CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Este estudo teve como objetivos principais analisar o perfil epidemiolÃgico e realizar uma avaliaÃÃo funcional dos acidentados de trÃnsito atendidos em um serviÃo de fisioterapia de Fortaleza. Para tal, foi realizado um estudo quantitativo e transversal, desenvolvido de maio a novembro de 2009, na ABCR-Centro. Participaram deste pacientes acidentados de trÃnsito realizando tratamento na instituiÃÃo, maiores de 18 anos e concordantes em participar da pesquisa. Para coleta dos dados, foram utilizados um roteiro, o instrumento MIF e a Escala de ParticipaÃÃo Social. Os dados foram analisados com o software SPSS 15.0. Foram avaliados 57 pacientes, 53 homens e quatro mulheres, com idade mÃdia de 37Â14 anos, sendo a maioria (49,1%) de casados e com o ensino fundamental completo (42,1%). Ao considerar as situaÃÃes trabalhistas antes e apÃs o acidente, encontrou-se diferenÃa significativa (p<0,01), depois do acidente, a maioria (80,7%) nÃo estava trabalhando. A motocicleta foi o veÃculo mais envolvido nos acidentes (70,2%) e o tipo mais recorrente foi colisÃo (54,4%). Ao comparar a mÃdia de idade de acordo com o tipo de veÃculo envolvido, encontrou-se diferenÃa estatisticamente significante (p=0,04) entre os acidentes com moto e aqueles com veÃculo nÃo motorizado ou sem nenhum veÃculo. As fraturas foram predominantes (73,7%) e os membros inferiores foram as regiÃes mais acometidas (60%). Ao comparar a regiÃo corporal lesionada de acordo com o veÃculo envolvido, encontrou-se que a moto acometia predominantemente os membros e os demais veÃculos a regiÃo da cabeÃa (p=0,02). A maioria dos pacientes apresentou independÃncia completa para a MIF total (54,4%), motora (42,1%) e cognitiva (86%). A locomoÃÃo foi o subdomÃnio que apresentou os maiores graus de dependÃncia. Quanto à participaÃÃo social, a maioria (28,1%) apresentou grave restriÃÃo. Ao correlacionar a MIF com a participaÃÃo social por meio do teste de correlaÃÃo de Spearman, obteve-se uma correlaÃÃo negativa moderada, estatÃsticamente significante (R=-0,54, p<0,01). Na anÃlise multivariada da participaÃÃo social, entraram no modelo explicativo a MIFmotora, o tempo de internaÃÃo e o estado civil (p=0,01; p=0,01; p=0,09, respectivamente). Concluiu-se que a maioria dos participantes era de homens, adultos jovens e solteiros; que a moto foi o veÃculo mais envolvido e a colisÃo o tipo mais recorrente; que as fraturas foram as lesÃes mais predominantes e os membros inferiores os mais acometidos; que, ao considerar o veÃculo envolvido, houve diferenÃa quanto à idade dos acidentados, bem como quanto ao perfil lesional (regiÃo acometida); que houve predominÃncia dos indivÃduos que apresentavam independÃncia funcional, entretanto ao considerar os quesitos, o mais acometido foi a locomoÃÃo; que se destacaram os indivÃduos com grave restriÃÃo da participaÃÃo social; que a MIFmotora, o tempo de internaÃÃo e o estado civil foram explicativos da participaÃÃo social. / The present study it had as objective main to analyze the profile epidemiologist and to carry through a functional evaluation of the taken care of victims of traffic in a service of physiotherapy in Fortaleza. For such, a quantitative and transversal study, developed of May the November of 2009 was carried through, in the ABCR-center. They had participated of this, patient rough of traffic carrying through treatment in the institution, greater of 18 years and concordant in participating of the research. For collection of the data, a script was used, instrument FIM and Scale de Social Participial. The data had been analyzed with software SPSS 15.0. 57 patients, 53 men and 4 women had been evaluated, with medium age of 37Â14 years, being the majority (49.1%) married and with complete basic education (42.1%). When considering the working situation before and after the accident, met significant difference between same (p<0.01), where after the accident the majority (80.7%) it wasnât working. The motorcycle was the vehicle most involved in the accidents (70.2%) e the type most recurrent was collision (54.4%). When comparing the acts average in accordance with the type of involved vehicle, met difference significant (p=0.04) it enters the accidents with motion and with vehicle not motorized or without no vehicle. The breakings had been predominant (73.7%) and the inferior members were the most injuried body region (60%). When comparing the injured body region in accordance with the involved vehicle, met that the motorcycle affect predominantly the members and the too much vehicles the region of the head (p=0.02). The majority of the patients presented complete independence for the total FIM (54.4%), motor (42.1%) e cognitive (86%).The locomotion was the subdomain that presented the biggest degrees of dependence. How much to the social participation, the majority (28.1%) it presented serious restriction of the same one. When correlating the MIF with the Social Participation through the test of correlation of Spearman, got a moderate negative correlation, statistical significant (R=-0.54, p<0.01). In the multivariate analysis of the Social Participation through multiple regression, they had entered in the clarifying model of the same a FIM motor, the time of internment and the civil state (p=0.01; p=0.01; p=0.09, respectively). Concluded that the majority of the participants were men, young adults and singles; that motorcycle was the vehicle more involved and the collision was the type more recurrent; that the factures were the most prevalent injuries and the lower limbs were the most affected; considering the vehicle involved, there was difference as the victimsâ age, as well as, the lesional profile (affected region); the people were more prevalent, who presenting functional independence, but in considering the questions of it, the most affected was the locomotion; that stood out individuals with severe restriction of social participation; that motor FIM, hospitalization time and marital status were explanatory of social participation.

As lesões medulares traumáticas (LMT) são comumente geradoras de deficiências e levam a limitações na execução de atividades, como também à restrição de participação em situações concretas de vida. Conhecer os indivíduos com LMT em termos de independência funcional permite aos serviços de reabilitação estruturarem-se para atenderem às demandas dessa população de forma mais eficiente. Estudo de delineamento metodológico objetivou construir e validar instrumento baseado no Core Set resumido da CIF para indivíduos com lesão medular aguda traumática. A pesquisa, aprovada pelo Comitê de Ética, foi realizada em três etapas: etapa 1:Elaboração do instrumento a partir do Core set resumido da CIF para lesão medular aguda: \"Instrumento baseado no Core set resumido da CIF para indivíduos com Lesão Medular Aguda Traumática\"; etapa 2: Validação do instrumento e coleta de dados; etapa 3: Aplicação do pré-teste.O instrumento para validação de face e conteúdo continha13 categorias que integraram os componentes da CIF: funções do corpo (3), estrutura do copo (1), atividades e participação (9), perfazendo um total de 109 itens. Em cada seção do instrumento tinha um campo para sugestões. A validade de conteúdo do instrumento foi realizada por um comitê de dezesseis juízes.Os resultados demonstraram que a maioria dos juízes de conteúdo eram do sexo feminino, jovens, com idade entre 30 e 39 anos. Quanto à titulação acadêmica e área de atuação, a maioria tinha doutorado e eram docentes, assim como, realizavam estudos sobre a CIF e à utilizavam na sua prática clinica.Cada item do instrumento foi avaliado em mais de 70% pelos avaliadores, sendo considerado aceitável para a validação de conteúdo. Na maioria dos itens, os juízes fizeram sugestões que visavam à modificação de termos, para serem substituídos ou reformulados, a partir do conceito apreendido, para que a estrutura e a propriedade do instrumento não fossem alteradas de modo significativo. Foram sugestões pertinentes que favoreceram a adequação do instrumento, a fim de facilitar a compreensão dos itens propostos pelo publico alvo. O pré-teste foi realizado no Centro de Reabilitação do HCFMRP-USP, participaram da pesquisa 10 indivíduos com diagnóstico de LTME, com até 6 meses lesão.A maioria eram do sexo masculino, com média de idade de 43 anos, sendo a principal etiologia do trauma os acidentes automobilísticos. Quanto à escolaridade verificou-se que a maioria dos participantes tinha ensino fundamental completo ou incompleto. Nesta etapa, houve substituição de alguns termos técnicos para melhor compreensão pelo público alvo. Mediante a análise entre os pesquisadores e após consenso das modificações sugeridas pelos especialistas e público alvo, foi elaborada a versão final do instrumento. Ressalta-se que o instrumento contribuíra na prática clinica como uma ferramenta inovadora a ser utilizado pela equipe multidisciplinar, na avaliação da funcionalidade para o planejamento da assistência, com foco nas necessidades individuais e nos resultados mais efetivos das intervenções no processo de reabilitação / Traumatic spinal cord injuries (TSCI) are usually the cause of disabilities and limited performance of some activities as well as limited participation in some life moments. Knowing if TSCI patients are functional dependent helps the rehabilitation services to be organized to effectively meet the demand of that population. The goal of the methodological design study was to create and validate an instrument based on summed up ICF Core Set for patients with acute traumatic spinal cord injury. The survey was approved by the Ethics Committee and it was divided in three phases: Phase 1 - Elaboration of the instrument based on summed up ICF Core Set for acute spinal cord injury: \"Instrument based on summed up ICF Core Set for patients with Acute Traumatic Spinal Cord Injury\"; Phase 2 - Validation of the instrument and data collect; Phase 3 - Implementation of the pre-test. Face and content validation tool had 13 categories which were part of ICF components: body functions (3), body structure (1), activities and participation (9); in total 109 items. Every section of the tool had a specific place for suggestions. A sixteen-judge committee validated the content. The results showed that most of the judges were 30 to 39-year-old women, with doctorate degree and they were professors who also studied ICF and applied it in their clinics. The evaluators checked more than 70% of each item of the tool and it was considered enough for the validation of the content. The judges made some suggestions for most of the items in order to replace or redesign the terms so that the structure and the effect of the tool would not be significantly changed. Those suggestions were relevant and they helped adjusting the tool to make easier for the community to understand the items. The pre-test was performed at Rehabilitation Center of HCFMRP-USP; ten patients who have had TSCI for up to 6 months participated on the survey. Most of them were 43 -year- old men, who studied up to elementary school, with a trauma caused by a car crash. At this stage some technical terms were replaced in order to help the community understanding. After the analysis of the researchers and the modifications suggested by the experts and the community, a final version of the tool was elaborated. In clinical practice this instrument was a new tool used by the multidisciplinary team when evaluating the functioning of helping individual necessities and more effective results of the interventions on the rehabilitation process

INTRODUÇÃO: Desde o início da doença de Alzheimer (DA), alterações de linguagem comprometem o engajamento, o exercício da vida social do indivíduo e, têm impacto em sua independência. A informação sobre essas alterações contribui para a caracterização do diagnóstico da doença. A limitação da capacidade de comunicação funcional, ou seja, a capacidade de emitir e compreender uma mensagem de maneira independente e eficiente em resposta à demanda do cotidiano, é uma das queixas mais importantes de familiares e cuidadores, daí a necessidade de se disponibilizar instrumento, em língua portuguesa, que avalie a comunicação, em contexto natural, para fins de diagnóstico e de acompanhamento de indivíduos acometidos. O objetivo deste estudo foi validar a escala de Avaliação Funcional das Habilidades de Comunicação - ASHA FACS para uso na população brasileira. A ASHA FACS é composta pelos domínios: Comunicação Social, Comunicação de Necessidades Básicas, Leitura, Escrita e Conceitos Numéricos, e Planejamento Diário. MÉTODOS: Foram realizadas a tradução e a adaptação da escala. Foram examinados 32 idosos com DA leve, 25 com DA moderada e 51 idosos sem demência. Os idosos com DA e os controles responderam ao Miniexame do Estado Mental (MEEM), à Escala Geriátrica de Depressão (GDS) e à Escala de Avaliação de Doença de Alzheimer (ADAS-cog). A ASHA FACS foi respondida pelo familiar/cuidador, tendo sido pesquisadas a consistência interna da escala, sua reprodutibilidade inter e intra-examinadores e a validade de critério, pela correlação com o MEEM e com a ADAS-cog, bem como a sensibilidade e a especificidade. Foi examinado o efeito da idade e da escolaridade no desempenho funcional da comunicação. O passo seguinte foi aplicar o instrumento em condições clínicas, com o intuito de detectar indivíduos com DA e estadiar as alterações de comunicação nas fases leve e moderada. RESULTADOS: Análises estatísticas indicaram que a ASHA FACS tem ótima consistência interna (alfa de Cronbrach = 0,955), ótima confiabilidade teste-reteste (coeficiente de correlação interclasse [ICC] = 0,995; p < 0,001) e interexaminadores (ICC = 0,998; p < 0,001), e ótima validade de critério ao ser correlacionada tanto com o MEEM como com a ADAScog. A escala ASHA FACS apresentou valores de sensibilidade (81,4%) e de especificidade (84,3%) considerados bons, já que se trata de avaliação ecológica ampla. Verificou-se que a variável escolaridade interfere no desempenho funcional da comunicação dos idosos saudáveis e com DA, mas o aumento da idade não tem a mesma influência nos dois grupos. A pontuação total da ASHA FACS diferenciou idosos saudáveis dos com DA leve e estes dos que apresentavam DA moderada. Os domínios que melhor diferenciaram os três grupos foram os de Comunicação Social e Planejamento Diário. CONCLUSÕES: A escala ASHA FACS, versão em Português, é válida e confiável para verificar alterações de comunicação em pacientes com DA, útil para fins diagnósticos e estadiamento de alterações ao longo da doença, tendo como objetivo o tratamento dos pacientes e a orientação aos familiares e cuidadores. A ASHA FACS vem preencher importante lacuna de indicadores de eficácia para intervenções fonoaudiológicas em nosso meio. / INTRODUCTION: Since the beginning of Alzheimer\'s disease (AD), language problems intervene in engagement, social life and individual\'s protection and have impact on one\'s independence. Information about such alterations, obtained from a natural context, contributes for diagnosing AD. Limitation on the ability to communicate functionally, that is, limitation on ability to utter and understand a message independently and efficiently in response to everyday demand is one of the most important complaints of relatives and caregivers. Therefore, there is a need for providing an instrument in Portuguese that assess communication in a natural context for diagnosing and following patients with AD and their relatives/caregivers. This study aimed to validate the Functional Assessment of Communication Skills - ASHA FACS for a Brazilian population. The ASHA FACS is composed of four domains: Social Communication, Communication of Basic Needs, Reading, Writing and Number Concepts and Daily Planning. METHODS: The scale was translated and adapted into Portuguese. Then, 32 mild AD patients, 25 moderate AD patients and 51 elderly without dementia were examined. The AD patients and the control group answered the Minimental State Examination (MMSE), the Geriatric Depression Scale (GDS) and Alzheimer\'s disease Assessment Scale (ADAS-cog). The ASHA FACS assessment was answered by their relative/caregiver. The scale internal consistency, its inter and intra-examiners reproducibility and scale\'s criterion validity were researched by correlation with MMSE and Adas-cog. The sensitivity and specificity were also researched. Besides, the effect of scholarship and age in functional communication performance were analyzed. The next step was to apply the ASHA FACS in clinical conditions aiming at diagnosing persons with AD and determining the communication alterations in mild and moderate AD stages. RESULTS: Statistical analyses indicated that the ASHA FACS has excellent internal consistency (Cronbach\'s Alpha=0,955), test-retest reliability (interclass correlation coefficient [ICC] = 0,995; p<0,001) and inter-examiners (ICC=0,998; p<0,001). Besides, it showed excellent criterion validity when correlated with MMSE and Adascog. The ASHA FACS scale showed good sensitivity (81.4%) and specificity (84.3%) values once it is an ecological and broad evaluation. It was verified that scholarship intervened in functional communication performance of healthy elderly people and ones with DA, but the age\'s increase did not have the same influence on functional communication performance in both groups. The ASHA FACS total score differentiated healthy elderly from mild AD patients and mild AD from moderate AD patients. Social Communication and Daily Planning were the domains that better differentiated the three groups. CONCLUSIONS: The ASHA FACS Portuguese version is a valid and reliable instrument to verify communication alterations in DA patients. It is useful for diagnosis and track alterations along the disease aiming patient\'s treatment and relative\'s and caregiver\'s orientation. Besides the use for diagnosis purpose, the ASHA FACS fills an important gap of efficiency indicators for speech language therapy in our country.

No description available.

<p>The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the&nbsp / functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the&nbsp / outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered&nbsp / questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating&nbsp / to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised&nbsp / outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human&nbsp / subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package&nbsp / 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using&nbsp / chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93&nbsp / with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke&nbsp / was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All&nbsp / patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients&nbsp / (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle&nbsp / weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following&nbsp / domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p&lt / 0.0001) and stroke (p&lt / 0.0001)&nbsp / between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on&nbsp / admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple&nbsp / redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p&lt / 0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity&nbsp / limitations and participation restrictions still experienced at the time of discharge. The latter finding&nbsp / questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation&nbsp / programme and referral process . </p>

Background: The main objective of this study was to investigate older people’s physical activity, their participation in various life situations, and their perceptions of their own health. This included an exploration of potential influences of urban versus rural residency on these outcomes, an evaluation of the measurement properties of a balance confidence scale, and an examination of the proposed usefulness of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to facilitate analysis and understanding of selected outcomes. Methods: The study design was cross-sectional, population-based, with random selection from the national register of one urban and two rural municipalities in Northern Iceland. There were 186 participants, all community-dwelling, aged 65 to 88 years (mean = 73.8), and 48% of the group were women. The participation rate was 79%. Data was collected in 2004, in face-to-face interviews and through various standardized assessments. The main outcomes were total physical activity; leisure-time, household, and work-related physical activity; participation frequency and perceived participation restrictions; and self-rated health. Other assessments represented aspects of the ICF body functions, activities, environmental factors and personal factors. Moreover, Rasch analysis methods were applied to examine and modify the Activities-specific Balance Confidence (ABC) scale and the ICF used as a conceptual framework throughout the study. Results: The total physical activity score was the same for urban and rural people and the largest proportion of the total physical activity behavior was derived from the household domain. Rural females received the highest scores of all in household physical activity and rural males were more physically active than the others in the work-related domain. However, leisure-time physical activity was more common in urban than rural communities. A physically active lifestyle, urban living, a higher level of cognition, younger age, and fewer depressive symptoms were all associated with more frequent participation. Rural living and depressive symptoms were associated with perceived participation restrictions. Moreover, perceived participation restrictions were associated with not being employed and limitations in advanced lower extremity capacity. Both fewer depressive symptoms and advanced lower extremity capacity also increased the likelihood of better self-rated health, as did capacity in upper extremities, older age, and household physical activity. Rasch rating scale analysis indicated a need to modify the ABC to improve its psychometric properties. The modified ABC was then used to measure balance confidence which, however, was found not to play a major role in explaining participation or self-rated health. Finally, the ICF was useful as a conceptual framework for mapping various components of functioning and health and to facilitate analyses of their relationships. Conclusions: The results highlighted the commonalities and differences in factors associated with participation frequency, perceived participation restrictions, and self-rated health in old age. Some of these factors, such as advanced lower extremity capacity, depressive symptoms, and physical activity pattern should be of particular interest for geriatric physical therapy due to their potential for interventions. While the associations between depressive symptoms, participation, and self-rated health are well known, research is needed on the effects of advanced lower extremity capacity on participation and self-rated health in old age. The environment (urban versus rural) also presented itself as an important contextual variable to be aware of when working with older people’s participation and physically active life-style. Greater emphasis should be placed on using Rasch measurement methods for improving the availability of quality scientific measures to evaluate various aspects of functioning and health among older adults. Finally, a coordinated implementation of a conceptual framework such as ICF may further advance interdisciplinary and international studies on aging, functioning, and health.

<p>The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the&nbsp / functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the&nbsp / outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered&nbsp / questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating&nbsp / to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised&nbsp / outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human&nbsp / subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package&nbsp / 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using&nbsp / chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93&nbsp / with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke&nbsp / was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All&nbsp / patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients&nbsp / (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle&nbsp / weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following&nbsp / domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p&lt / 0.0001) and stroke (p&lt / 0.0001)&nbsp / between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on&nbsp / admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple&nbsp / redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p&lt / 0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity&nbsp / limitations and participation restrictions still experienced at the time of discharge. The latter finding&nbsp / questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation&nbsp / programme and referral process . </p>

BEZERRA, Marcelo Augusto. Contribuições para o aprimoramento de políticas públicas na cadeia produtiva da lagosta. 2013. 200 f. : Tese (doutorado) - Universidade Federal do Ceará, Centro de Ciências Agrárias, Departamento de Engenharia de Pesca, Fortaleza-CE. 2013 / Submitted by Nádja Goes (nmoraissoares@gmail.com) on 2016-07-27T13:10:22Z No. of bitstreams: 1 2013_tese_mabezerra.pdf: 19623136 bytes, checksum: 86210e27bb4ec8a04f38a2201dd8e3a7 (MD5) / Approved for entry into archive by Nádja Goes (nmoraissoares@gmail.com) on 2016-07-27T13:10:42Z (GMT) No. of bitstreams: 1 2013_tese_mabezerra.pdf: 19623136 bytes, checksum: 86210e27bb4ec8a04f38a2201dd8e3a7 (MD5) / Made available in DSpace on 2016-07-27T13:10:42Z (GMT). No. of bitstreams: 1 2013_tese_mabezerra.pdf: 19623136 bytes, checksum: 86210e27bb4ec8a04f38a2201dd8e3a7 (MD5) Previous issue date: 2013 / The role of public policies application for the development of lobster fishing is from the Federal Brazilian Government, aiming to reconcile various interests in the productive chain of the lobster fisheries. This D.Sc. thesis presents a study about lobster fishing in the State of Ceará, Northeast region of Brazil, a traditional activity since the mid of the 1950 ́s, and represents an important fishing product of Brazil's exportation, driven by the lack of information on research, statistics, monitoring and evaluation. The history of the fishing in Ceará has shown minimal changes in the fleet, the types of vessels, the equipment and fishing methods, as well as in the species caught. There was a growing contingent of lobster fishermen and unemployment insurance as a social benefit. Some gaps were identified from design to application of the legislation involving lobster fisheries, since the identification of breeding areas protected, use the size of the meshes to the change on coefficient of the meshes. To optimize the process of commercialization and further analysis of Fisheries Biology, an international standardization was proposed for the classification of the entire lobster growth- related task to consistent weights and types. The various systems of existing databases and employed by various organs in the country were discussed. However, has not been verified the necessary integration to streamline monitoring and evaluation procedures, greatly hindering the process of management of public policies. The databases of fishing vessels present in the most diverse organs - Sisemb/DPC, MPA, SINE, MTE - should become single and with biometric reading by the boat owners, avoiding waste of time for both users, as for civil servants who feed and update information annually. In addition, recommendations or suggestions were presented to continuation and deepening of themes for the devel opment of future studies employed in productive chain management of lobster, and also to identify gaps and obstacles that hinder the implementation, monitoring and evaluation of development policy of lobster fishing by public agencies. The 21 undergraduate programs in Fishing Engineering existing in Brazil in 2013 and The Fishing Technology Colleges could contribute with their infrastructure, student body and teaching staff needed to achieve some goals of the MPA, as statistics and fishing extensions. / A formulação de políticas públicas para o ordenamento da pesca da lagosta é papel do Governo Federal, visando compatibilizar interesses diversos na cadeia produtiva da lagosta. Esta Tese de Doutorado apresenta um estudo sobre a pesca de lagostas no Estado do Ceará, Brasil, uma atividade tradicional desde meados dos anos de 1950, e que representa um importante produto pesqueiro de exportação do Brasil, motivado pela escassez de informações sobre pesquisa, estatística, monitoramento e avaliação. A situação histórica do setor pesqueiro cearense apresentou alterações mínimas na frota, nos tipos de embarcações, nos aparelhos e métodos de Pesca, assim como nas espécies capturadas. Houve um crescimento no contingente de pescadores de lagosta e do seguro-desemprego como benefício social. Foram identificadas algumas lacunas existentes desde a concepção à aplicação de parte da legislação que envolve a lagosta, seja na identificação de áreas de criadouros protegidas, no uso do tamanho das malhas e na alteração no coeficiente de entralhe das malhas. Para otimizar o processo de comercialização e posterior análise de biologia pesqueira, foi proposta uma padronização internacional para classificação da lagosta inteira relacionada ao crescimento coerente das gramaturas e dos tipos. Foram discutidos os vários sistemas de bancos de dados existentes e empregadas por diversos órgãos no país. No entanto, não foi verificada a integração necessária para agilizar os procedimentos de monitoramento e avaliação, dificultando sobremaneira o processo de gestão das políticas públicas. Os bancos de dados de embarcações pesqueiras presentes nos mais diversos órgãos - Sisemb/DPC, MPA, SINE, MTE - deveriam se tornar único e com leitura biométrica do proprietário da tripulação, evitando perda de tempo tanto para os usuários, quanto para funcionários públicos que alimentam e atualizam diversas informações anualmente. Além disso, recomendações ou sugestões foram apresentadas para a continuidade e o aprofundamento de temas para o desenvolvimento de futuros estudos empregados na gestão da cadeia produtiva da lagosta, ao identificar lacunas e óbices que impedem a implantação, o monitoramento e a avaliação da política de desenvolvimento da pesca de lagosta por órgãos públicos. Os 21 cursos de graduação em Engenharia de Pesca existentes no Brasil em 2013 e os tecnológicos em Pesca & Aquicultura poderiam contribuir com sua infraestrutura, corpo discente e docente necessários para atingir algumas metas do MPA, como estatística e extensões pesqueiras.

Submitted by Luis Guilherme Macena (guilhermelg2004@gmail.com) on 2013-05-07T15:40:21Z No. of bitstreams: 1 Tese - Lia Martins Moreira.pdf: 3329572 bytes, checksum: fc270c2266a2f89e6d2f0fbfece0fa1e (MD5) / Made available in DSpace on 2013-05-07T15:40:21Z (GMT). No. of bitstreams: 1 Tese - Lia Martins Moreira.pdf: 3329572 bytes, checksum: fc270c2266a2f89e6d2f0fbfece0fa1e (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / Investigamos a atuação da clínica fisioterapêutica, no tocante à funcionalidade dos pacientes com osteogênese imperfeita (OI), inscritos no Programa de Tratamento de Osteogênese Imperfeita do Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira da Fundação Oswaldo Cruz (INSMCA/IFF/FIOCRUZ), coordenado pelo Centro de Referência de Osteogênese Imperfeita do INSMCA/FIOCRUZ (CROI/IFF). A atuação da clínica fisioterapêutica considera aspectos como: (a) a funcionalidade; (b) os estímulos táteis e, (c) as ações preventivas como facilitadores do desenvolvimento motor e da reabilitação de indivíduos com OI. O objetivo geral foi analisar a funcionalidade dos indivíduos com OI em tratamento fisioterapêutico no CROI/IFF. Os objetivos específicos foram: (a) analisar o processo de locomoção dos pacientes com OI, mapeando os fatores que o influenciam; (b) avaliar a capacidade funcional mediante a mensuração da amplitude de movimento, e (c) discutir os exercícios, atividades fisioterapêuticas e orientações aos familiares propostas para os pacientes com OI. Lançamos mão de duas abordagens: as análises bioestatísticas e a perspectiva etnográfica, compondo uma pesquisa exploratória e um estudo de caso institucional. O estudo foi desenvolvido com pacientes com OI atendidos no CROI/IFF entre 2004 e 2008, totalizando 92 sujeitos de pesquisa. O Epi-Info versão 3.4 e o SPSS versão 15 foram empregados na construção de banco de dados e para cálculos estatísticos. Em relação à perspectiva etnográfica, tomou-se como fonte as anotações feitas num diário de campo durante as diversas avaliações fisioterapêuticas, analisando-as via uma codificação analítica qualitativa seguida pela análise semiótica. Os resultados são apresentados em três artigos. O primeiro expõe a relação entre a marcha independente na OI e os fatores que a influenciam, ressaltando-se a associação negativa entre hipotonia, número de fraturas e os desfechos de interesse e positiva entre marcha independente e OI tipo I. O segundo aborda a hipermobilidade articular como característica clínica da OI e a hipotonia observada nesta amostra como aspectos contribuintes às limitações funcionais, estabelecendo que a primeira se associa à idade e a segunda ao tipo de OI. O terceiro remete-se aos relatos da experiência de campo marcando as múltiplas dimensões da ação fisioterapêutica assentada num diálogo que envolve os pacientes, seus familiares e o fisioterapeuta, aprofundando a compreensão do movimento humano nesta doença. Salienta-se que o incentivo precoce reduziu as contraturas musculares com melhora do tônus muscular; os manuseios fisioterapêuticos facilitaram a integração da percepção do corpo e ajudou a afastar o medo das fraturas, permitindo a construção de uma nova imagem funcional. Concluímos que como a OI é uma doença rara, necessita uma abordagem multidisciplinar e, no que tange à Fisioterapia, esta deve focar questões relevantes à mobilidade dos pacientes, procurando estabelecer estratégias de ação e caminhos para a maximização e ou recuperação de sua independência funcional. / This study investigates a clinical physical therapy approach concerning functionality of patients with osteogenesis imperfecta (OI) enrolled at the OI Treatment Programme at the Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fundação Oswaldo Cruz (INSMCA/IFF/FIOCRUZ), which is coordinated by the OI Reference Center at the same institution (CROI/IFF). Physical therapy assistance provided by the CROI/IFF takes into consideration aspects such as: a) functionality, b) tactile stimuli, and c) preventive actions regarded as key elements for promoting motor development and rehabilitation of individuals with OI. The objective was to analyse the functionality of patients with OI under physical therapy treatment carried out as part of the cited programme, and, more specifically, a) to analyse the locomotion process in those patients, mapping out factors that influence it; b) to evaluate functional capacity by measuring the amplitude of movement, and c) to discuss with patients and their families physical therapy activities, exercises, and orientations. The analysis followed two different approaches: biostatistical analyses and an ethnographic perspective, comprising an exploratory research and an institutional case study. The research subjects were 92 patients with OI treated at the CROI/IFF between 2004 and 2008. Epi-Info version 3.4 and SPSS version 15 were used to construct the database and for statistical analyses. Ethnographic approach was based on fieldnotes taken during physical therapy assessments. Those fieldnotes were submitted to a two-part codification - open and focused - followed by semiotic techniques of analysis. Results are presented in three articles. The first one investigates the relationship between the locomotion process in patients with OI and connected factors, highlighting that a negative association was observed between hypotonia, number of fractures and the outcomes of interest, and a positive association was observed between independent walk and OI type I. The second article focuses on articular hypermobility, a clinical feature of OI, and the presence of hypotonia in those patients as major issues that tend to worsen functional limitations. It discusses the association between hypermobillity and age and hypotonia and type of OI. The third article examines accounts of physical therapy assistance and emphasizes its multiple dimensions. Moreover, the paper argues that this kind of assistance should be based on a dialogue between patients/families and physical therapists, contributing to deepen the understanding of human movement in relation to OI. We argue that early encouragement to perform active movements within a safe environment reduced articular contratures and enhanced muscular tonus; physiotherapy manipulation facilitated the integration of body perception, contributed to reduce fear of fractures and allowed the construction of a new functional image. Finally, we highlight the significance of a multidisciplinary approach to rare diseases such as OI and, in the case of physical therapy, the importance of establishing strategic actions in order to recover or enhance functional independence of patients with OI.

Os sistemas de farmacovigilância fundamentam as decisões sobre segurança no uso de medicamentos regulamentados por autoridades de saúde. Estudá-los e propor estratégias de melhorias contribuem para fortalecer os sistemas de saúde, aperfeiçoando a qualidade da assistência à saúde e assegurando a segurança do paciente e coletividade. A Tese objetivou analisar a evolução e desempenho do sistema brasileiro de farmacovigilância, denominado de SINAF, e as notificações dos pacientes com suspeitas de reações adversas a medicamentos (RAMs) registradas no Notivisa-medicamento no período de 2008 a 2013 e propor uma lista-referência de códigos da CID-10 para vigilância de RAMs e intoxicações medicamentosas (IMs). A Tese compreende seis artigos científicos organizados para publicação. No primeiro, uma revisão de escopo apresentou uma perspectiva histórica para caracterizar a evolução do SINAF e lacunas identificadas no processo, como a ausência de comissão de farmacovigilância que atenda aos requisitos mínimos de um sistema de farmacovigilância propostos pela Organização Mundial da Saúde. Os artigos 2, 3 e 4 analisaram características relacionadas com o desempenho do SINAF. O artigo 2 revelou que não há preferência digital da idade na base de dados das notificações de eventos adversos a medicamentos (EAMs) do Notivisa-medicamento. Mediante uma análise comparativa, o artigo 3 mostrou diferenças entre o formulário para notificação de EAMs utilizado no SINAF e de outros doze países latinoamericanos (Argentina, Bolívia, Chile, Colômbia, Costa Rica, Cuba, Guatemala, México, Panamá, Peru, Uruguai e Venezuela), sobretudo na quantidade de variáveis para preenchimento, podendo contribuir com a subnotificação de casos. No artigo 4 – um estudo de avaliação de sistemas de vigilância de saúde pública –, revelou que o desempenho do Notivisa-medicamento foi considerado satisfatório para três atributos (flexibilidade, validade e erro preditivo positivo) e deficitário para a maioria deles (simplicidade, aceitabilidade, representatividade, completude, consistência, oportunidade e clareza metodológica). O artigo 5, mediante estudo descritivo e retrospectivo, encontrou uma taxa de notificação de RAMs de 22,8/ 1 milhão de habitantes/ano. Trata-se de taxa bastante inferior a países de alta renda como Nova Zelândia, Suécia, Austrália e Suíça que possuem mais de 300 notificações por milhão, como em relação a países de média renda, como a África do Sul, com taxa de 77 por milhão de habitantes. A população feminina (60,5%) prevaleceu no total de pacientes (26.554), assim como, a raça/cor branca (58,1%). A idade variou de 0 a 112 anos (mediana = 46 anos). Quase 1/3 (32,5%) das suspeitas de RAMs ocorreram em populações vulneráveis (idosos e crianças). Foram avaliados 54.288 pares de medicamento-reação adversa, onde prevaleceram as reações adversas graves (59,2%), com destaque para as que resultaram em efeito clinicamente importante (83,1%). O estudo 6 propôs uma lista-referência com 691 códigos da CID-10, sendo 360 (52,1%) relacionados com RAMs e 331 (47,9%) com IMs. Um total de 511 (73,9%) códigos estão relacionados com casos de admissão hospitalar e/ou óbito. Os achados da Tese evidenciam a necessidade de mudanças em diferentes aspectos estudados do SINAF, como forma de contribuir na produção de informações completas, fidedignas e mais representativas sobre danos ocasionados por medicamentos comercializados no país. / The pharmacovigilance systems support the decisions on safety when using medications regulated by health authorities. Analyzing them and proposing improvement strategies are ways to make healthcare systems stronger, improving the quality of healthcare assistance, making sure the patient is safe and that the population is ensured. The dissertation was aimed at analyzing the evolution and performance of the Brazilian pharmacovigilance system, SINAF, and the notification of patients with suspected adverse drug reactions (ADRs) registered with the notification system NOTIVISA/medication from 2008 through 2013, as well as proposing a reference list of ICD-10 codes for surveillance of ADRs and intoxication due to medication (IDM). The dissertation is comprised of six scientific articles ready to be published. The first one, a scoping review, presents a historical perspective to demonstrate the development process of SINAF and the gaps identified during the process, such as the absence of a pharmacovigilance commission that complies with the minimum requirements of a pharmacovigilance system as proposed by World Health Organization. Articles 2, 3 and 4 presents an analysis of the performance-related characteristics of SINAF. Article 2 reveals that there is no digital age preference in the adverse drug events (ADEs) database belonging to NOTIVISA/medication. Using a comparative analysis, article 3 shows differences between the form for ADEs notification using SINAF and in other twelve Latin-American countries (Bolivia, Chile, Colombia, Costa Rica, Cuba, Guatemala, Mexico, Panama, Peru, Uruguay and Venezuela), highlighting the number of variables to complete, and it may collaborate with the sub-notification of cases. Article 4 – a study on the evaluation of public health surveillance systems over time – reveal that the performance of NOTIVISA/medication was considered satisfactory regarding three attributes (flexibility, validity and positive predictive error) and deficient regarding most of the others (simplicity, acceptability, representability, integrality, consistency, opportunity and methodological clarity). Article 5, by means of a descriptive and retrospective study, found an ADR notification rate of 22.8/million inhabitants/year. This is a much lower rate than in high income countries, such as New Zealand, Sweden, Australia and Switzerland, which have over 300 notifications per million, when compared against average income, such as South Africa, with a rate of 77/million inhabitants. Female population (60.5%) prevailed in the total number of patients (26,554), as well as white race/color (58.1%). Age was between 0 - 112 years old (median = 46 years). Almost 1/3 (32.5%) of the suspected ADRs occurred in vulnerable populations (elderly and children). 54,288 pairs of medication/adverse reactions were assessed. Severe adverse reactions prevailed (59.2%), and attention is drawn to those resulting in clinically important effect (83.1%). Study 6 proposes a reference list with 691 ICD-10 codes; 360 (52.1%) out of them are ADRs-related and 331 (47.9%) out of them are IDM. A total of 511 (73.9%) codes are related to cases of hospital admission and/or death. The dissertation findings prove the need of changes across different aspects in SINAF as a way to contribute to production of complete, reliable and representative information on damages caused by commercially available drugs in Brazil.