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This thesis presents a new conceptual model of occupational outcome based on the results of input from 5 key stakeholder groups in the field of occupational health including patients, healthcare providers, employers, unions, and insurers. Data from 77 participants who took part in one of either 18 individual interviews or 11 focus groups were qualitatively content analyzed. The goals were to: 1) compare the range of meanings given to the concepts of health, occupational health, and occupational outcome, 2) understand the range of opinions among stakeholders and identify areas of agreement or disagreement and, 3) to develop a framework of occupational outcome incorporating the views of all key stakeholders. Health, occupational health, and occupational outcome were found to have different and complex meanings that extended beyond those in existing research, and that related to the role a variable is hypothesized to have in a larger framework. Stakeholders differed in the depth, breadth, and qualitative nature of the themes discussed. Natural alignments among some stakeholder groups emerged which varied depending on the context, however a specific focus could be identified for each group. No single stakeholder group alone expressed all the themes and the complexity of the relationships among them; the whole could only be understood in terms of the sum of the stakeholder parts. A new model emerges in which occupational outcome is encompassed by the interactions of 3 key factors: Function and Ability, Individual Behaviours, and Environmental Factors. These are embedded within larger models of both occupational health that includes both individual health and workplace health, and of quality which is comprised of the interactions between structure variables, system participant factors, and outcome. The new model and the process undertaken to develop it meet two important needs for occupational health; enhancing understanding and conceptualization of occupational outcome, and enhancing understanding of the perspectives of stakeholders in the occupational healthcare system. The findings have implications for research, and delivery of quality care to patients with occupational disease or injuries. Some next steps include model validation and testing, measurement scale development, clarifying new variables through ongoing stakeholder discussion, and model application.

Abstract This study aimed to investigate the role played by treatment supporters in promoting patients’ treatment outcomes in six TB clinics of Ekurhuleni Metropolitan Municipality, Gauteng. A descriptive research design was used to study TB patients who were registered in the clinics in April and May 2006. Interviews were conducted on 216 new adult patients six months after their registration at clinics, all 30 treatment supporters of those who had supporters and the staff responsible for TB at the six clinics at which the patients were registered. The patients were grouped into those who had supporters 53% (n=115) and those who did not 47% (n=101). Patients’ response rate was 97%. Treatment outcomes were compared between these two groups. Results showed that significantly more supported patients achieved successful outcomes than patients who did not have supporters. The results did not change when transfers and deaths were excluded from the measurement. Successful treatment outcomes were significantly associated with treatment supporters having fewer than 10 patients, patients living with someone, patients of age 40 or more years, male patients, those whose highest education levels were tertiary and secondary. Patients and clinic staff said that supporters were useful in checking on patients’ treatment, giving medicine, counselling and advising patients on medication and in practical help. Conclusion: Treatment supporters had a significant role in promoting patients’ treatment outcomes. It is recommended that TB treatment programme staff should consider using treatment supporters in their programmes.

ABSTRACT A group of 133 hips with developmental dysplasia of the hip (DDH) are reviewed in the form of a clinical audit. The aim of the study is to determine the relevance of measuring the ossific nucleus centre edge angle (ONCEA) to determine if this measurement can be used to predict the final outcome and the need for a secondary procedure at an earlier age than currently determined. The ONCEA is defined as an approximation of the lowest centre edge angle within six months of removal of the Batchelor POP, following reduction (mean age 24.1 months). It is measured earlier than the centre edge angle (CEA), which is generally used from the age of five years. The ONCEA was divided into three groups: - Reduced (>=10°) – Group A - Mild subluxation (-9° to 9°) – Group B - Severe subluxation (<=-10°) – Group C The significance of the ONCEA was confirmed using the ONCEA/AI ratio, which was also divided into three groups: - Reduced (>0.5) – Group A - Mild subluxation (0 to 0.5) – Group B - Severe subluxation (<0) – Group C Outcome was assessed radiologically by way of the Severin score: In group C there were only 1/13 hips (8%) with an excellent result, in group B there were 20/44 hips (45%) with an excellent result and in group A there were 39/76 hips (51%) with an excellent result. Using Fisher’s exact test, a statistically significant association was shown between each group and subsequent outcome (p=0.001). A significant result was also shown in a comparison of the three ONCEA groups using the McKay classification (a clinical outcome measurement). The ONCEA/AI ratio was also used to include the degree of acetabular coverage. It had similar statistically significant results as described for the above ONCEA results, thus confirming the findings. In conclusion, the ONCEA or ONCEA/AI ratio can be used at an early age (within six months following removal of POP after reduction, at a mean of 18 months of age) for two purposes: 1. To prognosticate the medium and long-term outcome of the patient. 2. To enable the clinician to determine whether a secondary procedure should be performed at an earlier age than usual. A prospective study will be necessary to confirm this.

Objectives: We aimed to assess the variation in patient body weight over time according to the treatment outcome among multidrug-resistant tuberculosis (MDR-TB) cases. Methods: This was a retrospective cohort study. The data of patients commencing MDR-TB therapy were analyzed. Data were collected from different public TB treatment facilities located in peri-urban areas to the south of Lima, Peru. The outcome was patient body weight (kilograms) from treatment commencement, measured monthly. A random effects model was fitted using robust standard errors to calculate 95% confidence intervals. Results: Of a total of 1242 TB cases, 243 (19.6%) were MDR-TB. Only 201 cases were included in the analysis; 127 (63.2%) were males and the mean patient age was 33.6 (standard deviation 16.2) years. Weight changes over time among the patients who were cured differed from changes in those who died during therapy (p < 0.001). Weight curve divergence was important at the end of the third, fourth, and fifth treatment months: on average, the weight difference was 2.18 kg (p < 0.001), 3.27 kg (p = 0.007), and 3.58 kg (p = 0.03), respectively, when cured patients were compared to those who died. Conclusions: Our results show that weight variation during treatment can be a useful surrogate for the treatment outcome, specifically death during therapy. MDR-TB patients with weight loss should be followed more closely, as they are at greater risk of death. / Revisión por pares

Objetivo: Avaliar em pacientes submetidos à cirurgia de correção de ptose palpebral e dermatocálase: a) o nível de associação de medidas propedêuticas pré-operatórias (função do músculo levantador da pálpebra superior (FMLPS), distância margem palpebral superior ao centro da pupila (DMR1) e altura do sulco palpebral (AS), com a magnitude de desinserção do tendão do músculo levantador da pálpebra superior (MLPS). b) A influência da idade, sexo, presença de ectrópio/entrópio e cirurgia ocular prévia na magnitude de desinserção do tendão do MLPS. c) Avaliar as diferenças das medidas propedêuticas palpebrais pré e pós-operatórias . d) Avaliar a presença de desinserção do MLPS na pálpebra não-ptótica de pacientes com ptose unilateral. e) Avaliar a presença de desinserção do MLPS em pálpebras com DMR1 normal. Metodologia: Desenho do estudo: Série de casos, não comparativo, prospectivo. Casuística: Quarenta e quatro pacientes com ptose palpebral e dermatocálase foram incluídos. Intervenção: Exploração do tendão do MLPS durante a blefaroplastia em pacientes com ptose e dermatocálase. Nos casos de desinserção, o tendão foi refixado ao tarso. Desfechos analisados: Avaliação do nível de associação das medidas propedêuticas pré-operatórias (além de sexo, idade, diabetes, cirurgia ocular prévia, presença de ectrópio/entrópio e queixa de ptose) na magnitude de desinserção do MLPS. Foram utilizados modelos uni e multivariados. A interação entre as variáveis foi testada no modelo multivariado e também foi realizada a avaliação da diferença entre as medidas de FMLPS, DMR1 e AS antes e depois da intervenção. A dependência entre os olhos foi corrigida por meio de equações de estimações generalizadas. Correlação de Pearson foi utilizada para quantificar a dependência entre os olhos para FMLPS, DMR1 e AS. Resultados: A média de desinserção do tendão do MLPS foi de 5,47 mm ± 3,02 para o olho direito e 5,99 mm ± 2,60 para o esquerdo. Com exceção da queixa de ptose e da FMLPS, todas as variáveis testadas foram estatisticamente associadas à magnitude de desinserção do tendão do MLPS. Quando todas elas entraram em um modelo multivariado, somente a DMR1 e a AS foram estatisticamente preditoras da magnitude de desinserção do tendão do MLPS. Houve diferença estatisticamente significante entre a FMLPS antes e depois da cirurgia, sendo a excursão do MLPS mais limitada após a cirurgia, diminuindo, em média, 1,1 mm (p < 0,001). As medidas pré e pós-operatórias de DMR1 e AS foram estatisticamente diferentes, com melhora no pós-operatório, sendo que DMR1 aumentou, em média, 1,6 mm e a AS diminuiu, em média, 3,97mm (p < 0,001). Encontrou-se correlação significante entre os olhos para todas as variáveis propedêuticas analisadas antes e depois da cirurgia. O mesmo foi encontrado para a correlação quanto ao grau de desinserção nos dois olhos (p > 0,01). Conclusões: a) Das medidas pré-operatórias, DMR1 e AS foram as que mais se associaram à magnitude de desinserção do tendão do MLPS, sendo que houve interação entre as duas medidas para esta associação no modelo multivariado de análise. b) Idade, sexo, cirurgia ocular prévia e presença de ectrópio/entrópio estiveram associados ao grau de desinserção, mas somente no modelo univariado de análise. c) Houve aumento significativo das medidas de DMR1 no pós-operatório, diminuição da AS e da FMLPS. d) Houve quatro pacientes com ptose unilateral. Dois deles apresentaram desinserção do MLPS no olho sem ptose. e) Foram encontrados oito pacientes com medidas de DMR1 normais em um ou ambos os olhos. Destes, somente um não apresentou qualquer desinserção do MLPS / Purpose: To evaluate on patients who underwent to ptosis and dermatochalasis correction: a) the association of pre-operatory propedeutic measures (upper eyelid levator muscle function (UELMF), margin reflex distance (MRD1), and eyelid crease height (ECH)) on the amount of upper eyelid levator muscle (UELM) disinsertion. b) The association of gender, age, previous surgery, and ectropion/entropion were analyzed as predictive factors for the amount of upper eyelid levator muscle disinsertion. c) To evaluate the differences of eyelid propedeutic measures before and after surgery. d) To evaluate the amount of UELM disinsertion in the normal eyelids of patients with unilateral ptosis. e) To evaluate the amount of UELM disinsertion in patients with normal MRD1. Methods: Design of the study: prospective non comparative case series study. Population: Forty four patients with blepharoptosis and dermatochalasis were enrolled. Intervention: Exploration of the levator tendon (LT) during blepharoplasty and ptosis correction and in case of its disinsertion, the tendon was reattached to the tarsus. Outcome Measured: Margin reflex distance (MRD1), upper eyelid levator muscle function (UELMF), eyelid crease height (ECH), gender, age, diabetes, previous surgery, ectropion/entropion, and ptosis complaint were analyzed as predictive factors for the amount of upper eyelid levator muscle disinsertion. Both the uni and multivariate approaches were tested and for the latter, interaction from variables was also evaluated. The differences between UELMF, MRD1, ECH before and after surgery were evaluated bilaterally. Dependency between both eyes was corrected by generalized estimating equations. Pearson correlation was used to evaluate the dependency of the two eyes regarding UELMF, MRD1 and ECH. Results: The mean levator tendon disinsertion was 5.47 mm ± 3.02 for the right eye and 5.99 mm ± 2.60 for the left. For univariate models, with the exception of the complaint of ptosis and eyelid function, all variables were statistically related to the amount of disinsertion of the upper eyelid levator tendon. For the multivariate model, when all variables were considered, only MRD1 and ECH were significantly associated with the amount of disinsertion. There was a statistical significant difference between the measures of UELMF before and after surgery with excursion decreasing a mean value of 1.1 mm after the procedure (p < 0,001). Measures of MRD1 showed an increase in a mean of 1.6 mm and ECH decreased in a mean of 3.97 mm (p < 0,001). We had found a significant correlation between both eyes for all eyelid propedeutic variables analyzed, both before and after surgery. Correlation of the propedeutic measures before surgery, between the two eyes, was stronger for the group without previous surgery. The same results for correlation was found for the amount of disinsertion (p < 0.001). Conclusions: a) From the pre-operatory measures, MRD1 and ECH were the most important variables regarding association with the amount of UELM tendon disinsertion. A very important interaction was found between these two variables on the multivariable analysis model. b) Gender, age, diabetes, previous surgery, and presence of ectropion/entropion were associated with the amount of disinsertion but only on the univariable model of analysis. c) There was an increase on the measures of MRD1, ECH and UELMF decreased. d) Four patients had unilateral ptosis. Two of those patients presented UELM disinsertion on the eye without ptosis. (e) Eight patients had normal values for MRD1 in one or both eyes, from those, only one had no disinsertion

The Evidence-Based Practice (EBP) movement has gained considerable influence in the healthcare industry, including psychotherapy. The American Psychological Association's (APA) official stance on EBP encouraged clinicians to used standardized outcome measures in routine practice in order to establish the efficacy of their interventions. Routine Outcome Measurement (ROM) systems were designed specifically to accomplish this purpose, and have been shown to improve client outcomes and provide valuable aggregate data that contributes to empirical literature. Despite this research and the endorsement of the APA's official EBP stance, these measures have not been widely adopted by clinicians. Several studies have found that clinicians find the measures impractical and lacking in clinical relevance. In order to accommodate these clinician concerns, while still maintaining the major features of ROM, the Clinically Adaptive Multidimensional Outcome Survey (CAMOS) was developed. The CAMOS employs a unique system that allows clinicians to be able to tailor the measure to the needs of their client, while still maintaining a core of standardized items. The present study attempted to identify a short form of McBride's measurement model, in order to determine which items would form this standardized core. The study found evidence for the validity and reliability of the CAMOS short form. With this evidence, the short form can serve as the basis for the CAMOS's unique tailoring system. It is hoped that the novel features of the CAMOS can help accomplish the APA's goals in relation to EBP.

Alcohol misuse is a very common problem with high financial and personal costs. Treatment requires allocation of limited resources for optimal impact. Responsible decision making in this area should be based upon reasoned weighing of research evidence. Miller and colleagues completed a meta-analytic review of all controlled studies published before 1992 to help clinicians do just that. The coding system they employed examined methodological quality, as well as outcome, to obtain a rank­ordering of treatments that seem to have the most quality research support. The current study attempts to extend this work utilizing the same coding on studies published since 1992, and combine both databases of articles. Revised rank orderings of treatments and conclusions regarding variables related to outcomes are reported. Implications are discussed, along with limitations of this review. An upward trend in methodological quality over time was also discovered.

P.ORTEGA-VERDUGO1 S.GUZMAN-AMSTRONG1 D. COBB1, D.V.DAWSON1, J.KOLKER1, M.HERNANDEZ1, J.WARREN 1University of Iowa, Iowa City, USA. NA

Wrist surgery is a common method for treating carpal tunnel syndrome (CTS) although few studies have examined patient outcomes or predictive correlates of such procedures. The objectives of this study were to characterize Utah workers who received surgery for CTS in terms of relevant presurgical and outcome variables and to identify presurgical correlates of patient outcomes. Participants were 75 Utah workers' compensation patients who underwent surgery for CTS from 1999-2002 and were at least 6 months postsurgery at time of follow-up. A retrospective cohort design was utilized consisting of a review of presurgical medical records and a postsurgical telephone survey. Presurgical variables included: gender, age, history of depression, and litigation status. Correlational analyses revealed that age and lawyer involvement were consistent significant predictors of poorer outcomes. The importance of conceptualizing CTS surgery patient outcomes from a biopsychosocial perspective is discussed.