características clínicas diferem dos quadros neurodegenerativos. Esta escassez foi evidenciada pela revisão sistemática realizada como parte do presente trabalho. O Teste Breve de Memória e Funções Executivas (BMET) foi desenvolvido por Brookes e cols. (2012) especificamente para a detecção destes quadros clínicos. O objetivo desta dissertação foi discorrer sobre o CCVs e adaptar o BMET para o uso na população acima dos 60 anos do Brasil. Para tanto, seguiram-se etapas de tradução, avaliação de juízes de linguística e de neuropsicologia, avaliação por representante do público-alvo, retrotradução e, por fim, aplicação à amostra. Foi conduzido um estudo piloto para verificar a aplicabilidade e fornecer dados psicométricos preliminares do teste. Conclui-se que o BMET é de simples e rápida aplicação, podendo ser administrado por diferentes profissionais da saúde e possivelmente adequado à atenção primária em saúde. Considerando o contexto atual de um rápido envelhecimento populacional e do consequente aumento na prevalência de agravos associados às faixas etárias avançadas, tais como os transtornos neurocognitivos, é de grande relevância a detecção precoce do CCVs visando ao planejamento de intervenções e medidas de profilaxia secundária, contribuindo assim, para a qualidade de vida da população idosa. / [en] Subcortical Vascular Cognitive Impairment (sVCI) is characterized, upon a cognitive perspective, by the presence of dysexecutive function in its initial stages, leading to early functional difficulties for sufferers of this condition. However, data has indicated that it is often underdiagnosed, which could be attributed to the lack of accurate screening tools for the disorder. This shortcoming has been evidenced by a systematic review conducted as part of the current project. The Brief Memory and Executive Test (BMET) has been specifically developed by Brookes et al. (2012) for the detection of sVCI. This thesis aimed to discuss about sVCI and to adapt BMET for use in subjects over 60 years old from Brazil. For this purpose, consecutive stages, comprising translation, evaluation by experts in linguistics and neuropsychology, assessment by representant of the target population, retro-translation and, finally, application to an older sample, have been performed. A pilot study has been carried out to analyze the applicability and to draw preliminary information about psychometric properties of the scale. In conclusion, BMET has revealed to be easy and rapid to administer, feasible to be applied by different categories of health practitioners and possibly adequate for primary health settings. Considering the current context of a fast population aging and a rise in the prevalence of conditions associated with late-life, such as neurocognitive disorders, it is relevant to detect sVCI in its early stages, so that therapeutic and secondary preventive strategies could be planned, which could impact on the quality of lives of older population.

Personer med afasi lider ofta av sina språkliga svårigheter och upplever dem som ett allvarligt problem. När förmågan till effektiv kommunikation genom talat språk inte räcker till kan ett Alternativt och Kompletterande Kommunikationssätt (AKK) behövas. Det möjliggör att personen, förutom med tal, kommunicerar med till exempel bilder, gester eller tecken. Proceduren att välja ett passande AKK är komplicerad och det händer att ett hjälpmedel som inte passar individens behov sätts in av logoped, eller att ett hjälpmedel inte sätts in alls. För att utveckla och förbättra möjligheten att avgöra om och i så fall vilket hjälpmedel som bör användas har Lasker och Garrett utvecklat bedömningsverktyget The Multimodal Communication Screening Test for persons with Aphasia (MCST-A). Denna studies huvudsyfte var att översätta MCST-A till svenska. Studien delades upp i tre delar; 1) översättning och anpassning av MCST-A till svenska, 2) prövning av översättningen på personer utan afasi samt 3) en första testning på personer med måttlig till grav kronisk afasi där deras resultat på MCST-A jämfördes med en skattning av deras förmåga att kommunicera med AKK i vardagen. Översättningen och anpassningen ledde till en fungerande version på svenska. Resultatet från testningen på personer med afasi går i linje med tidigare forskning, där resultatet på MCST-A speglar personers skattade förmåga att kommunicera med AKK i vardagen. MCST-A kan således vara ett användbart instrument för att avgöra om och på vilken nivå ett hjälpmedel kan användas av en person med afasi. Det är dock inte möjligt att dra en generaliserbar slutsats utifrån denna studies resultat då urvalet var begränsat. / Individuals with aphasia often suffer from their language difficulties and experience them as a serious problem. When the ability to communicate effectively through spoken language is insufficient, an Augmentative and Alternative Communication (AAC) may be required. This allows the person, in addition to speech, to communicate with for example pictures, gestures or body language. The procedure for choosing a suitable AAC is complicated, sometimes an aid that doesn’t suit the needs of the individual is provided by speech-language pathologists and sometimes an aid isn’t provided at all. In order to develop and improve the ability to determine if and what aids should be used, Garrett and Lasker developed the assessment tool The Multimodal Communication Screening Test for Individuals with Aphasia (MCST-A). The main purpose of this study was to translate MCST-A into Swedish. The study was divided into three parts; 1) translation and adaptation of MCST-A to Swedish, 2) testing the translation on persons without aphasia, and 3) a first test on persons with moderate to severe chronic aphasia, where their results on MCST-A were compared with an estimate of their ability to communicate with AAC in daily life. The translation and adaptation led to a working version in Swedish. The results from the persons with aphasia is in line with previous research, where the results on MCST-A reflects the estimated ability to communicate with AAC in their daily lives. Thus, MCST-A can be a useful tool to determine whether if and on what level aids can be used by a person with aphasia. However, it’s not possible to draw a generalizable conclusion based on the results of this study as the sample was small.

Summaries in Afrikaans and English / Text in Afrikaans / With compulsory education in the New South· Africa, an increase in the number of school beginners can be expected, together with the probability of large gaps in their readiness for school. In £his study, materials have been developed together with a structure for the organisation of teaching_~!?.r trainers/subject advisers, teachers and pupils, to ensure effective education for school beginners. The "Battery for the Assessment of Bridging period Yields" (BABY) has been developed as a valid, realiable and usable school readiness battery of tests for teachers as unregistered test users. The Pre-Test for division into homogeneous ability groups is applied shortly after entrance to school. The Battery of Diagnostic Tests ensures continuous evaluation of pupils during the school readiness programme. The Post-Test is applied at the end of the first term. In this dynamic interaction between tester and pupil in an instruction-test-instruction cycle, the pupils' readiness to progress with formal instruction is continuously evaluated. / Met verpligte onderwys in die Nuwe Suid-Afrika, kan 'n toename in die getal swart skoolbeginners ve:wag word, asook dat daar in hulle skoolvoorbereiding groot leemtes kan voorkom. In die onderhawige studie is hulpmiddels en 'n struktuur vir onderwysorganisasie vir opleiers/vakadviseurs, onderwyseresse en leerlinge ontwikkel om aan skoolbeginners effektiewe onderwys te verseker. Die "Battery for the Assessment of Bridging period Yields" (BABY), 'n geldige, betroubare en bruikbare skoolgereedheidstoetsbattery vir onderwyseresse as ongeregistreerde toetsgebruikers, is ontwikkel. Die Voortoets vtr indeling in homogene bevoegdheidsgroepe word kort na skooltoetrede toegepas. Die Diagnostiese Toetsbattery verseker deurlopende evaluering van leerlinge gedurende die skoolgereedmakingsprogram. Die Natoets word aan die einde van die eerste kwartaal toegepas. In hierdie dinamiese interaksie tussen toetser en leerling in 'n onderrig-toets-onderrig siklus, word leerlinge se gereedheid om met formele onderrig voort te gaan, deurlopend geevalueer. / Psychology og Education / M. Ed. (Psychology of Education)

Summaries in Afrikaans and English / Text in Afrikaans / With compulsory education in the New South· Africa, an increase in the number of school beginners can be expected, together with the probability of large gaps in their readiness for school. In £his study, materials have been developed together with a structure for the organisation of teaching_~!?.r trainers/subject advisers, teachers and pupils, to ensure effective education for school beginners. The "Battery for the Assessment of Bridging period Yields" (BABY) has been developed as a valid, realiable and usable school readiness battery of tests for teachers as unregistered test users. The Pre-Test for division into homogeneous ability groups is applied shortly after entrance to school. The Battery of Diagnostic Tests ensures continuous evaluation of pupils during the school readiness programme. The Post-Test is applied at the end of the first term. In this dynamic interaction between tester and pupil in an instruction-test-instruction cycle, the pupils' readiness to progress with formal instruction is continuously evaluated. / Met verpligte onderwys in die Nuwe Suid-Afrika, kan 'n toename in die getal swart skoolbeginners ve:wag word, asook dat daar in hulle skoolvoorbereiding groot leemtes kan voorkom. In die onderhawige studie is hulpmiddels en 'n struktuur vir onderwysorganisasie vir opleiers/vakadviseurs, onderwyseresse en leerlinge ontwikkel om aan skoolbeginners effektiewe onderwys te verseker. Die "Battery for the Assessment of Bridging period Yields" (BABY), 'n geldige, betroubare en bruikbare skoolgereedheidstoetsbattery vir onderwyseresse as ongeregistreerde toetsgebruikers, is ontwikkel. Die Voortoets vtr indeling in homogene bevoegdheidsgroepe word kort na skooltoetrede toegepas. Die Diagnostiese Toetsbattery verseker deurlopende evaluering van leerlinge gedurende die skoolgereedmakingsprogram. Die Natoets word aan die einde van die eerste kwartaal toegepas. In hierdie dinamiese interaksie tussen toetser en leerling in 'n onderrig-toets-onderrig siklus, word leerlinge se gereedheid om met formele onderrig voort te gaan, deurlopend geevalueer. / Psychology og Education / M. Ed. (Psychology of Education)

No description available.

L’espérance de vie des personnes atteintes de la fibrose kystique (FK) ne cesse d’augmenter. Cette dernière, dépassant maintenant les 50 ans au Canada, est associée à l’émergence de nouvelles complications secondaires de la maladie; la plus importante étant le diabète associé à la FK (DAFK). Près de 50% des patients adultes en sont atteints. Le DAFK a été associé à une diminution de la fonction pulmonaire, à une perte de poids et à une morbidité accrue. La maladie pulmonaire terminale est la première cause de mortalité en FK, alors que la perte de poids est associée à une diminution de la fonction pulmonaire. Ainsi, le DAFK augmente le risque de mortalité précoce. Il est avant tout causé par une diminution de la sécrétion d’insuline secondaire aux pancréatites chroniques. Toutefois, une sécrétion d’insuline minimale est maintenue, permettant généralement à la glycémie à jeun de demeurer normale longtemps. La présence ou non de résistance à l’insuline est controversée. Notre groupe de recherche a émis l’hypothèse que, dans un contexte de sécrétion d’insuline réduite, une variation dans la résistance à l’insuline (secondaire aux infections pulmonaires, à l’inflammation, à la médication, à une diète riche en gras, etc.) peut entrainer une dégradation de la tolérance au glucose. Un test de dépistage annuel est recommandé dès l’âge de 10 ans. L’hyperglycémie provoquée par voie orale (HGPO) nécessite que le patient soit à jeun, ait un accès veineux et que le test soit d’une durée de deux heures. Ce test est largement critiqué dans la littérature scientifique, puisque les seuils diagnostiques sont basés sur le risque de complications micro-vasculaires (seuils du diabète de type 2) et non sur les complications pulmonaires de la FK. Notre groupe de recherche vise donc à étudier les tests de dépistage alternatifs du DAFK. La glycémie à une heure du test d’HGPO est actuellement à l’étude en FK, puisqu’elle serait associée au déclin clinique propre à la FK. Notre groupe de recherche a émis l’hypothèse que la glycémie à 1-h de l’HGPO peut prédire l’évolution du poids et de la fonction pulmonaire sur plusieurs années. Les travaux de cette thèse se divisent en deux volets. Dans un premier temps, nous souhaitions étudier l’impact de la résistance à l’insuline sur l’évolution de la tolérance au glucose sur deux ans et l’impact des niveaux de la glycémie et de l’insuline à 1-h de l’HGPO sur les paramètres cliniques de la FK sur 4 ans. Dans un deuxième temps, une revue de la littérature sur les méthodes de dépistages actuelles et alternatives du DAFK a été réalisée. Des études de validation de certains biomarqueurs du diabète ont également été réalisées dans notre cohorte de patients atteints de la FK (plus de 300 patients). Deux cohortes de patients atteints de la FK sont à l’étude. D’abord, la Montreal Cysctic Fibrosis Cohort (MCFC) regroupe les patients adultes suivis au Centre Hospitalier de l’Université de Montréal (CHUM). Établie en 2004, cette cohorte observationnelle regroupe plus de 300 patients qui font une visite d’HGPO chaque 12 à 24 mois. Ensuite, les données des patients de la cohorte MCFC ont été regroupées à celles d’une cohorte similaire établie à Lyon en France (150 patients). La nouvelle cohorte nommée GLYCONE vise à étudier l’impact des niveaux de la glycémie et de l’insuline à 1-h de l’HGPO sur l’évolution clinique (suivi prospectif de 4 ans). Les principales conclusions de cette thèse sont : 1. La résistance à l’insuline est impliquée dans le changement de tolérance au glucose sur 2 ans chez nos patients adultes; 2. Les patients de notre cohorte montréalaise ont une meilleure fonction pulmonaire et un poids plus élevé que les patients de la cohorte française. Toutefois, l’incidence de diabète et de pré-diabète est plus élevée dans la population canadienne; 3. La cohorte internationale GLYCONE montre que les niveaux de la glycémie à 1-h et à 2-h de l’HGPO n’influencent pas l’évolution clinique du poids et de la fonction pulmonaire sur 4 ans, suggérant que des mécanismes survenant plus tôt dans la vie permettent l’apparition des différences cliniques en fonction de la glycémie; 4. Une revue de la littérature scientifique montre que l’HGPO de 2-h doit demeurer le test standard de dépistage du DAFK, puisque les autres méthodes alternatives à l’étude n’ont pas démontré leur efficacité et; 5. Les biomarqueurs de dépistage alternatifs du DAFK tels que l’hémoglobine glyquée, la glycémie à jeun et les marqueurs de sensibilité à l’insuline ne permettent pas de cibler les patients diabétiques dans notre cohorte montréalaise. Toutefois, l’utilisation de ces marqueurs pourrait permettre de réduire le nombre de tests d’HGPO requis annuellement. / The life expectancy of people living with cystic fibrosis (CF) is increasing and is now over 50 years old in Canada. Higher life expectancy is associated with the emergence of new secondary complications of the disease; the most important being CF-related diabetes (CFRD). Almost half of adults with CF have CFRD. It has been associated with lung function decrease, weight loss and increased morbidity. End-stage lung disease is the leading cause of death in CF, while weight loss is associated with decreased lung function. Thus, CFRD increases the risk of early mortality. It is primarily caused by a decrease in insulin secretion secondary to chronic pancreatitis. However, minimal insulin secretion is maintained, usually allowing fasting blood glucose to remain normal for a long time. Whether or not there is insulin resistance is controversial. Our research group hypothesized that in a context of low insulin secretion, a change in insulin resistance (secondary to pulmonary infection, medication, a high fat diet, etc.) can lead to glucose intolerance. An annual screening test, the oral glucose tolerance test (OGTT), is recommended from the age of 10. The OGTT requires fasting, venous access, and lasts for two hours. This test is widely criticized in the scientific literature, since the diagnostic thresholds are based on the risk of microvascular complications (thresholds for type 2 diabetes) and not on pulmonary complications of CF. Our research group therefore aims to study alternative screening tests for CFRD. Glycemia at 1-hour of the OGTT is currently being investigated in CF, as it is believed to be associated with clinical decline specific to CF. Our research group hypothesized that the 1-h OGTT blood glucose can predict changes in weight and lung function over several years. The work of this thesis is divided into two sections. First, we wanted to study the impact of insulin resistance on the evolution of glucose tolerance over two years and the impact of 1-h glycemia and insulin of the OGTT on the CF clinical parameters over 4 years. Secondly, a review of the literature on current and alternative CFRD screening methods was carried out. Validation studies on diabetes biomarkers were also performed in our cohort of CF patients (over 300 patients). Two cohorts of CF patients are being studied. First, the Montreal Cystic Fibrosis Cohort (MCFC) includes patients followed at the Centre Hospitalier de l’Université de Montréal (CHUM). Established in 2004, this observational cohort includes over 300 patients with an OGTT every 12 to 24 months. Then, data from the MCFC were pooled with those of a similar cohort established in Lyon, France (150 patients). The new cohort named GLYCONE aims to study the impact of 1-h glycemia and insulin of the OGTT on the clinical course of CF patients (prospective follow-up of 4 years). The main conclusions of this thesis are: 1. Insulin resistance is implicated in the change in glucose tolerance over 2 years in our adult patients; 2. The patients of the MCFC have better lung function and a higher weight than the French patients. However, the incidence of diabetes and pre-diabetes is higher in the Canadian population; 3. The GLYCONE international cohort shows that 1-hour and 2-hour glucose levels of the OGTT do not influence the clinical course of weight and lung function over 4 years, suggesting that mechanisms occurring earlier in life allow the onset of clinical differences in blood glucose levels; 4. A scientific literature review shows that the 2-h OGTT blood glucose should remain the standard test for CFRD, since other alternatives methods have not been shown to be effective and; 5. Alternative screening biomarkers for CFRD such as glycated hemoglobin, fasting blood glucose and insulin sensitivity index do not allow us to target diabetic patients in our MCFC. However, the use of these markers could reduce the number of required annual OGTT.