Diabetes knowledge, self-efficacy and dietary, psychological and physical health barriers: Comparing young and usual-onset type 2 diabetes.

AIMS: Young-onset (21-39 years old) type 2 diabetes (YOD) is associated with high complication rates and glycaemic levels, and poor self-management plays a significant role. Knowledge, skills and barriers influence self-management behaviours considerably. Therefore, this study assessed diabetes knowledge, self-efficacy and barriers (situational dietary barriers, physical health, mental health and diabetes-related distress) between participants with young and usual-onset (40-59 years old) (UOD) diabetes. METHODOLOGY: A cross-sectional survey was conducted. Differences between YOD and UOD were analysed using bivariate analysis and effect sizes were estimated with Cohen's d. Differences were further adjusted by demographic factors (gender, ethnicity, marital status, educational level, income level) and diabetes duration. RESULTS: A total of 409 (97 YOD, 312 UOD) participants were recruited. Participants with YOD had lower self-efficacy levels (adjusted B = -0.19, CI -0.35 to -0.03) and higher dietary barriers (adjusted B = 3.6, CI 2.1-5.1), lower mental health scores (adjusted B = -3.5, CI -5.7 to -1.4) and higher diabetes-related distress levels (adjusted B = 0.2, CI 0.2-0.4). CONCLUSIONS: Our study found that participants with YOD faced more challenges with adapting to life with diabetes when compared with UOD. More effective self-management programmes are needed to support the multifaceted needs of adults with YOD.

Caminhos inclusivos: explorando barreiras e facilitadores no acesso e acessibilidade em serviços de saúde para pessoas com deficiência no município de Francisco Morato / Inclusive paths: exploring barriers and facilitators in access and accessibility to health services for people with disabilities in the municipality of Francisco Morato

Este trabalho teve como objetivo apresentar as barreiras e facilitadores em relação ao acesso de pessoas com deficiência (PCD) aos serviços de saúde do município de Francisco Morato, numa parceria realizada com o Instituto de Saúde. A temática da pessoa com deficiência foi priorizada pela gestão municipal por ser fundamental para garantir o acesso dessa população aos serviços de saúde. A pesquisa teve seu desenvolvimento através de entrevistas semi-estruturadas com gestores, gerentes, profissionais de saúde, usuários PCD e cuidadores, e foi desenvolvida de acordo com os aspectos éticos. Para a realização da pesquisa foi utilizado como método a abordagem qualitativa para análise de discurso, os temas abordados nas entrevistas geraram três categorias de análise, sendo elas a Acessibilidade, Gestão e Aspectos Demográficos do município em questão. A pesquisa revelou alguns facilitadores como acomodações prediais adaptadas, programas de capacitação profissional e parcerias com instituições de saúde, e evidenciou barreiras que impactam diretamente e indiretamente a vida da PCD e seu(s) cuidador(es) como falta de vagas no transporte sanitário, ruas e calçadas irregulares em frente a UBS e localização geográfica.

Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization.

BACKGROUND: Although disparities in cardiac rehabilitation (CR) participation are well documented, the role of community-level distress is poorly understood. This study evaluated the relationship between community-level distress and CR participation, access to CR facilities, and clinical outcomes. METHODS: A retrospective cohort study was conducted on a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. Outpatient claims were used to identify any CR use within 1 year of discharge. Beneficiary and CR facility zip codes were used to describe access to CR facilities. Adjusted logistic regression models evaluated the association between Distressed Community Index quintiles, CR use, and clinical outcomes, including one-year mortality, all-cause hospitalization, and acute myocardial infarction hospitalization. RESULTS: A total of 414 730 beneficiaries were identified, with 96 929 (23.4%) located in the first and 67 900 (16.4%) in the fifth quintiles, respectively. Any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%, P<0.001), which was significant after multivariable adjustment (odds ratio, 0.41 [95% CI, 0.40-0.42]). A total of 98 458 (23.7%) beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR use was associated with absolute reductions in mortality (-6.8% [95% CI, -7.0% to -6.7%]), all-cause hospitalization (-5.9% [95% CI, -6.3% to -5.6%]), and acute myocardial infarction hospitalization (-1.3% [95% CI, -1.5% to -1.1%]), which were similar across each Distressed Community Index quintiles. CONCLUSIONS: Although community-level distress was associated with lower CR participation, the clinical benefits were universally received. Addressing barriers to CR in distressed communities should be considered a significant priority to improve survival after coronary revascularization and reduce disparities.

Architectural accessibility and perception of falls of elderly people in the peridomicile: mixed method.

OBJECTIVE: To describe contents, structure and origin of social representations about falls by elderly people, the peridomiciliary structural conditions that predispose to falls, and to relate the implications of these empirical evidence on the routine of the elderly in the architectural context. METHOD: Convergent mixed method by triangulation. Qualitative approaches(structural, n=195 and procedural, n=40of the Theory of Social Representations) and quantitative (descriptive sectional, n=183) were used. Elderly people enrolled in primary care were interviewed at home in 2018. Analysis techniques: categorical-thematic, prototypical, statistical, and deductive according to Leininger. RESULTS: Categories of analysis: 1) Peridomicile: fall scenario and 2) Aging and vulnerability: risk of falls in peridomicile. The following environmental characteristics were precursors to falls: uneven floors, holes, unevenness and objects in the pathway. Feelings and behaviors allocated in the possible central core are associated, justifying falls, and determining their causes. CONCLUSION: There was an association between the peridomiciliary architectural environment and the predictive characteristics of the risk of falls.

Supervised smoking facility access, harm reduction practices, and substance use changes during the COVID-19 pandemic: a community-engaged cross-sectional study.

BACKGROUND: The potential public health benefits of supervised smoking facilities (SSFs) are considerable, and yet implementation of SSFs in North America has been slow. We conducted this study to respond to significant knowledge gaps surrounding SSF utilization and to characterize substance use, harm reduction practices, and service utilization following the onset of the COVID-19 pandemic. METHODS: A questionnaire was self-administered at a single site by 175 clients using an outdoor SSF in Vancouver, Canada, between October-December 2020. Questionnaire responses were summarized using descriptive statistics. Multinomial logistic regression techniques were used to examine factors associated with increased SSF utilization. RESULTS: Almost all respondents reported daily substance use (93% daily use of opioids; 74% stimulants). Most used opioids (85%) and/or methamphetamine (66%) on the day of their visit to the SSF. Respondents reported drug use practice changes at the onset of COVID-19 to reduce harm, including using supervised consumption sites, not sharing equipment, accessing medically prescribed alternatives, cleaning supplies and surfaces, and stocking up on harm reduction supplies. Importantly, 45% of SSF clients reported using the SSF more often since the start of COVID-19 with 65.2% reporting daily use of the site. Increased substance use was associated with increased use of the SSF, after controlling for covariates. CONCLUSIONS: Clients of the SSF reported increasing not only their substance use, but also their SSF utilization and harm reduction practices following the onset of COVID-19. Increased scope and scale of SSF services to meet these needs are necessary.

Analysis of Building Accessibility Using Inertial and Optical Sensors.

The inclusive use of urban spaces necessitates detailed knowledge of the accessibility of public buildings or places where educational, health or administrative services are provided. Despite the improvements already made in many cities regarding architectural work, further changes to public buildings and other spaces, such as old buildings or areas of historical importance, are still required. To study this problem, we developed a model based on photogrammetric techniques and the use of inertial and optical sensors. The model allowed us to perform a detailed analysis of urban routes in the surroundings of an administrative building, by means of mathematical analysis of pedestrian routes. It was applied to the specific case of people with reduced mobility and included analysis of the building accessibility as well as detection of suitable transit routes, deterioration of the road surfaces and the presence of architectural obstacles on the route.

Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study.

PURPOSE: To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke. BACKGROUND: Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse. METHODS: In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis. RESULTS: Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings. CONCLUSIONS: Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.

The Role and Implication of UD to Foster Inclusion in Built Environments.

The level of inclusion of all its members in the complex of community activities is a fundamental indicator of the progress of a society that wants to be defined as civil and there is a rising awareness about the evidence that diversity and inclusion are linked to positive outcomes. The Universal Design approach is increasingly recognized as the one that helps to shape environments - in terms of physical and virtual environments, as well as buildings, goods and services - so that it can be accessed, understood, and used to the greatest extent possible by all people, regardless of their diversity. Thus, making a more inclusive society for all. This short essay summarizes some reflections resulting from studies, research and field practices reported by literature, and also experienced by the author in her training as a researcher and university professor. Attention is focused in particular on some critical issues and implications inherent in the practical application of UD principles, as well as on the importance of its multidisciplinary dimension, which also entails a different attitude towards the training of professionals.

Designing for inclusion in public playgrounds: a scoping review of definitions, and utilization of universal design.

PURPOSE: Public playgrounds afford children and families important opportunities for outdoor play, social participation, and inclusion. Unfortunately, many children and families experience barriers to accessing, using, and being included in public playgrounds. Consequently, Universal Design (UD) is promoted for providing conceptual guidance for designing for inclusion in public playgrounds. However, a lack of research evidence means researchers have engaged in the ongoing interpretation of the UD concept and related non-discriminatory planning and design concepts. Therefore, the aim of this study was to examine how UD, and related concepts, are used in peer-reviewed articles concerning public playgrounds. MATERIALS AND METHODS: A scoping review was conducted in November 2019, which identified 15 peer-reviewed articles that met the inclusion criteria. RESULTS: Analysis revealed that the terms UD, inclusive design, accessibility, and usability are all being used to describe non-discriminatory planning and design concepts arbitrarily and without regard for higher or lower order concepts. Two broad interpretations were evident: (a) UD is synonymous with accessibility for some, and (b) UD is a higher-order concept that goes beyond accessibility for others. Nevertheless, findings highlight the utility of UD in underpinning the design of public playgrounds in many developed countries; however, the concept requires further clarity and specificity as it pertains to playground design and more pertinently inclusion in outdoor play. CONCLUSIONS: We argue for further conceptual refinement to consolidate the importance and future application of UD for Play (UDP) in the design of public playgrounds that promote outdoor play, social participation, and inclusion.IMPLICATIONS FOR REHABILITATIONMost peer-reviewed journal articles reviewed fail to define what is meant by the term Universal Design.Of those that do provide a definition, the outcome of inclusion in play, or the application of Universal Design to enable play in public playgrounds was unclear.Research to date has mostly focused on related concepts, including accessibility and usability, with less emphasis on Universal Design.Recommend a tailored perspective of Universal Design for Play (UDP).

An alternative system to improve accessibility for wheelchair users: The stepped ramp.

Ramps are one of the main solutions for people with motor disabilities to overcome small disparities in height, both across cities and inside buildings. To permit the autonomous use of ramps, they must satisfy specific requisites. In particular, the slopes must not be excessively steep but adhere to the values identified in regulations and validated by scientific research. In historic cities, however, the placement of ramps is often complicated by a lack of space required for their length. In Venice, in particular, its urban morphology often makes it impossible to conform to the required slopes. For this reason, a specific ramp, known as "stepped ramp", has been designed by technicians of the City of Venice with a steeper slope than allowed by regulations. It offers many possibilities but even some key problems. This paper presents a scientific analysis of ten different ramps to evaluate the structures that directly influence the feeling of comfort or discomfort of a wheelchair user with assistance, as well as the coefficients of friction of the different flooring surfaces. This study aims to understand objectively if this solution is efficient to improve accessibility in some specific circumstances, where it is not possible to follow the regulations using flat ramps.

Percepções de psicólogos organizacionais sobre inclusão de pessoas com deficiência em empresas / Organizational psychologists' perceptions on the inclusion of people with disabilities in organizations / Percepciones de los psicólogos organizacionales sobre la inclusión de personas con discapacidad en las empresas

As dificuldades e barreiras enfrentadas no processo de inclusão de pessoas com deficiência (PcD) nas organizações incitam o desenvolvimento de pesquisas. Este estudo compreendeu a percepção de psicólogos organizacionais sobre a inclusão de PcD em empresas. Dezoito psicólogos atuantes na área de gestão de pessoas de empresas das sete regiões do estado do Rio Grande do Sul responderam a uma entrevista individual. A média de idade dos participantes foi de 33,17 anos, atuavam em empresas de diferentes segmentos, eram predominantemente do sexo feminino e possuíam pós-graduação em áreas relacionadas. Os relatos dos psicólogos alertaram para o fato de que, em suas graduações, o conteúdo sobre deficiência humana e, especificamente, inclusão no mercado de trabalho foi escasso ou inexistente. Essa lacuna na formação, de egressos de diferentes instituições de ensino superior, é relatada desde os anos de 1990. Para esses psicólogos, barreiras atitudinais e organizacionais são frequentemente enfrentadas no processo de inclusão, tais como o despreparo das empresas, gestores e colaboradores para receber as PcD, os poucos programas voltados a uma prática efetiva de inclusão e não somente ao cumprimento da legislação, além das dificuldades dos próprios profissionais em identificar os potenciais e as limitações que a PcD apresenta e de adaptá-la de maneira correta ao trabalho. O psicólogo organizacional pode contribuir para um processo adequado de inclusão por meio de práticas, tais como treinamentos e sensibilizações, que fomentem a informação e diminuam a discriminação e as dificuldades.(AU)

Difficulties and barriers to including people with disabilities (PwDs) in organizations drives research development. This study sought to understand how organizational psychologists perceived the inclusion of PwDs in organizations. Eighteen organizational psychologists who work in people management for companies in the seven regions of the state of Rio Grande do Sul participated in an individual interview. Most interviewees were female, with average age of 33.17 years, had a postgraduate degree in the field, and worked in companies from different segments. During the interviews, the psychologists called attention to the little or nonexistent content on human disability and, specifically, inclusion in the labor market covered in the graduate course. This gap has been reported by graduates from different higher education institutions since the 1990s. According to the respondents, attitudinal and organizational barriers are often faced in the inclusion process, such as the unpreparedness of companies, managers, and employees to welcome PwD, the few programs aimed at an effective inclusion and not only to comply with the law, as well as the difficulties of the professionals themselves to identify the potentials and limitations that PwD present and to adapt them correctly to the work. Organizational psychologists can contribute to an adequate inclusion process by developing training and sensibilization activities that foster information and reduce discrimination and difficulties.(AU)

Las dificultades y barreras enfrentadas en el proceso de inclusión de personas con discapacidad (PcD) en las organizaciones fortalecen el desarrollo de la investigación. Este estudio entendió la percepción de los psicólogos organizacionales acerca de la inclusión de las PcD en las empresas. Dieciocho psicólogos que trabajan en el área de gestión de personas en empresas de las siete regiones del estado de Rio Grande do Sul (Brasil) respondieron a una entrevista individual. Los participantes tenían una edad promedio de 33,17 años, trabajaban en empresas de diferentes segmentos, eran predominantemente mujeres y tenían un posgrado en el área. Los informes de los psicólogos alertaron sobre el hecho de que el contenido sobre discapacidad humana y, específicamente, su inclusión en el mercado laboral era escaso o inexistente durante su formación académica. Esta brecha en la formación de los egresados de diferentes instituciones de educación superior se reporta desde los 1990. Para estos psicólogos, a menudo ocurren barreras organizacionales y de actitud en el proceso de inclusión de las PcD, como la falta de preparación de las empresas, gerentes y empleados para recibirlas, pocos programas destinados a una práctica efectiva de la inclusión, no solo al cumplimiento de la ley, y las dificultades de los profesionales para identificar las potencialidades y limitaciones y adecuarlas correctamente al trabajo. El psicólogo organizacional puede contribuir a un proceso de inclusión adecuado, con prácticas de capacitación y sensibilización que brindan información y reducen la discriminación y dificultades.(AU)

Formação em análise do comportamento no contexto da educação especial: variáveis pessoais e atitudinais relacionadas à inclusão / Training in behavior analysis in the context of special education: personal and attitudinal variables related to inclusion / Formación en análisis de conducta en el contexto de la educación especial: variables personales y actitudinales relacionadas con la inclusión

A inclusão educacional de estudantes com autismo e/ou deficiência intelectual no ensino regular, em classe comum, evidencia a urgência de programas de formação docente em práticas educacionais baseadas em evidências. O objetivo foi avaliar a estrutura de um processo formativo remoto para elaboração, aplicação e avaliação de uma intervenção comportamental na perspectiva educacional inclusiva e, mais especificamente, caracterizar as atitudes sociais de agentes educacionais participantes da formação. A formação ocorreu em dois formatos. No primeiro, todo o material foi disponibilizado em uma pasta virtual compartilhada e, no segundo, em um Ambiente Virtual de Aprendizagem (AVA). Nos dois formatos, a estrutura contou com parte teórica e prática, por meio de leitura de textos, realização de exercícios e discussões. Na parte prática, participantes tiveram a oportunidade de trabalhar com famílias e estudantes (crianças e jovens) com autismo e/ou deficiência intelectual visando identificar as necessidades e prioridades da família para elaboração colaborativa de um plano de intervenção (sistematização de práticas), implementação e análise das práticas. Para a caracterização da amostra foram levantadas informações pessoais, experiências prévias, familiaridade com ferramentas tecnológicas, conhecimento sobre os conceitos teóricos da Análise do Comportamento. Foi feita uma caracterização das atitudes sociais em relação à inclusão e analisada a validade social de participantes sobre a formação. Os resultados da formação identificaram correlações entre o nível de atitudes sociais e o engajamento nas atividades práticas entregues, além da relação entre o número de participantes que concluíram a formação, o cumprimento de tarefas e dificuldades de contato com a família. O estudo discutiu sobre estratégias que tenham em vista possibilidades de escalabilidade da formação docente de maneira sistemática e científica nesta área de atuação profissional.(AU)

The educational inclusion of students with autism and/or intellectual disabilities in regular education has highlighted the urgency of initial and continuing education programs with evidence-based educational practices. The objective was to evaluate the structure of a remote training process for the elaboration, application and evaluation of a behavioral intervention in the inclusive educational perspective and, complementarily, a specific objective was to characterize the social attitudes of educational agents participating in the training. The training took place in two formats. In the first, all material was made available in a shared folder and in the second, in a Virtual Learning Environment (VLE). In both formats, the structure had a theoretical and practical part, by reading and carrying out exercises and discussions. In the practical part, participants had the opportunity to work with families and students with autism and/or intellectual disability to identify the needs and priorities of the family for the collaborative elaboration of an intervention plan (systematization of practices), implementation and analysis of practices. For the characterization of the sample, personal information, previous experiences, familiarity with technological tools, and knowledge about the theoretical concepts of Behavior Analysis were collected. A characterization of social attitudes towards inclusion was carried out and the social validity of participants regarding training was analyzed. The results of the training identified correlations between the level of social attitudes and engagement in the practical activities delivered, in addition to the relationship between the drop in the number of participants, the fulfillment of tasks and difficulties in contacting the family. The study discussed strategies that aim at possibilities of scaling continuing education in a systematic and scientific way in this area of professional activity.(AU)

La inclusión educativa de estudiantes con autismo y/o discapacidad intelectual en la educación regular, en aulas regulares, ha puesto de relieve la urgencia de programas de educación inicial y continua en prácticas educativas basadas en evidencia. El objetivo de este estudio fue evaluar la estructura de un proceso de formación a distancia para la elaboración, aplicación y evaluación de una intervención conductual en la perspectiva educativa inclusiva y, de forma complementaria, el objetivo específico fue caracterizar las actitudes sociales de los agentes educativos participantes en la formación. La capacitación se llevó a cabo en dos formatos. En el primer, todo el material estaba disponible en una carpeta compartida y, en el segundo, en un entorno virtual de aprendizaje (EVA). En los dos formatos, la estructura tuvo una parte teórica y práctica, mediante la lectura de textos, la realización de ejercicios y discusiones. En la parte práctica, los participantes tuvieron la oportunidad de trabajar con las familias y los alumnos con autismo y/o discapacidad intelectual con el fin de identificar las necesidades y prioridades de la familia para la elaboración colaborativa de un plan de intervención (sistematización de prácticas), su implementación y el análisis de prácticas. Para la caracterización de la muestra, se planteó información personal, experiencias previas, familiaridad con herramientas tecnológicas, conocimiento sobre los conceptos teóricos del análisis de comportamiento. Se realizó una caracterización de las actitudes sociales hacia la inclusión y se analizó la validez social de los participantes respecto a la formación. Los resultados de la capacitación identificaron correlaciones entre el nivel de actitudes sociales y el compromiso en las actividades prácticas impartidas, además de la relación entre la disminución del número de participantes, el cumplimiento de las tareas y las dificultades de contacto con la familia. Este estudio discutió estrategias que apuntan a posibilidades de escalar la formación docente de forma sistemática y científica en esta área de actuación profesional.(AU)

Sillas de ruedas, accesibilidad y Odontología Pediátrica: Perspectivas en Latinoamérica / Cadeiras de rodas, acessibilidade e Odontopediatria: Perspectivas na América Latina / Wheelchairs, accessibility and Pediatric Dentistry: Perspectives in Latin America

Los niños que presentan limitaciones en la movilidad y usan sillas de ruedas, en general tienen menos oportunidades de explorar el mundo que los rodea y están en un mayor riesgo de presentar déficits en sus habilidades para la vida, en el hogar y en la escuela porque los entornos comunitarios y sociales a menudo no son aptos para permitir su accesibilidad. Lamentablemente, en Latinoamérica viven millones de niñas, niños y adolescentes que presentan alguna discapacidad, y quienes han experimentado algún tipo de exclusión o discriminación en el ámbito educativo, social o cultural. Los objetivos del artículo son identificar, analizar y sintetizar las perspectivas por parte de países latinoamericanos con respecto a la situación de accesibilidad para niños que son usuarios de sillas de ruedas, así como realizar una reflexión en el área de Odontología Pediátrica.

As crianças que têm mobilidade limitada e usam cadeiras de rodas geralmente têm menos oportunidades de explorar o mundo ao seu redor e correm maior risco de déficits nas habilidades para a vida, em casa e na escola, porque a comunidade e os ambientes sociais muitas vezes não permitem sua acessibilidade. Infelizmente, na América Latina existem milhões de meninas, meninos e adolescentes com deficiência e que sofreram algum tipo de exclusão ou discriminação no âmbito educacional, social ou cultural. Os objetivos do artigo são identificar, analisar e sintetizar as perspectivas dos países latino-americanos sobre a situação de acessibilidade para crianças cadeirantes, bem como refletir sobre a área de Odontopediatria

Children who have limited mobility and use wheelchairs generally have fewer opportunities to explore the world around them and are at a greater risk of deficits in life skills, at home and at school because community and social settings are often not suited to allow their accessibility. Unfortunately, in Latin America there are millions of girls, boys and adolescents who have a disability, and who have experienced some type of exclusion or discrimination in the educational, social or cultural sphere. The objectives of the article are to identify, analyze and synthesize the perspectives of Latin American countries regarding the situation of accessibility for children who use wheelchairs, as well as to explain a reflection on the area of Pediatric Dentistry.

O lazer para cegos ou surdos: acessibilidade nos espaços culturais / Leisure for the blind and deaf: accessibility in cultural space

O tema desta pesquisa foi escolhido a partir da identificação de lacunas de estudos que tratassem de forma conjunta temas como deficiência, acessibilidade, lazer e turismo. O objetivo geral foi compreender as dificuldades enfrentadas para o acesso à cultura e para a fruição do lazer e do turismo pelos cegos ou surdos. Discute-se sobre acessibilidade universal, inclusão social, cidadania e turismo, direito à cidade, autonomia das pessoas com deficiência, turismo de pessoas com deficiência, deficiência e inclusão social, lazer e espaços culturais. Para a coleta dos dados, utilizou-se abordagem qualitativa, por meio de entrevista semiestruturada, cujos dados foram analisados a partir da técnica de análise de conteúdo, sendo as principais categorias: acessibilidade, qualificação, vivência, público e adequações. Como resultado observou-se a existência de obstáculos para a fruição do lazer e do turismo, e que os equipamentos culturais são parcialmente acessíveis. Constatou-se o sentimento de falta de autonomia para os cegos ou surdos. A baixa acessibilidade atitudinal foi apontada como mais relevante na percepção dos entrevistados.

The theme of this research was chosen from the identification of gaps in studies that dealt jointly with issues such as disability, accessibility, leisure and tourism. The overall objective was to understand the difficulties faced for access to culture and for the enjoyment of leisure and tourism by the blind and deaf. The theoretical foundation was built mainly from the studies on universal accessibility, citizenship and tourism, right to the city, autonomy of people with disability, tourism of people with disability and social inclusion and leisure and museums. For data collection, a qualitative approach was used, through semi-structured interviews. Those data were analysed using the content analysis methodology, being the main categories: accessibility, qualification, experience, public and adjustments. As a result, it was observed the existence of obstacles to the practice of leisure and tourism and that the cultural facilities are partially accessible. It was found the feeling of lack of autonomy for the blind or deaf. The low attitudinal accessibility was pointed out as more relevant in the interviewees' perception.

Desplazamiento activo en adolescentes: importancia de las barreras percibidas y el acompañamiento / Active Commuting in Adolescents: Importance of Perceived Barriers and Accompaniment

El presente estudio tiene como objetivo conocer el valor predictivo de la edad, el acompañamiento, y las barreras físicas y psicosociales en el desplazamiento activo. Participaron un total de 1325 estudiantes procedentes de centros educativos de Educación Primaria y Educación Secundaria de la Comunidad Autónoma de Extremadura (España), con edades comprendidas entre los 10-17 años ( =12.1; DT= 1.60). Los estudiantes cumplimentaron información sobre el modo, distancia, tiempo y acompañamiento a través del cuestionario PACO, y de las barreras percibidas para el desplazamiento activo mediante la escala BATACE. Los resultados revelaron una importante incidencia del acompañamiento, la distancia y las barreras psicosociales percibidas para la realización de desplazamiento activo hacia el colegio (R2 = .53; p = 0.00). Se concluye en la importancia de la distancia hasta el centro educativo, las barreras psicosociales, y el acompañamiento como elementos más importantes en la realización de desplazamiento activo. (AU)

The present study aims to know the predictive value of age, accompaniment, and physical and psychosocial barriers in active commuting. A total of 1,325 students from Primary Education and Secondary Education centers of the Autonomous Community of Extremadura (Spain) participated, with ages between 10-17 years (M =12.1; SD = 1.60). The students filled in information on the mode, distance, time and accompaniment through the PACO questionnaire, and the perceived barriers to active displacement using the BATACE scale. The results showed a significant incidence of accompaniment, distance, and perceived psychosocial barriers for active travel to school (R2 = .53; p = 0.00). It concludes on the importance of distance to the educational center, psychosocial barriers, and accompaniment as the most important elements in the realization of active displacement. (AU)

Evaluation of anti-rollback systems in manual wheelchairs: muscular activity and upper limb kinematics during propulsion.

Self-propelling a wheelchair up a hill requires intense muscular effort and introduces the risk of the wheelchair rolling down. The purpose of this paper was to assess the user's muscular activity during ramp climbing. Tests were carried out on a group of 10 subjects who had to propel a wheelchair up a standardized wheelchair ramp. Basic parameters of upper limb kinematics were measured to determine the total push-rim rotation angle. This was 105.91° for a wheelchair with a stiff anti-rollback system, 99.39° for a wheelchair without an anti-rollback system and 98.18° for a wheelchair with a flexible anti-rollback system. The upper limb muscle effort was measured at 55 ± 19% for the wheelchair without an anti-rollback system, 59 ± 19% for the wheelchair with a stiff anti-rollback system and 70 ± 46% for the wheelchair with a flexible anti-rollback system. The conducted research showed an increase in muscle effort while using anti-rollback systems. In the case of push-rim rotation angle, no significant differences in the value of the rotation angle were found.

'Frontrunners" Understanding of Universal Design in Architecture.

In Denmark, the building sector is in a state of transition towards Universal Design (UD). Thus, UD has not yet completely found its way into the practice of architects and their clients. Legislation about accessibility has dominated. This paper studies understandings of UD through a discourse analysis based on a survey among professionals with experience and interest in UD and professionals who were expected to keep their fingers on the pulse of the profession's development. The findings illustrate the existence of five discourses: 1) Social sustainability, 2) Re-instatement of humans as a focal point, 3) It is not just about ramps, 4) Equality, and 5) Giving a voice. Across the discourses there exists a genuine attempt to legitimise and mainstream UD into the architectural practice, focusing on multisensory and architectural quality in the design of spaces for human diversity in all scales.

Universal Design in Exhibit.

Universal Design has become more prevalent in the general use of architectural design buT has rarely been applied to exhibits. This paper features two manuals developed for exhibit accessibility that incorporate several principles of Universal Design.

Perspectives on Accessibility and Its Users Amongst Practicing Danish Landscape Architects.

This paper presents findings from 15 interviews of randomly selected Danish landscape architectural offices focusing on how these work with and understand accessibility. The paper finds that Danish landscape architects mostly understand accessibility and its users in relation to existing building regulations. Moreover, in finding that the informants possessed a limited professional vocabulary for understanding accessibility, the paper discusses the type of knowledge requested and by, and necessary for, Danish landscape architects to gain a more reflective understanding of accessibility and its users. Towards such ends, universal design can help the profession. However, with only a few informants mentioning ideas related to universal design, this indicates that more education is needed for universal design to provide a different perspective on accessibility and its users amongst Danish landscape architects.

A "Best Practice" for Inclusive Art Cities: The Case Study of the I-Access Project.

The essay aims to illustrate the results of the I-Access Interreg Italia-Malta 2016-20 project, carried out by a partnership led by the Department of Architecture of the University of Palermo with the scientific coordination of Renata Prescia. The project involved the Vucciria district in Palermo and the Bijcceria district in Valletta. Within the framework of the products created (database, web platform, mobile apps, protocol, etc.), we would like to explain in this paper the measures taken to facilitate physical and cultural accessibility from the integrated point of view of restoration and exhibition design, that is, in particular measures to overcome architectural barriers, measures for cultural dissemination and measures of a museographic-communicative nature, including re-evocations of lost or dislocated monuments and artistic works. The proposal is designed as a method for historic urban areas that have similar problems to the district under study. The Vucciria, for example, despite its high density of monuments, has a low quality of life because many of its monuments, especially churches, are closed and therefore unusable and because there is little motivation for local people to engage with these monuments, partly because it is an evolving community. The proposal, therefore, provides for concrete actions to restore the memory of the inhabitants and to re-establish an identity bond with the context, with concrete implications for attracting widespread tourism to provide opportunities for renewal for the district. Project proposals included the installation of three urban totems, ten tactile maps associated with as many churches, and the design of two new access ramps to two churches. By being realized as smart additions in a contemporary and stimulating way compared to the interventions characterized by a solipsistic retour au passè and previously carried out in accordance with the philosophy of the current urban plan, they also become an educational opportunity for a dialoguing community.