Úlceras de pele são causadas devido à deficiência na circulação sanguínea. O diagnóstico é feito pela análise visual das regiões afetadas. A quantificação da distribuição de cores da lesão, por meio de técnicas de processamento de imagens pode auxiliar na caracterização e análise da dinâmica do processo patológico e resposta ao tratamento. O processamento de imagens de úlceras dermatológicas envolve etapas relacionadas a segmentação, caracterização e indexação. Esta análise é importante para classificação, recuperação de imagens similares e acompanhamento da evolução de uma lesão. Este trabalho apresenta um estudo sobre técnicas de segmentação e caracterização de imagens coloridas de úlceras de pele, baseadas nos modelos de cores RGB, HSV, L*a*b* e L*u*v*, utilizando suas componentes na extração de informações de textura e cor. Foram utilizadas técnicas de Aprendizado de Máquina e algoritmos matemáticos para a segmentação e extração de atributos, utilizando uma base de dados com 172 imagens. Nos testes de recuperação, foram utilizadas diferentes métricas de distância para avaliação do desempenho e técnicas de seleção de atributos. Os resultados obtidos evidenciam bom potencial para apoio ao diagnóstico e acompanhamento da evolução do tratamento com valores de até 75% de precisão para as técnicas de recuperação, 0,9 de área embaixo da curva receiver-operating-characteristic na classificação e 0,04 de erro médio quadrático entre a composição de cores da imagem segmentada automaticamente e a segmentada manualmente. Nos testes utilizando seleção de atributos, foi observado uma redução nos valores de precisão de recuperação (60%) e valores similares nos tetes de classificação (0,85). / Skin ulcers are caused due to deficiency in the bloodstream. The diagnosis is made by a visual analysis of the affected area. Quantification of color distribution of the lesion by image processing techniques can aid in the characterization and response to treatment. The image processing steps involves skin ulcers related to segmentation, characterization and indexing. This analysis is important for classification, image retrieval and similar tracking the evolution of an injury. This project presents a study of segmentation techniques and characterization of color images of dermatological skin ulcers, based on the color models RGB, HSV, L*a*b* and L*u*v*, using their components in the extraction of texture and color information. Were used Machine Learning techniques, mathematical algorithms for segmentation and extraction of attributes, using a database containing 172 images in two versions. In recovery tests were used different distance metrics for performance evaluation and techniques of features selection. The results show good potential to support the diagnosis and monitoring of treatment progress with values up to 75% precision in recovery techniques, 0.9 area under the curve receiver-operating-characteristic) in classification, and 0.04 mean square error between the color composition of the automatically segmented image and the manually segmented image. In tests utilizing feature selection was observed a decrease in precision values of image retrieval (60%) and similar values in the classification\'s tests (0.85).

Syfte: Syftet med studien var att beskriva distriktssköterskors erfarenheter av vad som underlättade och hindrade evidensbaserad vård av ben- och fotsår inom primärvården. Metod: En kvalitativ intervjustudie med semistrukturerade intervjuer genomfördes med åtta distriktssköterskor. Samtliga arbetade på hälsocentraler i södra Hälsingland. Intervjuerna transkriberades och analyserades med kvalitativ innehållsanalys. Som teoretisk referensram användes PARIHS modellen. Huvudresultat: I studien framkom olika faktorer som underlättar respektive hindrar distriktssköterskor inom primärvården att arbeta efter en rutin för ben- och fotsår. Det som underlättade var ett välfungerande teamarbete på arbetsplatsen, att rutinen var anpassad så att den var lätt att arbeta efter och att den fanns lättillgänglig i datasystemet, specifik kunskap om sårvård och ett engagemang för patienten och för ämnet sårvård samt att patienten behöver stöd och utbildning för att kunna medverka i vården. Det som hindrade var bristande förståelse och engagemang från chef och kollegor, svårigheter att motivera patienterna till att medverka till behandling samt att journalsystemet inte var anpassat efter ben- och fotsårsrutinen. Slutsats: I studien framkom olika faktorer som underlättade och hindrade distriktssköterskor att använda sig av evidensbaserad vård av ben- och fotsår i det dagliga arbetet. Det som påverkade distriktssköterskornas användning av rutinen var i störst utsträckning faktorer i omgivningen. För att underlätta för distriktssköterskor att kunna arbeta enligt evidensbaserad sårvård måste ansträngningar göras för att undanröja hinder. PARIHS modellen kan användas som stödjande verktyg före, under och efter implementeringsprocessen. / Purpose: The purpose of the study was to describe district nurses' experiences of the facilitating and preventative factors that influence the use of evidence-based wound care in primary healthcare. Method : A qualitative interview study with semi-structured interviews was conducted with eight district nurses. All worked at health centers in southern Hälsingland. The interviews were transcribed and analyzed by qualitative content analysis. As a theoretical reference frame, the PARIHS model was used. Main outcome : The study revealed different factors that facilitate or prevent district nurses in primary healthcare to work for a routine for leg and foot ulcers. What facilitated was a well-functioning team work at the workplace, that the routine was adapted so that it was easy to work after and was easily accessible in the computer system, specific knowledge about wound care and commitment to the patient and on the subject of wound care and that the patient needs support and education to be able to participate in healthcare. What was prevented was insufficient understanding and commitment from the boss and colleagues, difficulty in motivating patients to participate in treatment and that the journal system was not adapted to the leg and foot routine. Conclusion : The study identified various factors which facilitated and prevented district nurses from using evidence-based care of leg and foot ulcers in their daily work. What influenced the use of the routine by district nurses was to the greatest extent factors in the environment. In order to facilitate district nurses to work according to evidence-based wound care, efforts must be made to eliminate obstacles. The PARIHS model can be used as a supporting tool before, during and after the implementation process.

No description available.

DIABETESFOTEN HOS INNELIGGANDE STROKEPATIENTER: RISK, OMFATTNING, OCH OMVÅRDNADSÅTGÄRDERBAKGRUND: Fotkomplikationer är de allvarligaste komplikationerna till diabetes som ofta leder till kostnadskrävande behandlingar och amputation. Stroke resulterar i förlust eller begränsning av tidigare fysiska, psykiska och sociala aktiviteter, inklusive nedsatt förmåga att skydda sina fötter och utföra egenvård. Strokepatienter med diabetes har stor risk att skada sig i den förlamade sidan av kroppen. Nedsatt mobilitet är en riskfaktor som kan orsaka patienten skada. På vårdavdelning för strokedrabbade patienter kan sjuksköterskan genom god omvårdnad och preventiva åtgärder bidra till att risken för utveckling av skada på fötterna hos strokepatienter minskar.SYFTE: Syftet med studien är att kartlägga omfattningen av diabetesfot på en neurologisk klinik samt granska omvårdnadsdokumentationen om preventionsåtgärder hos strokepatienter med diabetes avseende risken att utveckla fotsår.METOD: En retrospektiv journalgranskningsstudie med kvantitativ och kvalitativ ansats. Studien genomfördes på en neurologisk klinik på ett universitetssjukhus i södra Sverige. Samtliga journaler N=101 från strokepatienter med diabetes som vårdades på kliniken från 1 januari 2015 till den 20 december 2015 granskades med hjälp av Global Trigger Tool (GTT). Dataanalysen delades i två delar: deskriptiv statistisk analys och manifest kvalitativ innehållsanalys.RESULTAT: Medianåldern är 78 år (41-93 år). Kvinnor n=40, män n=61. Journalgranskningen visade generellt på bristande dokumentation. Riskbedömning för fotsår var inte dokumenterad i någon av journalerna. För patienter som hade dokumenterade fotsår (n= 3) var lokalisationen av fotsår på samma sida som patienten var förlamad. Dokumenterade preventions- och omvårdnadsåtgärder i sängen: (n=12) och i stolen: (n=0). Enligt IWGDF riskklassifikation identifierades (n =12) som har riskfaktorer för fotproblem och fotsår. Dokumentation av omvårdnadsprocessen följdes inte i journalerna.SLUTSATS: Patienterna har hög ålder, är multisjuka och förlamade helt eller på ena sidan av kroppen. Lokalisationen av fotsår på samma sida som patienten var förlamad. Brister i omvårdnadsdokumentation och preventionsarbete medför risk för patientens säkerhet. Studien ger mer kunskap när det gäller risk för utvecklandet av fotsår hos patienter med stroke och diabetes som vårdas på neurologisk klinik. Studien ger ett underlag för att utveckla klinikens kvalitetsarbete och försäkra patientsäkerhet genom att öka kunskap om diabeteskomplikationer och riktlinjer, omvårdnadsdokumentation enligt omvårdnadsprocessen, samt kritiskt tänkande av omvårdnad. Fler studier om fotsår hos strokepatienter rekommenderas. / THE DIABETIC FOOT IN HOSPITALIZED STROKE PATIENTS: RISK, PREVELANCE AND NURSING ACTIONS.BACKGROUND: Complications in the foot is the most serious one of the diabetes. Often, this leads to expensive treatments and amputation. Stroke results in loss or limitation of previous physiological, psychological and social activities and including a reduced ability to protect their feet and perform self-care. Stroke patients with diabetes have a high risk of injury in the paralyzed side of the body. Impaired mobility is a risk factor that can cause patient harm. On the nursing ward for stroke patients the nurse can through good nursing intervention and preventive actions contribute to the risk of developing damage to their feet in stroke patients decreases.AIM: The aim of the study is to explore the prevalence of diabetic foot at a neurological clinic and review the nursing documentation of preventions actions in stroke patients with diabetes with regard to the risk of developing foot ulcers.METHOD: A retrospective medical record review study with quantitative and qualitative approach. The study was conducted at a neurological clinic at a university hospital in southern Sweden. All the records (n = 101) of stroke patients with diabetes who were treated at the clinic from 1 January 2015 to 20 December 2015. The examination was conducted using Global Trigger Tool (GTT). Data analysis was divided into two parts: the descriptive statistical analysis and manifest content analysis.RESULTS: Median age is 78 years (41-93). Women (n = 40), men (n = 61). Journal review showed insufficient documentation. Risk assessment for foot ulcers was not documented in any of the journals. Patients with documented foot ulcer (n= 3), the localization of ulcers is on the same side as the patient is paralyzed. Prevention and nursing actions, (n = 12) documented action in bed, (n = 0) documented actions in the chair. According IWGDF risk classification (n =12) identified as having risk factors for foot problem and foot ulcer. Documentation of nursing process was not followed in the journals.SUMMARY: The patients had high age with multiple comorbidities and paralyzed in the whole or on one side of the body. The localization of foot ulcers is on the same side as the patient is paralyzed. Insufficiency in nursing documentation and prevention work result in risk to patient safety and impaired quality of care. The study provides more knowledge about the risk of the developing foot ulcer for patients with stroke and diabetes who treated in the neurological clinic. The study provide foundation to develop the clinic quality work and ensure patient safety through increasing knowledge to the clinic about diabetic complications and guidelines, nursing documentation in accordance with the nursing process and critical thinking of nursing. More studies of foot ulcers in stroke patients are recommended. Keywords: diabetes mellitus, diabetes foot ulcers, documentation, Global Trigger Tool, journal examination, nursing, prevention,

No / Increasing pressure on health care budgets highlights the need for clinicians to understand the true costs of wound care, in order to be able to defend services against indiscriminate cost cutting. Our aim was to develop and test a straightforward method of measuring treatment costs, which is feasible in routine practice. The method was tested in a prospective study of leg ulcer patients attending three specialist clinics in the UK. A set of ulcer-related health state descriptors were defined on the basis that they represented distinct and clinically relevant descriptions of wound condition ['healed', 'progressing'; 'static''deteriorating; 'severe' (ulcer with serious complications)]. A standardised data-collection instrument was used to record information for all patients attending the clinic during the study period regarding (i) the health state of the ulcer; (ii) treatment received during the clinic visit and (iii) treatment planned between clinic visits. Information on resource use was used to estimate weekly treatment costs by ulcer state. Information was collected at 827 independent weekly observations from the three study centres. Treatment costs increased markedly with ulcer severity: an ulcer which was 'deteriorating' or 'severe' cost between twice and six times as much per week as an ulcer which was progressing normally towards healing. Higher costs were driven primarily by more frequent clinic visits and by the costs of hospitalisation for ulcers with severe complications. This exercise has demonstrated that the proposed methodology is easy to apply, and produces information which is of value in monitoring healing and in potentially reducing treatment costs.

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

Le rôle majeur de l’Helicobacter pylori dans l’étiopathogénie des maladies gastroduodénales (gastrite, ulcère gastrique et duodénal, lymphome gastrique) est bien établi aujourd’hui. L’OMS l’a reconnue comme jouant un rôle important dans la survenue des lésions cancéreuses gastriques. La prévalence de l’infection à H. pylori varie selon les pays de 20% à 90% avec des taux supérieurs à 60% dans les pays en développement, dont le Bénin. Les méthodes usuelles de diagnostic sont soit invasives nécessitant une endoscopie gastrique avec biopsies (test rapide à l’urée, histologie, culture et PCR), soit non-invasives (test respiratoire à l’urée marquée au carbone, sérologie, et détection de l’antigène dans les selles). La trithérapie associant un inhibiteur de la pompe à protons (IPP) et deux antibiotiques choisis parmi l’amoxicilline, la clarithromycine et le métronidazole est recommandée pour son traitement. La survenue de résistance des souches H. pylori aux différents antibiotiques devient une cause majeure de l’échec des régimes d’éradication.<p>Afin d’évaluer l’applicabilité et l’efficacité des régimes thérapeutiques recommandés en pratique courante, et à partir d’une étude de cohorte prospective, nous avons étudié la prévalence de l’infection à H. pylori chez les patients consultant à la clinique de Gastroentérologie de l’hôpital universitaire Erasme à Bruxelles, déterminé son taux de résistance primaire aux antibiotiques, et évalué le taux d’éradication d’H. pylori par la trithérapie. Nous avons aussi évalué la performance du test de détection de l’antigène d’H. pylori dans les selles pour le diagnostic chez l’adulte (avant traitement) comparé avec les méthodes de référence (culture, histologie), également dans le contrôle de l’éradication.<p>Au Bénin, nous avons évalué à partir d’une étude transversale prospective, la prévalence de l’infection à H. pylori dans une population en milieu urbain et rural. Nous avons déterminé la distribution par famille des sujets infectés, ainsi que l’influence des variables démographiques individuelles, et les caractéristiques socio-économiques familiales sur le risque de l’infection.<p>La prévalence de résistance primaire à la clarithromycine et au métronidazole fut observée respectivement dans 3% et 31% des souches isolées. Aucune résistance primaire à l’amoxicilline et à la tétracycline n’a été observée.<p>Les analyses en intention de traiter, ont montré que H. pylori a été éradiqué chez 80% des patients inclus dans l’étude thérapeutique. Le taux d’échec d’éradication fut de 20%. Comparé au 14C-TRU, le test HpSA avait une sensibilité de 100%, une spécificité de 91%, VPP de 69%, VPN de 100%. De même, la sensibilité du test HpSA par rapport aux deux méthodes usuelles (culture et histologie) est de 96.5% pour une spécificité de 91.2%, une VPP de 90.3% et une VPN de 96.8%. <p>Au Bénin, la prévalence de H. pylori était de 75.4% en ville et de 72.3% dans le village (p = 0.459). Aucune association n’a été observée avec l’âge, le sexe, le niveau d’instruction, la taille du ménage, l’activité économique ou le mode d’approvisionnement en eau potable. Le taux d’infection était plus élevé chez les enfants dont les parents étaient infectés et chez ceux ayant une mère H. pylori positive (p < 0.001). L’analyse multivariée par régression logistique a montré que la densité d’occupation des dortoirs [OR (95%) = 9.82 (4.13-23.31)] p < 0.001), et le statut des mères dans le ménage ([OR (95%) = 3.85 (1.53-9.67)] p < 0.001) étaient les prédicteurs indépendants de l’infection par H. pylori. Le risque de l’infection chez les enfants était 13 fois plus élevé quand les deux parents sont simultanément positifs OR (95% CI) = 13.6 (3.63-51.22), il l’était respectivement de 5.3 (1.52-18.45); 2.7 (0.47-15.44), quand la mère et le père sont positifs p < 0.001. Aussi le risque d’infection à H. pylori comparé aux enfants qui dorment seul dans leur chambre, était élevé pour ceux qui dorment avec un ou deux personnes OR (95% CI) = 5.2 (1.08-25.16), p < 0.05, et plus élevé chez les enfants qui dorment à 4 ou plus OR (95% CI) = 16.6 (2.66-103.44), p < 0.005, comparé à ceux qui dorme seuls. Donc, le contact avec des personnes infectées au sein de la famille et la vie en promiscuité, étaient associés avec un risque d’infection plus élevé indiquant une transmission intrafamiliale de l’infection par H. pylori.<p>En conclusion, nos résultats montrent une séroprévalence encore élevée de l’infection à H. pylori dans la population béninoise. Une surveillance de l’épidémiologie accompagnée de mesures de prévention ciblées sur les facteurs potentiels de risque de l’infection doit être poursuivie. La validation du test de détection de l’antigène dans les selles avant traitement et dans le contrôle de l’éradication de la bactérie pour le suivi thérapeutique des patients infectés, est une alternative intéressante notamment au Bénin. Le taux de résistance primaire pour le métronidazole est actuellement stable en Belgique, alors que la prévalence de la résistance à la clarithromycine mérite d’être précisée par d’autres études multicentriques. La trithérapie classique à base d’inhibiteur de la pompe à protons–amoxicilline-clarithromycine reste recommandable en première intention. La surveillance épidémiologique de l’infection basée sur la prévalence locale des souches clarithro-résistantes et métronidazole-résistantes devrait être poursuivie.<p><p><p><p><p><p><p><p><p><p><p>SUMMARY OF THE THESIS<p>The major role of H. pylori in the etiopathogeny of various gastroduodenal diseases (gastritis, gastric and duodenal ulcers, gastric lymphoma) is well established today. The World Health Organization concluded that H. pylori plays a causal role in the chain of events leading to cancer of the stomach.<p>The prevalence of H. pylori infection varies by country from 20% to 90%, with higher prevalence rates over 60% observed in developing countries, including Bénin. The usual methods allowing the diagnosis of the gastric infection by H. pylori are either invasive, requiring a gastric endoscopy and biopsies (fast urease test, anatomopathological examination, culture and PCR), or noninvasive (breath test with 13C or 14C marked urea, serology and stool antigen detection). Triple therapy associating a proton pump inhibitor (PPI) with two antibiotics, chosen between amoxicillin, clarithromycin and metronidazole, is currently recommended. Resistance of H. pylori strains to antibiotics becomes a major determinant in the failure of eradication of regimens.<p>To evaluate the applicability and efficacy of the therapeutic recommendations in our pratice, based on a prospective study, we studied the prevalence of H. pylori infection in the outpatient population of the Gastroenterology clinic at the Erasme University hospital in Brussels, determined its rate of primary resistance to antimicrobial agents and evaluated the rate of eradication of H. pylori by triple therapy. We also evaluated the performance of a stool antigen detection test for the diagnosis of H. pylori infection in adults (before treatment) compared with reference methods (culture and histology) as well as in control of eradication.<p>In Benin, we evaluated by a cross-sectional study the prevalence of the infection with H. pylori in the population living in urban and rural environment. We determined the family distribution of infected subjects as well as the influence of individual demographic variables and of the socio-economic family characteristics on the risk of infection.<p>In Brussels, primary resistance to clarithromycin and metronidazole was observed in 3% and 31% of the isolates, respectively. No primary resistance to amoxicillin and tetracycline was observed. By intention to treat analysis, H. pylori was eradicated in 80% of patients included in the therapeutic study. The rate of eradication failure was 20%. In comparison with 14C-Urea breath test, the H. pylori Stool Antigen test showed a sensitivity of 100%, a specificity of 91 %, PPV of 69%, and NPV of 100%. Compared to the reference methods (culture and histology), the HpSA test had a sensitivity of 96.5% and a specificity of 91.2%. PPV of 90.3% and NPV of 96.8%. <p>In Benin, the prevalence of H. pylori antibodies was 75.4% in town and 72.3% in the village (P= 0.459). No association was found between infection and age, sex, education level, size of the household, economic activity or source of drinking water. The infection rate was higher in children of parents who were both infected and also in those whose mother was infected (p < 0.001). By logistic regression analysis, the density of occupation of dormitories (more than three persons sharing dormitory, [OR (95%) = 9.82 (4.13-23.31)] p < 0.001), and mother status within the household ( [OR (95%) = 3.85 (1.53-9.67) ] p < 0.001), were independent predictors for H. pylori infection. The risk of H. pylori infection in children was 13 times higher when the two parents were simultaneously positive: OR (95% CI) = 13.6 (3.63-51.22) and it was respectively of 5.3 (1.52-18.45); 2.7 (0.47-15.44), when mother and father were positive p < 0.001. H. pylori infection risk in children was higher for a sharing a dormitory with one or two persons, OR (95% CI) = 5.2 (1.08-25.16), p < 0.05 and was even higher if a dormitory of 4 persons or more, OR (95% CI) = 16.6 (2.66-103.44), p < 0.005 as compared to sleeping alone. Family contact with infected persons and crowded living conditions were associated with increased risk of infection consistent with intrafamilial H. pylori transmission.<p>In conclusion, our results confirm a still high H. pylori seroprevalence in population in Benin. An epidemiolgic survey with prevention mesures targeted on potential risk predictors should be going on. Validation of antigen detection test in patients stools before treatment and for eradication control could be an interested alternative, notably in Benin. Primary resistance rate on metronidazole is stable today in Belgium, though the resistance prevalence on clarithromycin should be determined by other multicentric studies. Standard triple therapy by (PPI)-amoxicillin-clarithromycin is still recommended in first intention to treat. Epidemiological survey of infection based on local prevalence of claritromycin-resistant and metronidazole-resistant strains should be continued.<p><p><p><p><p><p> / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

[EN] Wheelchair users represent around 1% of the population. This group is characterised through the number of hours spent each day in a seated position. This can lead to health problems linked mainly to the development of pressure ulcers. In addition, the position in the wheelchair is critical in order to be able to perform different activities comfortably. The aim of the cushions, integrated in the whole seating system, is to contribute to the prevention, positioning and comfort of the person in a wheelchair. Incorporating the user adequately into the assessment, prescription and development of new cushions is a key aspect, clearly identified in the bibliography, which requires the use of innovation models to produce this incorporation systematically. This research paper adopts the cause-effect model, successfully used in other fields such as the car or shoe making industries, but to date not used in the field of tissue management cushions. The use of this model has allowed for the identification of different links between the consequences of the interaction person-cushion (developed perception of the user) with the cushion and person characteristics, as well as with the physiological and biomechanical response resulting from this interaction. This was a necessary step to obtain design and selection criteria for the cushions. The physiological and biomechanical variables which have been analysed are pressure and microclimate. To study the consequences of this interaction we have considered the user perception obtained by means of a questionnaire. Thirty-six wheelchair users have participated in this study which includes the assessment of twenty-five cushions. The main criteria for the inclusion of users in the study has been the risk level of risk of developing pressure ulcers. The inclusion of cushions was based on the market representation and consideration of the different typologies. From the point of view of the user's opinion this research paper has allowed for the identification of the quality perception factors (F1. Stability, F2.Heat-pain, F3. Fitting, F4. Collapse, F5. Size-aesthetics and F6. Weight-cold) and for the calculation of their weight on the global factors of goodness and evolution of the cushions. In addition, the comparison of the pressure values obtained directly from the wheelchair users and those measured using the dummy highlights a clear divergence between both behaviour. We have also defined design criteria and limit values, admissible and recommendable, for a group of variables, as well as the relation of the subjective variables with these quality factors. The results of this research support the importance of a comprenhensive approach to the cushions, including the design, development and prescription processes whereby the users may become more of a protagonist than they have been so far. / [ES] Las personas en silla de ruedas representan alrededor del 1% de la población. Este colectivo se caracteriza por pasar muchas horas al día sentado. Esto puede comportar problemas de salud vinculados principalmente al desarrollo de úlceras por presión. Por otra parte, el posicionamiento en la silla de ruedas es crítico para poder realizar actividades diversas de forma confortable. El objetivo de los cojines, integrados dentro del sistema de sedestación, es contribuir a la prevención, el posicionamiento y el confort de la persona en la silla de ruedas. Incorporar el usuario de forma adecuada en la evaluación, prescripción y desarrollo de nuevos cojines es un aspecto clave, identificado claramente en la bibliografía, que requiere el uso de modelos de innovación que faciliten esta incorporación de forma sistemática. En este trabajo de investigación se ha adoptado el modelo de evaluación causa-efecto, empleado con éxito en ámbitos como la automoción o el calzado, pero que hasta el momento no se había utilizado en el campo de los cojines antiescaras. El uso de este modelo ha permitido la identificación de diversos encadenamientos entre las consecuencias de la interacción cojín-persona (percepción desarrollada en el usuario) con las características del cojín y la persona, así como con la respuesta fisiológica y biomecánica resultante de esta interacción. Éste era el paso previo para poder obtener criterios de diseño y selección de cojines. Las variables fisiológicas y biomecánicas analizadas han sido la presión y el microclima. Para estudiar las consecuencias de la interacción hemos considerado la percepción del usuario obtenida mediante cuestionarios. Treinta y seis personas en silla de ruedas han participado en este estudio que ha incluido la valoración de veinticinco cojines. El principal criterio para la inclusión de usuarios en el estudio ha sido el nivel de riesgo de desarrollar úlceras por presión. La inclusión de los cojines se ha basado en la representatividad del mercado y la inclusión de tipologías diferentes. Desde el punto de vista de la opinión de los usuarios este trabajo de investigación ha permitido identificar los factores de calidad percibida (F1. Estabilidad, F2. Calor-dolor, F3. Encajonamiento, F4. Colapso, F5. Tamaño-estética y F6. Peso-frío) y calcular el peso de ellos sobre los factores globales de bondad y evolución de los cojines. Por otra parte, la comparación de los valores de presión obtenidos con las personas en silla de ruedas y los medidos con el maniquí constata una clara divergencia en el comportamiento. También se han definido criterios de diseño y valores límite, admisibles y recomendables, para un conjunto de variables, así como su relación con los factores de calidad y las variables subjetivas agrupadas en estos factores. Los resultados de este trabajo apoyan la importancia de una aproximación global a los cojines, que incluya los procesos de diseño, desarrollo y prescripción, donde los usuarios sean mucho más protagonistas de lo que han sido hasta ahora. / [CA] Les persones en cadira de rodes representen al voltant de l'1% de la població. Aquest col·lectiu es caracteritza per passar moltes hores al dia damunt la cadira, cosa que pot comportar problemes de salut vinculats principalment al desenvolupament d'úlceres per pressió. Per altra banda, el posicionament en la cadira de rodes és crític per poder realitzar activitats diverses i que aquestes puguen fer-se de forma confortable. L'objectiu dels coixins, integrats dins del sistema de sedestació, és contribuir a la prevenció, el posicionament i el confort de la persona en la cadira de rodes. Incorporar l'usuari de forma adequada en l'avaluació, prescripció i desenvolupament de nous coixins és un aspecte clau, identificat clarament a la bibliografia, que requereix l'ús de models d'innovació que faciliten aquesta incorporació de forma sistemàtica. En aquest treball d'investigació s'ha adoptat el model d'avaluació causa-efecte, emprat amb èxit en àmbits com l'automoció o el calcer, però que fins al moment no s'havia utilitzat en el camp dels coixins antiescares. L'ús d'aquest model ha permès la identificació de diversos encadenaments entre les conseqüències de la interacció coixí-persona (percepció desenvolupada en l'usuari) amb les característiques del coixí i la persona, així com amb la resposta fisiològica i biomecànica resultant d'aquesta interacció. Aquest era el pas previ per poder obtenir cri teris de disseny i selecció de coixins. Les variables fisiològiques i biomecàniques analitzades han estat la pressió i el microclima. Per a estudiar les conseqüències de la interacció hem considerat la percepció de l'usuari obtinguda mitjançant l'ús de qüestionaris. Trenta-sis persones en cadira de rodes han participat en aquest estudi que ha inclòs la valoració de vint-i-cinc coixins. El principal criteri per a la inclusió d'usuaris en l'estudi ha estat el nivell de risc de desenvolupar úlceres per pressió. Per a la inclusió dels coixins s'ha buscat la representativitat del mercat i la inclusió de tipologies diferents. Des del punt de vista de l'opinió dels usuaris aquest treball d'investigació ha permès identificar els factors de qualitat percebuda (F1. Estabilitat, F2. Calor-dolor, F3. Encaixament, F4. Col·lapse, F5. Grandària-estètica i F6. Pes-fred) i calcular el pes d'ells sobre els factors globals de bondat i evolució dels coixins. Per altra banda, la comparació dels valors de pressió obtinguts amb les persones en cadira de rodes i els mesurats amb el maniquí constata una clara divergència en el comportament. També s'han definit criteris de disseny i valors límit, admissibles i recomanables, per a un conjunt de variables i la seua relació amb els factors de qualitat i les variables subjectives. Els resultats d'aquest treball suporten la importància d'una aproximació global als coixins, que incloga els processos de disseny, desenvolupament i prescripció, on els usuaris siguen molt més protagonistes del que ho han estat fins ara. / Barbera Guillem, R. (2016). Identificació de criteris de disseny i selecció de coixins antiescares, a partir d'aspectes funcionals dels coixins i les característiques particulars i preferències dels usuaris [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/61463

Made available in DSpace on 2014-07-29T15:30:41Z (GMT). No. of bitstreams: 1 Dissertacao Ly de Freitas.pdf: 838915 bytes, checksum: 5243e0ddc38034e898d34138a6918a11 (MD5) Previous issue date: 2007-03-02 / O presente trabalho foi desenvolvido no Laboratório de Artropodologia Médica e Veterinária (LAMV) do Instituto de Patologia Tropical e Saúde Pública da Universidade Federal de Goiás (UFG) e no Hospital das Clínicas (HC) da UFG, na cidade de Goiânia, Goiás, Brasil. Este objetivou conhecer a freqüência dos diferentes tipos de miíases diagnosticadas em pacientes do HC, seus vários agentes etiológicos e fatores associados. Também objetivou identificar a microbiota bacteriana presente em lesões do tipo pés diabéticos e úlceras de estase venosa de pacientes do Pronto Socorro e Ambulatório do Pé Diabético do HC / UFG. Para isto foram realizados dois estudos. No primeiro estudo, realizado no período de Fevereiro de 2005 a Agosto de 2006, larvas de Muscomorpha foram coletadas das miíases diagnosticadas em 66 pacientes atendidos no HC e, encaminhadas ao LAMV para identificação taxonômica. Foram observadas em ordem decrescente de freqüência as seguintes espécies: Cochliomyia hominivorax (62,12%), Sarcodexia lambens (12,12%), Dermatobia hominis (10,6%), Chrysomya albiceps (6,06%), Chrysomya megacephala (4,54%), Lucilia cuprina (1,51%), e Eristalis tenax (1,51%). Miíases obrigatórias foram as predominantes nos pacientes. A freqüência de miíases foi maior em indivíduos do sexo masculino, sobretudo na idade produtiva, seguida por mulheres, crianças e pacientes neurológicos e psiquiátricos. As miíases incidiram principalmente nos membros inferiores, em lesões de pele e tecido subcutâneo pré-existentes de pacientes portadores de patologias diversas, mas principalmente em diabéticos e neuropatas, seguido pela localização no couro cabeludo, no qual predominaram miíases do tipo furuncular dermal, mas também do tipo múltipla, em associação com pediculose e impetigo. A freqüência de miíases foi maior em pacientes de baixo nível sócio-econômico. A higiene precária e o abandono vivido por diversos pacientes, com curativos em mau estado, úmidos de secreção e/ou com presença de tecidos necróticos, foram fatores importantes na incidência de miíases. Para corrigir esta situação, educação e medidas sanitárias se fazem necessárias. No Segundo estudo foram incluídos 79 pacientes portadores de lesões de membros inferiores, atendidos no HC. Sendo 50 pacientes diabéticos e 29 pacientes com úlcera de estase. A coleta de material foi realizada com swab de algodão produzidos pelo próprio hospital para realização de cultura e teste de sensibilidade antimicrobiana, correspondendo ao total 104 culturas desses 79 pacientes. Isolaram-se 14 espécies bacterianas em 104 amostras. Destas, 12 (11,54%) não apresentaram desenvolvimento microbiano. Os cocos Gram positivos foram caracterizados fenotipicamente como Staphylococcus aureus 20 amostras (19,23%), e Staphylococcus epidermidis sete (6,73%). Dentre os bastonetes Gram negativos identificou-se Pseudomonas aeruginosa 22 (21,15%); uma amostra de Pseudomonas sp. (0,96%), Escherichia coli, 14 (13,46%), Proteus mirabilis, oito (7,69%), Enterobacter sp 7sete (6,73%), Proteus vulgaris, três (2,88%), Enterobacter aerogenes, duas (1,92%), Providencia stuartii, duas (1,92%), e as demais com uma amostra cada (0,96%): Citrobacter sp, Enterobacter cloacae, Klebsiella pneumoniae, Klebsiella oxytoca, Morganella morganii, Proteus penneri. Os microrganismos isolados das lesões de membros inferiores (pé diabético e úlcera de estase venosa) incluíram germes Gram positivos e Gram negativos, sendo Staphylococcus aureus, Pseudomonas aeruginosa e Escherichia coli os mais freqüentes. O perfil de suscetibilidade mostrou resistência para ampicilina, a associação de ampicilina e sulbactan apresentou menor resistência apenas de Staphylococcus aureus. Ciprofloxacina foi eficaz na maioria dos casos (52%, 66%, 50%) respectivamente, entretanto, Pseudomonas aeruginosa mostrou-se multi-resistente. A necessidade de associação de antibióticos contra Gram positivos e Gram negativos ainda se justifica considerando os resultados, pela falta de drogas que atuem isoladamente bem nas diversas espécies de bactérias. / O presente trabalho foi desenvolvido no Laboratório de Artropodologia Médica e Veterinária (LAMV) do Instituto de Patologia Tropical e Saúde Pública da Universidade Federal de Goiás (UFG) e no Hospital das Clínicas (HC) da UFG, na cidade de Goiânia, Goiás, Brasil. Este objetivou conhecer a freqüência dos diferentes tipos de miíases diagnosticadas em pacientes do HC, seus vários agentes etiológicos e fatores associados. Também objetivou identificar a microbiota bacteriana presente em lesões do tipo pés diabéticos e úlceras de estase venosa de pacientes do Pronto Socorro e Ambulatório do Pé Diabético do HC / UFG. Para isto foram realizados dois estudos. No primeiro estudo, realizado no período de Fevereiro de 2005 a Agosto de 2006, larvas de Muscomorpha foram coletadas das miíases diagnosticadas em 66 pacientes atendidos no HC e, encaminhadas ao LAMV para identificação taxonômica. Foram observadas em ordem decrescente de freqüência as seguintes espécies: Cochliomyia hominivorax (62,12%), Sarcodexia lambens (12,12%), Dermatobia hominis (10,6%), Chrysomya albiceps (6,06%), Chrysomya megacephala (4,54%), Lucilia cuprina (1,51%), e Eristalis tenax (1,51%). Miíases obrigatórias foram as predominantes nos pacientes. A freqüência de miíases foi maior em indivíduos do sexo masculino, sobretudo na idade produtiva, seguida por mulheres, crianças e pacientes neurológicos e psiquiátricos. As miíases incidiram principalmente nos membros inferiores, em lesões de pele e tecido subcutâneo pré-existentes de pacientes portadores de patologias diversas, mas principalmente em diabéticos e neuropatas, seguido pela localização no couro cabeludo, no qual predominaram miíases do tipo furuncular dermal, mas também do tipo múltipla, em associação com pediculose e impetigo. A freqüência de miíases foi maior em pacientes de baixo nível sócio-econômico. A higiene precária e o abandono vivido por diversos pacientes, com curativos em mau estado, úmidos de secreção e/ou com presença de tecidos necróticos, foram fatores importantes na incidência de miíases. Para corrigir esta situação, educação e medidas sanitárias se fazem necessárias. No Segundo estudo foram incluídos 79 pacientes portadores de lesões de membros inferiores, atendidos no HC. Sendo 50 pacientes diabéticos e 29 pacientes com úlcera de estase. A coleta de material foi realizada com swab de algodão produzidos pelo próprio hospital para realização de cultura e teste de sensibilidade antimicrobiana, correspondendo ao total 104 culturas desses 79 pacientes. Isolaram-se 14 espécies bacterianas em 104 amostras. Destas, 12 (11,54%) não apresentaram desenvolvimento microbiano. Os cocos Gram positivos foram caracterizados fenotipicamente como Staphylococcus aureus 20 amostras (19,23%), e Staphylococcus epidermidis sete (6,73%). Dentre os bastonetes Gram negativos identificou-se Pseudomonas aeruginosa 22 (21,15%); uma amostra de Pseudomonas sp. (0,96%), Escherichia coli, 14 (13,46%), Proteus mirabilis, oito (7,69%), Enterobacter sp 7sete (6,73%), Proteus vulgaris, três (2,88%), Enterobacter aerogenes, duas (1,92%), Providencia stuartii, duas (1,92%), e as demais com uma amostra cada (0,96%): Citrobacter sp, Enterobacter cloacae, Klebsiella pneumoniae, Klebsiella oxytoca, Morganella morganii, Proteus penneri. Os microrganismos isolados das lesões de membros inferiores (pé diabético e úlcera de estase venosa) incluíram germes Gram positivos e Gram negativos, sendo Staphylococcus aureus, Pseudomonas aeruginosa e Escherichia coli os mais freqüentes. O perfil de suscetibilidade mostrou resistência para ampicilina, a associação de ampicilina e sulbactan apresentou menor resistência apenas de Staphylococcus aureus. Ciprofloxacina foi eficaz na maioria dos casos (52%, 66%, 50%) respectivamente, entretanto, Pseudomonas aeruginosa mostrou-se multi-resistente. A necessidade de associação de antibióticos contra Gram positivos e Gram negativos ainda se justifica considerando os resultados, pela falta de drogas que atuem isoladamente bem nas diversas espécies de bactérias.