No description available.

Thesis (M. P. H.)--University of Hong Kong, 2006. / Also available in print.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Ohio State University, 2008. / Title from first page of PDF file. Includes bibliographical references (p. 117-129).

Thesis (M. Phil.)--University of Hong Kong, 1998. / Includes bibliographical references (leaves 124-144).

Thesis (M.P.H.)--University of Hong Kong, 2006.

Abstract Background: Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Methods: A quality improvement project using a plan, do, study, act (PDSA) cycle was used. HCW needs were assessed using a questionnaire; this was followed by a focus group discussion with HCWs, which was recorded, transcribed and assessed using a general inductive approach for common themes. Staff training was done using the Diabetic Foot Assessment Questionnaire. Patient information pamphlets and screening tools were made available to all clinical staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 to that in the first half of 2014 after initiation of the PDSA cycle. Results: HCW confidence in conducting foot screening using the Diabetic Foot Assessment Questionnaire improved markedly after initial training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first PDSA cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusions: The findings showed a significant improvement in the number of diabetic patients who received foot screening. A feedback session was held with the team of HCWs involved in the project to discuss their experience and for future improvement planning. Using strategic planning with appreciative intent based on SOAR, proved to be inspirational and will be used in the planning of the next cycle.

Made available in DSpace on 2014-06-11T19:22:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-12-16Bitstream added on 2014-06-13T20:49:20Z : No. of bitstreams: 1 fortaleza_acs_me_prud.pdf: 477345 bytes, checksum: f49debf4b9a2f0a76c98e9512ad369eb (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo do estudo foi verificar a estabilidade do ato de locomoção em diabéticos com neuropatia periférica, em três situações: marcha habitual com os olhos abertos; marcha com os olhos fechados e marcha com olhos abertos e diminuição da base de sustentação. Participaram do estudo 41 indivíduos, sendo 18 do grupo neuropata e 23 do grupo controle (GC). A avaliação da estabilidade foi realizada por meio de um baropodômetro associado ao software Footwalk Pro. Os dados obtidos foram: velocidade da marcha e porcentagens de tempo de duplo apoio e de apoio simples. Foram encontradas diferenças significantes nas três situações entre os grupos para a velocidade e tempo de apoio simples, com diminuição para o grupo neuropata (p<0,05), e tempo de duplo apoio, com aumento para esse grupo (p<0,05) em todas as condições. Para os dados de velocidade, tempo de duplo apoio e tempo de apoio simples, a condição de olho aberto foi diferente da condição de olho fechado (p=0,001) e da condição com diminuição da base de sustentação (p=0,001). Foi possível observar que nas três situações avaliadas, o grupo neuropata apresentou déficit na estabilidade do ato de locomoção e tal desempenho foi ainda mais comprometido nas duas situações que exigiam mais do controle postural. Tais modificações da marcha, decorrentes da complexidade imposta pelas diferentes condições, sugerem a inserção destas na avaliação e no tratamento dessa população / The aim of this study was to verify the stability of the act of locomotion in diabetics with peripheral neuropathy in three situations: habitual gait with eyes opened, gait with eyes closed, and gait with eyes opened and reduced base of support. The study included 41 subjects: 18 of the neuropathic group and 23 in the control group. The stability was evaluated by baropodometry platform associated with the software Footwalk Pro. Data were obtained: gait speed and percentual of double stance time and single stance time. Significant differences were found in the three cases between the groups in the data of gait speed and single stance time, with a larger reduction for neuropathic group (p<0,05) and increased in double stance time in the neuropathic group (p<0,05) in all conditions. For data of gait speed measure, double stance time and single stance time, the condition eyes opened was different from eyes closed (p=0,001) and from the condition with reduced base of support (p=0,001). It was observed that in the three situations evaluated, the neuropathic group showed stability locomotion deficit and the performance was more injured in both situations that required more postural control. Such gait modifications, due to the complexity imposed by different conditions, suggest the inclusion of these in the evaluation and treatment of this population

DKD is the leading cause of kidney failure in Canada and its patients suffer the highest morbidity and mortality rates of any kidney failure patient group. Current interventions including strict glycemic control only delay DKD. Thus, there is a major need to identify new therapeutic targets. High glucose (HG) is identified as a major pathogenic factor, inducing the release of growth factors leading to kidney fibrosis. Although treatments have been developed to target these factors, their effectiveness is accompanied by adverse effects due to the lack of specificity. Recently, activins have been suggested to have a prominent role in promoting renal fibrosis and developing a specific anti-activin therapy can avoid potential side effects. Although there is evidence supporting an important role for activin A (ActA) in the induction of fibrosis in DKD, whether ActB also contributes is unknown. In this study, we aim to determine the potential contribution of ActB to promoting fibrosis. Our results show that ActA and ActB are upregulated in rodent and human DKD. We show that hyperglycemia leads to the secretion of ActA and ActB by mesangial cells (MC), whereas only ActB is secreted by renal fibroblasts (RF). Similar to HG, treatment with ActA or ActB leads to Smad2/3 activation and upregulation of extracellular matrix proteins, whereas specific inhibition of either ActA or ActB attenuates these effects. We show that ActA and ActB regulate HG-induced activation of MRTF-A/SRF in MC, leading to an activated phenotype characterized by increased α-SMA expression and ECM production. Lastly, we confirm the specificity and functionality of the activin propeptides in vitro, providing evidence for their effectiveness in vivo. This study will help further our knowledge of the role activins in DKD, potentially providing an alternative therapy. / Thesis / Master of Science (MSc) / As the leading cause of end stage renal disease, diabetic kidney disease (DKD) is described as the reduction in renal function due to chronic exposure to diabetes. This thesis is aimed to understand the pathways and mechanisms that contribute to the development and progression of DKD to help identify novel therapeutic options. This project identified activin B (ActB) as a contributor to the disease and gives evidence that blocking the actions of ActB can prevent profibrotic effects in cells, similar to the profibrotic effects seen in DKD. Furthermore, this thesis demonstrates preliminary evidence for the beneficial effects of anti-ActB therapy, providing a potential alternative therapeutic option for DKD patients.

Diabetic foot ulcers (DFUs) impart a large burden on patients and the healthcare system in Canada. Health utility estimates are an integral part of determining the cost-effectiveness of treatments for DFUs. The objective of this thesis was to identify health utility estimates for patients with non-healing DFUs. A systematic review of studies reporting health utility estimates for non-healing DFUs was conducted and included nine studies. The quality of the studies, as it related to the health utility estimates for non-healing DFUs, was difficult to determine due to a lack of reporting of study and patient characteristics. The health utility estimates ranged from 0.44 to 0.89. None of the studies investigated for factors associated with the health utility of patients with non-healing DFUs. In addition, an exploratory regression analysis of data from a randomized controlled trial (RCT) of hyperbaric oxygen therapy (HBOT) in patients with chronic, non-healing DFUs was conducted. No factors were identified that were associated with health utility; however, the sample size was small and the analysis exploratory. Further research is required to identify such factors. Finally, a descriptive regression model, including several baseline factors, was created which provided a heath utility estimate of 0.647 for Canadian patients with non-healing DFUs; however, the results should be interpreted with caution, especially as some subgroups had very small numbers of patients (e.g., Wagner Grade of 4; patients with 4 or more wounds). In summary, guidance is lacking on the best methodology to conduct and analyze studies that provide estimates of the health utility of patients with non-healing DFUs, or any other health state, that are to be used to inform economic evaluations. Additionally, a tool is needed to aid analysts in critically appraising studies so that they can select the best estimate of health utility value to include in economic evaluations. / Thesis / Master of Health Sciences (MSc) / Diabetic foot ulcers (DFUs) impart a large burden on patients and the healthcare system in Canada. The objective of this thesis was to identify health utility estimates for patients with non-healing DFUs. A systematic review was conducted and included nine studies, for which health utility estimates ranged from 0.44 to 0.89. An exploratory regression analysis of data from an Ontario-based study in patients with non-healing DFUs was conducted. No factors associated with health utility were identified but further research is required. A descriptive regression model, adjusting for several baseline factors, provides a health utility of 0.647 for Canadian patients, but should be interpreted with caution. Guidance is needed on the best methodology to conduct studies to estimate the health utilities for use in economic evaluations and for a tool to critically appraise studies to help select the best estimate of health utility for inclusion in economic evaluations.