Rotator cuff pathologies involving supraspinatus are a common cause of musculoskeletal morbidity and can lead to significant disability affecting the overall quality of life. Architectural parameters of the muscle directly influence its functional properties. Therefore, understanding of fiber bundle changes with surgery and different exercises can assist clinicians in planning better surgical and shoulder rehabilitative protocols. The first objective of this thesis was to systematically review human cadaveric studies of the normal supraspinatus architecture and highlight the key aspects that should be considered while performing studies of skeletal muscle architecture. The second objective was to understand the impact of surgical repair on the structural and functional recovery of the supraspinatus. The final objective was to provide a scientific rationale behind choosing an exercise to strengthen supraspinatus by investigating its muscle architecture. Study 1 systematically reviewed human cadaveric studies of the normal supraspinatus architecture. Results showed that the overall quality of majority of included is poor and there was a large range in the reported architectural values of the entire muscle. In conclusion, there were only a few studies providing the level of detail and quality suitable for advancing our understanding of shoulder biomechanics. Study 2 quantified and compared the fiber bundle architecture of the pathologic supraspinatus pre- and post-operatively at multiple time points. Results showed significant lengthening of fiber bundles after one month of surgery which then decreased significantly by 6 months of surgery. In contrast, an initial decrease followed by an increase in pennation angle overtime was found. The results suggest that the stretching applied to the tendon and muscle during repair could affect the length-tension relationship of the muscle, which in turn can compromise its function and may lead to inferior surgical outcomes. Study 3 compared the efficacy of three commonly prescribed supraspinatus strengthening exercises in the rehabilitation setting based on the architectural changes following resistance training. Results showed there was no change in FBL and increased strength after resistance training with prone horizontal abduction exercise. Findings suggest that prone horizontal abduction may be a more suitable exercise to strengthen supraspinatus.

This thesis is comprised of five papers that all relate to bootstrap methodology in analysis of non-stationary time series. The first paper starts with the fact that the Dickey-Fuller unit root test using asymptotic critical value has bad small sample performance. The small sample correction proposed by Johansen (2004) and bootstrap are two effective methods to improve the performance of the test. In this paper we compare these two methods as well as analyse the effect of bias-adjusting through a simulation study. We consider AR(1) and AR(2) models and both size and power properties are investigated. The second paper studies the asymptotic refinement of the bootstrap cointegration rank test. We expand the test statistic of a simplified VECM model and a Monte Carlo simulation was carried out to verify that the bootstrap test gives asymptotic refinement. The third paper focuses on the number of bootstrap replicates in bootstrap Dickey-Fuller unit root test. Through a simulation study, we find that a small number of bootstrap replicates are sufficient for a precise size, but, with too small number of replicates, we will lose power when the null hypothesis is not true. The fourth and last paper of the thesis concerns unit root test in panel setting focusing on the test proposed by Palm, Smeekes and Urbain (2011). In the fourth paper, we study the robustness of the PSU test with comparison with two representative tests from the second generation panel unit root tests. In the last paper, we generalise the PSU test to the model with deterministic terms. Two different methods are proposed to deal with the deterministic terms, and the asymptotic validity of the bootstrap procedure is theoretically checked. The small sample properties are studied by simulations and the paper is concluded by an empirical example. / <p>Ogiltigt ISBN: 978-91-554-9069-0</p>

Background: Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods: A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses. Results: 2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]). Conclusion: Chronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load.

An acht isolierten Hinterbeinen gliedmaßengesunder Rinder wurden röntgen- und querschnittsanatomische Untersuchungen des Tarsus, Metatarsus und der Phalangen durchgeführt. Im Gegensatz zu anderen Tierarten gab es bisher für das Rind noch keine Erkenntnisse zur Interpretation von MRT-Befunden. Zur besseren Orientierung werden magnetresonanztomographische und anatomische Schnitte gegenübergestellt und bewertet. Es sind 23 transversale Ebenen in T1-gewichteten Sequenzen beschrieben worden. Die röntgenanatomischen Untersuchungen erfolgten immer in den beiden Standardebenen und für Sprunggelenk und Zehe zusätzlich in zwei schrägen Aufnahmerichtungen. Mit den Untersuchungen wurde nachgewiesen, dass die verwendeten Röntgenrichtungen für eine umfassende Darstellung von Knochen und Gelenken geeignet sind. Durch die verschiedenen Aufnahmerichtungen konnten die meisten Bereiche überlagerungsfrei herausprojiziert und der Beurteilung zugänglich gemacht werden. Fast alle anatomischen Strukturen wurden in der MRT-Untersuchung dargestellt und voneinander differenziert. Über den direkten Vergleich zum anatomischen Sägeschnitt zeichneten sich die MRT-Befunde durch einen sehr hohen Informationsgehalt aus. Das Magic Angle Phänomen konnte im Bereich von Sehnen und Bändern nachgewiesen werden. Die Aufzweigungen des Ramus profundus des N. plantaris lateralis konnten im Rahmen dieser Untersuchung bis in den mittleren Metatarsusbereich nachgewiesen werden. Sie sind bei anderen Tierarten als Nn. metatarsei plantares in der Nomenklatur zu finden. Ausgehend von einer sehr umfangreichen Literaturauswertung erfolgte eine umfassende Zusammenstellung des Erkenntnisstandes unter anatomischen und orthopädischen Gesichtspunkten. Die dabei zusammengetragenen Ergebnisse bilden eine entscheidende Grundlage für die Auswertung und Interpretation von Befunden der Hintergliedmaße des Rindes mit Hilfe der bildgebenden Diagnostik. / The study was based on the evaluation of eight hindlimbs from animals free from orthopedic disease. The tarsus, metatarsus and phalanges were examined radiographically and by MRI to characterize anatomical structures. Twenty-three transverse MRI sections of each limb were collected using T1 weighted images. Corresponding MRI and cross-section anatomical preparations were compared to optimize understanding of structural features. In addition to standard 0° and 90° views of the hindlimbs, oblique views of the tarsus and phalanges were made. Comparison of photographs and images was satifactory for the evaluation of bony structures without superimposition in most cases. MRI examination resulted in visualization and differentiation of tissues in almost every situation. The magic angle phenomenon was observed in areas of tendons and ligaments. The terminal branches of the R. profundus of the N. plantaris lateralis were discernable to the level of the middle of the metatarsus. These branches are described in other species as the Nn. metatarsei plantares. This work was undertaken to document anatomical findings and relationships which may be used as a resource for interpretation of images obtained from the hindlimbs of cattle using various diagnostic imaging modalities.

BACKGROUND: Oral communication impairments (OCIs) are a common childhood problem with often long-term negative outcomes for both the child and society. Despite the growing body of knowledge about the epidemiology of this problem, the shift from traditional treatment approaches to population based approaches to management has been slow. One suggested reason for this is a lack of community based population data on such problems with which to plan services more broadly. AIM: The aim of this thesis is to contribute to the population knowledge of children with OCIs by developing and trialing a data collection method at a community level. LITERATURE REVIEW: One of the major issues in understanding OCIs from a population perspective is the disparate and often incongruent nature of epidemiological data reported in the literature. Five areas of epidemiological research were reviewed in order to critically evaluate the existing evidence base and identify gaps for further research. The five areas reviewed were: Prevalence (Regardless of the methodology used to collect prevalence data, OCIs have been described as a common childhood problem), Life Course (Children with OCIs often have ongoing communication problems and are at risk for poorer life outcomes in social, educational and occupational domains), Comorbidities (OCIs rarely occur in isolation and most children will have other developmental or health issues), Risk factors (There is no one easily definable cause of OCIs, however, genetic and environmental factors appear to increase the risk of OCI in the general population), and Service use (Only around half of children with recognised OCIs will access specialist intervention services).The review concluded that local community data measuring the 'burden', or impact, of the problem, comorbidities and service use in children with and without OCIs would assist in service planning. Therefore a methodology would need to be developed which addressed these issues.A further review of the literature considered this methodology development with specific reference to the issues of study design, sampling and identification of OCIs. The review concluded that a cross-sectional survey design of a community sample could provide the necessary data. Parent and teacher report was suggested as a method for identifying OCIs in surveys, however, a tool needed to be developed and trialed to ensure this method was effective, valid and reliable. PILOT STUDY: A survey tool for parents was designed which included the Child Health Questionnaire (PF - 28), questions relating to socio-demographic features, health and development conditions, service use and specifically developed questions regarding OCIs. The survey methodology was trialed in one school and one childcare centre. The results of the study were reviewed and suggestions made for methodological changes before a community trial was carried out. The reliability and validity of the questions designed to identify OCIs was assessed in a number of ways. Test-retest reliability of parent completed questionnaires proved to be good. Interrater reliability was examined by comparing parent and teacher responses. Parents and teachers agreed on identification of OCI in over 75% of cases for each of the OCIs studied. Criterion validity was assessed by comparing parent report to speech pathologist evaluation in a clinical sample and by comparing parent and teacher report to screening assessments of communication skills in a school sample. Both parents and teachers tended to over-identify children, however, when parent and teacher reports were considered together the validity approached that of the 'gold standard'. Construct validity was assessed by comparing reported OCIs with reports of other developmental conditions known to be commonly comorbid with OCIs. Once again using both parent and teacher report proved to be the most valid method of identifying OCIs using the developed tool. COMMUNITY STUDY: A targeted community survey of 3 to 7 year old children was conducted in a regional centre in Queensland, Australia. Children were sampled through schools and childcare centres. Information letters were distributed to the parents of 898 eligible children. Completed questionnaires were received for 397 children. Teachers completed questionnaires on 375 children which was 42% of the population sampled. Parents and teachers identified OCIs in 16% of the children. However, only 3% of the population were rated by parents or teachers as having severe problems. Over 70% of parents and teachers of children with a reported OCI rated the problem as having an impact on the child's life. Ratings of impact were not related to parent/teacher ratings of severity. Children with OCIs were reported to have significantly more health, developmental and behaviour problems than their peers. Children with OCIs were rated lower by their parents on most aspects of the Child Health Questionnaire (PF-28). In particular, parents reported impacts on their own time and family activities due to the child's problems. No significant differences were found between children with and without reported OCIs on any of the socio-demographic variables studied. Children with reported OCIs used more health and educational services than their peers. Around 60% of children with reported OCIs had seen a speech pathologist, but many parents had also sought advice from a range of other health and educational professionals. Those with two or more OCI conditions were more likely to have seen a professional, however socio-demographic variables did not generally predict service use. Parents reported that the type of service they chose was most commonly influenced by advice from a doctor or teacher. The limitations of this methodology for collecting this type of data are discussed. However despite these limitations data were collected which has major implications for the provision of population based services for children with OCI. CONCLUSION: This thesis has contributed to the understanding of children with OCIs by researching the development of a methodology to study this problem in a defined community sample. The information gained from the literature review and the community study were considered within two models of service provision. The models encompass service delivery from individualised to more population based approaches to the management of OCIs in children. From these models, specific suggestions for the community involved in the study were discussed. This thesis, therefore, provided a survey methodology that is resource efficient in the collection of community data useful in suggesting improved services for children with oral communication impairments.

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / "May 2008." Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0968. Adviser: Maria Fernandez. Includes bibliographical references.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0967. Adviser: Luisa Franzini. Includes bibliographical references.

Thesis--University of Oklahoma. / Bibliography: leaves 131-132.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Ethnographic study adapted to education that aimed to investigate the actions and relation of teachers and their daily work in sex education of adolescents in primary and secondary schools that configure the educational praxis of school experience and the specific objectives were: identify the teachers approach on sex education at school in the perception of adolescents; characterize the adolescents from the social and sex point of view; know the teachers' perception on sexuality and sex education; describe the teachers' work on sex education in a public school of Juazeiro do Norte- CE, Brazil; and, learn their values and attitudes toward adolescents' sexuality in school environment. The fieldwork was carried out from September 2009 to February 2010 through a questionnaire answered by 67 students, followed by observation and semi-structured interviews with seven teachers that had their classes observed. Questionnaire data was organized through the Collective Subject Discourse Method, teachers' perception of sexuality and sex education through thematic categorization. The analysis happened in a reflective and interpretive way. The students reported that the teachers usually did not approach the issues in classroom and when it was present it was predominantly in biological sciences, guided by the prerogative of preventing sexually transmitted infections. The concept of sexuality was divided in two categories: gender and sexual orientation. Besides physical aspects, there was spiritual elements and expression of love between humans, although these were secondary to the attributes of genitals and sexual intercourse, surrounded by the natural character. Sex education was based on three themes: sexual intercourse, body physiology and social behavior. Science classes figured as the most appropriate place to discuss the matter. It was found that even though the issues were raised by the students, the teachers were always omitted in any intervention. We verified the presence of moral and personal values in the conduction of educational practices, silence concerning the prejudice against homosexuals and the loss of virginity, as well as maintenance of gender inequalities. The approach on sexuality in the school environment does not happen in a cross-sectional way. The pedagogical practice was configured as sexist in a gender environment that uses silencing as a way of disciplining and controlling sexuality, as well as for the maintenance of hegemonic order, producing and reproducing the values and attitudes of the patriarchal and sexist society model. Thus, the teaching work needs constant renewal, being necessary to overcome the biomedical/scientific model on sexuality, considering its historical, social and cultural dimensions, whose crosssectional actions should be seek in various fields of knowledge. / Estudo do tipo etnográfico, adaptado à educação, cujo objetivo geral foi investigar ações e relações dos/as professores/as e seu trabalho cotidiano na educação sexual de adolescentes do Ensino Fundamental e Médio que configuram a práxis pedagógica da experiência escolar e os objetivos específicos foram: identificar a abordagem de professores/as acerca da educação sexual no espaço escolar segundo a percepção dos/as adolescentes; caracterizar os/as adolescentes escolares do ponto de vista social e sexual; conhecer a percepção sobre sexualidade e educação sexual dos/as professores/as; descrever o trabalho de educação sexual dos/as professores/as de uma escola pública de Juazeiro do Norte- CE; e, apreender os valores e as atitudes dos/as professores/as em relação à sexualidade de adolescentes no espaço escolar. O trabalho de campo foi desenvolvido de setembro de 2009 a fevereiro de 2010 por meio da aplicação de um questionário respondido por 67 estudantes, seguido de observação e entrevista semiestruturada com sete professores/as que tiveram aulas observadas. Os dados dos questionários foram organizados através do Método do Discurso do Sujeito Coletivo, a percepção docente de sexualidade e educação sexual por categorização temática. A análise aconteceu de forma reflexiva e interpretativa. Os/As estudantes referiram que os/as professores/as, geralmente, não abordavam as questões em sala de aula e quando esta esteve presente localizava-se, predominantemente, nas ciências biológicas, pautadas na prerrogativa da prevenção das infecções sexualmente transmissíveis. O conceito de sexualidade foi dividido em duas categorias: sexo e opção sexual. Além de aspectos corporais, houve elementos espirituais e de expressão do amor entre os seres, embora estes fossem secundários aos atributos genitais e do intercurso sexual, circundados pelo caráter natural. A educação sexual foi pautada sobre três eixos: relação sexual, fisiologia corporal e comportamento social. Para os/as docentes, as aulas de ciências se figuraram como espaço mais adequado para se tratar do assunto. Constatou-se que, mesmo sendo o assunto suscitado por parte dos/as estudantes, os/as professores/as se omitiram em realizar qualquer intervenção. Observou-se a presença de valores morais e pessoais na condução das práticas educativas, atitudes de silenciamento em relação ao preconceito a homossexuais e perda da virgindade, assim como manutenção das desigualdades de gênero. Conclui-se que a abordagem da sexualidade no espaço escolar não ocorre de forma transversal. A prática pedagógica configurou-se como sexista em ambiente generificado que usa o silenciamento como forma de disciplinamento e controle da sexualidade assim como para a manutenção da ordem hegemônica, produzindo e reproduzindo os valores e as atitudes do modelo de sociedade patriarcal e machista. Neste sentido, o trabalho docente necessita de constante renovação, sendo preciso superar o modelo biomédico/científico na sexualidade, considerando dimensões histórica, social, cultural e política, cuja transversalidade das ações deve ser meta a ser alcançada nos diversos campos do saber.

Made available in DSpace on 2014-12-17T15:43:55Z (GMT). No. of bitstreams: 1 SauloVS_DISSERT.pdf: 1488017 bytes, checksum: b6dafb093bd681e3fd6ec08af1e0b388 (MD5) Previous issue date: 2014-02-24 / Urinary incontinence (UI) is a geriatric syndrome that is especially prevalent in institutionalized individuals, and that causes economic and social impacts derived from treatment costs and overload of caregiver. UI also entails physical consequences to the health of the elderly, such as urinary tract infections or pressure ulcers, among other health problems. However, the existing national research on this condition is still scarce and comprises serious methodological biases. Therefore, the objective of this study is to determine the prevalence of urinary incontinence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December, 2013 and carried out in 10 nursing homes in the city of Natal (Northeast Brazil). UI was verified through the program Minimum Data Set version 3.0, which was also used to assess fecal incontinence, urinary devices and UI control programs. Data collection included sociodemographic information, UI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). Bivariate analysis was performed using the Chi-Square Test (or Fisher?s Exact Test) and the Linear Chi-Square Test, calculating the prevalence ratio with 95% confidence interval. Variables with p value under 0.20 were included in the multivariate analysis, which was performed using the Stepwise Forward logistic regression. The inclusion of variables in the final model depended on the likelihood ratio test, absence of multicollinearity and on the Hosmer-Lemeshow test. A statistical significance level of 0.05 was considered. Six (1.8%) hospitalized elderly, one individual in palliative care (0.3%) and one (0.3%) individual under the age of 60 were excluded from the study. The final sample consisted of 321 elderly, mostly females, with a mean age of 81.5 years. The prevalence of UI was 59.43% and the final model revealed statistically a significant association between UI and white race, physical inactivity, stroke, mobility constraints and cognitive decline. The most frequent UI type was functional UI due to physical or cognitive disability, and incontinence control measures were applied only to a minority of residents (approximately 8%). It is concluded that UI is a health issue that affects more than half of the institutionalized elderly, and is associated with white race, physical inactivity, stroke and other geriatric syndromes such as immobility and cognitive disability. Most of these associated factors are modifiable and therefore the findings of this study highlight the importance of UI prevention and treatment in nursing homes, which include general measures, such as physical and psychosocial activities, and specific measures, such as prompted voiding / A incontin?ncia urin?ria (IU) ? uma s?ndrome geri?trica especialmente prevalente em indiv?duos institucionalizados, que gera um forte impacto econ?mico e social derivado principalmente dos custos de tratamento e da sobrecarga dos cuidadores. Al?m disso, acarreta consequ?ncias f?sicas ? sa?de do idoso, como infec??o urin?ria ou ?lceras por press?o, entre outros agravos ? sa?de. No entanto, os trabalhos realizados no pa?s sobre este agravo ? sa?de s?o escassos e cont?m s?rios vieses metodol?gicos. Sendo assim, o objetivo do presente trabalho ? verificar a preval?ncia da incontin?ncia urin?ria e fatores associados nos idosos institucionalizados. Trata-se de um estudo transversal realizado entre outubro e dezembro de 2013 e desenvolvido em 10 institui??es de longa perman?ncia para idosos da cidade do Natal. A IU foi aferida mediante o Minimum Data Set vers?o 3.0, que tamb?m se utilizou para avaliar a incontin?ncia fecal, os dispositivos urin?rios e as medidas de controle da IU. Foram coletadas vari?veis sociodemogr?ficas, de caracteriza??o da IU e relacionadas ? institui??o e ?s condi??es de sa?de (comorbidades, medica??o, cirurgias do assoalho p?lvico, ?ndice de Barthel de capacidade funcional e Teste de Pfeiffer de capacidade cognitiva). Foi realizada a an?lise bivariada mediante os testes qui-quadrado de Pearson (ou teste de Fisher) e o teste qui-quadrado de tend?ncia linear, calculando a raz?o de preval?ncia com intervalo de confian?a de 95%. Por fim, as vari?veis com valor de p menor que 0,20, foram inclu?das na an?lise m?ltipla, que foi realizada mediante regress?o log?stica do tipo Stepwise Forward. A perman?ncia das vari?veis no modelo final deu-se segundo o teste da raz?o de verossimilhan?a, aus?ncia de multicolinearidade e teste de Hosmer and Lemeshow. Foi considerado o n?vel de signific?ncia estat?stica de 0,05. Foram exclu?dos 6 (1,8%) indiv?duos hospitalizados, 1 (0,3%) em fase terminal e 1 (0,3%) menor de 60 anos. A amostra foi composta por 321 idosos, a maioria do sexo feminino e com m?dia de idade de 81,5 anos. A preval?ncia de IU foi de 59,43% e o modelo multivariado mostrou associa??o estatisticamente significativa da IU com a ra?a branca, inatividade f?sica, acidente cerebrovascular, restri??o da mobilidade e decl?nio cognitivo. O tipo mais frequente foi a IU funcional por incapacidade f?sica ou cognitiva, e as medidas de controle da incontin?ncia foram aplicadas apenas em uma minoria dos residentes (aproximadamente 8%). Pode-se concluir que a IU ? um agravo ? sa?de que afeta a mais da metade dos idosos institucionalizados, e que est? associado ? ra?a branca, inatividade f?sica, acidente vasculocerebral e outras s?ndromes geri?tricas como a imobilidade e incapacidade cognitiva. A maior parte destes fatores associados s?o modific?veis e, portanto, os achados deste estudo alertam para a import?ncia de a??es de preven??o e tratamento da IU no ?mbito das institui??es, que incluam medidas gerais, como atividades f?sicas e psicossociais, e espec?ficas, como a evacua??o precoce