Rheumatoid arthritis (RA) is a progressive disease, often leading to disability. Because the disease course develops rapidly during the first years after diagnosis, more knowledge is needed about the early disease course to minimize later disability. This thesis describes the course of disability in early RA such as hand function, pain intensity, activity limitation and sick leave. In addition, this thesis compares disability between women and men and compares disability between RA patients and referents. This thesis is primarily based on data from the 320 patients that were included in the multi-centre project in Sweden called ‘Early interventions in rheumatoid arthritis’ (TIRA). A wide range of outcome variables was registered between 1996 and 2006 during regular follow-ups from time for diagnosis through the eight-year follow-up. Outcome regarding disease activity and disability of RA patients still remaining in TIRA at the three and five year follow-up respectively are used in this thesis. Data concerning sick leave were obtained for the patients during six years (1993-2001) – three years before and three years after diagnosis. Referents were included in two of the studies. Data regarding disability in referents were obtained according to hand function and activity limitation using the Health Assessment Questionnaire (HAQ). Data for sick leave were obtained for six years in referents, for the same period as the RA patients. For most variables, disability in RA was most pronounced at time of diagnosis but before intervention started. Disability was then reduced already at the 3-month follow-up and thereafter affected but stable during the following five years. The exception was participation, reflected by sick leave, a variable that was stable from inclusion to three years from diagnosis. Activity limitation, pain intensity and sick leave in RA that represents different aspects of disability were explained by other aspects of disability and contextual factors rather than by disease activity. RA affects women and men differently in some aspects. Women had more severe course of activity limitations than men according to HAQ. Men were more affected than women in range of motion, although the differences were small in a clinical perspective. However, pain intensity and frequency of sick leave did not differ between women and men. Patients with RA have pronounced disability in relation to referents although several variables improve soon after diagnosis. This discrepancy refers to hand function as well as activity limitations and sick leave. The frequency of sick leave increased during the year before diagnosis in relation to referents and was thereafter high compared to sick leave in referents.

The aim of the present study was to investigate all long-term institutions in the county of Västerbotten, Northern Sweden, to give a detailed description of the institutionalized population with respect to motor functions, vision, hearing, speech, ADL-functions, prevalence of psychiatric symptoms and behavioral disturbances, staff work load, use of psychoactive drugs and prevalence of dementia. Another aim was to select some specific 'problem areas' in the nursing care of demented patients for further descriptive and interventional studies. For this reason, morning care procedure (hygiene, dressing), meal behavior (eating, communication), nutrition, constipation and relocation between institutions were selected. The results of the study have been reported in six papers summarized below: I.The study has shown that the proportion of demented patients is increasing in longterm institutions in Sweden. Furthermore, demented patients were shown to be more impaired in all rated functioning abilities and exhibited more psychiatric symptoms and behavioral symptoms. A high proportion of the demented probands were also prescribed psychoactive drugs, i.e. neuroleptics. II. Five patients with Alzheimer-type dementia were monitored during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients were able to manage morning care independently, but there was a wide variation in their highest level of performance. III. Five patients with Alzheimer-type dementia were observed (video taped) during their meals in a changed meal milieu and with new meal routines. When the patients ate without staff participation, the two least demented patients became 'caregivers'. When two mental nurses joined the group, first in civil clothes and then in white uniforms, the patients dropped their roles as helpers. The patients were able to compose complete meals in 0-79 per cent of the meals. The conversation during the meals could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all utterances were about food and eating and almost all conversation concerned the present time. IV. Thirty-three psychogeriatric patients, with severe constipation were given a high- bran bread instead of their accustomed laxatives. During the high-bran treatment period, the number of bowel evacuations and the volume of faeces increased. The total laxative consumption decreased by 93 per cent. V. Nutritional status and dietary intake were studied in a sample of severely demented, institutionalized patients. Energy and /or protein malnutrition was found in 50 per cent of the patients. The mean energy intake was 2059 kcal. Malnourished patients had had four times as many infectious periods during their hospital stay as patients without malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay. VI. Thirty-three psychogeriatric patients were followed for 36 weeks after relocation from a mental hospital to two newly built nursing homes. An intensive pre-relocation program was performed. No negative effects of the relocation were found. On the contrary, the relocated group improved their ADL-functions after the transfer. Based upon the above cited studies, a model for nursing care of demented patients is presented. / <p>S. 1-45: sammanfattning, s. 46-192: 6 uppsatser</p> / digitalisering@umu

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 5 uppsatser.

Dans cette thèse, nous proposons un nouveau système e-santé sensible au contexte pour les sujets âgés, dépendants et isolés. Le système surveille et suit les activités de la vie quotidienne (AVQ) de la personne tout en considérant les standards les plus utilisés en gériatrie pour l'évaluation du niveau de dépendance tel que le modèle SMAF. Le cadre de travail proposé offre automatiquement de nombreux services adaptables tels que la collection d'informations pertinentes et contextuelles et l'évaluation de l'état de santé en se basant sur le niveau de dépendance. Les approches proposées permettent d'apprendre le mode de vie des sujets en se basant sur l'accomplissement des AVQ et la détection des changements de comportement qui peuvent représenter un risque pour la personne. Pour se rapprocher de la vie réelle, nous avons généré des longs scénarios réalistes en définissant un modèle Markovien. Concernant la prédiction du comportement, nous proposons une nouvelle approche basée l'extension du modèle GM (1,1). Les performances de notre proposition sont évaluées et comparées avec les approches traditionnelles de suivi continu en considérant différents scénarios et profils de sujets. Les résultats révèlent que notre système offre un suivi efficace des sujets qui optimise la consommation des ressources du système en termes de calcul, énergie et réseau. Avec un minimum de volume de données collectées et traitées et un minimum de ressources utilisées, notre système réussit à assurer un suivi avec une précision élevée de l'évaluation du niveau de dépendance, d'apprentissage du comportement, de prédiction des conditions de santé et de détection de situation anormales. / In this thesis, we propose a new e-health monitoring system for elderly, dependent and isolated persons living alone. We provided a better understanding of the monitored person's context. We develop a context-aware framework for monitoring the person's activities of daily living (ADL) and consider the most famous scales applied in the dependency evaluation models used in the geriatric domain such as the Functional Autonomy Measurement System (SMAF). The proposed adaptive framework offers several services such as the collection of high relevant and contextual data and an evaluation of the health status (i.e. dependency level) of persons. The proposed approach allows learning the human's lifestyle regarding the achievement of the ADL and the detection of the behavioral changes that may represent a risk for the monitored person. In order get closer to real-life situations, we use a Markovian-based model built for generating long term and realistic scenarios. For the behavior detection and prediction, we propose a novel forecasting approach based on the extension of the Grey theory GM (1, 1). The performances of the proposed system are evaluated and compared to traditional monitoring approaches within different scenarios and persons' profiles. The results of our evaluations reveal an efficient monitoring that optimizes the system resources in terms of computing, energy consumption, and network. With a minimum of sensing data, our system succeeds to ensure a high accuracy regarding the evaluation of the person's dependency, behavioral patterns learning, prediction of the health condition, and the detection of abnormal situations.

The aim of this diploma thesis is to analyze the development of the total volume of debt in the Czech Republic and the analysis separately for the household sector and non-financial corporations. From economic theoretical assumptions it can be concluded that there is a correlation between the amount of loans and GDP development or between credit and economic cycle. The thesis is divided into three parts. The first part made up of chapters 1 to 4, describes the theory used further in the text. The second part, Chapter 5, describes the specific time series used in the thesis, i.e. The time series of the volume of debt for the Czech Republic, GDP and interest rates. Interest rates and the volume of debt are further broken down by maturity and also by two selected sectors. The last part, Chapter 6, focusing on co-integration analysis, ADL and error correction models, attempts to capture short-term and long-term relationships between the time series.

No description available.

This study examines the rise of al-Adl wal-Ihsan in the early 1980s, its development, its attitude towards a number of Islamic and contemporary issues, and its strategy to take root in society and press for social and political reform in Morocco. The aim is to provide an account that reflects as far as possible what is perceived to be the true nature of al-Adl wal-Ihsan and, more importantly, to identify the factors behind its rapid growth and its ability to become the largest organized Islamic force in the country despite operating under an authoritarian regime and in an environment already populated by several Islamic groups. Drawing on the dialogic model of interpretation which entails, among things, presenting the Islamists’ ideas, experiences and arguments using their own terms and categories, this study has used a wide range of primary and secondary sources and benefited from interviews with a variety of people, including the movement’s founding leader, Sheikh Yassine, before he passed away on 13th December 2012, in order to achieve a better understanding of al-Adl wal-Ihsan. The major findings that come from this research demonstrate that al-Adl wal-Ihsan is a mere response, among others, based on Islamic sources and ijtihad, to legitimate demands of social, political and moral order. Hence, to exclude the moral and spiritual dimension from the analysis would not help to generate plausible explanations of the rise and nature of al-Adl wal-Ihsan or any other Islamic group for that matter. As for al-Adl’s rapid expansion, it has been found to be closely related to five basic factors: a charismatic leadership, an adequate organizational structure, a coherent theoretical framework, an appealing reform strategy and special emphasis on tarbiya [education]. Thus what becomes of al-Adl wal-Ihsan in the future seems to depend on its ability to maintain, if not to improve on what is deemed to be the source of its strength, which is a big challenge.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T19:56:10Z No. of bitstreams: 1 Dayse Danielle de Oliveira Silva.pdf: 1056626 bytes, checksum: 3d7b90a2e792675f504f13d5b0cfc13c (MD5) / Made available in DSpace on 2018-07-20T19:56:10Z (GMT). No. of bitstreams: 1 Dayse Danielle de Oliveira Silva.pdf: 1056626 bytes, checksum: 3d7b90a2e792675f504f13d5b0cfc13c (MD5) Previous issue date: 2018-03-07 / Objectives: Study I - To analyze the psychometric properties of the Unified Parkinson's Disease Rating Scale (UPDRS). Study II - Analyze the construct validity and the discriminatory power and verify if the Daily Life Activity-Glittre test (AVD-Glittre) is able to differentiate the stages of Parkinson's Disease (PD). Methods: Study I - systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The searches in PubMed, SciELO, PsycINFO, LILACS, PEDro and Cochrane Central Register of Controlled Trials databases occurred between March 1 and May 31, 2017, using the terms "Parkinson's Disease", "Unified Parkinson's Disease Rating Scale "" UPDRS "," outcome assessment "," psychometrics "," reliability "and" reproducibility ", including suggested synonyms, without language restrictions. Study II - cross-sectional, observational study performed at the Respiratory Exercise and Health Laboratory (LERES) at the University of Pará-UEPA from May 2016 to August 2016. Thirty individuals with PD (GP), and 19 healthy individuals in the control group (CG) were submitted to the study. Age from 50 to 80 years, without sex restrictions, hemodynamically stable (BP <140mmHg x 90mmHg), cognitively preserved. All participants had the following parameters before, during and after the tests: Blood Pressure (BP), Heart Rate (HR), Peripheral Oxygen Saturation (SpO2) and effort perception, as well as the perception of fatigue of lower members, by the Modified Borg Scale. Participants of the GP, after the application of the AVD-Glittre test, also underwent UPDRS, the 6-minute Walk Test (6MWT) and the 10-meter Walk Test (TC10m). Results: Study I - 19 studies were analyzed. The internal consistency for sections I to IV presented strong positive evidence. The reproducibility of section IV presented strong negative evidence. All sections presented strong negative evidence for content validity; in the hypothesis test of sections II and III, strong positive evidence was observed. The AVD-Glittre test presented a moderate positive correlation with section II (rho = 0.371, p = 0.043), a moderate to strong positive correlation with section III (rho = 0.658, p = 0.000) and a moderate correlation with the total UPDRS score (rho = 0.552; p = 0.002). There was a negative correlation between the AVD-Glittre test and the 6MWT (rho - 0.772, p <0.001), and a positive correlation, with a strong magnitude with the TC10m (rho = 0.854, p <0.001). The area under the ROC curve (AUC) obtained was 0.855 (confidence interval: 0.753 to 0.957, p = 0.000), characterizing the test as a good discriminatory instrument to differentiate individuals with PD from healthy subjects. Conclusions: Sections II and III presented reliability evidence to assess ADLs and motor performance of individuals with PD, respectively, however the correlation with the AVD-Glittre test was of moderate magnitude. The AVD-Glittre test proved to be valid to assess functional capacity, with discriminatory power to differentiate patients from healthy, but was not able to differentiate the various stages of PD. / Objetivos: Estudo I - Analisar as propriedades psicométricas da Unified Parkinson's Disease Rating Scale (UPDRS). Estudo II - Analisar a validade do construto e o poder discriminatório e verificar se o teste de Atividade de Vida Diária-Glittre (AVD-Glittre) é capaz de diferenciar os diversos estágios da Doença de Parkinson (DP). Métodos: Estudo I – revisão sistemática baseada no Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). As buscas nas bases PubMed, SciELO, PsycINFO, LILACS, PEDro e Cochrane Central Register of Controlled Trials, ocorreram entre 01 de março e 31 de maio de 2017, utilizando-se os termos: “Parkinson’s Disease”, “Unified Parkinson's Disease Rating Scale”, “UPDRS”, “outcome assessment”, “psychometrics”, “reliability” e “reproducibility”, incluindo sinônimos sugeridos, sem restrições de idiomas. Estudo II - estudo observacional, de corte transversal, realizado no Laboratório de Exercício Resistido e Saúde (LERES) da Universidade do Estado do Pará- UEPA, no período de maio a agosto de 2016. Participaram 30 indivíduos com DP, alocados no grupo Parkinson (GP) e 19 indivíduos sadios no grupo controle (GC). Idade entre 50 e 80 anos (GP=62,10 +8,62 e GC= 63,84+8,18), ambos os gêneros, hemodinamicamente estáveis (PA < 140mmHg x 90mmHg), cognitivamente preservados. Foram coletadas a Pressão Arterial (PA), Frequência Cardíaca (FC), Saturação Periférica de Oxigênio (SpO2) e percepção do esforço, assim como a percepção da fadiga de MMII, pela escala de Borg Modificada antes, durante e após os testes. Os participantes do GP também foram submetidos à avaliação pela UPDRS, Teste de Caminhada de 6 minutos (TC6’) e Teste de Caminhada de 10 metros (TC10m). Resultados: Estudo I – 19 estudos foram analisados. A consistência interna para as seções I a IV apresentou forte evidência positiva. A reprodutibilidade da seção IV apresentou uma forte evidência negativa. Todas as seções apresentaram uma forte evidência negativa para validade de conteúdo; no teste de hipóteses das seções II e III foi observada uma forte evidência positiva. Estudo II – O teste AVD-Glittre apresentou correlação positiva, de moderada magnitude com a seção II (rho=0,371; p=0,043), correlação positiva de moderada a forte com a seção III (rho=0,658; p=0,000) e uma correlação moderada com a pontuação total da UPDRS (rho=0,552; p=0,002). Observou-se correlação negativa, de forte magnitude entre o teste AVD-Glittre e o TC6’ (rho - 0,772, p<0,001), e uma correlação positiva, de forte magnitude com o TC10m (rho=0,854, p <0,001). A área sob a curva ROC (AUC) obtida foi de 0,855 (intervalo de confiança: 0,753 a 0,957; p=0,000), caracterizando o teste como um bom instrumento discriminatório para diferenciar indivíduos com DP dos saudáveis. Conclusão: As seções II e III, apresentaram evidências de confiabilidade para avaliar as AVDs e o desempenho motor de indivíduos com DP respectivamente, no entanto a correlação com o teste AVD-Glittre foi de moderada magnitude. O teste AVD-Glittre mostrou-se válido para avaliar a capacidade funcional, com poder discriminatório para diferenciar os doentes dos saudáveis, no entanto não foi capaz de diferenciar os diversos estágios da DP.

INLEDNING Vårdplaneringar kräver ett entydigt och nyanserat språk för att identifiera patienternas förmåga och insatsbehov gällande aktiviteter i det dagliga livet (ADL). Studiens utgångspunkt är KASAM, människans behov av sammanhang, begriplighet, hanterbarhet och meningsfullhet i sitt dagliga liv. SYFTE Att belysa och validera ADL-terminologin inom sjukvård och rehabilitering. METOD Uppsatsen är en kvalitativ och kvantitativ studie med en deduktiv ansats. ADL-verktyget Rainbow användes som mall. Materialet har insamlats genom enkäter och fokusgruppsintervjuer. Biståndshandläggare och arbetsterapeuter har intervjuats. Studien beskriver även hur en grupp seniorer, utan relation till eller erfarenhet av vård eller vårdplanering, tolkade terminologin och synonymerna. Intervjuerna behandlade följande teman: ADL-terminologi, synonymer, uppfattningar samt kategorisering utifrån en hierarkisk ordning. RESULTAT Nuvarande terminologi och tillvägagångssätt kan innebära att patienterna och deras anhöriga upplever otrygghet angående teamets planerade insatser. Studiens resultat visar att sjukvårdens team och patienter kan dela och använda ett gemensamt språk. SLUTSATS Språket är nyckeln till att förstå sammanhang. KASAM som ledstjärna i språket skapar en värdegrund för vad som har överenskommits och kvalitetssäkrar patienternas vård- och rehabiliteringsinsatser. / INTRODUCTION Healthcare planning require an unambiguous and varied language to identify patient´s ability and effort needs regarding activities of daily living (ADL). The study's starting point is KASAM, the human need for coherence, comprehensibility, manageability and meaningfulness in their daily lives. AIM To highlight and validate ADL terminology of medical care and rehabilitation. METHODOLOGY The thesis is a combined, descriptive study with a deductive approach. ADL Rainbow tool was used as a template. The material was collected through questionnaires and focus group interviews. Care managers and occupational therapists were interviewed. The study also describes how a group of seniors, without relation to or experience of care or care planning, interpreted the terminology and synonyms. The interviews covered the following themes: ADL terminology, synonyms, views and categorization based on a hierarchical order. RESULTS Current terminology and approach could mean that the patients and their relatives could feel insecure regarding the team's planned interventions. The study results show that the medical team and patients can share and use a common language. CONCLUSION Language is the key to understanding the context. KASAM as a guiding-star in language, creates a value base for what has been agreed and ensures quality assures patient´s care and rehabilitation efforts.

Ett nytt instrument utvecklades från Katz´ ADL-index, vilket visat sig vara ett allt för grovt instrument, för att kartlägga patientens aktivitetsförmåga och självständighetsutveckling. Bedömningsinstrumentet innehåller patientdata samt kategori-index och kom att kallas RAINBOW på grund av att instrumentet är i fyrfärgstryck. En kontroll av det nykonstruerade team-instrumentet utfördes i syfte att mäta dess tillförlitlighet. Mellanbedömar reliabilitet mellan oberoende bedömare har prövats. Validiteten har analyserats på 4 patienter ur materialet och jämförts med Katz´ ADl-index. Studien, som bestod av parvisa oberoende bedömningar, utfördes av sjuksköterskor, sjukgymnaster och arbetsterapeuter. 40 patienter deltog i studien. Delaktivitetsbedömningarna uppgick till 950 och innehöll 36 avvikelser. Resultaten visade på 96 % samstämmighet i bedömningarna. Den kvalitativa analysen visade, i jämförelse med Katz´ ADL-index, att RAINBOW kategori-index gav utförligare information om patientens självständighetsnivå samt hjälpbehov. I denna studie bedömdes endast strokepatienter, men då begreppen som ingår i instrumentet kan anses allmängiltiga, torde det även kunna användas på andra diagnosgrupper. En gemensam rehabiliteringsterminologi gav teamarbetet en ökad kvalitet gällande bedömning, planering samt utvärdering av den enskilde patientens aktivitetsförmåga. / <p>Uppsatsarbete omfattande 10 poäng, C-nivå, inom ramen för arbetsterapeutprogrammet 120 p., Högskolan i Örebro, Institutionen för vårdvetenskap och omsorg. Författarens namn i uppsatsen är Gull-Britt Johansson.</p>