Objectif : L’objectif est l’étude de plusieurs méthodes de prise en compte des facteurs de confusion, mesurés ou non mesurés, ce en situation observationnelle de population de patients psychotiques ou schizophrènes. Méthodes : Deux méthodes ont été utilisées : le score de propension (adaptés aux données mesurées) et les analyses de sensibilité (pour les informations non mesurées). Le champ d’application est celui de l’épidémiologie clinique en psychiatrie, et plus spécifiquement celui de la schizophrénie. Le développement s’appuie sur trois parties successives. La première partie met en exergue la question de la discussion du biais résiduel. Pour cela, on s’appuie sur les résultats d’une étude transversale d’exposition à un facteur contextuel (la prison), ce dans le cadre de la présence de troubles psychotiques (au sens axe DSM IV), à partir d’une méthodologie d’ajustement conventionnelle classique. La deuxième partie est une comparaison d’une technique d’ajustement classique à un ajustement par score de propension. Pour cela, on utilise les résultats issus d’une étude de cohorte avec la survenue d’un évènement selon l’exposition à un traitement en population schizophrène, à partir de l’utilisation du score de propension comme outil d’ajustement. La troisième partie est une synthèse sur la modélisation de l’incertitude et des biais de confusion non mesurés multiples. Les théories et méthodes sont décrites, puis appliquées aux résultats des deux études précédentes. Résultats : L’étude transversale, dont les résultats non montrés jusqu’à présent, permet de poser la problématique de la qualité de l’ajustement dans le cadre d’une exposition à un facteur en situation observationnelle. L’étude de cohorte permet de comparer une technique d’ajustement classique à un ajustement par score de propension (SP). Nous avons étudié plusieurs méthodes d’ajustement (multivarié standard, avec ajustement sur SP, avec appariement sur SP). Et nous mettons en évidence que, selon la méthode d’ajustement utilisée, les résultats obtenus sont différents. La méthode de stratification sur SP semble être la meilleure. Les méthodes de prise en compte des facteurs de confusion non mesurés sont ensuite étudiées. Une première étape fait état de l’apport des théories probabilistes et des techniques apparentées, ensuite une combinaison de ces théories est proposée avec une application pratique aux deux études présentées précédemment. Conclusion : Dans le cas des études observationnelles, l’objectif de ce travail a été d’étudier, de décrire et d’appliquer des techniques de modélisation pour mieux prendre en compte les différences initiales, potentiellement source de confusion. C’est un travail à la frontière entre la méthodologie, les biostatistiques et l’épidémiologie. Nous nous appuyons sur des difficultés rencontrées, en pratique en épidémiologie psychiatrique (pathologies mentales à étiologies multifactorielles et interdépendantes) pour proposer une approche pragmatique de la prise en compte optimale des facteurs de confusion potentiels, mesurés ou non mesurés. / Objective : To evaluate control methods for measured or unmeasured confusion bias, in observational situation of psychotic or schizophrenic patients. Methods : Propensity score method (for measured confusion bias) and analyses of sensibility (for unmeasured confusion bias) were applied in the field of psychiatric epidemiology, specifically in schizophrenia. In first, the question of residual bias was underlined by the results of a transversal study. The exposition at a contextual parameter (prison) was studied in link with psychotic disorders (DSM IV), with a classic control method.Second, to lead to an unbiased estimation of treatment effect, we compared a classic control method with a method based on propensity score. These approach were applied to a cohort of French schizophrenic patients where we studied the event (relapse) by the treatment exposition (polypharmacy or not).Third, we developed a synthesis on modelisation of uncertainty and non-measured confusion bias. Theories and methods were described, and then applied on results of previous studies. Results : The transversal study, with non-demonstrated results still then, allow us to reach the question of control quality in the case of exposition to a parameter in observational situation. The cohort study permit to compare a classic control method and propensity score (PS). We highlighted different results according to some control method. Stratification method on PS seemed to be the best method to predict relapse according to treatment exposition. Non-measured bias control methods were then described. And a combination of probabilistic methods was applied to the previous studies. Conclusion : In the case of observational studies, the objective was to study, to describe and to apply modelisation methods to take in account differences at baseline, potentially source of confusion bias. This research is at the crossroads of methodology, biostatistics and epidemiology.

Depression is common in people with coronary heart disease (CHD) and is associated with worse physical outcomes. The nature of the causal association between CHD and depression, and the mechanism underpinning the association of depression with worse physical outcomes, remains unclear. Perseverative negative thinking may contribute to the development of depression in people with CHD. The aim of this thesis was to investigate the prospective association of perseverative negative thinking with depression, anxiety and worse physical outcomes in people with CHD, and to explore factors that may mediate this association. First, a systematic review identified 30 studies, of which the majority found an association between measures of perseverative negative thinking and subsequent depression, anxiety or emotional distress in people with long term conditions. Studies that controlled for covariates showed more mixed results, though the majority (15 / 25) still supported a significant association, with effects being small in magnitude. Findings were limited mainly to the association of rumination and/or catastrophizing with subsequent depression, and study quality was limited. Next, in an observational prospective cohort study 169 inpatients and outpatients with recent acute coronary syndrome (ACS) completed self-report assessments of rumination (Ruminative Responses Scale brooding subscale), worry (Penn State Worry Questionnaire), depression (Patient Health Questionnaire-8), anxiety (Beck Anxiety Inventory), and health-related quality of life (EuroQol-5D health-related quality of life, Seattle Angina Questionnaire) after hospitalisation, and at 2 month and 6 month follow-up. Additionally, assessments of potential mechanistic factors (social support, problem solving, instrumental behaviours and negative cognitive biases) were made. Baseline brooding was a significant independent predictor of depression at 6 months after controlling for the effects of important confounding variables, accounting for 2% of the variance. Findings suggested that the association of brooding with depression may be explained by deficits in problem solving ability. Rumination and problem solving may provide useful targets for the development of evidence-based interventions to improve depression among people with CHD, although the findings presented here fall short of proving a causal relationship. Future trials could be used to investigate the causal nature of the association of rumination and problem solving with depression in people with ACS.

INTRODUÇÃO: A hipertensão arterial sistêmica é a principal causa evitável de morbimortalidade cardiovascular no mundo contemporâneo, principalmente nos países de baixa renda. Avaliações populacionais das taxas de sucesso no controle dessa entidade precisam ser instituídas e continuamente realizadas. A compreensão do comportamento epidemiológico da hipertensão arterial sistêmica em coortes contemporâneas é importante para o planejamento de novas medidas de intervenção populacional. O presente estudo visa, como objetivo primário, a avaliar a eficácia no controle da hipertensão arterial sistêmica e a determinar preditores independentes associados ao melhor controle pressórico, em uma população de hipertensos sob tratamento medicamentoso derivada do Mutirão de Avaliação de Risco Cardiovascular. Como objetivo secundário, o estudo visa a avaliar a taxa de sujeitos sem diagnóstico prévio de hipertensão arterial sistêmica que apresentam a primeira medida pressórica alterada, assim como a determinar os preditores independentes desse achado. MÉTODOS: Estudo observacional, transversal, em que foram avaliados os participantes do Mutirão de Avaliação de Risco Cardiovascular dos municípios de São Paulo e Campinas. Foram incluídos nessa análise sujeitos com mais de 18 anos de idade, residentes nos municípios de São Paulo e Campinas. Para responder ao objetivo primário, foram analisados hipertensos com diagnóstico prévio e uso de medicamento anti-hipertensivo. Para responder ao objetivo secundário, foram analisados os sujeitos sem diagnóstico prévio de hipertensão e que não estavam em uso de medicações anti-hipertensivas. Utilizou-se análise multivariada para identificar preditores associados ao controle pressórico. RESULTADOS: Identificou-se 43.647 sujeitos hipertensos em uso de medicação, sendo que 40,9% destes estavam com níveis pressóricos controlados, considerando a meta de pressão arterial sistólica < 140 mmHg e pressão arterial diastólica < 90 mmHg. Entre os hipertensos não controlados, 42,5% apresentaram hipertensão arterial sistêmica em estágios II ou III (pressão arterial sistólica > 160 mmHg ou pressão arterial diastólica > 100 mmHg). Em análise multivariada, mostraram-se preditores independentes para melhor controle pressórico: idade < 60 anos [razão de chance (RC) 1,14, intervalo de confiança (IC) 95% 1,09-1,18], atividade física de moderada intensidade (RC 1,18, IC 95% 1,13-1,23), antecedente de doença cardiovascular (RC 1,09, IC 95% 1,04-1,13) e ingesta de frutas diariamente (RC 1,05, IC 95% 1,01-1,10). Mostraram-se preditores para controle pressórico inadequado: sexo masculino (RC 0,69, IC 95% 0,66-0,72), diabetes (RC 0,83, IC 95% 0,80-0,87), etnia negra (RC 0,88, IC 95% 0,83-0,94) ou parda (RC 0,92, IC 95% 0,87-0,97) em relação à branca e obesidade (RC 0,73, IC 95% 0,70-0,76). Entre 45.021 participantes sem diagnóstico prévio de hipertensão arterial sistêmica, 27,6% apresentaram a primeira medida pressórica elevada (pressão arterial > 140 x 90 mmHg). Mostraram-se preditores independentes para esse achado: sexo masculino (RC 2,05, IC 95% 1,96-2,15), idade > 60 anos (RC 1,88, IC 95% 1,78-1,98), etnia negra (RC 1,15, IC 95% 1,06-1,24) ou parda (RC 1,11, IC 95% 1,06-1,17) em relação à branca, obesidade (RC 2,08, IC 95% 1,98-2,19), diabetes (RC 1,09, IC 95% 1,01-1,18), antecedente de doença cardiovascular (RC 0,91, IC 95% 0,87-0,96) e atividade física de moderada intensidade (RC 0,87, IC 95% 0,83-0,92). CONCLUSÕES: Menos da metade dos hipertensos em tratamento estavam com seus níveis pressóricos controlados. Preditores independentes associados ao controle pressórico foram identificados, sendo três deles modificáveis. Estratégias populacionais devem ser implantadas para o controle efetivo desse importante fator de risco cardiovascular. / INTRODUCTION: Systemic arterial hypertension is the leading avoidable cause of cardiovascular morbidity and mortality in the contemporary world, mainly in low-income countries. Population evaluation of efficient strategies for blood pressure control should be implemented, and continually evaluated. Epidemiological understanding of systemic arterial hypertension in large cohorts plays important role for planning new interventions in the population level. The study objective is to evaluate the effectiveness of blood pressure control and to determine independent predictors, associated with better blood pressure control, in hypertensive patients on medical treatment from the Cardiovascular Risk Assessment in Sao Paulo and Campinas. The secondary objective is to access the rate of patients without previous diagnosis of systemic arterial hypertension in whom the blood pressure measurement is above recommended values, as well as determining independent predictors related with this finding. METHODS: The study design is an observational cross-sectional strategy in the municipalities of São Paulo and Campinas. Patients over the age of 18 living in São Paulo and Campinas, with previous diagnosis of systemic arterial hypertension and use of anti-hypertensive were included. Patients without previous diagnosis of hypertension and not using anti-hypertensive medication were also included. It was conducted a multivariate analysis to identify independent predictors associated with blood pressure control. RESULTS: We identified 43,647 hypertensive subjects on anti-hypertensive treatment. Of these 17,835 (40.9%) had controlled blood pressure levels, considering a target systolic blood pressure <140 mmHg and diastolic blood pressure < 90 mmHg. Among patients with uncontrolled hypertension, 42.5% were categorised as stage II or III hypertension (systolic blood pressure >=160 mmHg or diastolic BP >=100 mmHg). In a multivariate analysis, the following independent predictors were identified indicating better blood pressure control: age< 60 years [odds ratio (OR) 1.14, confidence interval (CI) 95% 1.09-1.18], moderate physical activity (OR 1.18, CI 95% 1.13-1.23), pre-existing atherosclerotic cardiovascular disease (OR 1.09, CI 95% 1.04-1.13) and daily consumption of fruit (OR 1.05, CI 95% 1.01-1.10). Predictors of poorer BP control were male sex (OR 0.69, CI 95% 0.66-0.72), diabetes mellitus (OR 0.83, CI 95% 0.80-0.87), African ethnicity (OR 0.88, CI 95% 0.83-0.94) or mixed African ethnicity (OR 0.92, CI 95% 0.87- 0.97) when compared to Caucasian ethnicity, obesity (OR 0.73, CI 95% 0.70-0.76). Among 45,021 participants without previous diagnosis of hypertension, 27.6% presented abnormal levels of blood pressure at the first measurement (BP >= 140/90 mmHg). The following independent predictors were identified: male sex (OR 2.05, CI 95% 1.96-2.15), age > 60 years (OR 1.88 CI 95% 1.78-1.98), African ethnicity (OR 1.15, CI 95% 1.06-1.24) or mixed African ethnicity (OR 1.11, CI 95% 1.06-1.17) when compared to Caucasian, obesity (OR 2.08, CI 95% 1.98-2.19), diabetes (OR 1.09, CI 95% 1.01-1.18), previous history of cardiovascular disease (OR 0.91, CI 95% 0.87-0.96) and moderate physical activity (OR 0.87, CI 95% 0.83-0.92). CONCLUSIONS: Less than half of hypertensive patients in treatment had controlled blood pressure. Independent predictors associated with blood pressure control were identified and three of them are modifiable. Population strategies should be implemented for effective control of this clinically relevant cardiovascular risk factor.

Os objetivos desse estudo de coorte realizado em crianças pré-escolares foram: (1) avaliar a validade preditiva e de constructo utilizando um critério de avaliação de atividade de lesões de cárie associado ao Sistema Internacional de Detecção e Avaliação de Cárie (ICDAS, do inglês International Caries Detection and Assessment System); (2) avaliar o risco de superfícies hígidas, com lesões iniciais de cárie (escores 1 e 2 do ICDAS) e lesões moderadas (escores 3 e 4) progredirem para lesões cavitadas em dentina (escores 5 e 6 do ICDAS) em dentes decíduos; (3) avaliar a influência da presença de lesões iniciais no risco de desenvolvimento de lesões de cárie; (4) avaliar se o impacto da cárie dentária na qualidade de vida de crianças se altera com o incremento de novas lesões ao longo do tempo; e (5) avaliar o impacto da cárie dentária em diferentes estágios de severidade na piora da qualidade de vida relacionada à saúde bucal em crianças. Um exame inicial foi realizado por 15 examinadores durante o Dia Nacional de Vacinação em junho de 2010, na cidade de Santa Maria (RS). Nesse dia, 639 crianças de um a cinco anos de idade foram examinadas utilizando o ICDAS para detecção das lesões de cárie e um critério adicional para avaliação da atividade das lesões de cárie. Outras variáveis demográficas e socioeconômicas relacionadas a cada criança foram coletadas com os pais das crianças. Um questionário para avaliar o impacto das condições bucais na qualidade de vida das crianças (ECOHIS, do inglês Early Childhood Oral Health Impact Scale) também foi aplicado aos pais. Após dois anos, as mesmas crianças foram reexaminadas por quatro examinadores treinados e recalibrados para a avaliação das condições relacionadas à cárie dentária. O questionário ECOHIS também foi reaplicado. A associação entre as diversas variáveis explanatórias e os desfechos foram avaliadas usando análises de regressão de Poisson apropriadas (regular ou de multinível) que permitiram o cálculo dos valores de risco relativo e respectivos intervalos de confiança a 95%. Após dois anos, um total de 469 crianças foram reavaliados (taxa de acompanhamento positivo de 73,4%). As lesões de cárie ativas não cavitadas na superfície oclusal apresentaram um risco duas vezes maior de progressão quando comparado com as lesões inativas. Também foi observado que lesões não cavitadas em crianças com lesões de cárie severa no início do estudo apresentaram três vezes maior risco de progressão do que crianças com apenas lesões iniciais. Além disso, crianças com lesões moderadas ou severas apresentaram maior risco de desenvolverem novas lesões comparadas a crianças livres de cárie. Esse efeito foi observado em crianças com lesões iniciais quando eram menores de três anos. Quando o desfecho foi o impacto da saúde bucal na qualidade de vida, as crianças que tiveram novas lesões apresentaram piora na qualidade de vida quando comparadas com aquelas crianças que não desenvolveram novas lesões cariosas, e isso foi relacionado à severidade. Considerando os diferentes estágios da doença cárie na avaliação longitudinal da qualidade de vida, apenas as crianças com lesões moderadas ou crianças com lesões severas no início do estudo apresentaram piora na qualidade de vida após dois anos. Em conclusão, o sistema de atividade de cárie adicional associado ao ICDAS apresenta validade preditiva e de constructo em dentes decíduos. No entanto, as lesões de cárie iniciais de um modo geral apresentam baixa taxa de progressão, e essas lesões têm maior risco de progressão em crianças com pelo menos uma lesão moderada ou severa em outro dente. Outro fato é que a presença de lesões moderadas ou severas é um importante preditor para o surgimento de novas lesões de cárie. No entanto, comparado a crianças livres de cárie, crianças com apenas lesões iniciais de cárie aparentemente possuem maior risco de desenvolverem novas lesões somente nas idades mais precoces (até três anos de idade). Ainda, pôde-se constatar que o maior número de novas lesões de cárie provoca uma piora da qualidade de vida em crianças pré-escolares. Entretanto, a presença de lesões iniciais não causa um impacto na qualidade de vida após dois anos, mas a presença de lesões moderadas e extensas provocam essa piora. / The aims of the present cohort study carried out in preschool children were: (1) to evaluate predictive and construct validity of an additional criteria to assess caries lesions activity associated to the International Caries Detection and Assessment System (ICDAS); (2) to evaluate the risk of sound surfaces, initial (scores 1 and 2 of ICDAS) and moderate caries lesions (ICDAS scores 3 and 4) to progress to dentin cavitated lesions (ICDAS scores 5 and 6) in primary teeth; (3) to investigate the influence of presence of initial caries lesions on risk of occurrence of new caries lesions; (4) to evaluate if the impact of dental caries on quality of life of children suffers worsening due to the occurrence of new caries lesions; and (5) to investigate the impact of dental caries in different stages of progression on worsening of oral health-related quality of life. An initial examination was conducted by 15 examiners during the National Children\'s Vaccination Day in June, 2010, in Santa Maria (RS). At this day, 639 children aged from one to five years were examined using the ICDAS for the detection of caries lesions and with an additional criteria for evaluation of caries lesions activity. Other demographic and socioeconomic variables related to each child were collected with the children\'s guardians. A questionnaire to evaluate the impact of oral health on quality of life of the children (Early Childhood Oral Health Impact Scale - ECOHIS) was also applied for the parents. After two years, the same children were reexamined by four trained and recalibrated examiners to evaluate the oral conditions related to the dental caries. ECOHIS was also answered again. Association among the explanatory and the outcome variables were assessed through Poisson regression analysis (regular or multilevel), which permitted to calculate the relative risk values and respective 95% confidence intervals. After two years, a total of 469 children were re-evaluated (follow-up rate of 73.4%). Active non-cavitated caries lesions in occlusal surfaces presented a twice higher risk of progression when compared with inactive lesions. It was also observed that non-cavitated caries lesions in children presenting extensive caries lesions at the baseline had thrice higher risk of progression than in children with only initial caries lesions. Moreover, children with moderate or extensive caries lesions showed higher risk of having new caries lesions than caries free children. This effect was observed in children who were younger than three years old. When the variable outcome was the impact of oral health on quality of life, children who had new caries lesions presented worsening on quality of life when compared with children who had not developed new caries lesions, and this was related to the severity. Considering the different stages of dental caries on the longitudinal evaluation, only children with moderate or extensive caries lesions at the baseline presented worsening on the quality of life after two years. In conclusion, the additional criteria system to assess caries activity used with the ICDAS presents predictive and construct validity in primary teeth. Nevertheless, initial caries lesions generally present a low progression rate, and these lesions have higher risk of progression in children with at least one moderate or extensive caries lesion in other tooth. Other fact is that the presence of moderate or extensive caries lesions is an important predictor for caries incidence. Nonetheless, compared with caries-free children, children with only initial caries lesions apparently have higher risk of developing new caries lesions only at the earlier ages (up to three years old). In addition, it was observed that higher number of new caries lesions provokes worsening on quality of life of preschool children. However, presence of only initial caries lesions does not cause impact on quality of life after two years, but presence of moderate and extensive caries lesions does cause.

Os objetivos desse estudo de coorte realizado em crianças pré-escolares foram: (1) avaliar a validade preditiva e de constructo utilizando um critério de avaliação de atividade de lesões de cárie associado ao Sistema Internacional de Detecção e Avaliação de Cárie (ICDAS, do inglês International Caries Detection and Assessment System); (2) avaliar o risco de superfícies hígidas, com lesões iniciais de cárie (escores 1 e 2 do ICDAS) e lesões moderadas (escores 3 e 4) progredirem para lesões cavitadas em dentina (escores 5 e 6 do ICDAS) em dentes decíduos; (3) avaliar a influência da presença de lesões iniciais no risco de desenvolvimento de lesões de cárie; (4) avaliar se o impacto da cárie dentária na qualidade de vida de crianças se altera com o incremento de novas lesões ao longo do tempo; e (5) avaliar o impacto da cárie dentária em diferentes estágios de severidade na piora da qualidade de vida relacionada à saúde bucal em crianças. Um exame inicial foi realizado por 15 examinadores durante o Dia Nacional de Vacinação em junho de 2010, na cidade de Santa Maria (RS). Nesse dia, 639 crianças de um a cinco anos de idade foram examinadas utilizando o ICDAS para detecção das lesões de cárie e um critério adicional para avaliação da atividade das lesões de cárie. Outras variáveis demográficas e socioeconômicas relacionadas a cada criança foram coletadas com os pais das crianças. Um questionário para avaliar o impacto das condições bucais na qualidade de vida das crianças (ECOHIS, do inglês Early Childhood Oral Health Impact Scale) também foi aplicado aos pais. Após dois anos, as mesmas crianças foram reexaminadas por quatro examinadores treinados e recalibrados para a avaliação das condições relacionadas à cárie dentária. O questionário ECOHIS também foi reaplicado. A associação entre as diversas variáveis explanatórias e os desfechos foram avaliadas usando análises de regressão de Poisson apropriadas (regular ou de multinível) que permitiram o cálculo dos valores de risco relativo e respectivos intervalos de confiança a 95%. Após dois anos, um total de 469 crianças foram reavaliados (taxa de acompanhamento positivo de 73,4%). As lesões de cárie ativas não cavitadas na superfície oclusal apresentaram um risco duas vezes maior de progressão quando comparado com as lesões inativas. Também foi observado que lesões não cavitadas em crianças com lesões de cárie severa no início do estudo apresentaram três vezes maior risco de progressão do que crianças com apenas lesões iniciais. Além disso, crianças com lesões moderadas ou severas apresentaram maior risco de desenvolverem novas lesões comparadas a crianças livres de cárie. Esse efeito foi observado em crianças com lesões iniciais quando eram menores de três anos. Quando o desfecho foi o impacto da saúde bucal na qualidade de vida, as crianças que tiveram novas lesões apresentaram piora na qualidade de vida quando comparadas com aquelas crianças que não desenvolveram novas lesões cariosas, e isso foi relacionado à severidade. Considerando os diferentes estágios da doença cárie na avaliação longitudinal da qualidade de vida, apenas as crianças com lesões moderadas ou crianças com lesões severas no início do estudo apresentaram piora na qualidade de vida após dois anos. Em conclusão, o sistema de atividade de cárie adicional associado ao ICDAS apresenta validade preditiva e de constructo em dentes decíduos. No entanto, as lesões de cárie iniciais de um modo geral apresentam baixa taxa de progressão, e essas lesões têm maior risco de progressão em crianças com pelo menos uma lesão moderada ou severa em outro dente. Outro fato é que a presença de lesões moderadas ou severas é um importante preditor para o surgimento de novas lesões de cárie. No entanto, comparado a crianças livres de cárie, crianças com apenas lesões iniciais de cárie aparentemente possuem maior risco de desenvolverem novas lesões somente nas idades mais precoces (até três anos de idade). Ainda, pôde-se constatar que o maior número de novas lesões de cárie provoca uma piora da qualidade de vida em crianças pré-escolares. Entretanto, a presença de lesões iniciais não causa um impacto na qualidade de vida após dois anos, mas a presença de lesões moderadas e extensas provocam essa piora. / The aims of the present cohort study carried out in preschool children were: (1) to evaluate predictive and construct validity of an additional criteria to assess caries lesions activity associated to the International Caries Detection and Assessment System (ICDAS); (2) to evaluate the risk of sound surfaces, initial (scores 1 and 2 of ICDAS) and moderate caries lesions (ICDAS scores 3 and 4) to progress to dentin cavitated lesions (ICDAS scores 5 and 6) in primary teeth; (3) to investigate the influence of presence of initial caries lesions on risk of occurrence of new caries lesions; (4) to evaluate if the impact of dental caries on quality of life of children suffers worsening due to the occurrence of new caries lesions; and (5) to investigate the impact of dental caries in different stages of progression on worsening of oral health-related quality of life. An initial examination was conducted by 15 examiners during the National Children\'s Vaccination Day in June, 2010, in Santa Maria (RS). At this day, 639 children aged from one to five years were examined using the ICDAS for the detection of caries lesions and with an additional criteria for evaluation of caries lesions activity. Other demographic and socioeconomic variables related to each child were collected with the children\'s guardians. A questionnaire to evaluate the impact of oral health on quality of life of the children (Early Childhood Oral Health Impact Scale - ECOHIS) was also applied for the parents. After two years, the same children were reexamined by four trained and recalibrated examiners to evaluate the oral conditions related to the dental caries. ECOHIS was also answered again. Association among the explanatory and the outcome variables were assessed through Poisson regression analysis (regular or multilevel), which permitted to calculate the relative risk values and respective 95% confidence intervals. After two years, a total of 469 children were re-evaluated (follow-up rate of 73.4%). Active non-cavitated caries lesions in occlusal surfaces presented a twice higher risk of progression when compared with inactive lesions. It was also observed that non-cavitated caries lesions in children presenting extensive caries lesions at the baseline had thrice higher risk of progression than in children with only initial caries lesions. Moreover, children with moderate or extensive caries lesions showed higher risk of having new caries lesions than caries free children. This effect was observed in children who were younger than three years old. When the variable outcome was the impact of oral health on quality of life, children who had new caries lesions presented worsening on quality of life when compared with children who had not developed new caries lesions, and this was related to the severity. Considering the different stages of dental caries on the longitudinal evaluation, only children with moderate or extensive caries lesions at the baseline presented worsening on the quality of life after two years. In conclusion, the additional criteria system to assess caries activity used with the ICDAS presents predictive and construct validity in primary teeth. Nevertheless, initial caries lesions generally present a low progression rate, and these lesions have higher risk of progression in children with at least one moderate or extensive caries lesion in other tooth. Other fact is that the presence of moderate or extensive caries lesions is an important predictor for caries incidence. Nonetheless, compared with caries-free children, children with only initial caries lesions apparently have higher risk of developing new caries lesions only at the earlier ages (up to three years old). In addition, it was observed that higher number of new caries lesions provokes worsening on quality of life of preschool children. However, presence of only initial caries lesions does not cause impact on quality of life after two years, but presence of moderate and extensive caries lesions does cause.

The purpose of this pilot investigation was to assess the inter-rater reliability of an expert-validated pediatric feeding assessment, designed for clinician use with children who have severe disabilities. The tool would ideally allow for standardization of the clinical mealtime assessment process. A comprehensive review of available feeding instruments revealed that there is a need for an assessment tool for children with motor and developmentally based feeding problems.In response to this need, a new clinician administered instrument called the Mealtime Assessment Tool for Children (MATCH) was developed in order to guide the assessment of a child during a clinical meal. The items on the MATCH were selected based on expert validation of normal and abnormal feeding patterns that remain constant across the feeding assessments found in the literature. The tool includes a rating scale that allows for gradation of the severity of the problem. Child participants were taped while eating, and clips were rated by four SLPs using the MATCH. The resulting data was analyzed quantitatively, and it was found that across items there was a strong percentage agreement.

The Common Core State Standards for Mathematics (CCSSM) require students with learning disabilities in mathematics to use a range of cognitive, skills, and foundational numerical competencies to learn and understand complex standards. Students with learning disabilities in mathematics experience deficits in cognitive processes skills and foundational numerical competencies which have emerged as underlying barriers associated with mastering CCSSM. Examining the impact of high-stakes assessments on readiness for college and careers and student achievement may provide evidence that deficits in cognitive processing skills and numerical competencies can impact achievement levels. Using the cognitive theoretical frameworks of Bandura and Gagné, along with the concepts of cognitive learning, instructional interventions, and inclusion, the relationship between students' scores in the algebraic foundations (AF) intervention inclusion method and the regular algebra (RA) nonintervention inclusion method, as measured on the end of the year assessments were examined in this study. An ANCOVA design was used to test the statistical significance of the relationship between the two intervention methods and the use of cognitive and numerical competencies for the two groups and to analyze the disparity in achievement scores between the AF intervention inclusion method and RA nonintervention inclusion method. The results revealed a statistically significant relationship between cognitive processing skills and foundational numerical competencies as measured on the final exam for both methods. The intended audience include academic communities using evidence-based inventions to improve college and career readiness results, leading to positive social change.

Research has shown that video modelling can improve social behaviours in children with ASD. In addition, research in behaviour modelling training from the field of organisational psychology has shown that using a mix of positive and negative exemplars can assist in acquisition and generalisation of a skill. The current study compared the use of one negative and one positive exemplar, with the use of two positive exemplars to determine which combination would result in faster acquisition and/or superior generalisation of a skill. No other studies have examined this with children diagnosed with ASD. Seven children, aged between 5 and 15 years, and diagnosed with ASD participated in a multiple baseline design across children; within child across two modelling conditions; and within each modelling condition across two tasks. In one condition, a participant watched a video containing one exemplar of a model (same sex and of similar age but with normal development) perform a task the wrong way, and one exemplar of the same model perform the same task the right way (wrong/right). In another condition, the participant watched a video containing two different exemplars of the model perform a matched task the right way (right/right). During the intervention, 1 participant refused to watch the videos. For 13 of the 16 tasks, where training was completed, participants either reached criterion or made some gains in acquisition of the social skills. However, for seven of the tasks criterion was not reached. Generally, neither modelling condition was superior in acquisition or generalisation of the targeted social skills. Confounds occurring during the course of the study may have contributed to the equivocal results. For some children with ASD, video modelling in combination with the delivery of preferred reinforcers may be required for successful skill acquisition. Further implications, particularly the potential negative effects of vicarious reinforcement when an observer does not gain reinforcement for imitation are discussed, as are recommendations for future research.

Thesis (M.A.)--Miami University, Dept. of Speech Pathology and Audiology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 28-30).

The thesis parts from the view that statistics starts with data, and starts by introducing the data sets studied: marine benthic species counts and chemical measurements made at a set of sites in the Norwegian Ekofisk oil field, with replicates and annually repeated. An introductory chapter details the sampling procedure and shows with reliability calculations that the (transformed) chemical variables have excellent reliability, whereas the biological variables have poor reliability, except for a small subset of abundant species. Transformed chemical variables are shown to be approximately normal. Bootstrap methods are used to assess whether the biological variables follow a Poisson distribution, and lead to the conclusion that the Poisson distribution must be rejected, except for rare species. A separate chapter details more work on the distribution of the species variables: truncated and zero-inflated Poisson distributions as well as Poisson mixtures are used in order to account for sparseness and overdispersion. Species are thought to respond to environmental variables, and regressions of the abundance of a few selected species onto chemical variables are reported. For rare species, logistic regression and Poisson regression are the tools considered, though there are problems of overdispersion. For abundant species, random coefficient models are needed in order to cope with intraclass correlation. The environmental variables, mainly heavy metals, are highly correlated, leading to multicollinearity problems. The next chapters use a multivariate approach, where all species data is now treated simultaneously. The theory of correspondence analysis is reviewed, and some theoretical results on this method are reported (bounds for singular values, centring matrices). An applied chapter discusses the correspondence analysis of the species data in detail, detects outliers, addresses stability issues, and considers different ways of stacking data matrices to obtain an integrated analysis of several years of data, and to decompose variation into a within-sites and between-sites component. More than 40 % of the total inertia is due to variation within stations. Principal components analysis is used to analyse the set of chemical variables. Attempts are made to integrate the analysis of the biological and chemical variables. A detailed theoretical development shows how continuous variables can be mapped in an optimal manner as supplementary vectors into a correspondence analysis biplot. Geometrical properties are worked out in detail, and measures for the quality of the display are given, whereas artificial data and data from the monitoring survey are used to illustrate the theory developed. The theory of display of supplementary variables in biplots is also worked out in detail for principal component analysis, with attention for the different types of scaling, and optimality of displayed correlations. A theoretical chapter follows that gives an in depth theoretical treatment of canonical correspondence analysis, (linearly constrained correspondence analysis, CCA for short) detailing many mathematical properties and aspects of this multivariate method, such as geometrical properties, biplots, use of generalized inverses, relationships with other methods, etc. Some applications of CCA to the survey data are dealt with in a separate chapter, with their interpretation and indication of the quality of the display of the different matrices involved in the analysis. Weighted principal component analysis of weighted averages is proposed as an alternative for CCA. This leads to a better display of the weighted averages of the species, and in the cases so far studied, also leads to biplots with a higher amount of explained variance for the environmental data. The thesis closes with a bibliography and outlines some suggestions for further research, such as a the generalization of canonical correlation analysis for working with singular covariance matrices, the use partial least squares methods to account for the excess of predictors, and data fusion problems to estimate missing biological data.