International Classification of Functioning, Disability and Health (ICF) – way to Health Promotion

The International Classification of Functioning, Disability and Health (ICF) is a classification of the World Health Organization (WHO). It is a reference document for the description of phenomena related to functioning and disability. The aim of the present study is to assess the relationship between the theoretical assumptions of ICF and the field of Health Promotion. The dissemination of ICF has been widely documented in literature over the last few years, however, there is a large gap between enthusiasm with the paradigm change that the classification proposes and its effective incorporation in the different environments of health care. This study presents an example of ICF operationalization. The biopsychosocial evaluation model of ICF presented is a strategy of light technology in health that advances towards the proposals of the field of Health Promotion

Link between the King’s Health Questionnaire and the International Classification of Functioning, Disability and Health, for the evaluation of patients with urinary incontinence after gynecological oncology surgery

O tumor de colo uterino é o segundo mais incidente entre as mulheres no mundo e no Brasil estimam-se para 2008, 18.680 casos novos. O tratamento de escolha para esta neoplasia envolve procedimentos cirúrgicos, quimioterápicos e radioterápicos, que possibilitam a cura, mas que de forma negativa permitem o surgimento de seqüelas, como incontinência urinária. A incontinência apresenta-se como uma complicação precoce e comum ao tratamento cirúrgico destas pacientes e envolve deterioração da qualidade de vida, gerando níveis de morbidade, afetando domínios psicológicos, ocupacionais, domésticos, físicos e sexuais. Para a avaliação de qualidade de vida em pacientes portadoras de incontinência existem vários questionários que são divulgados na literatura científica mundial, dentre estes, o King s Health questionário (KHQ) é o mais utilizado como instrumento de pesquisa. Além dos questionários de qualidade (QV), a OMS vem preconizando a utilização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), como ferramenta de estatística, pesquisa, clinica e política social, para proporcionar uma linguagem comum das condições relacionadas à saúde. O presente trabalho teve como objetivo estabelecer a ligação entre o KHQ e a CIF. O KHQ foi relacionado através de dois profissionais (individualmente), seguido de discussão e conclusão dos domínios codificados. Foram encontrados 12 categorias de funções corporais (b), 22 para atividades e participação (d) e 4 para fatores ambientais (e), no entanto, 7 conceitos significativos do questionário não puderam ser ligados com a CIF. O KHQ tem enfoque predominante nas questões referentes à atividade e participação. Trata-se de um estudo piloto que necessita de mais evidências para conclusão dos achados.Uterine cervix tumors are the second most common type of tumor among women in the world. In Brazil, 18,680 new cases were estimated for 2008. The treatment of choice for this type of cancer involves surgery, chemotherapy, and radiotherapy that encourage healing but, on the down side, impairments develop such as urinary incontinence. This incontinence appears as an early and common complication of the surgical treatment and involves deterioration in the quality of life, generating levels of morbidity, affecting psychological, occupational, domestic, physical, and sexual areas. To asses the quality of life in patients with incontinence there are several questionnaires in the scientific literature. Among them, the King’s Health Questionnaire (KHQ) is the most widely used as a research tool. In addition to accessing quality of life, the World Health Organization is advocating the use of the International Classification of Functioning, Disability and Health (ICF) as a tool for statistics, research, clinical and social policies, to provide a common language for the conditions related to health. The objective of this study is to establish a correlation between the KHQ and the ICF. The KHQ was correlated by two separate professionals, and followed by a discussion and conclusion of the coded domains. Twelve categories were found for body functions (b), 22 for activities and participation (d), and 4 for environmental factors (e), however, 7 significant concepts of the questionnaire could not be linked to the ICF. The KHQ has focused predominantly on issues related to activity and participation. This is a pilot study that needs more evidence to conclude its findings

Brazilian publications on the International Classification of Functioning

Considerando o aumento das doenças crônicas e da expectativa de vida, é de grande interesse atual a mensuração dos fenômenos de funcionalidade e incapacidade. A Organização Mundial de Saúde há cerca de 30 anos vem desenvolvendo ferramentas para entendimento e classificação destes processos, sendo o modelo atual a Classificação Internacional de Funcionalidade (CIF). A CIF propõe uma mudança de paradigma, onde o modelo biopsicossocial substitui o modelo biomédico predominante. É o mais recente e abrangente modelo taxonômico para a funcionalidade e incapacidade dentro de uma perspectiva universal e unificada. Objetivo: Em virtude do crescente interesse da comunidade científica pelo tema, o objeto do trabalho é descrever e classificar por áreas de conhecimento as publicações referentes à CIF. Método: As bases de dados utilizadas foram Lilacs e Scielo. Foram selecionadas 39 publicações. Resultados: A maioria das publicações foi referente a artigos originais (51,3%) e a área de conhecimento com maior número de trabalhos foi a Neurologia. Conclusão: Os resultados apontam que houve um crescimento elevado de publicações nos últimos cinco anos.Considering the increase of chronic disease and life expectancy there is now an emerging interest in measuring the phenomena of functioning and disability. For nearly 30 years the World Health Organization has been developing tools for understanding and classifying these processes, currently favoring the International Classification of Functioning (ICF). The ICF proposes a paradigm shift, where the biopsychosocial model replaces the biomedical model. It is the most recent and comprehensive taxonomic model for functioning and disability and has a unified and universal perspective. Objective: Given the increasing interest of the scientific community in the subject, the objective of this study is to describe and classify the publications in Brazilian literature related to the ICF by areas of knowledge. Method: The database used was the Lilacs and Scielo. Results: Thirty-nine publications were selected. Most of the papers were related to original articles (51.3%) and Neurology was the field written about most. Conclusion: The results show an increase in the number of publications in the last five years

Addressing functional activities and the influence of environmental factors in post-stroke hemiparetic patients before and after physical therapy

Stroke is the leading cause of neurological disability and hemiparesis is its most common sequelae. The physical and functional limitations combined with the influence of environmental factors directly affect an individual’s functionally. For an effective neurological rehabilitation, it is essential that physiotherapists know the patient’s functional profile in order to plan the treatment to meet his/her real needs. Objective: To analyze the functional activities and influence of environmental factors in poststroke hemiparetic patients before and after physical therapy. Method: Twelve post-stroke hemiparetic patients were evaluated before and after 20 physical therapy sessions with the Barthel Index (BI) and an evaluation model based on an abbreviated core set of the International Classification of Functioning, Disability and Health (ICF) for stroke, based in the generic qualifiers system of the ICF. Results: There was significant improvement for the activities walk (d450) (p = 0.0033), dress (d540) (p = 0.018) and eat (d550) (p = 0.018) for the evaluation model based on the ICF. According to the BI, significant improvement was detected for the activities of feed (p = 0.0341), dress (p = 0.0277), toilet (p = 0.0117), and up/ down stairs (p = 0.0077). The environment factors immediate family and health professionals were the most positive influence on the health status of patients. Conclusion: Physical therapy was effective for improving the condition of patients since, according to the patients, some daily activities can be performed with more ease at the end of the physical therapy treatment. To meet their needs, it is important to develop an individual treatment plan, emphasizing the context in which he/she is inserted, in order to address the real limitations on activities and restrictions to participation.O Acidente Vascular Encefálico (AVE) é a principal causa de incapacidade neurológica, sendo a hemiparesia a sequela mais comum da doença. As limitações físico-funcionais associadas à influência de fatores ambientais afetam diretamente a funcionalidade dos indivíduos. Para a efetividade da reabilitação neurológica é indispensável que o fisioterapeuta conheça o perfil funcional do paciente a fim de traçar o plano de tratamento que atenda as reais necessidades. Objetivo: Analisar as atividades funcionais e a influência dos fatores ambientais em pacientes hemiparéticos pós-AVE antes e após o tratamento fisioterapêutico. Método: Foram avaliados 12 pacientes hemiparéticos pós-AVE antes e após 20 sessões de fisioterapia, utilizando-se o Índice de Barthel (IB) e um modelo avaliativo baseado no core set abreviado da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para AVE, com base no sistema de qualificadores genéricos da CIF. Resultados: Observou-se melhora significativa para as atividades andar (d450) (p = 0,0033), vestir (d540) (p = 0,018) e comer (d550) (p = 0,018), de acordo com um modelo avaliativo baseado na CIF. Por meio do IB, detectou-se melhora significativa para as atividades de alimentação (p = 0,0341), vestir (p = 0,0277), toalete (p = 0,0117) e subir/descer escadas (p = 0,0077). Os fatores ambientais família imediata (e310) e profissionais da saúde (e355) foram os que mais influenciaram positivamente na condição de saúde dos pacientes. Conclusão: A Fisioterapia mostrou-se eficaz para melhorar a condição de saúde dos pacientes, visto que de acordo com a percepção deles algumas atividades diárias puderam ser executadas com mais facilidade ao final do tratamento fisioterapêutico. Para atender às necessidades do paciente, é importante elaborar o plano de tratamento individual, ressaltando o contexto em que ele está inserido, visando atender as reais limitações nas atividades e restrições à participação

VALIDAÇÃO DE UM INSTRUMENTO DE AVALIAÇÃO DA FUNCIONALIDADE PARA INDIVÍDUOS COM LESÃO TRAUMÁTICA DO PLEXO BRAQUIAL -- PERSPECTIVA DOS PACIENTES

Introdução: Dentre as Lesões do Plexo Braquial (LPB), 80% a 90% sãoresultantes de traumas auto/motociclísticos. As Lesões Traumáticas do Plexo Braquial (LTPB) são uma condição altamente incapacitante, com prevalência em homens entre 21 e 40 anos, que em sua maioria, são moradores de região urbana e trabalhadores braçais. Objetivo: O estudo visa realizar uma das três etapas necessárias para a validação de um instrumento de avaliação da funcionalidade, baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), para indivíduos com LTPB. Métodos: Trata-se de um estudo qualitativo com grupo focal, composto por 5 (cinco) indivíduos adultos com LTPB. Resultados: Das cinquenta e seis categorias da CIF presentes no instrumento a ser validado, trinta e uma foram relatadas pelos indivíduos que participaram do grupo focal. Uma categoria referente ao componente de atividade e participação foi citada pelos participantes e não havia sido contemplada pelo instrumento. Em relação às categorias da CIF de fatores ambientais, apenas duas categorias citadas pelos participantes do grupo não estão presentes no instrumento de avaliação. Conclusão: A maioria das categorias da CIF presentes no instrumento de avaliação a ser validado pôde serconfirmada a partir da perspectiva de indivíduos com LTPB participantesdo grupo focal

General, verbal, and non-verbal cognitive functioning of children and adolescents with 22q11.2 Deletion Syndrome

ABSTRACT Background: Cognitive dysfunctions are frequently found in the 22q11.2 Deletion Syndrome, being an aggravating factor in the impairment of social relationships and communication, strongly impacting the functionality of the individual. Increasing the knowledge regarding cognitive skills may provide contributions to the diagnostic process and the intervention planning. Objectives: To estimate the general, verbal, and non-verbal cognitive functioning of children and adolescents with 22q11.2 Deletion Syndrome. Methods: This is a cross-sectional, descriptive, and case series study regarding 15 individuals between 7-18 years-old diagnosed with 22q11.2 Deletion Syndrome. An assessment of the cognitive functions was performed using the Wechsler Abbreviated Scale of Intelligence (WASI). For data analysis we used a descriptive statistics analysis, having absolute frequencies for variables, and mean, median, standard deviation, minimum and maximum values for numerical variables. Results: In the group analysis, we observed an important cognitive impairment degree. Most of the sampling (n=8; 53.33%) presented a considerably low total intelligence quotient score. Cases showing lower performances also presented greater difficulties regarding Visual Motor and Visuospatial coordination. Regarding the intelligence quotient representative punctuation in the WASI scale, the sample showed a large variability in the results (between 40 and 92 points), with the median total of 83. Conclusions: We observed important dysfunctions, cognitive difficulties, and intellectual, verbal, and non-verbal disabilities in the population studied. These findings indicate the need for an early intervention to assist not only the cognitive aspect, but also the socio-emotional development of children with the 22q11.2 Deletion Syndrome, aiming at their participation in society

Construction and validation of a logical model for specialized Rehabilitation Centers

OBJETIVO Construir e validar um modelo lógico para a atenção nos Centros Especializados em Reabilitação (CER) a partir da análise do processo de trabalho e de questões organizativas de centros do Rio Grande do Norte. MÉTODOS Estudo metodológico desenvolvido em três etapas: 1) estudo documental de legislações e portarias relacionadas ao serviço de saúde e à Rede de Cuidados à Pessoa com Deficiência (RCPD); 2) realização de grupos focais, com estudo censitário dos CER do Rio Grande do Norte, para compreender e avaliar o cotidiano do serviço; e 3) sistematização das informações coletadas e, por fim, proposição e validação do modelo lógico avaliativo. RESULTADOS O modelo englobou cinco categorias centrais do processo de trabalho e organizacional: “demandas”, “recursos” (insumos, financeiros e força de trabalho), “processos”, “produtos e resultados” e “missão, valores e fatores externos”. CONCLUSÃO O modelo lógico construído foi adequado para representação gráfica do processo de trabalho e questões organizativas dos CER. Evidenciou-se que o funcionamento dos serviços está alinhado com as normativas. Contudo, ainda há lacunas organizacionais que precisam ser abordadas a fim de melhorar a resolutividade do serviço e a articulação com outros pontos da rede.OBJECTIVE To build and validate a logical model for health care in Specialized Rehabilitation Centers (CER) by analyzing the work process and organizational issues of centers in Rio Grande do Norte. METHODS This is a methodological study developed in three stages: 1) documentary research of legislation and ordinances concerning the healthcare service and the Disability Care Network (RCPD); 2) focus groups with a Census study of the CER in Rio Grande do Norte to understand and assess the daily activities of the service; and 3) systematization of the information collected and, finally, proposition and validation of the evaluative logical model. RESULTS The model encompassed five central categories of the work and organizational process: “demands”, “resources” (inputs, financial and workforce), “processes”, “products and results” and “mission, values and external factors”. CONCLUSION The logical model built was suitable for graphical representation of the work process and organizational issues of the SRC. The study showed that the functioning of the services is in line with the regulations. However, there are still organizational gaps that need to be addressed to improve the resolution capacity of the service and the articulation with other points of the network

Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model.

Understanding functioning and disabilities in children with Congenital Zika Syndrome (CZS) is essential for health planning. We describe disabilities present in children with CZS followed in a reference hospital in Rio de Janeiro, Brazil, based on the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). This was a cohort study of children >3 years of age with CZS. Disability was characterized through outcomes related to ICF components assessed via clinical and motor development evaluations. Among 50 children, with a median age of 40 months, 47 (94%) presented with severe impairment and 46 (92%) had microcephaly. Damage to the head and neck was found in most children, with abnormal central nervous system imaging universally present. Most children had cognitive impairment (92%), muscle tone problems (90%), and speech deficits (94%). We found movement limitations in all categories but more pervasively (80-94%), in postural transfers and displacements. The main environmental factors identified in the ICF model were the use of products or substances for personal consumption and access to health services. Children with CZS have extremely high rates of disability beyond aged 3 years, particularly regarding motor activity. ICF-based models can contribute to the assessment of health domains

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe