The impact of rehabilitation support services on health-related quality of life for women with breast cancer

As the number of women surviving breast cancer increases, with implications for the health system, research into the physical and psychosocial sequelae of the cancer and its treatment is a priority. This research estimated self-reported health-related quality of life (HRQoL) associated with two rehabilitation interventions for breast cancer survivors, compared to a non-intervention group. Women were selected if they received an early home-based physiotherapy intervention (DAART, n = 36) or a group-based exercise and psychosocial intervention (STRETCH, n = 31). Questionnaires on HRQoL, using the Functional Assessment of Cancer Therapy - Breast Cancer plus Arm Morbidity module, were administered at pre-, post-intervention, 6- and 12-months post-diagnosis. Data on a non-intervention group (n = 208) were available 6- and 12-months post-diagnosis. Comparing pre/post-intervention measures, benefits were evident for functional well-being, including reductions in arm morbidity and upper-body disability for participants completing the DAART service at one-to-two months following diagnosis. In contrast, minimal changes were observed between pre/post-intervention measures for the STRETCH group at approximately 4-months post-diagnosis. Overall, mean HRQoL scores (adjusted for age, chemotherapy, hormone therapy, high blood pressure and occupation type) improved gradually across all groups from 6- to 12-months post-diagnosis, and no prominent differences were found. However, this obscured declining HRQoL scores for 20-40% of women at 12 months post-diagnosis, despite receiving supportive care services. Greater awareness and screening for adjustment problems among breast cancer survivors is required throughout the disease trajectory. Early physiotherapy after surgery has the potential for short-term functional, physical and overall HRQoL benefits.

A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer

The purpose of this research was to estimate the cost-effectiveness of two rehabilitation interventions for breast cancer survivors, each compared to a population-based, non-intervention group (n = 208). The two services included an early home-based physiotherapy intervention (DAART, n = 36) and a group-based exercise and psychosocial intervention (STRETCH, n = 31). A societal perspective was taken and costs were included as those incurred by the health care system, the survivors and community. Health outcomes included: (a) 'rehabilitated cases' based on changes in health-related quality of life between 6 and 12 months post-diagnosis, using the Functional Assessment of Cancer Therapy - Breast Cancer plus Arm Morbidity (FACT-B+4) questionnaire, and (b) quality-adjusted life years (QALYs) using utility scores from the Subjective Health Estimation (SHE) scale. Data were collected using self-reported questionnaires, medical records and program budgets. A Monte-Carlo modelling approach was used to test for uncertainty in cost and outcome estimates. The proportion of rehabilitated cases was similar across the three groups. From a societal perspective compared with the non-intervention group, the DAART intervention appeared to be the most efficient option with an incremental cost of $1344 per QALY gained, whereas the incremental cost per QALY gained from the STRETCH program was $14,478. Both DAART and STRETCH are low-cost, low-technological health promoting programs representing excellent public health investments.

Community-based programmes to prevent falls in children: A systematic review

Objective: We systematically reviewed the literature to examine the evidence for the effectiveness of community-based interventions to reduce fall-related injury in children aged 0-16 years. Methods: We performed a comprehensive search of the literature using the following study selection criteria: community-based intervention study; target population was children aged 0-16 years; outcome measure was fall-related injury rates; and either a community control or historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Results: Only six studies fitting the inclusion criteria were identified in our search and only two of these used a trial design with a contemporary community control. Neither of the high quality evaluation studies showed an effect from the intervention and while authors of the remaining studies reported effective falls prevention programmes, the pre- and post-intervention design, uncontrolled for background secular trends, makes causal inferences from these studies difficult. Conclusion: There is a paucity of research studies from which evidence regarding the effectiveness of community-based intervention programmes for the prevention of fall-related injury in children could be based.

Teacher responses to the communicative attempts of children with autism

We assessed teacher responses to the communicative attempts of children with autism. Teachers were first interviewed using the Inventory of Potential Communicative Acts (IPCA) to identify behaviors in each child's repertoire that the teachers considered to be communicative. Interview results suggested that the teachers interpreted many of the children's prelinguistic gestures, body movements, and facial expressions, as forms of communication. Naturalistic observations were then conducted in the child's classroom to determine how teachers responded to the children's identified forms of prelinguistic behaviors. The results of these naturalistic observations suggested that the teachers often did not respond to the child's prelinguistic behaviors in ways that acknowledged their communicative intent. Implications of the results on the child's communication development and for intervention efforts are discussed.

Faciltating the transition into motherhood through lullaby singing: A pilot study

This study explored how singing lullabies to babies impacts on first-time mothers' perceived coping and experience of mothering. Eighteen first-time mothers participated in a six-week lullaby intervention program. Data comprised of detailed diaries kept by the mothers over the six weeks in addition to semi-structured interviews with the mothers, pre and post-intervention. Results suggest that lullabies benefit mothers by relaxing and calming them, distracting them from other stressful thoughts, enhancing their experience of the bedtime task and enhancing their perception that they are good mothers. Results indicate that mothers' experience of the bedtime task and her transition to motherhood may be enhanced through singing lullabies to their babies at bedtime.

The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit

To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU. The intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit. Adult mechanically ventilated patients were selected consecutively (n =322) The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group. An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy. The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P = 0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P = 0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used. The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.

A review of awareness interventions in brain injury rehabilitation

Unawareness related to brain injury has implications for participation in rehabilitation, functional outcomes, and the emotional well-being of clients. Addressing disorders of awareness is an integral component of many rehabilitation programmes, and a review of the literature identified a range of awareness interventions that include holistic milieu-oriented neuropsychological programmes, psychotherapy, compensatory and facilitatory approaches, structured experiences, direct feedback, videotaped feedback, confrontational techniques, cognitive therapy, group therapy, game formats and behavioural intervention. These approaches are examined in terms of their theoretical bases and research evidence. A distinction is made between intervention approaches for unawareness due to neurocognitive factors and approaches for unawareness due to psychological factors. The socio-cultural context of unawareness is a third factor presented in a biopsychosocial framework to guide clinical decisions about awareness interventions. The ethical and methodological concerns associated with research on awareness interventions are discussed. The main considerations relate to the embedded nature of awareness interventions within rehabilitation programmes, the need for individually tailored interventions, differing responses according to the nature of unawareness, and the risk of eliciting emotional distress in some clients.

Occupational therapists' decision making in three therapy settings in Australia

Can a work setting with its organizational, cultural, and practical considerations influence the way occupational therapists make decisions regarding client interventions? There is currently a paucity of evidence available to answer this question. This study aimed to investigate the influence of work setting on therapists’ clinical reasoning in the management of clients with cerebral palsy and upper limb hypertonicity. Specifically the study aimed to examine therapists’ objective and stated policies, and their intervention decisions using Social Judgement Theory methodology. Participants were eighteen occupational therapists with more than five years experience with clients with cerebral palsy who were asked to make intervention decisions for clients represented by 90 case vignettes. They worked in three settings, hospitals (5), schools (6), and community (6). The results indicated that therapy settings did influence therapists’ decisions about intervention choices but not their objective and subjective policy decisions.

Quality of Life in Chinese elderly people with depression

Background Depression is the most prevalent functional mental disorder of later life. It is estimated that about 5% of the elderly population of Hong Kong are suffering from depression. Aim To investigate the self-rated quality of life of community-dwelling elderly people diagnosed with depression, and to examine the relationships between quality of life and mental, physical health, functional status and social support. Methods and results A cross-sectional descriptive survey was conducted in psychiatric outpatient clinics. A convenience sample of 80 Chinese elderly people with a diagnosis of depressive disorder was recruited. Perception of quality of life was measured by the Hong Kong Chinese World Health Organization Quality of Life Scale-Brief Version. Participants' mental status, functional abilities, physical health condition, and social support status were assessed. Sixty-one (76.3%) participants were female. They were least satisfied with meaningfulness of life, life enjoyment, concentration and thinking, energy and work capacity. Functional abilities had a positive association with participants' perceived quality of life, level of depression and number of physical health conditions had a negative association. Participants had low ratings of quality of life when compared with healthy persons and persons with chronic physical problems. Findings are discussed in light of the socio-cultural environment in Hong Kong. Conclusion Comprehensive treatment and better control of depression, including different modes of medical and psychosocial intervention, could help to improve participants' perception of quality of life. A longitudinal study with a larger sample with various levels of depression and socio-demographic characteristics is recommended. Copyright © 2006 John Wiley & Sons, Ltd.

Treating Jarrod: A core vocabulary approach

This paper is the final paper in a special issue of Advances in Speech-Language Pathology. The paper presents an intervention case study of a 7 year old child with severe phonological difficulties described in Holm and Crosbie (2006). Dodd et al (2006) hypothesised that Jarrod had an underlying deficit of generating phonological plans for word production and suggested that Jarrod would benefit from core vocabulary therapy. This paper reports on one block of core vocabulary therapy undertaken with Jarrod. Pre- and post-intervention measures showed that Jarrod made significant progress. His speech became more consistent and his accuracy (percent consonants correct) increased.

AÇÃO PASTORAL DA IGREJA CATÓLICA APOSTÓLICA ROMANA FACE AO DIREITO À INSERÇÃO SOCIAL DE PESSOAS EM SITUAÇÃO DE RUA

A proposta do presente estudo é verificar a ação pastoral da Igreja Católica junto ao povo de rua da cidade de São Paulo, tendo como objetivo formar um conceito teórico sobre a contribuição social da pastoral em um contexto urbano, a partir da ação de Entid ades de apoio ao povo de rua. A metodologia utilizada foi a bibliográfica. As implicações do estudo foram o direcionamento que a práxis pastoral está direcionada à priorização da superação e do reconhecimento da necessidade material e psicossocial de quem está morando na rua. A concretização da práxis se dá por meio de uma prática interventora sócio-politica, a qual visa a efetivação de medidas públicas para uma demanda de pessoas que usam a rua como moradia. A ação pastoral contribui ao mostrar a ausência de política pública que dificulta o reconhecimento deste grupo social como pessoas capacitadas a produzir e pertencer a sociedade em geral. E, ao mesmo tempo em que aponta a lacuna exposta pelo poder público, o agir pastoral sinaliza alternativa para o reconhecimento de pessoas que moram na rua com parcerias entre entidades não governamentais e movimentos sociais, como o MST, sendo assim uma via de reinserção social, além da promoção de Fóruns para a criação de medidas públicas com participação direta de pessoas que vivem na rua e albergues da cidade de São Paulo. Portanto, verifica-se uma práxis pastoral fundamentada por uma responsabilidade social dinamizada pela prática de parceria participativa que envolva as diversas esferas sociais para efetivação concreta dos direitos sociais da pessoa em situação de rua que vive em áreas urbana como a Cidade de São Paulo.

Designing a Computer Vision System for Underwater Robotic Interventions

This thesis deals with the challenging problem of designing systems able to perceive objects in underwater environments. In the last few decades research activities in robotics have advanced the state of art regarding intervention capabilities of autonomous systems. State of art in fields such as localization and navigation, real time perception and cognition, safe action and manipulation capabilities, applied to ground environments (both indoor and outdoor) has now reached such a readiness level that it allows high level autonomous operations. On the opposite side, the underwater environment remains a very difficult one for autonomous robots. Water influences the mechanical and electrical design of systems, interferes with sensors by limiting their capabilities, heavily impacts on data transmissions, and generally requires systems with low power consumption in order to enable reasonable mission duration. Interest in underwater applications is driven by needs of exploring and intervening in environments in which human capabilities are very limited. Nowadays, most underwater field operations are carried out by manned or remotely operated vehicles, deployed for explorations and limited intervention missions. Manned vehicles, directly on-board controlled, expose human operators to risks related to the stay in field of the mission, within a hostile environment. Remotely Operated Vehicles (ROV) currently represent the most advanced technology for underwater intervention services available on the market. These vehicles can be remotely operated for long time but they need support from an oceanographic vessel with multiple teams of highly specialized pilots. Vehicles equipped with multiple state-of-art sensors and capable to autonomously plan missions have been deployed in the last ten years and exploited as observers for underwater fauna, seabed, ship wrecks, and so on. On the other hand, underwater operations like object recovery and equipment maintenance are still challenging tasks to be conducted without human supervision since they require object perception and localization with much higher accuracy and robustness, to a degree seldom available in Autonomous Underwater Vehicles (AUV). This thesis reports the study, from design to deployment and evaluation, of a general purpose and configurable platform dedicated to stereo-vision perception in underwater environments. Several aspects related to the peculiar environment characteristics have been taken into account during all stages of system design and evaluation: depth of operation and light conditions, together with water turbidity and external weather, heavily impact on perception capabilities. The vision platform proposed in this work is a modular system comprising off-the-shelf components for both the imaging sensors and the computational unit, linked by a high performance ethernet network bus. The adopted design philosophy aims at achieving high flexibility in terms of feasible perception applications, that should not be as limited as in case of a special-purpose and dedicated hardware. Flexibility is required by the variability of underwater environments, with water conditions ranging from clear to turbid, light backscattering varying with daylight and depth, strong color distortion, and other environmental factors. Furthermore, the proposed modular design ensures an easier maintenance and update of the system over time. Performance of the proposed system, in terms of perception capabilities, has been evaluated in several underwater contexts taking advantage of the opportunity offered by the MARIS national project. Design issues like energy power consumption, heat dissipation and network capabilities have been evaluated in different scenarios. Finally, real-world experiments, conducted in multiple and variable underwater contexts, including open sea waters, have led to the collection of several datasets that have been publicly released to the scientific community. The vision system has been integrated in a state of the art AUV equipped with a robotic arm and gripper, and has been exploited in the robot control loop to successfully perform underwater grasping operations.

Modellazione strutturale di edifici storici in muratura e misti: valutazioni comparate e criteri operativi

L’obiettivo della presente tesi è evidenziare l’importanza dell’approccio critico alla valutazione della vulnerabilità sismica di edifici in muratura e misti Il contributo della tesi sottolinea i diversi risultati ottenuti nella modellazione di tre edifici esistenti ed uno ipotetico usando due diversi programmi basati sul modello del telaio equivalente. La modellazione delle diverse ipotesi di vincolamento ed estensione delle zone rigide ha richiesto la formulazione di quattro modelli di calcolo in Aedes PCM ed un modello in 3muri. I dati ottenuti sono stati confrontati, inoltre, con l’analisi semplificata speditiva per la valutazione della vulnerabilità a scala territoriale prevista nelle “Linee Guida per la valutazione e riduzione del rischio sismico del Patrimonio Culturale”. Si può notare che i valori ottenuti sono piuttosto diversi e che la variabilità aumenta nel caso di edifici non regolari, inoltre le evidenze legate ai danni realmente rilevati sugli edifici mostrano un profondo iato tra la previsione di danno ottenuta tramite calcolatore e le lesioni rilevate; questo costituisce un campanello d’allarme nei confronti di un approccio acritico nei confronti del mero dato numerico ed un richiamo all’importanza del processo conoscitivo. I casi di studio analizzati sono stati scelti in funzione delle caratteristiche seguenti: il primo è una struttura semplice e simmetrica nelle due direzioni che ha avuto la funzione di permettere di testare in modo controllato le ipotesi di base. Gli altri sono edifici reali: il Padiglione Morselli è un edificio in muratura a pianta a forma di C, regolare in pianta ed in elevazione solamente per quanto concerne la direzione y: questo ha permesso di raffrontare il diverso comportamento dei modelli di calcolo nelle sue direzioni; il liceo Marconi è un edificio misto in cui elementi in conglomerato cementizio armato affiancano le pareti portanti in muratura, che presenta un piano di copertura piuttosto irregolare; il Corpo 4 dell’Ospedale di Castelfranco Emilia è un edificio in muratura, a pianta regolare che presenta le medesime irregolarità nel piano sommitale del precedente. I dati ottenuti hanno dimostrato un buon accordo per la quantificazione dell’indice di sicurezza per i modelli regolari e semplici con uno scarto di circa il 30% mentre il delta si incrementa per le strutture irregolari, in particolare quando le pareti portanti in muratura vengono sostituite da elementi puntuali nei piani di copertura arrivando a valori massimi del 60%. I confronti sono stati estesi per le tre strutture anche alla modellazione proposta dalle Linee Guida per la valutazione dell’indice di sicurezza sismica a scala territoriale LV1 mostrando differenze nell’ordine del 30% per il Padiglione Morselli e del 50% per il Liceo Marconi; il metodo semplificato risulta correttamente cautelativo. È, quindi, possibile affermare che tanto più gli edifici si mostrano regolari in riferimento a masse e rigidezze, tanto più la modellazione a telaio equivalente restituisce valori in accordo tra i programmi e di più immediata comprensione. Questa evidenza può essere estesa ad altri casi reali divenendo un vero e proprio criterio operativo che consiglia la suddivisione degli edifici esistenti in muratura, solitamente molto complessi poiché frutto di successive stratificazioni, in parti più semplici, ricorrendo alle informazioni acquisite attraverso il percorso della conoscenza che diviene in questo modo uno strumento utile e vitale. La complessità dell’edificato storico deve necessariamente essere approcciata in una maniera più semplice identificando sub unità regolari per percorso dei carichi, epoca e tecnologia costruttiva e comportamento strutturale dimostrato nel corso del tempo che siano più semplici da studiare. Una chiara comprensione del comportamento delle strutture permette di agire mediante interventi puntuali e meno invasivi, rispettosi dell’esistente riconducendo, ancora una volta, l’intervento di consolidamento ai principi propri del restauro che includono i principi di minimo intervento, di riconoscibilità dello stesso, di rispetto dei materiali esistenti e l’uso di nuovi compatibili con i precedenti. Il percorso della conoscenza diviene in questo modo la chiave per liberare la complessità degli edifici storici esistenti trasformando un mero tecnicismo in una concreta operazione culturale . Il presente percorso di dottorato è stato svolto in collaborazione tra l’Università di Parma, DICATeA e lo Studio di Ingegneria Melegari mediante un percorso di Apprendistato in Alta Formazione e Ricerca.

ADOLESCÊNCIA, ESCOLA DOMINICAL E EDUCAÇÃO: PERSPECTIVAS DE UM NOVO PROCESSO

Este estudo tem como objetivo identificar alguns fatores que têm contribuído para a evasão de adolescentes da Escola Dominical. O trabalho limita-se ao âmbito da Igreja Metodista, em cidades do interior do Estado de São Paulo. Entender a atual condição da adolescência é requisito para desenvolver ações capazes de prepará-la para o exercício da fé. O primeiro capítulo enfoca o desenvolvimento da adolescência.. Desde o início da Revolução Industrial pesquisadores, médicos, psicólogos, educadores entre outros têm se voltado à pesquisa desta fase de vida. O segundo capítulo propõe uma análise da Escola Dominical. O objetivo deste capítulo é compreender suas origens, seu relacionamento com a adolescência, sua estrutura e funcionamento, pois, ela é um dos melhores espaços para a formação do adolescente. Este precisa de um modelo educativo que ajude seu desenvolvimento e a Escola Dominical pode ser a agência educativa para garantir uma educação apropriada à época atual. O terceiro capítulo aprofunda o conceito de educação de modo geral e educação cristã de modo específico distinguindo-as de ensino. O modelo de educação necessário para o desenvolvimento do adolescente deve ser aquele que o ajude a elaborar seu próprio desenvolvimento numa prática contínua de elaboração e re-elaboração de sua educação, propiciando experiências de vida numa perspectiva cristã. Por fim, o quarto capítulo analisa o resultado da pesquisa de campo, a opinião do adolescente sobre a Escola Dominical e a partir desta compreensão identificar os fatores que contribuem para a evasão.

Adolescência, Escola Dominical e Educação:perspectivas de um novo processo.

Este estudo tem como objetivo identificar alguns fatores que têm contribuído para a evasão de adolescentes da Escola Dominical. O trabalho limita-se ao âmbito da Igreja Metodista, em cidades do interior do Estado de São Paulo. Entender a atual condição da adolescência é requisito para desenvolver ações capazes de prepará-la para o exercício da fé. O primeiro capítulo enfoca o desenvolvimento da adolescência.. Desde o início da Revolução Industrial pesquisadores, médicos, psicólogos, educadores entre outros têm se voltado à pesquisa desta fase de vida. O segundo capítulo propõe uma análise da Escola Dominical. O objetivo deste capítulo é compreender suas origens, seu relacionamento com a adolescência, sua estrutura e funcionamento, pois, ela é um dos melhores espaços para a formação do adolescente. Este precisa de um modelo educativo que ajude seu desenvolvimento e a Escola Dominical pode ser a agência educativa para garantir uma educação apropriada à época atual. O terceiro capítulo aprofunda o conceito de educação de modo geral e educação cristã de modo específico distinguindo-as de ensino. O modelo de educação necessário para o desenvolvimento do adolescente deve ser aquele que o ajude a elaborar seu próprio desenvolvimento numa prática contínua de elaboração e re-elaboração de sua educação, propiciando experiências de vida numa perspectiva cristã. Por fim, o quarto capítulo analisa o resultado da pesquisa de campo, a opinião do adolescente sobre a Escola Dominical e a partir desta compreensão identificar os fatores que contribuem para a evasão.