Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / O presente estudo investigou o perfil epidemiológico dos pacientes assistidos no Centro de Fisioterapia Domiciliar, no Rio de Janeiro. A amostra estudada foi composta por todos os pacientes atendidos no período de 1 de janeiro de 1999 a 1 de janeiro de 2009, totalizando 1.203 indivíduos de ambos os sexos. De acordo com a metodologia adotada, a estatística descritiva foi utilizada para atingir os objetivos do estudo. Os dados coletados nos prontuários dos sujeitos do estudo foram organizados nos seguintes itens: faixa de idade, sexo e bairros (área de moradia dos pacientes). Com relação às doenças crônicas, foram analisados: os diferentes tipos de doenças, o tempo da patologia ao iniciar o tratamento e o nível de dependência. Com relação ao tratamento domiciliar de fisioterapia, foram analisados: o tipo de tratamento aplicado, o objetivo do tratamento, o tempo de permanência no tratamento e o nível de melhora obtido pelos pacientes. A análise comparativa utilizou o teste Qui-quadrado de Pearson e o linear, para as tendências estudadas. Todos os cálculos foram efetuados usando o software estatístico SPSS 16.0. Os resultados mostraram que o perfil epidemiológico do paciente atendido no Centro de Fisioterapia Domiciliar, no Rio de Janeiro é: idoso, com idade média de 75,8 anos, do sexo feminino, com sequela de AVC, acometido até um ano atrás (do início do tratamento), está restrito ao leito, com dependência de terceiros para deambular. O perfil do tratamento de fisioterapia domiciliar utilizado é do tipo motor com o objetivo de treino de marcha e equilíbrio; o tempo de permanência no tratamento é em média de 5,8 meses, com o resultado de boa melhora, que corresponde à recuperação da metade ou mais dos objetivos propostos na avaliação inicial. Confirmou-se que existe associação da idade com o nível de dependência dos pacientes, e que quanto maior a idade, maior a frequência encontrada na restrição ao leito total. Concluiu-se que a fisioterapia domiciliar é uma assistência prevalentemente geriátrica, e que é viável a estruturação de um modelo de fisioterapia domiciliar mais inclusivo e gratuito, com uma provável rotatividade de vagas por alta, em torno de 17% ao mês. / This study investigated the epidemiological profile of patients attended at the Home-Based Physiotherapy Center in Rio de Janeiro. The study sample was made up of all the patients attended between January 1, 1999, and January 1, 2009, totaling 1,203 individuals of both sexes. In accordance with the methodology adopted, descriptive statistics were used to reach the study objectives. The data collected from the study subjects medical files were organized into the following categories: age group, sex and district (area where the patients lived). The following were analyzed in relation to chronic diseases: different types of chronic disease, duration of the pathological condition at the start of treatment and level of dependence. Regarding the home-based physiotherapy, the following were analyzed: type of treatment applied, treatment objective, duration of the treatment and degree of improvement attained by the patients. The comparative analysis used the Pearson chi-square test and the linear test on the study trends. All the calculations were made using the SPSS 16.0 statistical software. The results showed that the epidemiological profile of the patients attended at the Home-Based Physiotherapy Center in Rio de Janeiro was as follows: elderly, with a mean age of 75.8 years; female; presenting sequelae from a stroke that occurred up to one year before the start of treatment; bedridden; and dependent on third parties to walk around. The home-based physiotherapy treatment used had a profile of motor type, with the aim of gait and balance training. The mean duration of the treatment was 5.8 months, resulting in a good improvement that corresponded to achievement of half or more of the objectives proposed at the initial assessment. It was confirmed that there was an association between age and the patients level of dependence, and that the greater their age was, the more often a totally bedridden condition was found. It was concluded that the home-based physiotherapy was predominantly geriatric and that it was viable to structure a more inclusive and free-of-charge home-based physiotherapy model, with probable rotation of places according to discharge, of around 17% per month.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / O presente estudo investigou o perfil epidemiológico dos pacientes assistidos no Centro de Fisioterapia Domiciliar, no Rio de Janeiro. A amostra estudada foi composta por todos os pacientes atendidos no período de 1 de janeiro de 1999 a 1 de janeiro de 2009, totalizando 1.203 indivíduos de ambos os sexos. De acordo com a metodologia adotada, a estatística descritiva foi utilizada para atingir os objetivos do estudo. Os dados coletados nos prontuários dos sujeitos do estudo foram organizados nos seguintes itens: faixa de idade, sexo e bairros (área de moradia dos pacientes). Com relação às doenças crônicas, foram analisados: os diferentes tipos de doenças, o tempo da patologia ao iniciar o tratamento e o nível de dependência. Com relação ao tratamento domiciliar de fisioterapia, foram analisados: o tipo de tratamento aplicado, o objetivo do tratamento, o tempo de permanência no tratamento e o nível de melhora obtido pelos pacientes. A análise comparativa utilizou o teste Qui-quadrado de Pearson e o linear, para as tendências estudadas. Todos os cálculos foram efetuados usando o software estatístico SPSS 16.0. Os resultados mostraram que o perfil epidemiológico do paciente atendido no Centro de Fisioterapia Domiciliar, no Rio de Janeiro é: idoso, com idade média de 75,8 anos, do sexo feminino, com sequela de AVC, acometido até um ano atrás (do início do tratamento), está restrito ao leito, com dependência de terceiros para deambular. O perfil do tratamento de fisioterapia domiciliar utilizado é do tipo motor com o objetivo de treino de marcha e equilíbrio; o tempo de permanência no tratamento é em média de 5,8 meses, com o resultado de boa melhora, que corresponde à recuperação da metade ou mais dos objetivos propostos na avaliação inicial. Confirmou-se que existe associação da idade com o nível de dependência dos pacientes, e que quanto maior a idade, maior a frequência encontrada na restrição ao leito total. Concluiu-se que a fisioterapia domiciliar é uma assistência prevalentemente geriátrica, e que é viável a estruturação de um modelo de fisioterapia domiciliar mais inclusivo e gratuito, com uma provável rotatividade de vagas por alta, em torno de 17% ao mês. / This study investigated the epidemiological profile of patients attended at the Home-Based Physiotherapy Center in Rio de Janeiro. The study sample was made up of all the patients attended between January 1, 1999, and January 1, 2009, totaling 1,203 individuals of both sexes. In accordance with the methodology adopted, descriptive statistics were used to reach the study objectives. The data collected from the study subjects medical files were organized into the following categories: age group, sex and district (area where the patients lived). The following were analyzed in relation to chronic diseases: different types of chronic disease, duration of the pathological condition at the start of treatment and level of dependence. Regarding the home-based physiotherapy, the following were analyzed: type of treatment applied, treatment objective, duration of the treatment and degree of improvement attained by the patients. The comparative analysis used the Pearson chi-square test and the linear test on the study trends. All the calculations were made using the SPSS 16.0 statistical software. The results showed that the epidemiological profile of the patients attended at the Home-Based Physiotherapy Center in Rio de Janeiro was as follows: elderly, with a mean age of 75.8 years; female; presenting sequelae from a stroke that occurred up to one year before the start of treatment; bedridden; and dependent on third parties to walk around. The home-based physiotherapy treatment used had a profile of motor type, with the aim of gait and balance training. The mean duration of the treatment was 5.8 months, resulting in a good improvement that corresponded to achievement of half or more of the objectives proposed at the initial assessment. It was confirmed that there was an association between age and the patients level of dependence, and that the greater their age was, the more often a totally bedridden condition was found. It was concluded that the home-based physiotherapy was predominantly geriatric and that it was viable to structure a more inclusive and free-of-charge home-based physiotherapy model, with probable rotation of places according to discharge, of around 17% per month.

Magister Legum - LLM / Disability in South African labour law is reduced to incapacity. An evaluation of disability and incapacity was made to advocate a clear conceptual break between the two concepts. Also, that disability should be grounded in a social model paradigm of disability which was a materialist critique of how capitalism constructs disability. To enhance the analysis discourse analysis was employed to illustrate how language, ideology and power sustained the notion of disability in capitalist society. A comparative analysis was made drawing on American disability jurisprudence and Canadian disability jurisprudence to illustrate the difference in approach between the two legal systems with a suggestion that the Canadian approach was better suited to the development of a South African disability law. And the development of South African disability law it was argued would benefit if a legal construction of disability was crafted to deal with the obstacles that disabled people encounter in the work-place. / South Africa

Longtemps délaissé par les différents législateurs européens, le droit des incapacités fait l'objet d'une toute nouvelle attention depuis la fin des années 1990. Sous l'influence du Conseil de l'Europe, la France a entrepris des réformes qui se veulent davantage humanistes. Ces nouveaux textes doivent permettre de protéger les personnes les plus vulnérables tout en garantissant l'exercice de leur droit au respect de la vie privée et familiale. Ce double objectif peut sembler à la fois utopique et contradictoire, puisque toutes les mesures de protection entrainent des restrictions de la capacité et ont donc des répercutions sur les décisions les plus intimes du majeur protégé.Pourtant, que ce dernier vive dans la cité ou qu'il soit accueilli en établissement sanitaire ou social, la loi semble parvenir à un équilibre. Celui-ci résulte d'une place toute particulière accordée à la capacité naturelle, à la volonté mais également à l'autonomie de l'intéressé.Le système n'est toutefois pas parfait. Parfois, le législateur n'a pas eu l'audace d'aller au bout de sa démarche et maintient des incapacités de principe dans les domaines les plus intimes de la vie privée du protégé. D'autres fois, au contraire, il est allé trop loin, sacrifiant la protection sur l'autel de l'autonomie. Des améliorations sont donc nécessaires. À cette fin, il est possible d'envisager la suppression de ces dernières incapacités et de les remplacer par un dispositif de protection s'adaptant au degré d'inaptitude de l'intéressé. Il est également possible d'imaginer une généralisation de l'assistance, mécanisme idoine lorsque les décisions sont particulièrement liées à la personne. / Neglected by the various European legislators for a long time, incapacity Law has been a primary focus since the late nineties. Influenced by the European Council, France has undertaken a more humanistic reform. The new legislation should help to protect the most vulnerable ones while ensuring the exercise of their fundamental rights, including the right for respect of privacy. This dual objective seems both unrealistic and contradictory at the same time since all protection measures lead to capacity restrictions and therefore impact the most intimate decisions the protected adult has to make.Yet, wherever the protected adult live, in the city or in an institution, the llaw seems to have found balance. This is the result of a particular importance given to the natural ability, the will but also the autonomy of the individual.However, the system is not perfect. Sometimes, the legislator did not dare to go further and maintains disabilities by principle in areas the most related to the protected person’s privacy. At other times however, it goes too far choosing autonomy over protection. Improvements are needed. To this end, it is possible to consider the removal of the remaining disabilities and replace them with a protection scheme adjusting to the degree of disability of the individual. It is also possible to imagine a generalization of the assistance which is appropriate when decisions are closely related to the person.

Les personnes atteintes de troubles mentaux, en tant que personnes dotées de la personnalité juridique, sont titulaires de droit. Les maladies mentales et déficiences intellectuelles ayant des incidences sur la perception de la réalité, la conscience et/ou les capacités intellectuelles de la personne, entraînent inévitablement des conséquences sur la capacité de vouloir ou de décider. Répondant à ce constat, le législateur a mis en place des mesures assurant la protection de la personne et de ses biens, tout en veillant à respecter son autonomie. Il existe également des dispositions favorisant l'autonomie des personnes handicapées mentales. En outre, l'altération du discernement de la personne a des répercussions sur les mécanismes de la responsabilité civile et pénale. Par ailleurs, en tant que personne vulnérable, la personne atteinte de troubles mentaux a besoin de protection. Au nom du principe du respect de la dignité, le Droit assure une protection particulière du corps et de la personne. Il encadre également les mesures d'hospitalisation sous contrainte nécessaires à la prise en charge du trouble mental. / The persons affected by mental disorders and illnesses, as persons given the legal personality, have rights. The mental illnesses and the intellectual deficiencies having incidences on the perception of the reality, the consciousness and/or the intellectual abilities of the person, entail inevitably consequences on the capacity to will or to decide. Taking this acknowledgement into consideration, the legislator has set up rules providing the protection of the person and of his goods, while respecting the person's autonomy. There are also legal provisions facilitating the autonomy of the disabled persons. Moreover, the change in judgment of the person has consequences on the person's civil and penal liability. Furthermore, as vulnerable person, the person affected by mental disorders and illnesses needs protection. In accordance with the principle of the respect of dignity, laws and regulations guarantee a specific protection of the body and of the person. Laws and regulations also cover the hospitalization under constraint required by the care of mental disorders.

Participation in sport activities brings various benefits to the individuals involved as well as to the society as a whole. One of these benefits is a higher labour productivity following from a lower disease-induced absence rate and from the improved personal work characteristics. This thesis investigates the influence of public money spent in support of sport on labour productivity. The study is based on the data about these expenditures on the level of the Czech municipalities, whereas the expenditures on sport are aggregated over the municipalities belonging to each of the fourteen regions composing the Czech Republic. The performed regression analysis traces the influence of these expenditures on the disease-induced work incapacity rate in the respective region, which constitutes a proxy for labour productivity. The results of the analysis show that municipal expenditures on sport significantly decrease the disease-induced work incapacity: if municipalities in a region spend extra one hundred CZK per person on sport, the disease-induced work incapacity in the following year lowers by 0.064 to 0.083%.

Face au phénomène complexe de la vulnérabilité, le législateur a compris que la réponse ne pouvait pas être unique. Le nombre de mesures proposées en droit des majeurs protégés est ainsi suffisamment conséquent pour qu’une grande diversité de situations apparaisse. Que ce soit sur le plan de l’âge, de la situation familiale, sociale ou professionnelle ou au regard du handicap ou de l’état de santé (physique ou mental), la « population » des majeurs protégés présente une forte hétérogénéité. La loi offre à l’organe de protection, titulaire d’un pouvoir pour exercer sa mission, de multiples outils pour sauvegarder l’intérêt du majeur protégé. Variables, ces instruments laisseraient à penser qu’il n’est pas concevable de construire une théorie générale du pouvoir cohérente en droit des majeurs protégés. Toutefois, en ce domaine, au cœur de la notion de pouvoir, se trouve le critère de la prise en charge de l’intérêt exclusif du majeur protégé. C’est là en effet le critère auquel il est systématiquement fait référence. L’objectif de notre thèse était dès lors de parvenir à démontrer que s’il existe en droit des majeurs protégés des variables attachées au pouvoir, ces dernières ne sauraient masquer l’unité de son régime. La découverte de constantes, lesquelles sont consubstantielles au pouvoir en ce domaine, permet d’en extraire une théorie générale. À partir de cet instant, le pouvoir en droit des majeurs protégés prend une coloration nouvelle. En adaptant la définition proposée par la doctrine à la spécificité du droit des majeurs protégés, nous proposons de définir le pouvoir comme la prérogative juridique et/ou matérielle confiée à un organe de protection et le plus souvent sous le contrôle d’un juge, qui ne remédie pas forcément à une incapacité d’exercice mais qui est toujours répartie entre différents organes. Le pouvoir est finalisé par l’intérêt exclusif, mais non égoïste, d’une personne majeure vulnérable, du fait de l’altération de ses facultés personnelles. Tant le principe de responsabilité que celui de l’interdiction d’agir sous l’empire d’un conflit d’intérêts constituent des procédés efficients pour lutter contre le mauvais exercice du pouvoir. Une conception renouvelée du pouvoir a ainsi pu être proposée à partir de l’étude de ses variables et de ses constantes en droit des majeurs protégés. Ayant abouti à une théorie générale du pouvoir, l’étude ici menée peut donc servir de base à une analyse critique du droit positif et aboutir à son amélioration. / Confronted to the complex phenomenon that vulnerable adults represent, the legislative body has realized that the answer to this situation had to be multi-faceted. The number of measures taken in the field of the vulnerable adult's legal status is substantial enough to lead to a great variety of situations. Vulnerable adults represent a widely heterogeneous group whether we look at age, family, social and work situations, or physical or psychological conditions. The protective body that holds the power to carry out its mission has various legal tools at its disposal to protect the vulnerable adult's interests. These instruments are variable, and could first lead us to think that it would be impossible to build a consistent general theory of legal power in the field of the vulnerable adults’ protection. Here, however, at the heart of the notion of power, stands the idea of how to fully care to the vulnerable adult's sole interest. It is the one guideline that is systematically referred to. Thus, our goal was to show that even though there are many power-related variable features in the legal field of vulnerable adults protection and safeguarding, they cannot dissimulate the unity of the field. As we unveiled the permanent features, inherent to the power in this matter, it allowed us to draw a general theory. From then on, the concept of power in the vulnerable adults protection takes a different tone. By adjusting the classic definition of power to the specificity of the vulnerable adult protection and its legal field, we propose to define the power as the legal and/or material prerogative entrusted to a protective body and mostly under the control of a judge. This prerogative does not necessarily remedy the incapacity to act in law but is always divided between several actors. The purpose of the power is the sole but non-egotistic interest of the vulnerable adult because of his or her cognitive impairment. The principle of responsibility and the principle of a ban on acting under the influence of a conflict of interests are both efficient ways to prevent an improper use of power. The analysis of variables and permanent features in the vulnerable adult protection legal field thus allowed us to propose a refreshed idea of power. Since the study undertaken here has resulted in a general theory of legal power, it can then be used as a critical analysis of positive/substantive law and lead to its improvement.

Au Québec, l’amélioration de l’accès aux soins de première ligne est basée sur le développement des Groupes de Médecine de Famille (GMF). Depuis 2014, les GMF sont incités à diversifier leur offre de service en incluant de nouvelles professions (physiothérapie, nutrition, inhalothérapie ou kinésiologie). Actuellement, peu de données sont disponibles sur leurs pratiques au sein d’un GMF. L’objectif du mémoire était d’évaluer la pratique de la physiothérapie en première ligne pour les patients souffrant de pathologies musculosquelettiques, au GMF Universitaire de l’Hôpital Maisonneuve-Rosemont de Montréal (GMF-U HMR). Une 1ère étude rétrospective (revue de 100 dossiers) visait à décrire la clientèle ayant consulté en physiothérapie au GMF-U HMR et son parcours de soins. Une 2nde étude, prospective, évaluait la fonction et la qualité de vie de patients lors d’une évaluation initiale en physiothérapie et à 3 mois, à l’aide de questionnaire autorapportés. La satisfaction envers l’évaluation et le processus de soins en physiothérapie et la perception des patients de l’efficacité des équipes de soins étaient évaluées. La clientèle du service de physiothérapie du GMF-U HMR était d’âge varié, de profil socio-économique faible et consultait pour des troubles musculosquelettiques de toutes localisations. Les 52 participants exprimaient une diminution de leur qualité de vie et des incapacités fonctionnelles modérées. Les soins de physiothérapie visaient l’autonomisation du patient (i.e. éducation thérapeutique et exercices à domicile, principalement). À 3 mois, l’évolution de la qualité de vie était significative. L’évolution de la fonction était significative pour les participants souffrant du membre supérieur. Les participants exprimaient de hauts niveaux de satisfaction envers la prise en charge en physiothérapie et une haute perception d’efficacité de l’équipe soignante. Ce projet suggère de l’intérêt de la physiothérapie auprès de la clientèle du GMF-U HMR. D’autres études sont nécessaires à travers les GMF du Québec afin de confirmer ces observations faites auprès de la clientèle du GMF-U HMR. / In Quebec, improving the access to primary care is based on the development of family medicine groups (FMGs). Since 2014, FMGs have diversified their service offerings into new professions (physiotherapy, nutrition, respiratory therapy or kinesiology). This choice of professional is specific to each FMGs but there is little data available to support this choice. The objective of the dissertation was to evaluate the practice of physiotherapy in primary care for patients with musculoskeletal disorders at University FMGs of Montreal Maisonneuve-Rosemont Hospital (UFMGs HMR). A first retrospective study (review of 100 files) aimed to describe the clientele who consulted in physiotherapy at the GMF-U HMR and its care pathway. A second, prospective study assessed the function and quality of life of patients during an initial assessment in physiotherapy and at 3 months, using self-reported questionnaire. Satisfaction with assessment and process of physiotherapy care and patient perception of the effectiveness of care teams was also assessed. The clientele of the UFMGs HMR physiotherapy department was of varied age, of low socio-economic profile and consulted only for musculoskeletal disorders of all locations. participants expressed a decrease in their quality of life and moderate functional disability. Physiotherapy care was aimed at patient empowerment (i.e. therapeutic education and home exercise, mainly). At 3 months, the evolution of the quality of life was significant. The evolution of function was significant for participants suffering from the upper limb. Participants expressed high levels of satisfaction with the management of physiotherapy and a high perception of the effectiveness of the health care team. This project suggests the interest of physiotherapy with UFMGs HMR clients. Further studies are needed across Quebec FMGs to confirm these observations made to the GMF-U HMR clientele.

[pt] O presente trabalho tem como objetivo investigar as bases da capacidade de um indivíduo estar só e apreender o que comprometeria a possibilidade de alguém ser, existir e de se constituir em uma unidade, alcançando o crescimento emocional e a autonomia. Para isso, foi desenvolvida uma pesquisa teórica a partir do método conceitual analítico. A investigação foi fundamentada, principalmente, no pensamento do psicanalista inglês Donald Winnicott. Em uma primeira parte, investigou-se o aspecto positivo da solidão partindo da concepção winnicottiana do estar só como uma capacidade. Na segunda parte, a capacidade de estar só foi relacionada com o espaço potencial winnicottiano, partindo da releitura e da compreensão de Thomas Ogden de que na capacidade de estar só a criança se torna capaz de gerar um espaço continente no qual ela vive. Por fim, na terceira parte desta pesquisa, refletiu-se sobre o aspecto desértico da solidão buscando apreender possíveis dificuldades no desenvolvimento emocional primitivo que inviabilizariam a vivência do estar só. Procurou-se compreender as ansiedades primitivas e os processos defensivos envolvidos nos primórdios do desenvolvimento, explorando a etiologia do falso self winnicottiano em contraponto com o gesto espontâneo do bebê. / [en] The present work aims to investigate the basis of an individual s capacity to be alone and to apprehend what would compromise the possibility of someone being, existing and constituting a unit, achieving emotional growth and autonomy. For this, a theoretical research was developed from the analytical conceptual method. The investigation was based mainly on the theory of the English psychoanalyst Donald Winnicott. In a first part, it was investigated the positive aspect of aloneness based on the Winnicottian conception of being alone as a capacity. In the second part, it was related the capacity to be alone with the Winnicottian potential space, starting from the reinterpretation and understanding of Thomas Ogden that in the capacity to be alone, the child becomes capable of generating a continent space in which he lives. Finally, in the third part of this research, it was contemplated the desert aspect of loneliness, seeking to understand possible difficulties in primitive emotional development that would make the experience of being alone unfeasible. It was investigated the primitive anxieties and the defensive processes involved in the beginnings of development, exploring the etiology of the Winnicottian false self in counterpoint to the baby s spontaneous gesture.

A substantial number of employees in South Africa may soon be out of work as the result of their HIV-positive status. The dismissal of an infected employee may be motivated by the fact that he is considered to be incompetent or incapable of doing the work for which he was employed. Customers and fellow employees may refuse to deal with an infected employee, with the result that the employee is dismissed for economic reasons. The nature of the undertaking's activities may be such that the presence of an infected employee constitutes a health risk. For the purposes of carrying out his duty to create and maintain safe working conditions, the employer dismisses the employee. The employer may even force the infected employee to resign. Measures should be taken to improve the situation of infected employees. They include educating employers and employees about the transmission of the human immunodeficiency virus. / Mercentile Law / LL. M.