Bakgrund: Medellivslängden ökar världen över och en åldrande population ställer större krav på att vårdpersonal har kunskap om åldersrelaterade sjukdomar som demens. Demenssjukdom yttrar sig som tilltagande kognitiva- och fysiska försämringar som resulterar i minskad fysisk aktivitet och rörelseförmåga. En personcentrerad omvårdnad som verkar för att bibehålla patientens autonomi och förmåga till att utföra aktiviteter i dagliga livet (ADL) är centralt inom dagens vård av personer med demenssjukdom, där sjuksköterskan har en central koordinerande roll. Forskning tyder på att fysisk aktivitet som omvårdnadsåtgärd kan underlätta vid demenssjukdom Syfte: Att sammanställa befintlig forskning om hur fysisk aktivitet påverkar demenssjukas förmåga att klara egen ADL. Metod: En allmän litteraturstudie gjordes för att analysera underlag hämtat från databaserna Cinahl, PubMED och PsycINFO. Totalt analyserades nio kvantitativa studier. Resultat: Analysen resulterade i de tre övergripande kategorierna påverkad förmåga till ADL, fysiska funktioner och kognitiv förmåga. Sammantaget sågs ett resultat som påvisade att fysisk aktivitet främjar demensdrabbades förmåga till ADL, förbättrar fysiska egenskaper och motverkar depression – men inte alltid av statistisk signifikans. Slutsats: Träning kan bromsa både fysisk och kognitiv funktionsförlust hos demensdrabbade, vilket verkar mot bättre självständighet och högre livskvalitet. Bäst effekt sågs i träningsprogram som var anpassade efter individen och sjukdomsbilden, vilket går i linje med Socialstyrelsens och Svensk sjuksköterskeförenings rekommendation om personcentrerad vård. Ytterligare forskning behövs inom området, men forskning visar minskad fallrisk och ökad rörelseförmåga hos vilket kan ge lägre vårdbörda.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第19276号 / 社医博第67号 / 新制||社医||9(附属図書館) / 32278 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 川上 浩司, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

No description available.

Ett symtom som kan uppkomma i samband med stroke är neglekt. Neglekt innebär svårigheter att uppmärksamma ena sidan av kroppen samt stimuli som uppkommer vid den påverkade kroppshalvan. Att drabbas av neglekt kan innebära en lång rehabiliteringsperiod och begränsar utförandet av aktiviteter i det dagliga livet. Syftet med studien var att undersöka arbetsterapeutiska interventioners effekt för att möjliggöra aktivitet i det dagliga livet för personer som har neglekt. Den metod som har valts var en litteraturstudie med kvantitativ ansats. Författarna har använt sig av både manuell sökning och databassökning. Urvalet genomfördes i flera steg för att hitta artiklar som besvarade studiens syfte. Åtta artiklar av kvantitativ ansats presenterades och analyserades enligt den traditionella modellen och delades upp i top-down och bottom-up interventioner. Resultatet visade att det fanns arbetsterapeutiska interventioner som visade på en förbättring av aktivitetsutförande i ADL för personer som har neglekt. Författarna anser att det inte finns tillräckligt med studier som har huvudfokus på ADL vilket indikerar på att mer forskning behövs inom området.

Nombre d'applications ont pour comportement principal l'attente d'un événement venant d'un environnement extérieur, la préparation d'un résultat et l'exécution d'actions sur cet environnement. Les interfaces graphiques et les systèmes avioniques en sont des exemples. Le paradigme SCC, pour sense-compute-control, est particulièrement adapté à la description de ces applications. Le développement d'applications suivant ce paradigme est complexe à cause du manque de cadre conceptuel et d'outils de support.Cette thèse propose un cadre conceptuel dédié au paradigme SCC et se concrétise par un langage de description d'architectures. À partir d'une description dans ce langage, un framework de programmation peut être généré. Il guide l'implémentation d'une application grâce à un support dédié et vérifie que cette implémentation est conforme à l'architecture décrite. Les contributions de cette thèse sont évaluées suivant des critères d'expressivité, d'utilisabilité et de productivité. / Numerous applications have, as their main behavior, to wait for information coming from a foreign environment, to prepare a result, and to execute actions on this environment. Graphical user interfaces and avionic systems are two examples. The SCC paradigm, for Sense–Compute–Control, is dedicated to the description of such applications. Developing applications with this paradigm is made difficult by the lack of conceptual framework and tool support.This thesis proposes a conceptual framework dedicated to the SCC paradigm which is materialized by an architecture description language named DiaSpec. This language provides a framework to support the development of an SCC application, assigning roles to the stakeholders and providing separation of concerns. This thesis also proposes dedicated programming support. Indeed, from DiaSpec descriptions a dedicated programming framework is generated in a target language. This programming framework guides the implementation of an SCC application and raises the level of abstraction of this implementation with both high-level and dedicated mechanisms. This programming framework is designed to ensure conformance of the implementation to its architecture described in DiaSpec by leveraging the target language type system. Contributions of this thesis are evaluated through three criteria: expressiveness, usability and productivity.

A presente tese de Doutorado trata de investigar a aplicação da mineração de texto, para a construção de uma terminologia que atenda aos preceitos estipulados pela normalização, nacional e internacional, referente à constituição de um Registro Eletrônico em Saúde (RES). As normas internacionais estudadas pelo presente trabalho foram as seguintes: ISO 13606-1 e ISO TS 17117. O padrão internacional ISO 13606-1 especifica os modelos de referência para a construção de arquétipos que são a estrutura-base do RES. A especificação técnica ISO 17117 estipula a formatação de terminologias controladas para o âmbito da informática em saúde. Localmente, o trabalho analisou o relatório técnico ABNT/ISO TR 20514 que dá a definição, o escopo e o contexto para o RES e o relatório técnico ABNT/ISO TR 12309 que visa a garantir o desenvolvimento de terminologias padronizadas para a área da saúde. Vários trabalhos científicos demonstram que, para a construção do RES baseado em arquétipos, pesquisadores utilizam terminologias de mercado como o SNOMED CT e SNOMED RT. No caso do Brasil, não existe uma terminologia oficialmente desenvolvida regionalmente ou traduzida para o português do Brasil que suporte a criação de modelos de referência. Essa situação dificulta a implantação das normas nacional e internacional de padronização, citadas anteriormente. Nesse ambiente, a tese aqui apresentada construiu uma ontologia no domínio da especialidade de Radiologia e Diagnóstico por Imagem, tendo como base a aplicação de métodos de mineração de texto para compor uma terminologia eficiente e eficaz que atendesse às lacunas demonstradas. A aplicação de método de mineração de texto foi realizada em uma amostra de 2.566.358 de sujeitos-laudos, consistindo em sujeitos-laudos dos exames de Ressonância Magnética, Raios-X, Tomografia Computadorizada e Ultrassonografia de regiões anatômicas humanas. Com base nessa extração, foi construída uma ontologia contendo 5.859 termos-indivíduos, 20.994 axiomas e 15.084 axiomas lógicos. Essa ontologia foi desenvolvida utilizando o software Prótége em linguagem OWL. A partir da formalização da ontologia (terminologia), foram construídos Archetype Definition Language (ADL), para o componente INSTRUCTION para exame de imagem, e ADL para o componente COMPOSITION de Tomografia Computadorizada de Coluna Cervical, Ressonância Magnética de Cervical e Torácica e Ressonância Magnética de Carótida. O trabalho mostrou a aplicabilidade da mineração de texto para a geração de uma terminologia que desse suporte à criação de ADL, conforme preconizado na normativa da área de informática em saúde. / This Doctoral Thesis aim to investigate the application of text mining for the construction of a terminology that meets the procedures laid down for standardization, national and international, regarding the establishment of an Electronic Health Record (RES). International standards studied in this work were ISO 13606-1 and ISO TS 17117. The ISO 13606-1 international standard specifies the reference models for the construction of archetypes, which is the basis of the RES structure. The technical specification ISO 17117 provides the formatting of controlled terminology for the scope of health informatics. Locally, the paper analyzed the technical ABNT / ISO TR 20514 report, which gives the definition, scope and context for the RES and technical ABNT / ISO TR 12309 report aimed at ensuring the development of standardized terminology for the health sector. Several scientific studies have shown that for the construction of RES based on archetypes, researchers use market terminology such as SNOMED CT and SNOMED RT. In Brazil, there is no terminology officially developed regionally or translated into Portuguese-Brazilian who support the creation of reference models. This situation impedes the deployment of national and international standards of standardization mentioned above. In this environment, the thesis presented here built an ontology in the field of specialty of Radiology and Diagnostic Imaging based on the application of text mining methods to make efficient and effective terminology that meets the demonstrated shortcomings. The application of text mining method was performed on a sample of 2,566,358 of subject-report, consisting of subject-reports of examinations MRI, X-ray, CT and ultrasound of human anatomical regions. Based on this extraction was built an ontology containing 5,859 individuals terms, axioms 20,994 and 15,084 logical axioms. This ontology was developed using Protégé OWL language software. From the formalization of the ontology (terminology) were built Archetype Definition Language (ADL) for INSTRUCTION component for imaging examination, and ADL for COMPOSITION component of CT cervical spine, MRI Cervical and Thoracic and MRI Carotid. The study showed the applicability of text mining to generate terminology that supported the creation of ADL as recommended by rules in the IT sector in health.

L'architecture logicielle est devenue un thème scientifique majeur de l'informatique. En effet, l'architecture logicielle fournit l'abstraction qui permet de développer rigoureusement et de faire évoluer des systèmes logiciels complexes au vu des besoins tant fonctionnels que non fonctionnels. Afin de modéliser les architectures logicielles, un nouveau type de langage est apparu : les langages de description d'architectures (ADL, Architecture Description Language). Divers ADL ont été proposés dans la littérature, mais ces ADL sont restreints à la modélisation d'architectures abstraites, indépendantes des plateformes d'implémentation. Lors de l'implémentation, l'architecture n'est plus représentée. Cette thèse s'inscrit dans le domaine des ADL et porte sur la définition et la mise en œuvre d'un langage pour la concrétisation, c'est-à-dire l'implémentation explicite, d'architectures logicielles. Elle adresse le problème de la construction d'un tel langage et son système d'exécution. Pour cela elle aborde le problème d'un point de vue nouveau : la construction d'un langage centré sur l'architecture logicielle. Assis sur des bases formelles, notamment sur le π-calcul et π-ADL, ces travaux ont donné lieu à un langage formel pour décrire et garantir l'intégrité architecturale d'un système au niveau de sa spécification, de son implémentation et de ses évolutions ultérieures. La machine virtuelle et le compilateur associé sont enfouis dans la plateforme .NET.

Gérer l'évolution des logiciels est une tâche complexe mais nécessaire. Tout au long de son cycle de vie, un logiciel doit subir des changements, pour corriger des erreurs, améliorer ses performances et sa qualité, étendre ses fonctionnalités ou s’adapter à son environnement. A défaut d’évoluer, un logiciel se dégrade, devient obsolète ou inadapté et est remplacé. Cependant, sans évaluation de leurs impacts et contrôle de leur réalisation, les changements peuvent être sources d’incohérences et de dysfonctionnements, donc générateurs de dégradations du logiciel. Cette thèse propose une approche améliorant la gestion de l'évolution des logiciels dans les processus de développement orientés composants. Adoptant une démarche d’ingénierie dirigée par les modèles (IDM), cette approche s’appuie sur Dedal, un langage de description d’architecture (ADL) séparant explicitement trois niveaux d’abstraction dans la définition des architectures logicielles. Ces trois niveaux (spécification, configuration et assemblage) correspondent aux trois étapes principales du développement d’une architecture (conception, implémentation, déploiement) et gardent la trace des décisions architecturales prises au fil du développement. Ces informations sont un support efficace à la gestion de l’évolution : elles permettent de déterminer le niveau d’un changement, d’analyser son impact et de planifier sa réalisation afin d’éviter la survenue d’incohérences dans la définition de l’architecture (érosion, dérive, etc.). Une gestion rigoureuse de l’évolution nécessite la formalisation, d’une part, des relations intra-niveau liant les composants au sein des modèles correspondant aux différents niveaux de définition d’une architecture et, d’autre part, des relations inter-niveaux liant les modèles décrivant une même architecture aux différents niveaux d’abstraction. Ces relations permettent la définition des propriétés de consistance et de cohérence servant à vérifier la correction d’une architecture. Le processus d’évolution est ainsi décomposé en trois phases : initier le changement de la définition de l’architecture à un niveau d’abstraction donné ; vérifier et rétablir la consistance de cette définition en induisant des changements complémentaires ; vérifier et rétablir la cohérence globale de la définition de l’architecture en propageant éventuellement les changements aux autres niveaux d’abstraction.Ces relations et propriétés sont décrites en B, un langage de modélisation formel basé sur la théorie des ensembles et la logique du premier ordre. Elles s’appliquent à des architectures définies avec un adl formel écrit en B dont le méta-modèle, aligné avec celui de Dedal, permet d’outiller la transformation de modèles entre les deux langages. Cette intégration permet de proposer un environnement de développement conjuguant les avantages des approches IDM et formelle : la conception d’architectures avec l’outillage de Dedal (modeleur graphique); la vérification des architectures et la gestion de l’évolution avec l’outillage de B (animateur, model-checker, solver). Nous proposons en particulier d’utiliser un solver B pour calculer automatiquement des plans d’évolution conformes à notre proposition et avons ainsi défini l’ensemble des règles d’évolution décrivant les opérations de modification applicables à la définition d’une architecture. Le solver recherche alors automatiquement une séquence de modifications permettant la réalisation d’un changement cible tout en préservant les propriétés de consistance et de cohérence de l’architecture. Nous avons validé la faisabilité de cette gestion de l’évolution par une implémentation mêlant optimisation et génie logiciel (search-based software engineering), intégrant notre propre solver pourvu d’heuristiques spécifiques qui améliorent significativement les temps de calcul, pour expérimenter trois scénarios d’évolution permettant de tester la réalisation d’un changement à chacun des trois niveaux d’abstraction. / Managing software evolution is a complex task. Indeed, throughout their whole lifecycle, software systems are subject to changes to extend their functionalities, correct bugs, improve performance and quality, or adapt to their environment. If not evolved, software systems degrade, become obsolete or inadequate and are replaced. While unavoidable, software changes may engender several inconsistencies and system dysfunction if not analyzed and handled carefully hence leading to software degradation and phase-out.This thesis proposes an approach to improve the evolution management activity in component-based software development processes. The solution adopts a Model-Driven Engineering (MDE) approach. It is based on Dedal, an Architecture Description Language (ADL) that explicitly separates software architecture descriptions into three abstraction levels: specification, configuration and assembly. These abstraction levels respectively correspond to the three major steps of component-based development (design, implementation and deployment) and trace architectural decisions all along development. Dedal hence efficiently supports evolution management: It enables to determine the level of change, analyze its impact and plan its execution in order to prevent architecture inconsistencies (erosion, drift, etc.). Rigorous evolution management requires the formalization, on the one hand, of intra-level relations linking components within models corresponding to different architecture abstraction levels and on the other hand, of the formalization of inter-level relations linking models describing the same architecture at different abstraction levels. These relations enable the definition of the consistency and coherence properties that prove necessary for architecture correctness analysis. The evolution process therefore consists of three steps: First, change is initiated on an architecture description at a given abstraction level; then, the consistency of the impacted description is checked out and restored by triggering additional changes; finally, the global coherence of the architecture definitions is verified and restored by propagating changes to other abstraction levels.Relations and properties are expressed in B, a set-theoretic and first-order logic language. They are applied on B formal ADL, the meta-model of which is mapped to Dedal's and helps automatic model transformations. This integration enables to implement a development environment that combines the benefits of both MDE and formal approaches: Software architecture design using Dedal tools (graphical modeler) and architecture analysis and evolution management using B tools (animator, model-checker, solver).In particular, we propose to use a B solver to automatically calculate evolution plans according to our approach. The solver explores a set of defined evolution rules that describe the change operations that can apply on architecture definitions. It automatically searches for a sequence of operations that both changes the architecture as requested and preserves architecture consistency and coherence properties. The feasibility of the evolution management approach is demonstrated through the experimentation of three evolution scenarios, each addressing a change at different abstraction level. The experimentation relies on an implementation of a search-based software engineering approach mixing software engineering and optimization and integrates our own solver with specific heuristics that significantly improve calculation time.

Trots att studier visar att personer med autismspektrumdiagnos (ASD) ofta behöver hjälp med att sköta sin personliga hygien, samt att mödrar till barn med ASD ofta behöver assistera dem i deras aktiviteter i dagliga livet (ADL) saknas det forskning om vad detta stöd faktiskt består av. Syftet med den aktuella studien är att öka kunskapen om mödrars erfarenheter av att hjälpa ungdomar med ASD med deras personliga hygien samt med påklädning. 3 flickmödrar och 3 pojkmödrar intervjuades om hur de hjälpte sina barn med Dusch/Tvätt, Hårvård, Naglar, Påklädning, Tandborstning, Toalettbesök, Torka sig efter toalettbesök samt Torka sig med handduk. Flickmödrar fick också frågor om Menstruation. Analysen baserades på Anthony Giddens' teorier om Modernitet och Självidentitet. Intervjuerna skrevs om till 6 narrativ, vilka analyserades tillsammans med relevanta delar från intervjuerna. Resultatet presenteras som 3 huvudteman. Resultatet visar bland annat att ungdomarna hade ett omfattande hjälpbehov och att mödrarna hjälpte sina barn både fysiskt och verbalt. Mödrarnas förståelse för och lojalitet gentemot barnen och deras svårigheter var förhållandevis hög medan deras tillit till sakkunniga var relativt låg. / Although studies indicate that people with Autism Spectrum Disorder (ASD) often need help with their personal hygiene, in addition to the fact that mothers of children with ASD often need to assist them in their activities of daily living (ADL), little research has been made as to what this support actually consists of. The purpose of the present study is to investigate how mothers of children aged 10-15 with ASD help their children to manage their personal hygiene, and what effect this has on their mothers. 3 mothers of girls and 3 mothers of boys were interviewed about how they supported their children in the following activities: Dressing, Hair care, Nail cutting, Toilet use, Tooth brushing, Toweling, Washing and Wiping. Mothers of girls were also asked about Menstruation. The analyses were based on Anthony Giddens' theories on Modernity and Self Identity. Afterwards, the interviews were converted into six narratives. These narratives along with pertinent elements from the interviews were analyzed and the result presented as 3 main themes. Results show among other things that the mothers supported their children both physically and verbally. The mothers' appreciation and loyality with their children were proportionately high, whereas their confidence in experts was rather low.

A presente tese de Doutorado trata de investigar a aplicação da mineração de texto, para a construção de uma terminologia que atenda aos preceitos estipulados pela normalização, nacional e internacional, referente à constituição de um Registro Eletrônico em Saúde (RES). As normas internacionais estudadas pelo presente trabalho foram as seguintes: ISO 13606-1 e ISO TS 17117. O padrão internacional ISO 13606-1 especifica os modelos de referência para a construção de arquétipos que são a estrutura-base do RES. A especificação técnica ISO 17117 estipula a formatação de terminologias controladas para o âmbito da informática em saúde. Localmente, o trabalho analisou o relatório técnico ABNT/ISO TR 20514 que dá a definição, o escopo e o contexto para o RES e o relatório técnico ABNT/ISO TR 12309 que visa a garantir o desenvolvimento de terminologias padronizadas para a área da saúde. Vários trabalhos científicos demonstram que, para a construção do RES baseado em arquétipos, pesquisadores utilizam terminologias de mercado como o SNOMED CT e SNOMED RT. No caso do Brasil, não existe uma terminologia oficialmente desenvolvida regionalmente ou traduzida para o português do Brasil que suporte a criação de modelos de referência. Essa situação dificulta a implantação das normas nacional e internacional de padronização, citadas anteriormente. Nesse ambiente, a tese aqui apresentada construiu uma ontologia no domínio da especialidade de Radiologia e Diagnóstico por Imagem, tendo como base a aplicação de métodos de mineração de texto para compor uma terminologia eficiente e eficaz que atendesse às lacunas demonstradas. A aplicação de método de mineração de texto foi realizada em uma amostra de 2.566.358 de sujeitos-laudos, consistindo em sujeitos-laudos dos exames de Ressonância Magnética, Raios-X, Tomografia Computadorizada e Ultrassonografia de regiões anatômicas humanas. Com base nessa extração, foi construída uma ontologia contendo 5.859 termos-indivíduos, 20.994 axiomas e 15.084 axiomas lógicos. Essa ontologia foi desenvolvida utilizando o software Prótége em linguagem OWL. A partir da formalização da ontologia (terminologia), foram construídos Archetype Definition Language (ADL), para o componente INSTRUCTION para exame de imagem, e ADL para o componente COMPOSITION de Tomografia Computadorizada de Coluna Cervical, Ressonância Magnética de Cervical e Torácica e Ressonância Magnética de Carótida. O trabalho mostrou a aplicabilidade da mineração de texto para a geração de uma terminologia que desse suporte à criação de ADL, conforme preconizado na normativa da área de informática em saúde. / This Doctoral Thesis aim to investigate the application of text mining for the construction of a terminology that meets the procedures laid down for standardization, national and international, regarding the establishment of an Electronic Health Record (RES). International standards studied in this work were ISO 13606-1 and ISO TS 17117. The ISO 13606-1 international standard specifies the reference models for the construction of archetypes, which is the basis of the RES structure. The technical specification ISO 17117 provides the formatting of controlled terminology for the scope of health informatics. Locally, the paper analyzed the technical ABNT / ISO TR 20514 report, which gives the definition, scope and context for the RES and technical ABNT / ISO TR 12309 report aimed at ensuring the development of standardized terminology for the health sector. Several scientific studies have shown that for the construction of RES based on archetypes, researchers use market terminology such as SNOMED CT and SNOMED RT. In Brazil, there is no terminology officially developed regionally or translated into Portuguese-Brazilian who support the creation of reference models. This situation impedes the deployment of national and international standards of standardization mentioned above. In this environment, the thesis presented here built an ontology in the field of specialty of Radiology and Diagnostic Imaging based on the application of text mining methods to make efficient and effective terminology that meets the demonstrated shortcomings. The application of text mining method was performed on a sample of 2,566,358 of subject-report, consisting of subject-reports of examinations MRI, X-ray, CT and ultrasound of human anatomical regions. Based on this extraction was built an ontology containing 5,859 individuals terms, axioms 20,994 and 15,084 logical axioms. This ontology was developed using Protégé OWL language software. From the formalization of the ontology (terminology) were built Archetype Definition Language (ADL) for INSTRUCTION component for imaging examination, and ADL for COMPOSITION component of CT cervical spine, MRI Cervical and Thoracic and MRI Carotid. The study showed the applicability of text mining to generate terminology that supported the creation of ADL as recommended by rules in the IT sector in health.