Abstract: Syfte: Att beskriva hur kommunernas äldre- och handikappomsorg infört och använder sig av ICF. Metod: Semistrukturerade telefonintervjuer med representanter för åtta svenska kommuner. Intervjuerna har transkriberats och analyserats genom kvalitativ innehållsanalys, Resultat: Resultatet redovisas under två teman. Ett tema handlar om hur kommuner infört ICF i kommunernas äldre- och handikappomsorg, med kategorierna införande i journalstruktur och införande av tankemodell. Ett tema handlar om hur kommunerna använder ICF i kommunernas äldre- och handikappomsorg. Kategorierna under det temat är användning i journalstruktur, användning av tankemodell och problem och utvecklingsbehov.  Två olika typer av införande och användningssätt av ICF inom kommunernas äldre- och handikappomsorg framkom i studien. Införandet initieras ofta av medicinskt ansvarig för rehabilitering (MAR) eller medicinskt ansvarig sjuksköterska (MAS) och startar vanligtvis i projektform för båda arbetssätten. Två av kommunerna använder sig mest av den första delen i den svenska versionen av ICF, som handlar om ICF:s tankemodell och sex komponenter, för att göra en brukarnära kartläggning och formulera beslutsunderlag. I de övriga sex kommunerna används ICF:s komponenter och klassifikationer som sökord i journalsystemens sökordsträd. Diskussion: Studien visar att delaktighet, friskperspektiv och helhetssyn inte är något som automatiskt följer med när ICF införs. Det framstår som om användningen kräver mer utbildning om, och mera bearbetning av ICF än vad kommunerna hade trott från början. Det framgår tydligt av studien att arbetsterapeuter har lättare att ta till sig tankesättet medan sjuksköterskor har betydligt svårare. Eftersom ICF är på stark frammarsch så behöver inslagen av ICF öka i alla vårdutbildningar.  Sökord: International Classification of Functioning, Disability and Health, Äldreomsorg, Arbetsterapi, Hälsa, Social omsorg

Disability is seen as a result of an interaction between a person and that person's contextual factors. Viewing disability in the context of the built environment, a better design of this environment helps to reduce the disability faced by an individual. In spite of significant research in Universal Design (UD), the existing methods provide insufficient guidance for designers: designers demand more specific examples of, and methods for, good universal design. Within the overarching goal of improving universal product design, the specific goal of this research is to determine if the ADA guidelines for architectural design can be adapted to product design. A methodology that foresees the accessibility issues while designing a product would be constructive. The new technique should be built on the pre-existing principles and guidelines. A user activity and product function framework is proposed for this translation using actionfunction diagrams. Specific goals include determining if the function-based approach is able to anticipate a functional change that improves product accessibility. Further, generate user activity and product function association rules that can be applied to the universal design of products. Proposed research activities are to identify thirty existing universal products and compare with its typical version to identify the function that introduces an accessibility feature. Next, categorize the observed changes in a product function systematically and extract trends from accessible architectural systems to generate rules for universal design of consumer products. For validation, the task is to select around fifteen consumer product pairs for validation of the generated rules to determine if the ADA guidelines can be adapted for universal product design using the proposed framework. The results of this research show promise in using the International Classification of Functioning, Disability and Health (ICF) lexicon to model user limitation. The actionfunction diagram provides a structured way to approach a problem in the early stage of design. The rules generated in this research translate to products having similar user-product interface.

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Until recently, the development and maintenance of the standard international disease classification for diagnostic, epidemiological and health management purposes has been handled by a closed group of experts with little input from other members of the medical community, interested organizations, or patient groups. The eleventh revision of the World Health Organization's International Classification of Diseases (ICD-11) represents an attempt to involve a much broader stakeholder group in the process of redesigning a standardized classification. Our research is an exploratory case study of this revision effort. We examine the socio-technical ecosystem of the ICD-11 project and produce a set of five recommendations for developing inclusive standardization systems. These recommendations are supported by an analysis of two additional projects in the health information and informatics domain, as well as a varied collection of literature. Our first recommendation implores system designers to consider technology-readiness and collaboration-readiness. We also advocate for the support of articulation and coordination work, and address the need for a distinct purpose and clearly defined process surrounding any introduced technology. Finally, we shed light on the need for incremental openness when attempting to involve a wide audience of stakeholders in the development process. / Graduate

Thesis (M.Sc.). / Written for the School of Physical and Occupational Therapy. Title from title page of PDF (viewed 2008/07/29). Includes bibliographical references.

Introduction Primary health care in South Africa is predominantly provided by clinics and Community Health Centres (CHC). These primary care facilities are situated in the community to ensure accessibility to care. 1 As part of ensuring quality planning, implementation and transformation of the health system, good knowledge of which cases are prevalent at our primary health facilities is important. Thus the rationale for this study as to know what are the reasons our patients come to our facilities and which diagnoses are made by the attending health care workers based on these reasons. Aim The aim of this study was to describe the spectrum of clinical and non-clinical problems encountered and the diagnoses made at our primary care facilities in the North West province of South Africa. Methods A prospective, cross-sectional survey at 19 Clinics and 5 Community Health Centres in 4 sub-districts of the Ngaka Modiri Molemma District of NW Province, South Africa. The International Classification of Primary Care-Version 2 (ICPC-2) was used to code data on selected days over a 10-month period from patients presenting at the participating clinics and community health centres. Results In total, 5082 patient encounters were recorded of which 3438 (67.7%) were females while 1644 ( 32.3%) were males. The category with highest reasons for encounter (RFE) was the general and unspecific component with 16.5% (n = 1202), followed by the respiratory component at 14.7% (n= 1066) and the cardiovascular component at 12.1% (n=882). The most common diagnoses were in the general component at 16.5% (n= 981) followed by cardiovascular at 16.0% (n= 951) and the respiratory component at 14.5% (n= 865). The average numbers of RFE was 1.4 per encounter among females and 1.5 amongst males. Diagnoses per encounter averaged 1.2 among females and males. Younger people under 40 years of age 67% (n = 3409) and females 68% (n = 3438) made up the majority of encounters. Conclusion Of all the health care facilities surveyed, there were mixtures of RFEs and various diagnoses of mixture of disease components. There were very few patients that came to the facilities for administrative purposes. Majority of the attendees were women. Collection of hypertension medication was the most common reason for encounter (RFE) with uncomplicated hypertension being the commonest diagnoses while psychosocial and problems related to male genitals were the least RFEs. There were more RFEs presented by patients than the diagnoses made by the attending HCWs. The ICPC-2 is a very user friendly tool that can be successfully utilised to monitor encounters and diagnoses at any health care facilities.

Leprosy it mainly affects the skin and the peripheral nervous system, causes multiple deformities and body disfigurations, interfering directly in the individual’s personal and professional life. The International Classification of Functioning, Disability and Health (ICF) is an instrument that classifies and assists to describe function and disability related to health conditions, reflecting a new approach to identify dysfunctions, classifying them in the biological, individual and social context. The objective of this study is to identify, through a clinical study, the main dysfunctions presented in cases of leprosy and thus to select categories to develop the core set of the ICF for leprosy. The type of this study is clinical descriptive, cross-sectional with quantitative and qualitative analysis. The sample was composed of patients with leprosy, who were recruited at the Centers of leprosy in Sergipe. For data collection with the quantitative approach, validated and standardized functional evaluations were used that represented each ICF domain. In the data collection of the qualitative approach, a structured, standardized questionnaire developed by WHO was used. The data were recorded in Office 2010 program to calculate means, frequencies and percentages. The dysfunctions prevalent in at least 5% of the participating volunteers were selected to be extracted the categories of the ICF with their respective codes to compose the core set. Participants in this study were 29 patients with leprosy. The mean age of the participants was 44.9 (± 13.72), predominance of 60% men. In the study with a quantitative approach, the most relevant functional disabilities were in the body structure domain, where "Structures of areas of skin - s810" was the most prevalent with 78%, in the body function domain the most representative category were "Touch function - b265" with 100% prevalence of participants who presented deficits in sensory. In the field of activity and participation the category: “Carrying, moving and handling objects - d430” had 100% of the participants with limitations. In the area related to participation the category: “Recreation and Leisure - d920”, 89% of the participants had restriction to participate. Regarding environmental impact, the category "Health services, systems and policies - e580" represented a barrier to 56% of participants. Different from what was found in the quantitative study, the results collected in the qualitative study demonstrated a greater number of categories in the environmental factors domain. However, when the amount of categories in the two studies were compared considering the total number of categories of the ICF, with the relative frequency of categories, we observed that the environmental domain is the “incapacity” most prevalent in both studies with the quantitative and qualitative approach. The ICF categories in each domain found in the quantitative study and the qualitative study help to map the functional disabilities of patients with leprosy. / Hanseníase afeta principalmente a pele e o sistema nervoso periférico, provocando múltiplas deformidades e desfigurações no corpo, interferindo diretamente na vida pessoal e profissional do indivíduo. A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) é um instrumento que classifica e auxilia na descrição da funcionalidade e da incapacidade relacionadas às condições de saúde, classificando-as no âmbito biológico, individual e social. O objetivo deste estudo é identificar através de um estudo clínico as principais disfunções apresentadas em casos de hanseníase e com isso selecionar categorias para desenvolver o core set da CIF para hanseníase. Trata-se de um estudo observacional, transversal, com abordagem de análise quantitativa e qualitativa, composta por pacientes com hanseníase, que foram recrutados nos centros de referência em hanseníase do Estado de Sergipe. Para coleta de dados da abordagem quantitativa foram utilizadas avaliações funcionais validadas que representassem cada domínio da CIF. Já na coleta de dados da abordagem qualitativa foi utilizado um questionário estruturado, padronizado, desenvolvido pela OMS. Os dados foram registrados no programa Office 2010 para cálculo das médias, frequências e porcentagens. As disfunções prevalentes em pelo menos 5% dos voluntários participantes foram selecionadas para serem extraídas as categorias da CIF com seus respectivos códigos para compor o core set. Participaram desse estudo 29 pacientes com hanseníase, com idade média de 44,9 (±13,72), predomínio do sexo masculino (60%). No estudo com abordagem quantitativa, as incapacidades funcionais mais relevantes foram no domínio estrutura do corpo, sendo que “Estrutura das áreas da pele - s810” foi a mais prevalente com 78%, no domínio função do corpo a categoria mais representativa foi “Função tátil - b265” com 100% de prevalência dos participantes que apresentaram déficit na sensibilidade. No domínio atividade e participação a categoria: “Levantar e carregar objetos - d430” apresentou limitação em 100% dos participantes. Já no domínio relativo a participação a “Recreação e Lazer - d920” foi observada como restrição a participação em 89% dos participantes. Em relação ao impacto ambiental a categoria “Serviços, sistemas e políticas de saúde - e580” representou uma barreira para 56% dos participantes. Diferente do encontrado no estudo quantitativo, os resultados coletados no estudo qualitativo demonstraram um número maior de categorias no domínio fatores ambientais. Porém, quando as quantidades de categorias nos dois estudos são comparadas considerando o número total de categorias da CIF, obtendo uma frequência relativa de categorias, observou-se que as incapacidades relativas ao domínio ambiente são prevalentes nos dois estudos tanto na abordagem quantitativa quanto na qualitativa. As categorias da CIF, em cada domínio, encontradas no estudo quantitativo e no estudo qualitativo auxiliam a mapear as incapacidades funcionais de pacientes com hanseníase. / Lagarto, SE

A utilização adequada de um sistema de códigos é fundamental para a qualidade das informações de saúde registradas com o propósito de subsidiar o planejamento, a programação e a avaliação das ações de saúde. O objetivo do trabalho foi descrever o padrão de uso da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID) em atestados odontológicos apresentados em um serviço público federal com a finalidade de concessão de licença para tratamento de saúde. Analisou-se a concordância entre a codificação apresentada nos atestados e a codificação atribuída por cirurgiões-dentistas peritos oficiais; o grau de especificidade das codificações e a perspectiva de uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Este estudo concluiu que é necessário um aperfeiçoamento na utilização da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde Décima Revisão (CID-10) e que o uso complementar da Classificação Internacional de Doenças em Odontologia e Estomatologia (CID-OE) e da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) pode favorecer o processo de tomada de decisão quanto à necessidade de afastamento do trabalho, fornecendo dados relevantes para o monitoramento do absenteísmo por motivo odontológico. / Appropriate use of a code system is fundamental to the quality of registered health information in order to support the planning, programming and assessment of health measures. The objective of this study was to describe the pattern of use of the International Statistical Classification of Diseases and Related Health Problems (ICD) in dental certificates presented in a federal public service for the purpose of granting permission for medical treatment. The degree of agreement between the coding presented in health certificates and the coding given by official dental experts was assessed, as the degree of specificity of coding and the prospect of using the International Classification of Functioning, Disability and Health (ICF).This study concluded that an improvement is needed in the use of the International Statistical Classification of Diseases and Related Health Problems - Tenth Revision (ICD-10) and that complementary use of the International Classification of Diseases in Dentistry and Stomatology (ICD-DA) and International Classification of Functioning, Disability and Health (ICF) can aid the decision-making process regarding the need to take time off work, providing relevant data for monitoring absenteeism for dental reasons.

A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) é uma ferramenta para descrever os estados de saúde e estados relacionados à saúde. O objetivo do estudo foi utilizar a CIF para descrever o perfil de funcionalidade relacionado à incapacidade para o trabalho por motivo odontológico. Foram avaliados 41 indivíduos que necessitaram de afastamento do trabalho para tratamento de saúde bucal. As principais deficiências identificadas no componente Funções do corpo referem-se a mastigar (b5102), funções emocionais (b152) e sensação de dor (b280). No componente Estruturas do corpo, as deficiências mais observadas pelo perito relacionam-se aos dentes (s3200) e gengivas (s3201). As principais dificuldades referidas no componente Atividades e Participação relacionam-se ao cuidado dos dentes (d5201), comer (d550), realizar a rotina diária (d230), fala (d330) e produção da linguagem corporal (d3350). Os principais facilitadores no componente Fatores Ambientais referem-se aos medicamentos (e1101), alimentos (e1100) e ao apoio de profissionais de saúde (e355) e da família imediata (e310). O uso da CIF pode fornecer dados relevantes para a avaliação de resultados de intervenções, necessidades de reabilitação e planejamento das ações de saúde bucal, possibilitando uma melhor compreensão do processo vivenciado pelos indivíduos, bem como sua relação com o bem-estar e a qualidade de vida. / The International Classification of Functioning, Disability and Health (ICF) is a tool to describe the health status and health-related states. The aim of this study was to use the ICF to describe the functioning profile related to work disability due to dental reasons. A total of 41 participants requiring sick leave were evaluated. The main disabilities identified in the component Body functions were chewing (b5102), emotional functions (b152) and sensation of pain (b28010). In the component Body Structures, the main disabilities observed by the expert were teeth (s3200) and gums (s3201). The main difficulties related to the component Activities and Participation were caring for teeth (d5201), eating (d550), carrying out daily routine (d230), speaking (d330) and producing body language (d3350). The main facilitators in the component Environmental Factors were drugs (e1101), food (e1100) and support from health professionals (e355) and immediate family (e310). The use of the ICF can provide relevant data to the outcome evaluation, assessment of rehabilitation needs and oral health planning, conducting to a better understanding of the process experienced by individuals, as well as its relation with the well-being and quality of life.

Orientador: Maria Ines Rubo de Souza Nobre / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T06:28:15Z (GMT). No. of bitstreams: 1 Zimmermann_AnaBeatriz_M.pdf: 1435162 bytes, checksum: b4c9ce47e60113462690e7d8723f2d96 (MD5) Previous issue date: 2012 / Resumo: A Medida Canadense de Desempenho Ocupacional (COPM) foi criada para favorecer uma prática centrada no cliente, tendo como foco a autopercepção da pessoa sobre seu desempenho ocupacional. Avaliações padronizadas são cada vez mais utilizadas no âmbito da reabilitação, no entanto, a maioria dos instrumentos buscam favorecer a independência em atividades pré-estabelecidas, baseadas no que é esperado pela sociedade, podendo não contemplar necessidades individuais dos clientes. Atividades e Participação são aspectos centrais da Terapia Ocupacional e os terapeutas ocupacionais reconhecem que o envolvimento e o desempenho ocupacional contribuem e apoiam à saúde. O modelo proposto na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), em 2001, reconhece a influência das atividades e participação, assim como dos fatores contextuais e funções e estruturas do corpo na condição de saúde. Tem-se por objetivo verificar a autopercepção do desempenho ocupacional por meio da COPM em usuários adultos e idosos de um centro de reabilitação no estado do Paraná e classificar os problemas de desempenho ocupacional segundo a CIF. Realizou-se um estudo descritivo com usuários acometidos por lesão medular ou lesão encefálica adquirida em processo de reabilitação entre o período de agosto/2010 a fevereiro /2011. A COPM foi aplicada por meio de entrevista semiestruturada e os problemas de desempenho ocupacional identificados pelos 28 usuários foram classificados segundo a CIF. Entre os 122 problemas classificados, houve maior frequência nos seguintes domínios do componente Atividade e Participação: Mobilidade (36%), Vida Comunitária Social e Cívico (24%) e Cuidado Pessoal (15%). Sugere-se que dificuldades relacionadas a Vida Comunitária, Social e Cívica são mais frequentes dependendo do tempo de lesão e do contexto de tratamento. Percebe-se a abrangência e variedade de problemas identificados por meio da COPM pode colaborar no processo de reabilitação com o estabelecimento de objetivos mais congruentes às demandas e experiências de vida diária dos clientes. Tem-se o desafio de se construir e conduzir práticas de saúde na área de reabilitação à pessoa com deficiência em conjunto com outros setores, ampliando nosso olhar de forma a contemplar as várias dimensões da funcionalidade humana. A classificação dos problemas de desempenho ocupacional de acordo com a CIF pode favorecer a comparação entre estudos que utilizam diferentes instrumentos de avaliação e que por vezes possuem terminologias distintas. Por outro lado, há desafios no processo de codificação no tocante a utilização de categorias abrangentes e inespecíficas para atividades e situações não tão comuns, pois permite interpretações variadas entre os usuários da CIF / Abstract: In the context of rehabilitation, standardized assessments are being more utilized in order to evaluate the impact of the impairment on the individual's daily routine. Most of the assessment instruments focus on favoring the independence on predefined activities, based on what is expected by society, and may not be meeting the client's individual needs. The COPM was created to facilitate a client-centered practice, allowing the client to identify his/her own limitations and restrictions lived on the occupational performance. The model proposed on CIF (International Classification of Functionality, Impairment and Health) in 2001 states that environmental and personal factors, activities and participation, body functions and structures, and health conditions are in dynamic interaction, so that any modifications in one of these components have the potential of generating changes on the others. Activity and participation are core aspects of occupational therapy. Occupational therapists recognize that the involvement and occupational performance contributes and promotes health. One of the goals is to verify self-perception of the occupational performance through COPM on adults and elderly from a rehabilitation center in the state of Paraná and classify the problems of occupational performance in CIF. A descriptive study was performed on users stricken by spinal cord injury or brain injury, obtained during the rehabilitation process between August of 2010 and February of 2011. COPM was applied through semi-structured interviews and the problems of occupational performance identified by 28 participants were classified in CIF. Among the 122 problems of occupational performance classified in CIF, there was a greater frequency on the following domains of the Activity and Participation component: Mobility (36%), Community, Social and Civic Life (24%) and Personal Care (15%). It is suggested that the difficulties related to Community, Social and Civic Life are more frequent depending on the time of injury and on the treatment context. It is noticed that the scope and variety of problems identified through COPM can collaborate in the process of rehabilitation, with the setting of objectives that are more congruent with the demands and experiences of the clients' daily lives. There is a challenge of building and conducting health practices on the area of rehabilitation to the person with disability along with other sectors, expanding our view in order to contemplate the various dimensions of human functionality. The classification of occupational performance problems in CIF can favor the comparison between studies that utilize different evaluation instruments and that sometimes have distinct terminologies. On the other hand, there are challenges related to the selection of codes: comprehensive and non-specific items can facilitate the classification of uncommon and unlikely elements, but at the same time can generate semantic accumulations and increase disagreements on the choice made by the evaluators / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação