Psychometric Evidence of the Coping Inventory for Brazilian Paralympic Athletes in Competition Situations / Evidências Psicométricas do Inventário de Coping para Atletas Paralímpicos Brasileiros em Situação de Competição / Evidencias Psicométricas del Inventario de Afrontamiento para Atletas Paralímpicos Brasileños en Situación de Competición

Abstract Paralympic athletes face stressful situations in sports competitions daily, and assessing how they cope with these situations is important. This study aimed to evaluate the psychometric properties of the Coping Inventory for Brazilian Paralympic Athletes in Competition Situations. This study included 531 Brazilian Paralympic athletes aged 18 years or older, of both sexes, living in different Brazilian regions. They competed nationally or internationally and had physical or visual disabilities. Athletes with cerebral palsy were excluded. The participants answered a data questionnaire and the coping inventory. A confirmatory factor analysis confirmed a 12-theoretical dimension structure: six adaptive (Self-Reliance, Support-Seeking, Problem-Solving, Information-Seeking, Accommodation, Negotiation) and six maladaptive dimensions (Delegation, Social Isolation, Helplessness, Escape, Submission, and Opposition). Reliability indexes ranged between 0.60 and 0.94. The conclusion is that the instrument is reliable for assessing coping strategies among Brazilian Paralympic athletes.

Resumo Atletas paralímpicos lidam diariamente com situações estressantes na competição, sendo importante avaliar como as enfrentam. Este estudo teve como objetivo avaliar as propriedades psicométricas do Inventário de Coping para Atletas Paralímpicos Brasileiros em Situação de Competição. Participaram 531 atletas paralímpicos brasileiros, a partir de 18 anos de idade, de ambos os sexos, residentes em diferentes regiões do Brasil. Competiam em nível nacional e internacional e apresentavam deficiência física e visual. Foram excluídos atletas com paralisia cerebral. Participantes responderam a um questionário de dados e ao inventário de coping. A análise fatorial confirmou a estrutura de 12 dimensões teóricas, sendo seis adaptativas (Autoconfiança, Busca de Suporte, Resolução de Problemas, Busca de Informações, Acomodação, Negociação) e seis mal-adaptativas (Delegação, Isolamento, Desamparo, Fuga, Submissão e Oposição). Os índices de fidedignidade para as dimensões variaram entre 0,60 e 0,94. Conclui-se que o instrumento é confiável para avaliar as estratégias de coping de atletas paralímpicos brasileiros.

Resumen Los deportistas paralímpicos se enfrentan a diario a situaciones estresantes en competición, y es importante evaluar cómo las afrontan. El objetivo de este estudio fue evaluar las propiedades psicométricas del Inventario de Afrontamiento para Atletas Paralímpicos Brasileños en Situación de Competición. El estudio incluyó a 531 atletas paralímpicos brasileños, mayores de 18 años, de ambos os sexos, residentes en diferentes regiones de Brasil. Competían a nivel nacional e internacional y presentaban deficiencias físicas y visuales. Respondieron un cuestionario de datos y el inventario de afrontamiento. Se excluyeron los deportistas con parálisis cerebral. El análisis factorial confirmó la estructura de 12 dimensiones teóricas, siendo seis adaptativas (Autosuficiencia, Búsqueda de apoyo, Resolución de problemas, Búsqueda de información, Acomodación, Negociación) y seis desadaptativas (Delegación, Aislamiento social, Desamparo, Escape, Sumisión y Oposición). La confiabilidad varió entre 0,60 y 0,94. Se concluye que el instrumento es confiable para evaluar estrategias de afrontamiento en atletas paralímpicos brasileños.

Depressão em Pais de Crianças com Deficiência Física: uma Revisão da Literatura de 2013 a 2018 / Depression in Parents of Children with Physical Disabilities: A Literature Review from 2013 to 2018 / Depresión en Padres de Niños con Discapacidad Física: Una Revisión de la Literatura de 2013 a 2018

Os primeiros anos do bebê são períodos sensíveis em que a disponibilidade dos pais é necessária para o desenvolvimento infantil. Estudos indicam que a detecção da deficiência física na criança aumenta o risco de depressão parental. Evidenciar suas causas e consequências para os pais e para a qualidade do vínculo que estabelecem com seus filhos é fundamental para fornecer os cuidados necessários a essas famílias. Este artigo revisa e discute a literatura acerca da depressão em pais de crianças com deficiência física nos últimos cinco anos. Os termos "disability", "depression", "parents" e "physical disability" foram utilizados nas bases PsycNET, Scopus, Web of Science, BVS e PEP-Web. Foram selecionadas 20 publicações. Os resultados revelaram que pesquisas quantitativas e transversais predominam, assim como o estudo das variações em relação à gravidade da deficiência. Quando detectada, a depressão foi frequentemente moderada, com aspectos singulares como culpa e remorso mediando sua probabilidade de ocorrência. Poucos estudos exploram como o sofrimento dos pais pode incidir sobre o aumento do grau de incapacitação motora da deficiência. Concluiu-se que o tempo transcorrido após o diagnóstico parece um fator preponderante, mas que agrega outros como reações ao diagnóstico e modos de elaboração. Pesquisas longitudinais futuras são necessárias para essa verificação. (AU)

Baby's early years are sensitive periods when parent's availability is necessary for the children development. Studies indicate that the physical disability detection in a child increases the parent risk for depression. Thus, highlighting its causes and consequences for the parents and for the quality of the bond with their children is fundamental to provide the necessary care for these families. This research reviews and discusses the literature on depression in parents of children with physical disabilities in the last five years. The terms "disability", "depression", "parents" and "physical disability" were used at the PsycNET, Scopus, Web of Science, BVS and PEP-Web. 20 publications were selected. The results revealed that quantitative and cross-sectional studies predominate, as well as the study of variations due to the severity of the disability. When the depression is detected, it is predominantly scored as moderate, and singular aspects, as guilt and remorse, controlling its probability of occurrence. Few studies have shown how parental distress can increase the degree of motor disability. In conclusion, the time elapsed after the disability disclosure seems a remarkable factor, to which other variables are associated, such as the reactions to the diagnosis, and elaboration modes. Further longitudinal research is needed to support it. (AU)

Los primeros años del bebé son períodos sensibles en que la disponibilidad de los padres es necesaria para el desarrollo infantil. Los estudios indican que la detección de discapacidad física en un niño aumenta el riesgo de depresión parental. Resaltar sus causas y consecuencias para los padres y para el vínculo con sus hijos es fundamental para suministrar los cuidados necesarios. Este artículo revisa y discute la literatura sobre la depresión en padres de niños con discapacidades físicas en los últimos cinco años. Los términos "discapacidad", "depresión", "padres" y "discapacidad física" se utilizaron en PsycNET, Scopus, Web of Science, BVS y PEP-Web. Se seleccionaron 20 publicaciones. Los resultados revelaron que predominan los estudios cuantitativos y transversales, así como el estudio de las variaciones debidas a la gravedad de la discapacidad. Cuando detectada, la depresión se clasificó predominantemente como moderada, con aspectos singulares, como culpa y remordimiento, controlando su ocurrencia. Pocos estudios han demostrado cómo el sufrimiento de los padres puede aumentar la incapacidad motora. En conclusión, el tiempo transcurrido después de lo descubrimiento de la discapacidad parece ser un factor notable, pero puede reunir otros, como las reacciones al diagnóstico y los tipos de elaboración. Se necesita más investigación longitudinal para apoyarlo. (AU)

Diseño innovador para remodelación arquitectónica y estudio de eficiencia energética en áreas de rehabilitación integral de la Fundación Teleón Pro Rehabilitación: en asocio con FUNTER / Innovative design for remodeling architectural and efficiency study energy in rehabilitation areas of Teletón Foundation Pro Rehabilitation: in association with FUNTER

Se desarrolló una propuesta de intervención arquitectónica y constructiva de iluminación natural, ventilación y confort térmico para el área de rehabilitación del edificio de la Fundación Teletón Pro Rehabilitación FUNTER. Se diseñó una propuesta de interiorismo para uso eficiente de espacios, mobiliario, iluminación artificial, texturas y colores apropiados para el desarrollo de terapias. Se realizó un estudio de eficiencia energética para proponer medidas de ahorro y uso eficiente de la energía en el edificio. Se diseñó una nueva distribución de espacios en la zona de terapia y se aplicaron criterios de bioclimatismo pasivo, como la ventilación cruzada, ventilación cenital y la apertura de áreas de ventilación basándose en el análisis de vientos del sitio para mejorar la sensación térmica interna. La implementación de un jardín sensorial ayudará a los pacientes de terapia de marcha a interactuar en un área más cercana a las superficies reales del ambiente.

An architectural and constructive intervention proposal for natural lighting, ventilation and thermal comfort was developed for the rehabilitation area of ​​the Teletón Pro Rehabilitation Foundation FUNTER building. An interior design proposal was designed for the efficient use of spaces, furniture, artificial lighting, textures and appropriate colors for the development of therapies. An energy efficiency study was carried out to propose measures for saving and efficient use of energy in the building. A new distribution of spaces was designed in the therapy area and passive bioclimatic criteria were applied, such as cross ventilation, overhead ventilation and the opening of update areas in the site wind analysis to improve the internal thermal sensation. Implementing a sensory garden will help gait therapy patients interact in an area closer to the actual surfaces of the environment.

Entre ter uma deficiência e ser deficiente: um estudo sobre as identificações / Entre tener una deficiencia y ser deficiente: un estudio sobre las identificaciones / Between have a disability and being disabled: a study on identifications

Diversos trabalhos consideram que pessoas com deficiência física possuem sentimentos de inadequação, inferioridade e baixa autoestima. Parte-se da narrativa de Sunaura Taylor para localizar a questão no paradigma ver/ser visto para problematizar o tema. Assim, tem-se por objetivo discutir os efeitos imaginários da identificação nestes casos. De Freud à Lacan o conceito de narcisismo remete à formação do eu, bem como os processos de identificação a imagens e palavras advindas do Outro. Das imagens e sentidos atribuídos à deficiência pelo social encontram-se descritos na literatura as concepções de estranho e incapaz, da deficiência como doença ou castigo e referências a seres fantástico. Deste modo, foi proposto que pessoas com deficiência possam assumir o lugar de "deficiente" e seus respectivos sentidos por meio da identificação. Concluiu-se que os sentimentos de inadequação perpassam a dimensão imaginária de se ver sendo visto como "deficiente". Dada esta função de representação para o Outro e unificação do eu, tratam-se de momentos em que se deixa de ter uma deficiência para sê-la, enquanto uma forma que lhe dá sentido e o organiza, ainda que possa trazer sofrimento

La literatura considera que las personas con deficiencia física tienen sentimientos de inadecuación, inferioridad y baja autoestima. Con la narrativa de Sunaura Taylor, fue localizar la cuestión en el paradigma ver/ser visto para problematizar. Su objetivo es discutir los efectos imaginarios de la identificación en estos casos. De Freud a Lacan el concepto de narcisismo se refiere a la formación del ego, así como a los procesos de identificación con imágenes y palabras del Otro. De él se atribuye a la deficiencia por las concepciones sociales de extrañas e incapaces, como enfermedad o castigo y referencias a seres fantásticos. Se propuso que los sujetos con discapacidad puedan asumir el lugar de la "deficiencia" y sus sentidos respectivos a través de la identificación. Se concluyó que los sentimientos de inadecuación impregnan la dimensión imaginaria de ser vistos como "deficiencia". Dada esta función de representación para el Otro y la unificación del ego, son momentos en los que uno deja de tener una deficiencia para ser uno, como una forma que le da sentido y lo organiza, aunque pueda traer sufrimiento.

Studies consider that people with physical disabilities have feelings of inadequacy, inferiority and low self-esteem. Following from the Sunaura Taylor's narrative, it was located the matter on the see/to be seen paradigm to problematize. Thus, it aims to discuss the imaginary effects of identification in these cases. From Freud to Lacan, the concept of narcissism refers to the formation of the ego, as well as the processes of identification to images and words from the Other. From the perception and meaning attributed to disability by the social conception found on the literature as strange, an inability, disease, punishment and references to fantastic beings. Therefore, it was proposed that subjects with disabilities can assume the place of "disabled" and their respective senses through identification. In conclusion, the feeling of inadequacy intersects the imaginary dimension of being seen as "disabled". Given this function of representation for the Other and unification of the ego, these are moments in which one ceases from having a disability to becoming one, as a form that gives it meaning and organizes it, even if it causes suffering.

Fatores que interferem no processo de inclusão de bebês com deficiência física no berçário / Factors that interfere with the process of inclusion of infants with physical disability in the nursery / Factores que interfieren en el proceso de inclusión de bebés con discapacidad física en la guardería

Este estudo teve por objetivo investigar os fatores que interferem no processo de inclusão de bebês com deficiência física no berçário, na perspectiva das educadoras. Participaram 11 educadoras de duas creches públicas que tinham bebês com deficiência física incluídos no berçário. A análise qualitativa dos relatos das educadoras apontou diversos fatores que interferem na inclusão, atribuídos às educadoras, ao bebê com deficiência e seus colegas, à creche, ao município e a outros profissionais. Nenhum aspecto foi ressaltado com relação à família dos bebês com deficiência, o que remete à dificuldade das educadoras em perceber as famílias como agentes da inclusão. Salienta-se que mesmo transcorridos mais de 20 anos das principais declarações e leis que representam as políticas de educação na perspectiva inclusiva, a inclusão ainda ocorre de forma incipiente, sem que se dedique prioridade de investimentos na educação. Isso remete à necessidade de pesquisas e intervenções na área.

This study aimed to investigate the factors that interfere in the process of inclusion of infants with physical disabilities in the nursery, from the educators' perspective. Eleven educators from two public daycare centers that had children with physical disabilities included in the nursery participated. The qualitative analysis of the educators' reports pointed to several factors that interfere in the inclusion, attributed to the educators, the disabled baby, and his colleagues, the daycare center, the municipality and other professionals. No aspect was pointed out regarding the family of infants with disabilities, which refers to the difficulty of educators in perceiving families as agents of inclusion. It should be noted that even after more than 20 years of the main declarations and laws that represent education policies in an inclusive perspective, inclusion still occurs in an incipient way, without prioritizing investments in education. This points to the need for research and interventions in the area.

En este estudio se tuvo por objetivo investigar los factores que interfieren en el proceso de inclusión de bebés con discapacidad física en la guardería, en la perspectiva de las educadoras. Participaron 11 educadoras de dos guarderías públicas que tenían bebés con discapacidad física incluidos en la guardería. El análisis cualitativo de los relatos de las educadoras apuntó diversos factores que interfieren en la inclusión, atribuidos a las educadoras; al bebé con discapacidad y sus compañeros; y, a la guardería, al municipio y a otros profesionales. Ningún aspecto fue resaltado con relación a la familia de los bebés con discapacidad, lo que remete a la dificultad de las educadoras en percibir las familias como agentes de la inclusión. Se subraya que, aunque transcurridos más de 20 años de las principales declaraciones y leyes que representan las políticas de educación en la perspectiva inclusiva, la inclusión aún ocurre de forma incipiente, sin que se dedique prioridad de inversiones en la educación. Eso remite la necesidad de investigaciones e intervenciones en el área.

Contribuições psicanalíticas para a clínica de crianças com deficiência física congênita / Psychoanalytic contributions to the clinic of children with congenital physical disabilities / Contribuciones psicoanalíticas a la clínica de niños con discapacidad física congénita

Crianças com deficiência física apresentam aparência física diferente, movimentos não usuais e formas alternativas de comunicação. O sujeito se fará presente na clínica com e por meio dessas especificidades. Diante destas, este artigo busca discutir a clínica de crianças nos casos de deficiência física congênita. Na primeira parte, ilustram-se quatro casos clínicos. Na segunda, discute-se a presença de equipamentos, a manifestação do corpo e o uso da deficiência pelo sujeito. Na terceira, apontam-se alguns manejos clínicos que perpassam um trabalho de luto, no sentido de apropriação simbólica da deficiência. Concluindo, aponta-se a importância da prevenção.

Children with physical disabilities have a different physical appearance, unusual movements, and alternative forms of communication. The subject will be present in the clinic with and through these specificities. This article aims at discussing the clinic of children in cases of congenital physical disability. Firstly, four clinical cases are illustrated. Secondly, the presence of equipment, body manifestation, and the use of the disability by the subject are discussed. Finally, we pointed out clinical management procedures that go through a work of grief, towards a symbolic appropriation of disability. As conclusion, we point out the importance of prevention.

Los niños con discapacidad física presentan un aspecto físico diferente, movimientos no comunes y formas alternativas de comunicación. El sujeto se hará presente en la clínica con y por medio de estas especificidades. Este artículo busca discutir la clínica de niños en los casos de discapacidad física congénita. En la primera parte se ilustran cuatro casos clínicos. En la segunda se discuten la presencia de equipos, la manifestación del cuerpo y el uso de la discapacidad por el sujeto. En la tercera se apuntan manejos clínicos que pasan por un trabajo de luto, en el sentido de apropiación simbólica de la discapacidad. Por último, se concluye con la importancia de la prevención.

An investigation on the life quality and mental health status of the disabled people in Zhejiang Province / 预防医学

Objective To learn the quality of life (QOL) and mental health status of the physically disabled people in Zhejiang Province,in order to provide evidence for improving the quality of life and mental health of the physically disabled people.Methods Using questionnaires and interviews to make household surveys of 950 physically disabled people.The questionnaire included the brief quality of life scale (SF-36) and the general health questionnaire (GHQ-28) in the anxiety and depression scale,physical and mental health status.The basic information and other living conditions of physically disabled people were collected through interviews.Results A total of 907 valid questionnaires were recovered,and the effective response rate was 95.47％.Scores of QOL of 907 physically disabled people was 60.89,and anxiety and depression scores were more than 4 points and there was a high score on anxious and depression.The scores of quality of life,anxiety and depression were not statistically significant between males and females(P ＞0.05).There were significant differences in all dimensions of SF-36 and anxiety and depression in different levels of physically disabled people(P ＜ 0.01).There was a significant negative correlation between the quality of life and anxiety and depression in physically disabled people(rs =-0.626、-0.639,P ＜ 0.01).The multiple linear regression showed that physiological function,role physical,physical pain and general health were the influencing factors of anxiety of the physically disabled people,and role physical,physical pain and general health were the influencing factors of depression of the physically disabled people.Condusion The quality of life of physically disabled people were comparably poor,and presented anxiety,depression and other psychological problems.Physical function status directly affects the quality of life and mental health status.

Desenho da Figura Humana: avaliação da imagem corporal na deficiência física / Draw-a-Person Test: Body image evaluation in physical disability / Dibujo de la Figura Humana: evaluación de la imagen corporal en la deficiencia física

O Desenho da Figura Humana (DFH) possibilita avaliar a psicodinâmica e a imagem corporal. Questiona-se sua aplicação em pessoas com deficiência física com problemas orgânicos e sociais que incidem sobre a imagem corporal. Buscou-se revisar e discutir a literatura do DFH sobre essa população, tendo sido encontrados 15 trabalhos entre 1949 e 2016. Esses estudos contemplam a avaliação da imagem corporal, a comparação entre grupos e as críticas em relação ao procedimento. Foram encontrados, nas figuras, tratamento inusual dos membros e do tronco e assimetrias, indicando dificuldades no contato com o ambiente e integridade da imagem corporal. Discutiu-se a relação entre os prejuízos motores e a projeção de fato nos desenhos, e ressaltaram-se cuidados para evitar vieses nas análises. Concluiu-se que o DFH oferece contribuições clínicas e científicas, e apresenta questões a serem discutidas que necessitam de atualização da literatura. Pesquisas podem contribuir para um futuro parecer favorável à técnica projetiva.(AU)

Draw-a-Person Test (DPT) evaluates psychodynamics and body image. Its use on people with physical disabilities is controversial, for there are organic and social issues that concern their body image. This article aims to review and discuss the DPT literature regarding this population. In a review, 15 papers from 1949 to 2016 were found that encompassed body image evaluation, group comparison and critiques concerning the technique. Unusual treatment of the limbs and upper body, and asymmetry were reported in the drawings, indicating difficulties with contact with the environment and body image integrity. Questions about the relationship between motor damage and a noticeable projection in the drawings were raised, warning professionals about the care needed to avoid biases in interpretations. The paper concludes that DPT provides clinical and scientific contributions, and raises questions to be discussed that need an update in the literature. Further studies may contribute to validate the use of the HFD as a projective technique.(AU)

El Dibujo de la Figura Humana (DFH) permite evaluar la psicodinámica y la imagen corporal. Se cuestiona su aplicación en personas con deficiencia física en las que hay problemas orgánicos y sociales que inciden en la imagen corporal. Se buscó revisar y discutir la literatura del DFH en esta población, habiéndose encontrado 15 trabajos entre 1949 y 2016. Estos trabajos consideran la evaluación de la imagen corporal, la comparación entre grupos y las críticas con relación al procedimiento. Se encontró un las figuras un tratamiento inusual de los miembros y del tronco y asimetrías, indicando dificultades en el contacto con el ambiente y la integridad de la imagen corporal. Se discutió la relación entre perjuicios motores y la proyección de hecho en los dibujos y se destacaron cuidados para evitar sesgos en los análisis. Se llegó a la conclusión que el DFH ofrece contribuciones clínicas y científicas, presenta puntos a ser discutidos y que necesita actualización de la literatura. Las investigaciones pueden contribuir para un futuro dictamen favorable de esta técnica proyectiva.(AU)

Attributes of primary health care provided to children/adolescents with and without disabilities / Atributos da atenção primária prestada às crianças/adolescentes com e sem deficiência

Abstract This study sought to compare the attributes of the Primary Health Care (PHC) provided by caregivers of the Family Health Strategy (FHS) to children and adolescents with and without physical disabilities in Palmas (State of Tocantins, Brazil). This is a cross-sectional, descriptive study with a quantitative approach. For data collection, the PCA Tool-Brazil (child version) was applied to caregivers of children and adolescents residing and registered in family health teams. The attributes of primary care were evaluated through scores measured according to the criteria of the instrument. The results indicated that three attributes had scores above the cutoff point for the physically disabled population and two attributes for the population without disabilities. Overall, the data showed no significant differences between children with and without disabilities from the standpoint of caregivers. The general score also showed a below satisfactory score in both groups. The evaluation of the attributes of the PHC was characterized as low-quality care to children and adolescents, be they physically challenged or not, which highlights the fact that the biggest challenges lie in ensuring health care to children and adolescents.

Resumo Este estudo objetivou comparar os atributos da Atenção Primária à Saúde (APS) prestada pelas equipes da Estratégia Saúde da Família (ESF) às crianças e adolescentes com e sem deficiência física em Palmas (TO). Trata-se de um estudo transversal, descritivo de abordagem quantitativa. Para coleta de dados utilizou-se o instrumento PCATool-Brasil (versão criança), aplicado aos cuidadores das crianças e adolescentes residentes e cadastradas em equipes de saúde da família. Os atributos da atenção primária foram avaliados através dos escores aferidos de acordo com critérios do instrumento. Os resultados registraram que três atributos apresentaram escores acima do ponto de corte para a população deficiente e dois para a população sem deficiência. Em geral os dados não apresentam diferenças significativas entre crianças com e sem deficiência segundo a visão dos cuidadores. O escore geral também mostrou valor abaixo do satisfatório nos dois grupos. A avaliação dos atributos da APS caracterizou-se como um atendimento de baixa qualidade à população infanto-juvenil, independente de ter ou não deficiência física, ressaltando que os desafios maiores são a garantia da atenção à saúde para crianças e adolescentes.

Public and Private Hospitals in Kuala Lumpur and Selangor, Malaysia: How Do They Fare in Terms of Accessibility for the Physically Disabled?

Public and private hospitals in Kuala Lumpur and Selangor were evaluated in terms of their accessibility for the physically disabled. The research hypotheses for this study included the following: (1) Both types of hospitals are accessible for the physically disabled as measured by specifi c criteria but (2) the degree of accessibility is higher in the case of private hospitals as compared to public hospitals. A total of 23 private hospitals and 11 public hospitals in Kuala Lumpur and Selangor were invited to participate in the study. The 5 private hospitals and 5 public hospitals that agreed were evaluated for adequacy of facilities for the physically-disabled. For this purpose, 13 specifi c criteria were assessed and scored for each hospital. These criteria were also grouped into 5 categories, namely, parking, toilet, door and lift, corridor and ramp. Scores were compared between each hospital and then aggregated and compared for private hospitals versus public hospitals. It was found that none of the 5 private hospitals and 5 public hospitals studied satisfi ed 100% of the criteria evaluated. Looking at each hospital individually, the overall scores range from 32% to 92% for the criteria set. Only 4 of the 10 hospitals in our sample achieved overall scores of 80% or higher in terms of the evaluation criteria we used. With the exception of availability of ramps where public hospitals scored slightly higher ,for most of the individual criterion, private hospitals scored higher than public hospitals. Looking at each criterion across all hospitals, the scores range from 59.2% (adequacy of parking) to 85% (adequacy of corridors). The median score obtained by private hospitals and by public hospitals for all 13 criteria were analysed for any difference. The difference between private hospitals and public hospitals is not statistically signifi cant (Mann-Whitney U = 6.5, p-value = 0.099). There is no signifi cant difference between Kuala Lumpur/Selangor private and public hospitals in terms of accessibility for physically disabled people. However, some hospitals are more accessible for the physically disabled than other hospitals. These fi ndings indicate that there is room for improvement.

Useful Points for Physiatrist When Writing Medical Certificates for Physically Disabled / The Japanese Journal of Rehabilitation Medicine

According to statistics from the Japanese Ministry of Health, Labour and Welfare for the last ten years, the number of people with physically disabled persons' certificates increased from about 4,370,000 in 2001 to more than 5 million in 2008 and reached about 5,110,000 in 2010. The incidence of stroke and various internal diseases are increasing following an increase in lifestyle-related diseases and the development of Japan's rapidly aging society. In this social background, the physiatrist has many chances to write a physically disabled persons' medical certificate during the patients' care-planning. The most important point to consider is to understand the reason why the patient wants to get a physically disabled persons' certificate. Patients have several needs in their care-plan requiring a physically disabled persons' certificate such as financial aid for medical bills and travel expenses, and also for the cost or supply for orthosis, prosthesis and other technical aids for the disabled. The degree of invalidity must correlate with the medical findings and impairment in the medical certificate. For example the medical findings are the grade of paralysis, joint range of motion and muscle weakness, etc. Activities of daily living (ADL) provide the evidence of those findings and the degree of invalidity. The best practice when writing a medical certificate for physically disabled is that there must be no discrepancy between the medical opinion for the degree of invalidity and the medical findings, impairment and ADL of the patients.

Quality Of Life And Its Influencing Factors Among Physically Disabled Teenagers In Kuala Lumpur, Malaysia

A cross-sectional study was conducted from December 2009 till May 2010 to determine the quality of life and factors influencing it among physically disabled teenagers. Data were collected from 59 physically disabled teenagers using guided questionnaire Short Form 36 (SF-36) and General Health Questionnaires 12 (GHQ 12). Quality of life among physically disabled teenagers is low for most domains of SF-36 as compared to the general Malaysian population. There was significant difference in quality of life among different races (mental health domain) and among different educational level and type of disability (physical functioning domain). There was no significant association between general health domain and other variables. Higher satisfaction in house, school and recreational environment showed a better quality of life. Higher stress level had a lower quality of life. Lack of disabled friendly environment at home, school and recreational places probably contribute to their quality of life. Schools and public places should have more disabled friendly facilities to improve independency and accessibility. Better education and training will increase their independence and enhance self-confidence. More attention and support at this age is important for them to develop interpersonal skills and character for their future.

Differences in Obesity Rates Between People With and Without Disabilities and the Association of Disability and Obesity: A Nationwide Population Study in South Korea / 예방의학회지

OBJECTIVES: The objective of this study was to identify the differences in obesity rates among people with and without disabilities, and evaluate the relationship between obesity rates and the existence of disabilities or characteristics of disabilities. METHODS: Mass screening data from 2008 from the National Disability Registry and National Health Insurance (NHI) are used. For analysis, we classified physical disability into three subtypes: upper limb disability, lower limb disability, and spinal cord injury. For a control group, we extracted people without disabilities by each subtype. To adjust for the participation rate in the NHI mass screening, we calculated and adopted the weight stratified by sex, age, and grade of disability. Differences in obesity rates between people with and without disabilities were examined by a chi-squared test. In addition, the effect of the existence of disabilities and grade of disabilities on obesity was examined by multiple logistic regression analysis. RESULTS: People with disabilities were found to have a higher obesity rate than those without disabilities. The obesity rates were 35.2% and 35.0% (people with disabilities vs. without disabilities) in the upper limb disability, 44.5% and 34.8% in the lower limb disability, 43.4% and 34.6% in the spinal cord injury. The odds for existence of physical disability and grade of disability are higher than the non-disabilities. CONCLUSIONS: These results show that people with physical disability have a higher vulnerability to obesity.

Analysis of ADL in using Assistive Devices Users at a Rehabilitation Counseling Center for Persons with Disabilities / The Japanese Journal of Rehabilitation Medicine

At this Center, we directly interviewed 393 applicants for prostheses, orthotics, or other assistive devices in the last year and assessed their activities of daily living (ADL) using the functional independence measure (FIM). By investigating the relationship between the FIM scores and the prescription of prostheses, orthotics, or other assistive devices, we analyzed ADL in persons prescribed for assistive devices at a rehabilitation counseling center for persons with disabilities. This analysis revealed that there were some ADL patterns on the occasion of preparing medical writings and prescriptions. The FIM scores were totally good with upper or lower limb prostheses. In the case of computer based communication systems, there appeared a specific pattern wherein cognitive ratings except “expression” were good. Some patterns in ADL covering a combination of physical aspects and cognitive ones were found with the lower limb prostheses. ADL patterns were found to be overlapping among seating systems, wheelchairs and powered wheelchairs. Some patterns were seen in active usage for locomotion, some in usage with low physical and cognitive aspects, and others in different usages. From the viewpoint of ADL, some prescription grounds became clear, and it was shown that these grounds could be one of the guidelines used for the indication of assistive devices.

A Comparative Study on the Level of Perceived Stigma Towards Physically Disabled Between Physically Disabled and Non-disabled / 재활간호학회지

PURPOSE: The purposes were to explore and compare the level of perceived stigma toward physically disabled, and to find factors related with the perceived stigma. METHOD: Data were collected by structured questionnaire from July to September 2007. The participants consisted of 292 physically disabled and 294 non-disabled living in Daejeon, Korea. These data were analyzed using SPSS Win 12.0 by descriptive statistics, Chi-Square test, t-test, one-way ANOVA. RESULT: The perceived stigma towards physically disabled of the physically disabled was higher than non-disabled's. The physically disabled stigmatized themselves in all the subcategories of the perceived stigma. The physically disabled perceived the stigma differently according to the spouses, economic status, educational level, comorbidity and impairment sites. The non-disabled's perceived stigma was different according to gender, existence of spouses, job and economic status. Non-disabled's stigma towards physically disabled was not different by experiences related with physically disabled. CONCLUSION: For reducing the perceived stigma, nursing intervention strategies should be developed, especially for physically disabled, and further studies should be conducted to define related factors. The results of this study might be a standard to evaluate effects of nursing interventions for decreasing the stigma.

Inserção social universitária: uma investigação com base no átomo social mínimo / Inclusión social universitaria: una investigación con base en el átomo social mínimo / College social insertion: an investigation based on the minimum social atom

Ao longo da história, os deficientes ocupam um lugar de marginalização e sua inserção depende, em grande parte, do contexto social. Este trabalho se propôs a mapear as redes sociais de alunos universitários com deficiência física a partir de uma leitura psicodramática e identificar como o aluno avalia sua inserção a partir dos papéis desempenhados. Criou-se um instrumento inspirado no átomo social de Moreno e no Mapa Mínimo proposto por Sluzki, que se denominou átomo mínimo. Participaram da pesquisa sete estudantes universitários com deficiência física que foram entrevistados com base no instrumento criado. Os resultados indicam que os participantes desempenham diferentes papéis na família e no ambiente de trabalho/estudo, a universidade foi apontada como um local em que puderam testar seus limites e desenvolver laços de amizade. A maior dificuldade de inserção aponta o problema de locomoção dentro do campus. Percebe-se a necessidade de maiores subsídios para políticas de inclusão universitária.

It is evident through history that disabled individuals occupy marginal positions and their insertion depend, in great part, on the social context. This study aims to investigate the social networks of college students with disabilities from a psychodramatic point of view. To achieve such goal, a new instrument called minimal atom, was created. This instrument was based on Moreno's social atom theory and Sluzki's minimal map. The interview and instrument were applied to seven students with physical disabilities. Results indicate that people with disabilities develop different roles in their families and at work/college. The university seems to be a place where these students can test their limits and develop friendships. The major difficulty for their inclusion in the university is related to their ability of moving around the campus. There is a clear need of supporting public policies for college inclusion criteria.

Al largo de la historia, los discapacitados ocupan un lugar de marginalización y su integración depende, en gran parte, del contexto social. Este trabajo se propone a dibujar el mapa de las redes sociales de alumnos universitarios con discapacidad física desde una lectura psicodramática e identificar como este alumno evalúa su integración desde los papeles desarrollados. Se creó un instrumento inspirado en el átomo social de Moreno y en el Mapa Mínimo propuesto por Sluzki, que se denominó átomo mínimo. La investigación se realizó con siete participantes con discapacidad física que fueron entrevistados por medio del nuevo instrumento. Los resultados indican que los participantes, juegan diferentes papeles en la familia y en el ambiente de trabajo/estudio. La universidad fue señalada como el sitio donde estos alumnos pudieran probar sus límites y desarrollar lazos de amistad. La mayor dificultad de integración está en el problema de la locomoción dentro del campus. Se percibe una necesidad de más recursos para políticas de integración universitaria.

The situation of the assistance for the physically disabled people in Cambodia / 国際保健医療

Many people have been killed or physically disabled during twenty-year internal conflict in Cambodia. People still get injured due to remained land mines and unexplosive ordnances, even a decade after the cease-fire. This paper aims to examine the situation of the physically disabled and assistance programs in Cambodia by analyzing published documents and visiting activity sites, and to discuss future challenges. In this paper, the physically disabled mainly implies adults and children with orthopedic impairments.<br>The major causes of physical disability are: land mines; unexplosive ordnances; traffic accidents; occupational accidents such as falling down from palm trees; infectious diseases, etc. Casualties of land mines and unexplosive ordnances were 50,915 (13,686 were dead) between 1979 and 2000. Recently, the number of land mine accidents has been declining, while that of traffic accidents has been increasing. <br>Since 1980s, many international NGOs have assisted land mine victims through providing with artificial limbs, prostheses and rehabilitation services. However, the assistance for the disabled people of other categories has been neglected. The international NGOs provide services based on their own interests, therefore, the participation of the disabled people and their family in the assistance programs has been limited. The government plays only limited roles to endorse the activities of the international NGOs, and has not had any specific strategies to prepare for the future withdrawal of the NGOs.<br>Disabled people require assistance not only for health, but also for education, employment, etc. On the other hand, it is also very important to empower and build capacity of them, so that they can contribute to the development of the Cambodian society. Additionally, means of prevention should be considered as one of the key perspectives. Sustainable supporting systems should be established by the government and domestic NGOs through participation of the disabled themselves.

Stress Related Factors of Physically Disabled Workers in Manufacturing Industry / 대한산업의학회지

OBJECTIVES: This study was performed to measure the stress level of physically disabled workers, and to investigate the relationship between the stress dimensions and stress inducing factors of physically disabled workers in the Korean manufacturing industry. METHODS: The sample used in this study consisted of 341 physically disabled workers who had been working at companies in Seoul, Inchon, and Gyung-gi provinces. The Psycho-social Well-being Index (PWI), a modified version of Goldberg's 60-items of General Health Questionnaire (GHS), was used to measure the stress level. The following independent and moderate variables were designed for the same purpose. The independent variables were general and disability characteristics, workplace-related characteristics, and job stressor of the respondents. The other variables included organization-related stressors (social and family support) and person related stressors (needs and values, type A behavior pattern, locus of control and demographics), self-esteem and coping strategy. The collected data were analyzed using SAS version 6.12 program. RESULTS: Multiple logistic regression analysis showed that the significant variables on the stress level of physically disabled workers were poor self-perceived health status, low self-esteem, absence of regular exercise, physically disabled condition affecting work performance capability, dependent mobility at home, interpersonal conflict, role conflict and A type behavior pattern. CONCLUSIONS: The results of this study suggest that appropriate health promotion program should be established and provided for reducing the stress of physically disabled workers in the manufacturing industry. In addition, various vocational programs for decreasing interpersonal and role conflicts should be developed.

Cuida-dor (d)eficiente: as representações sociais de familiares acerca do processo de cuidar / (D)efficient pain caregiver: the social representations of family members about the care process

Este estudo objetivou analisar os significados do cuidar para cuidadores/familiares que compartilham o cuidado domiciliar de deficientes físicos por lesão medular traumática. Tendo como referencial metodológico a teoria das Representações Sociais (RS), a análise dos discursos obtidos por meio de entrevistas abertas, realizadas junto a oito cuidadores, apontou para os dois eixos condutores dos significados: o processo de sofrimento vivido pelos sujeitos na prática do cuidar e as águas turbulentas que permeiam este sofrimento. Estes eixos, caracterizados como Núcleo Central e Sistema Periférico das RS, respectivamente, compuseram-se de temas como a visão da deficiência, a afetividade, a religiosidade, as mudanças socioeconômicas e (falta de) suporte técnico-institucional. Os resultados desvelam um cuida-dor (d)eficiente voltado para o cuidar de uma pessoa também deficiente, tida como inválida, e realizado com muito sofrimento e privações, alicerçado na culpa e na religiosidade, suportado por uma ambiguidade afetiva e marcada por desgastantes mudanças socioeconômicas e falta de suporte técnico-institucional, para uma prática que pressupõe tantas especificidades. As alternativas de transformações do cotidiano desses cuidadores sinalizam, principalmente, para uma simbiose de invalidez com o outro - o viver pelo deficiente - ou ainda, para poucos, um esboço de retomada dos projetos pessoais de vida - viver com o deficiente

The objective of this study was to analyse what looking after physically disabled persons with spinal cord injury by trauma means to their caregivers and family members. The analysis of the testimony of eight caregivers obtained in open interviews, which was methodologically based on the Social Representations Theory (SR), pointed to two main routes: the coping with the suffering process in the caregiving practice and the troubled waters that permeate this suffering process. These two routes, characterized as SR Central Core and Peripheric System respectively, consisted of themes such as the way of looking at impairment, affectivity, religiosity, social-economical changes and (lask of) technical and institutional support. The results show a handicapped caregiver dedicated to look after someone who is physically disabled, considered incapacitated, and who leads his or her chores with distress and privations, based on guilt and religiosity, supported by affection ambiguity and affected by deteriorating social-economical changes and lack of technical and institutional support to practice an activity that implies in so many peculiarities. The transformation alternatives of the daily life of these caregivers lead principally to a symbiosis of disability with the patient - to live for the physically disabled - or yet, for a few, a sketch to restart personal life projects - to live with the physically disabled

Prevalence of Physically Disabled Students in Rural Community

OBJECTIVE: To compare key-person method with census method on the prevalence of physically disabled students and to obtain the prevalence of the physically disabled students in rural community. METHOD: Total 4,890 students of 20 schools in Kyungaido province were surveyed in 1997. Two-thousands and twenty-two students of 8 schools were surveyed by a census method and 2,868 students of 12 schools by a key-person method. RESULTS: The prevalence of the physically disabled students in rural community was 0.53% of the population. The prevalence of the physically disabled students was 0.69% by a census method and 0.42% by a key-person method. This result suggests that there is no significant difference in the prevalence of physically disabled students between the two survey methods (p>0.05). CONCLUSION: A key-person method is as effective as a census method for prevalence survey of physically disabled students in rural communities because of cost effectiveness and less personnel.