O Plano de Atenção Gerontológica (PAGe), instrumento desenvolvido no Bacharelado em Gerontologia da Universidade de São Paulo, possui uma escala de avaliação multidimensional de idosos (AMI) que ainda não foi submetida ao processo de validação. Objetivo geral: realizar a validação de conteúdo da AMI do PAGe. Métodos: A validade de conteúdo foi realizada nas seguintes etapas: 1) revisão sistemática de instrumentos de avaliação multidimensional de idosos validados na língua inglesa: os descritores \"geriatric assessment\", \"validity\", \"reliability\" e \"elderly\" foram associados e pesquisados em quatro bases de dados. Os artigos foram selecionados por dois avaliadores após aplicação dos critérios de inclusão. Pesquisas adicionais foram feitas na tentativa de encontrar adaptações/validações para a população brasileira; 2) definição das bases conceituais: estudo aprofundado sobre como domínios/itens foram medidos por outros pesquisadores; 3) análise do desenvolvimento da escala: itens avaliados e modificados considerando: ambiguidade, comprimento, dificuldade de leitura, múltiplas negativas e duplo-caminho; e 4) avaliação do comitê de especialistas: profissionais experts em avaliação multidimensional do idoso analisaram o conteúdo do instrumento. Foram seguidos métodos sistemáticos para coleta de dados: carta convite, termo de consentimento livre e esclarecido, formulário de caracterização dos participantes, carta explicativa e questionário de avaliação dos itens/domínios. A concordância entre os especialistas foi analisada considerando os valores críticos da Content Validity Ratio (CVR) (nível de significância de p<0,02). Resultados: Foram encontradas 14 escalas validadas, na maioria voltadas para identificação de fragilidade e demandas/risco de saúde. Os domínios mais frequentes foram suporte social (100%) e capacidade funcional (92,8%), enquanto o menos presente foi sobre violência (7,1%). Todas as escalas apresentaram índices de confiabilidade, seguidos por validade de critério concorrente e conteúdo (78,5%, ambas). Validades de face (21,4%) e construto (21,4%) foram menos prevalentes. Na validação do conteúdo da AMI do PAGe seu construto foi definido, suas bases conceituais foram devidamente descritas e seus itens modificados para melhor qualidade psicométrica. O comitê foi constituído por dez especialistas. A partir do cálculo das CVRs, 42,7% dos 103 itens foram validados, 50,4% modificados, 5,8% excluídos e 0,9% mantidos sem modificações. As médias das CVRs da escala inteira nos quesitos clareza e pertinência são 0,78 e 0,95, respectivamente. Foram feitas alterações no layout e nas instruções do instrumento, excluídas as propostas de escores e incluídos sete itens. Conclusão: As escalas encontradas na revisão são mais voltadas para a área da saúde e apresentam limitações em suas validações. Há escassez de instrumentos originados no Brasil e validados para idosos brasileiros. Esta pesquisa proporcionou a identificação do construto latente da AMI pertencente ao PAGe, a qual passou a ser denominada escala de Vulnerabilidade Biopsicossocial do Idoso (VBI). O conteúdo dessa escala não foi totalmente validado, contudo os itens mantidos na mesma foram todos considerados pertinentes. Neste panorama, espera-se que a escala VBI do PAGe venha contribuir para o campo de instrumentos avaliativos da população idosa brasileira e que este trabalho contribua para maior interesse em estudos de avaliação psicométrica e uso crítico de instrumentos / The Gerontological Care Plan (originally called Plano de Atenção Gerontológica -PAGe), developed in the Bachelor of Gerontology of the University of São Paulo, has a scale of multidimensional assessment of the elderly (MAE) that has not been yet submitted to a validation process. General objective: to determine the content validation of the MAE of the PAGe. Methods: Content validity was performed in the following stages: 1) systematic review of multidimensional assessment tools for elderly validated in the English language: the descriptors \"geriatric assessment\", \"validity\", \"reliability\" and \"elderly\" were associated and searched in four databases. The articles were selected by two researchers after applying the inclusion criteria in the abstracts/titles and full articles. Additional research was done in an attempt to find adaptations/validations for the Brazilian population; 2) definition of the conceptual bases: an in-depth study on how domains/items were measured by other researchers; 3) analysis of the development of the instrument: the items were evaluated and modified considering: ambiguity, length, reading difficulty, multiple negatives and double barreled; and 4) evaluation of the specialists committee: experts in multidimensional assessment analyzed the content of the instrument. Systematic methods for data collection were followed: invitation letter, informed consent form, participant characterization form, explanatory letter and questionnaire to evaluate the items/domains. The agreement among the experts was analyzed considering the critical values of the content validity ratio (CVR) (significance level of p <0.02). Results: A total of 14 validated scales were found, mostly focused on the identification of frailty and demands / health risk. The most frequent domains were social support (100%) and functional capacity (92.8%), while the least present was violence (7.1%). All scales presented reliability indices, followed by validity of concurrent criterion and content (78.5%, both). Validities of face (21.4%) and construct (21.4%) were less prevalent. In the content validation of the MAE of the PAGe its construct was defined, its conceptual bases were properly described and its items modified for better psychometric quality. The committee consisted of ten specialists. From the CVR calculation, 42.7% of the 103 items were validated, 50.4% modified, 5.8% excluded and 0.9% maintained unchanged. The CVR averages of the entire instrument in the clarity and relevance questions are 0.78 and 0.95, respectively. Changes were made to the layout and instructions of the instrument, proposed scores were excluded and seven items were included. Conclusion: The scales retrieved in the systematic review are more focused on the healthcare field and have limitations in their validations. No instrument was originally developed in Brazil and fewer were validated for Brazilian elderly. This research provided the identification of the latent AMI construct belonging to the PAGe, which was renamed scale of Biopsychosocial Vulnerability of the Elderly (BVE). The content of this scale was not fully validaded, however the items kept in it were all considered pertinent. Finally, it is expected that BVE would contribute to the field of evaluation instruments for Brazilian elderly population and that the present study contributes to an increase interest in psychometric evaluation and critical use of instruments

Understanding underlying mechanisms and pathways that lead to chronic homelessness would help develop intervention strategies that could help prevent subsequent episodes of homelessness. Quantitative data for this cross-sectional study was gathered by interviewing individuals who were homeless in the State of Arkansas, using a structured survey between 2007 and 2011. Qualitative data was gathered using semi-structured interviews between 2016 and 2018. Chi-square statistics and a multivariate logistic regression model was used to analyze the quantitative data, while phenomenological methods were used to analyze the qualitative data. Nearly half of the study participants identified themselves as being chronically homeless. Chronically homeless adults in this region were significantly more likely to be older men with no family ties, more likely to be victims of domestic violence, have higher rates of physical health problems, and have alcohol and substance abuse problems. Results from the multivariate nominal regression revealed that individuals who reported themselves as chronically homeless were more likely to be in the 50 years or older age group. In addition, study findings highlighted a dynamic interplay between three biopsychosocial risk factors for homelessness. Fostering development of inclusive sustainable communities, intergenerational relationships, and shared housing practices could help ease such social inequities and prevent problems such as chronic homelessness in older homeless adults.

In an attempt to meet monetary-driven mandates to improve student achievement test scores, administrators are replacing physical education activities with subject matter classes in many American schools. This practice negates the positive contributions of physical activity to academic performance and student fitness. Guided by self-efficacy theory, this study assessed the impact of optimal versus minimal physical fitness state on student academic achievement. The study sample included 5,416 9th grade students from the same school district who completed a minimum of 5 of the 6 components of the FITNESSGRAM tests, and who also completed the math and English language arts (ELA) portions of the California Standards Test. The independent variables were optimal and minimal physical fitness based upon completing 6 or 5 FITNESSGRAM components, respectively. Analyses included independent samples t tests, ANOVA, and Dunnet's C test to detect differences in mean academic scores with gender and ethnicity as covariates. Optimally fit students had significantly higher (p < 0.05) scores in math and ELA tests relative to minimally fit students. Female academic test scores tended to be higher than male scores in both academic tests. School officials, when contemplating curricular programs devoid of a physical education component, might judiciously reassess the positive effects of physical fitness upon academic achievement and the associated biopsychosocial benefits for their students. Physically fit and academically enriched students may provide a foundation for positive social change directed at engendering a healthier, motivated, and productive citizenry.

Previous studies indicated that parents raising children with autism (CWA) experience higher rates of stress; however, no qualitative studies have addressed low-income parents' lived experiences of raising CWA. The purpose of this hermeneutic phenomenological study was to understand the challenges that low-income parents of CWA face daily within the framework of family systems theory and biopsychosocial theory. Research questions focused on the impact of income and the core symptoms of autism (social deficits, communication deficits, and repetitive behaviors) on marital and interpersonal relationships. Semistructured interviews with 13 parents were conducted, and transcripts were analyzed for themes using a 4-step process. Results indicated some negative impacts on parents' marital, social, and professional relationships. Themes included higher levels of stress and depression, decreased social interaction, less personal and professional satisfaction, and lower levels of marital satisfaction. Findings may be used to increase empathy and understanding of parents' challenges and improve access to resources and services required for CWA and their parents to enhance their quality of life.

This study aimed to assess the impact of an Mindfulness-based stress reduction (MBSR) intervention in a program serving women who survived Intimate partner violence (IPV). The biopsychosocial model, formulated by Engel, was the theoretical basis of this study. The impact of the MBSR intervention was assessed by qualitatively evaluating researcher notes and 5 participants' journals and reflections, and quantitatively evaluating 16 participants' self-reported stress, mindfulness, well-being, and optimism before and after the intervention. The themes that emerged from the qualitative data included participants' feelings of relaxation or balance, improved self-awareness, mindfulness exercises becoming easier over time, and improved intentionality. The Kentucky Inventory of Mindfulness Skills (KIMS) self-report inventory was used to assess participants' mindfulness. The KIMS instrument is composed of four subscales: observe, describe, act, and accept. There were significant improvements in the describe and accept dimensions of mindfulness from pretest to posttest, after Bonferroni adjustment. The subscale describe measures how well the participants report being able to describe, identify, or observe mental phenomena in a nonjudgmental manner. There were no significant differences from pre to posttest on stress, well-being, and optimism, a non-equivalent dependent variable not expected to change as a result of the intervention, as optimism is presumed to be a stable personality trait. This study may provide a valuable link to the development of coping and treatment strategies for IPV survivors that can be integrated into therapy programs and individual treatment.

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Bakgrund: Fysisk aktivitet är en viktig del för hälsan och det krävs flera olika fysiska och psykosociala förmågor för att vara fysiskt aktiv. Ridterapi kan påverka de olika förmågorna till fysisk aktivitet, både fysiskt och psykosocialt, dock är den vetenskapliga evidensen tvetydig. Ett sätt att stärka den evidensbaserade praktiken för ridterapi är att öka kunskapen om fysioterapeuters erfarenheter av hur ridterapi påverkar förmågan till fysisk aktivitet. Syfte: Att utforska fysioterapeuters erfarenheter av hur ridterapi kan påverka förmågan till fysisk aktivitet hos individer med permanent fysisk funktionsnedsättning i olika åldrar. Metod: En kvalitativ deskriptiv studie genomfördes med en induktiv ansats och en semistrukturerad intervjuguide användes. Ett ändamålsenligt bekvämlighetsurval användes, där sex fysioterapeuter från olika verksamheter rekryterades. Resultat: Analysen resulterade i sex underkategorier och tre kategorier. Kategoriernas namn var ”Påverkan på fysisk funktion”, ”Ger möjligheter till att vara aktiv på fritiden” och ”Förändrade tankar och känslor om rörelse”. Slutsats: Deltagarna erfar att ridterapi påverkar förmågor till fysisk aktivitet, utifrån ett bio-psyko-socialt perspektiv. Förmågor på individ- och omgivningsnivå var kroppskontroll, motivation, självförtroende, handikappanpassad anläggning och kuperad terräng. Resultatet bidrar till EBP genom att fylla kunskapsluckan gällande fysioterapeuternas erfarenheter inom området. / Background: Physical activity is an important part of health, and several different physical and psychosocial abilities are required to be physical active. Hippotherapy can affect the different abilities to physical activity, both physically and psychosocially, however, the scientific evidence is ambiguous. One way to strengthen the evidence-based practice for hippotherapy is to increase knowledge about physiotherapists' experiences of how hippotherapy affects the ability to do physical activity. Aim: To explore physiotherapists experience of how hippotherapy can affect the ability to be physical active in individuals with permanent physical disability at different ages. Method: A qualitative descriptive study was conducted with an inductive approach and a semi-structured interview guide. A purposeful convenience sample was used, where six physiotherapists from different practices were recruited.  Results: The analysis resulted in six subcategories and tree categories. The name of the categories was “effect on physical function”, “provides opportunities to be active in free time” and “changed thoughts and feelings about movement”.  Conclusion: The participants experienced that hippotherapy affects abilities for physical activity based on biopsychosocial perspective. Abilities at the individual and environment level were body control, motivation, self-confidence, disabled facilities and hilly terrain. The result contributes to EBP by filling the knowledge gap regarding physiotherapists' experiences in the field.

Chronic pain is common and a burden for both the individual and society. In chronic pain, the pain has lost its function as a warning system and instead has become a disease in itself. Neurobiologically, several areas of the brain are involved, but to gain a broader understanding of the long-term pain, the biopsychosocial model is the best starting point. In line with thisand many scientific studies since the late 90's, psychological factors have proven to be an important factor in the development and maintenance of chronic pain. Interdisciplinary multimodal rehabilitation programs (IMMRP) are the treatment currently given to patients with long-term pain in the specialized pain rehabilitation. When the IMMRP has been reviewed, patients have shown improvement over time, but it is not possible to say whether it is the IMMRP or which parts of the IMMRP that explain the improvement (1). In this licentiate thesis, I have studied the importance of psychological factors in the rehabilitation of patients with chronic pain. This has been done in three studies reported in three published articles. All the studies have been close to the clinic and have been performed on patients in the specialized pain rehabilitation care in Sweden. The first article studied the effect of the multimodal investigation (MMI). More specifically, it was investigated whether alliance building and feelings of validation in patients with chronic pain affected their acceptance of pain, pain management, catastrophic thoughts, and depression. This was performed in a "single case" study on six patients in MMI. The results showed that despite good alliance and sense of validation, acceptance increased only in one patient and no improvement was seen in pain management, catastrophizing, and depression. In study two, subgroups of patients with chronic pain were studied. The subgroup analysis showed that patients referred for IMMRP could be divided into groups with different profiles regarding emotional problems and pain avoidance. These profiles were important for how the patients relatedto their pain and the results of IMMRP. The results of the study can increase the understanding of which patients should be selected for IMMRP and how the treatment can be adapted to the patients' needs. In study three, opioid treatment in patients with long-term pain who were referred to IMMRP was studied. The result showed that opioid prescribing was common and 55% of the participants received at least one prescription for opioids during the two years after the first assessment. It also turns out that there was a connection between individual patient characteristics (especially pain and depressive symptoms) and opioid prescription. Understanding how individual patient characteristics relate to prescribing patterns and long-term opioid use is an important prerequisite for managing opioid prescribing and the basics for preventing overuse. Overall, this licentiate thesis shows that MMU has no therapeutic effect on patients with long-term pain. It also shows that patients with chronic pain are a heterogeneous group that can be divided into subgroups based on psychological characteristics. The subgroups, in turn, had different ways of managing their pain and absorbing the treatment offered. In addition, it emerged that opioid prescribing was common among patients with long-term pain and that there was a link between opioids and patient characteristics.