No description available.

This study was undertaken with the objective of assessing whether the ingestion of a Multivitamin Complex with Calcium and Magnesium would be efficacious in reducing stress. Tlrree hundred subjects who were suffering from stress were selected in Gauteng and Kwa-Zulu Natal, South Africa. The selection was based on a stress questionnaire. The subjects took a battery of tests and questionnaires to assess the level ofthe stress they were experiencing. A 30 day supply of effeiVescent tablets was given to all subjects - half placebos and half the vitamin supplement. These were randomly allocated. At the end of30 days a further battery oftests were administered. The results were statistically analysed. It was found that both the placebo and the vitamin supplement proved beneficial but the Multivitamin Complex with Calcium and Magnesium had a greater effect in reducing and helping to manage stress. / Psychology / M.A. (Psychology)

Made available in DSpace on 2016-01-26T12:51:44Z (GMT). No. of bitstreams: 1 mariacristinadeavilameinberg_dissert.pdf: 2412515 bytes, checksum: a1233bb3e2f1e020476d33588e32153f (MD5) Previous issue date: 2013-06-07 / Introduction: Nosocomial pneumonias determine a significant increase length of Stay, in hospital costs and mortality. Oral hygiene with chlorhexidine has been considered a tool in the prevention of nosocomial pneumonia. However, current data suggest that such benefits are more significant in cardiac surgeries patients. Objective: To evaluate the effects of oral chlorhexidine hygiene with tooth brushing on the rate of ventilator-associated pneumonia in a mixed population of critically ill patients under prolonged mechanical ventilation. Methods: Prospective, randomized, and placebo-controlled pilot study. Patients who were receiving mechanical ventilation, had been admitted in the intensive Care Unit in the previous 24 hours, and were anticipated to require mechanical ventilation for more than 72 hours were included in the study. The patients were randomly divided in to one of the following groups: chlorhexidine hygiene with toothbrushing or a placebo group (gel with the same color and consistency and tooth brushing). Results: The planned interim analysis was conducted using 52 patients, and the study was terminated prematurely. In total, 28 patients were included in the chlorhexidine/tooth brushing group, and 24 patients were included in the placebo/tooth brushing group. Ventilator-associated pneumonia occurred in 45.8% of the placebo group and in 64.3% of the chlorhexidine hygiene with toothbrushing group (RR=1.4; 95% CI=0.83-2.34; p=0.29). Conclusion: The use of gel with chlorhexidine 2% and toothbrushing for oral hygiene did not have effect on the rate of VAP in this heterogeneous population of critically ill patients under prolonged mechanical ventilation. / Introdução: As pneumonias nosocomiais determinam significativo aumento em tempo de internação, custos hospitalares e mortalidade. A higiene bucal com clorexidina é considerada de grande importância na prevenção de pneumonia nosocomial. Contudo os dados atuais mostram que tais benefícios são mais significativos em pacientes submetidos à cirurgia cardíaca. Objetivo: Avaliar os efeitos da higiene bucal com clorexidina 2% e escovação mecânica sobre a taxa de pneumonia associada a ventilador (PAV) em uma população mista de pacientes sob ventilação mecânica prolongada. Método: Estudo piloto prospectivo, aleatório e placebo-controlado. Foram incluídos pacientes sob ventilação mecânica, com menos de 24 horas de internação e cuja perspectiva de duração da ventilação mecânica era a de um período > 72 horas. Os pacientes foram randomizados para o grupo clorexidina (gel com clorexidina a 2%) e escovação mecânica ou grupo placebo (gel da mesma cor e consistência e escovação mecânica) na higiene bucal. Resultados: A análise interina planejada foi realizada quando 52 pacientes foram incluídos e o estudo foi interrompido precocemente. Um total de 28 pacientes foi incluído no grupo clorexidina e 24 no grupo placebo. As taxas de PAV foram de 45,8% no grupo placebo/escovação mecânica e de 64,3% no grupo clorexidina/escovação mecânica (RR=1,4; IC95%= 0,83-2,34; p=0,29). Conclusão: Os resultados deste estudo não evidenciaram beneficio do uso de clorexidina a 2% e escovação mecânica na higiene bucal nas taxas de PAV nesta população heterogênea de pacientes críticos sob ventilação mecânica prolongada.

No description available.

This study was undertaken with the objective of assessing whether the ingestion of a Multivitamin Complex with Calcium and Magnesium would be efficacious in reducing stress. Tlrree hundred subjects who were suffering from stress were selected in Gauteng and Kwa-Zulu Natal, South Africa. The selection was based on a stress questionnaire. The subjects took a battery of tests and questionnaires to assess the level ofthe stress they were experiencing. A 30 day supply of effeiVescent tablets was given to all subjects - half placebos and half the vitamin supplement. These were randomly allocated. At the end of30 days a further battery oftests were administered. The results were statistically analysed. It was found that both the placebo and the vitamin supplement proved beneficial but the Multivitamin Complex with Calcium and Magnesium had a greater effect in reducing and helping to manage stress. / Psychology / M.A. (Psychology)

<div>This dissertation redefines the placebo effect in light of new empirical observations and certain strands of philosophical ethics. </div>Chapter 1 critically reviews available definitions of placebo responsiveness against their abilities to hang together the diversity of empirical observations and emerging research interests. Projecting Wittgenstein's example of a child learning pain language, Chapter 2 redefines the phenomenon as a particular kind of experience of meaning and reconsiders clinical empathy in terms of the loss and recovery of language that belongs to illness experience and diagnosis. Chapter 3 broadens the account of psychosomatic responsiveness from the experience of meaning to the experience of values, utilising Canguilhem's definition of health and Nietzsche's genealogical account of the health of values. Chapter 4 explores the foregoing by recounting how Wittgenstein's moral philosophy might hold together the traditional ethical and bioethical question of what makes life worth living with psychosomatic responsiveness.

Introduction : Le syndrome de l’apnée obstructive du sommeil (SAOS) est un trouble très prévalent chez les patients atteints du diabète de type 2 (DT2) et la littérature préconise un lien étroit entre le SAOS et la dysfonction glycémique. Cependant, les essais randomisés actuels évaluant le traitement du SAOS et les effets métaboliques chez les patients diabétiques sont limités au traitement par pression positive continue (PPC) – parcontre, une limitation majeure de ces études est une faible compliance. L’orthèse d’avancée mandibulaire (OAM) est une option de traitement alternative pour le SAOS qui est généralement mieux tolérée et acceptée par les patients que la PPC. Objectifs : L’objectif principal de cette étude est d’évaluer si un traitement de 3 mois avec une OAM améliore le contrôle glycémique chez les patients atteints du SAOS et le DT2 comparé à celui avec un appareil placébo. Les objectifs secondaires sont : 1) d’évaluer la faisabilité d’une OAM comme traitement du SAOS chez une population diabétique, 2) comparer les effets secondaires subjectifs ressentis lors du port de l’OAM ou de l’appareil placébo, 3) comparer les changements subjectifs dans la qualité de vie et sommeil avec les deux appareils, 4) comparer la compliance subjective et objective dans les deux groupes. Méthodes : 17 patients ont participé à cette étude pilote contrôlée et randomisée comparant le traitement du SAOS à l'aide d’une OAM (Somnodent®, n=7) et d'un appareil placébo (appareil Essix® mandibulaire, n=10). Des échantillons de sang mesurant le contrôle glycémique par les taux d'hémoglobine glyquée ont été prélevés avant et après le traitement. Trois polysomnographies ont été réalisées (au départ, après une période de titration de 2 mois et après une période de traitement de 3 mois). Tous les patients ont répondu à un questionnaire sur les effets indésirables après la période de titration. Les questionnaires suivants ont été comparés avant (V1), pendant (V4) et après (V6) le traitement : échelle de somnolence d’Epworth (ESS), questionnaire sur les résultats fonctionnels du sommeil (FOSQ), indice de qualité du sommeil de Pittsburg (PSQI), et l'échelle hospitalière d'anxiété et de dépression (HADS). Les patients ont rapporté leur compliance subjective dans un journal quotidien, et la compliance objective a été mesurée par une micropuce. Résultats : Aucune différence significative n'a été observée pour l’hémoglobine glycquée après 3-mois de traitement entre les deux groupes (p =0.75). L’OAM a présenté une diminution significative du SAOS mesurée par l'indice d'apnée-hypopnée (p =0.02) et l'indice de désaturation en oxygène (p =0.02). Aucune différence significative n'a été constatée lors de la comparaison des questionnaires sur les effets secondaires entre les groupes, plus précisément pour l'inconfort au niveau des mâchoires (p =0.15) et des changements occlusaux (p =0.41). La fréquence des complications était faible dans les deux groupes et n'a montré aucune différence significative (p =1.00). La satisfaction globale des patients était élevée dans les deux groupes et ne montrait aucune différence significative (p =1.00). Les deux groupes ont présenté des améliorations significatives des scores FOSQ (p =0.004 entre V1-4 et p =0.026 entre V1-6), des diminutions significatives pour ESS (p =0.023 entre V1-4), des diminutions significatives des scores d'anxiété (p =0.003 entre V1-4 et p =0.041 entre V1-6), ainsi qu’une diminution significative des scores de dépression (p =0.025 entre V1-6). Les patients du groupe avec OAM ont sur-rapporté de façon significative leur compliance subjective par rapport à la compliance objective mesurée par les micropuces (p =0.02). Conclusion : L’OAM est un traitement faisable pour le traitement du SAOS chez les patients atteints du DT2 et a démontré des effets secondaires minimes et un taux de satisfaction élevé. Un « effet placébo » important a été observé avec l’appareil placébo, ce qui souligne l’importance des études randomisées et contrôlées dans le domaine du traitement du SAOS. Les micropuces utilisées pour mesurer la compliance objective offrent des données plus fiables que les rapports subjectifs des patients. D'autres essais randomisés et contrôlés à grande échelle sont nécessaires, et des analyses futures d’un système de mesure de glucose en continue pourrait être plus précis pour évaluer les effets de l’OAM sur le contrôle glycémique ; l’investigation de phénotypes métaboliques chez certains patients qui pourraient mieux répondre au traitement de leur SAOS serait aussi important. / Introduction: Obstructive sleep apnea (OSA) is a disorder that is highly prevalent among patients with type 2 diabetes mellitus (T2DM) and the literature supports a strong link between OSA and glucose dysregulation. However, current randomized trials assessing the effect of OSA treatment on metabolic outcomes have been limited to continuous positive airway pressure (CPAP) therapy, and one of the main limitations of these studies is poor compliance. A mandibular advancement device (MAD) is an alternative treatment option for OSA that is generally better tolerated and accepted by patients than CPAP. Objectives: The main objective of this study is to evaluate if 3 months of treatment with a MAD will improve glycemic control in patients with OSA and T2DM as compared to a Placebo Device. Secondary objectives will be: 1) to evaluate the feasibility of a MAD to treat sleep apnea in a diabetic population, 2) to compare subjective side effects of the MAD and Placebo Device, 3) to compare subjective changes in quality of life and sleep with both devices, and 4) to compare subjective and objective compliance in both groups. Methods: 17 patients participated in this randomized controlled pilot study, comparing treatment of OSA using a MAD (Somnodent, n=7) and a placebo device (mandibular Essix, n=10). Blood samples measuring glycemic control by glycated hemoglobin levels were collected before and after treatment. Three polysomnographies were performed (at baseline, after a 2-month titration period and after a 3-month treatment period). All patients answered a side-effects questionnaire after the titration period, and the following questionnaires were compared before (V1), during (V4) and after treatment (V6): Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Pittsburg Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale. Patients recorded subjective compliance in a daily journal, and objective compliance was measured by a microchip. Results: No significant difference was found in glycated hemoglobin levels between groups (p=0.75). The MAD group showed a significant decrease in OSA as measured by the Apnea-Hypopnea Index (p=0.02) and the Oxygen Desaturation Index (p=0.02). No significant difference was found when comparing Side Effects Questionnaires between groups, more specifically for discomfort in jaws (p=0.15) and changes in occlusion (p=0.41). Frequency of complications were low in both groups and showed no significant differences (p=1.00). Overall patient satisfaction was high in both groups and showed no significant differences (p=1.00). Both groups showed significant improvements in FOSQ scores (p=0.004 between V1-4, and p=0.026 between V1-6), significant decreases in ESS (p= 0.023 between V1-4), significant decreases in Anxiety scores (p=0.003 between V1-4, and p=0.041 between V1-6), as well as a significant decrease in Depression scores (p=0.025 between V1-6). Patients in the MAD group significantly over-reported their subjective compliance as compared to the objective compliance measured by a microchip (p=0.02). Conclusion: MAD is a feasible treatment for OSA in patients with T2DM as it was able to significantly improve OSA while demonstrating high overall satisfaction and minimal complications. A strong “placebo effect” was noted with the Placebo Device and reinforces the importance of randomized and controlled studies in the field of OSA treatment. Microchips to measure objective compliance should be used as they offer more reliable data than subjective records. Further large-scale randomized and controlled trials are required, as well as future analyses of Continuous Glucose Monitoring Systems which may allow for more precise evaluation of glycemic outcomes; investigating possible metabolic phenotypes in patients which may respond better to OSA treatment will be important.

La chiropratique est une profession de la santé qui s’intéresse au diagnostic, au traitement, et à la prévention des troubles musculosquelettiques. L’intervention la plus communément utilisée en chiropratique est la manipulation vertébrale (dite « ajustement chiropratique »). D’ailleurs, les consultations en chiropratique sont principalement pour des douleurs vertébrales, particulièrement dans la région lombaire. La lombalgie est la principale cause d'incapacité à travers le monde. Elle engendre des coûts considérables pour la société et les individus atteints. Chez environ un tiers des individus, la lombalgie persiste et devient chronique, entraînant une incapacité et une diminution de la qualité de vie. Chez ces individus, aucun processus pathologique affectant les tissus vertébraux ne peut être mis en évidence. En effet, cette douleur, dite nociplastique, serait plutôt causée par des mécanismes pathologiques du système nociceptif. La lombalgie chronique, dite primaire chez ces individus, est ainsi considérée comme le diagnostic en soi, et non un symptôme secondaire à une pathologie sous-jacente. Chez certains individus, les manipulations vertébrales peuvent soulager la lombalgie chronique primaire. Cependant, leur efficacité comme intervention de première ligne et leurs mécanismes hypoalgésiques restent à démontrer. L'objectif général de cette thèse est d’examiner les mécanismes hypoalgésiques des manipulations vertébrales. Le premier objectif spécifique est d’examiner les mécanismes hypoalgésiques d’une manipulation vertébrale à l’aide d’un modèle expérimental de douleur persistante chez des individus en santé. Le deuxième objectif spécifique est d’examiner les mécanismes du soulagement de la douleur lombaire chronique primaire par une intervention chiropratique de quatre semaines, qui comprend douze séances de manipulations vertébrales. La thèse comprend deux études empiriques, soit une étude expérimentale et une étude clinique, qui sont précédées d’une revue de littérature ciblée. Le premier article est une revue narrative explorant les mécanismes neurophysiologiques de la manipulation vertébrale pour soulager la douleur vertébrale. Le deuxième article décrit les résultats d’une étude expérimentale chez des individus en santé. Dans cette étude, nous avons examiné les mécanismes d'inhibition de la douleur en réponse à une manipulation vertébrale ciblant un segment vertébral dont la peau a été sensibilisée par une application topique de capsaïcine. Le troisième article est une revue narrative examinant l'efficacité des manipulations vertébrales pour le traitement des douleurs vertébrales. Le quatrième article décrit les résultats d’un essai contrôlé randomisé avec groupe placebo chez des individus atteints de lombalgie chronique primaire. Dans cette étude, nous avons examiné si le soulagement de la lombalgie chronique primaire par une intervention chiropratique s’accompagne d’une atténuation de processus pathologiques contribuant à la douleur nociplastique. Les résultats indiquent qu’une manipulation vertébrale peut atténuer l’hyperalgésie mécanique secondaire observée avec le modèle expérimental de douleur persistante. Ceci suggère qu’une manipulation vertébrale pourrait agir sur des processus pathologiques qui mènent à la douleur chronique. Ces résultats sont cohérents avec la réduction de la douleur observée chez les patients atteints de lombalgie chronique primaire recevant des manipulations vertébrales. De plus, la réduction de la lombalgie chronique était accompagnée d’une réduction de l’hyperalgésie mécanique lombaire et de la dramatisation de la douleur. Dans l’ensemble, ces résultats suggèrent qu’une intervention chiropratique comprenant des manipulations vertébrales est efficace pour réduire la lombalgie chronique primaire, et que cet effet pourrait découler en partie d’une réduction de processus contribuant à la douleur nociplastique. Ceci renforce les recommandations cliniques sur l’utilisation de la chiropratique pour le soulagement de la lombalgie chronique primaire. D’autres études seront nécessaires pour clarifier les mécanismes neurophysiologiques et anti-inflammatoires des manipulations vertébrales. / Chiropractic is a health profession focused on the diagnosis, treatment, and prevention of musculoskeletal disorders, mainly through spinal manipulation (also known as "chiropractic adjustment"). The majority of patients consult a chiropractor seeking spine pain relief, primarily in the lower back. Low back pain is the leading cause of global disability, generating considerable costs for society and affected individuals. At least one third of people with low back pain experience persistent pain, leading to chronic disability and a decrease in quality of life. In affected individuals, no pathological process affecting the spinal tissues can be identified. Instead, this pain, called nociplastic, is presumed to be caused by pathological mechanisms within the nociceptive system. Thus, in these individuals, low back pain is considered as chronic primary pain, and not the symptom of an underlying disease. In some individuals, spinal manipulations can relieve chronic primary low back pain. However, their effectiveness as a first-line intervention and their hypoalgesic mechanisms remain to be demonstrated. The overarching aim of this thesis is to examine the hypoalgesic mechanisms of chiropractic spinal manipulations. The first specific objective is to investigate the hypoalgesic mechanisms of a spinal manipulation using an experimental model of persistent back pain in healthy individuals. The second specific objective is to investigate the mechanisms of relief of chronic primary low back pain by a four-week chiropractic intervention, including twelve sessions of spinal manipulations. The thesis includes two empirical studies: an experimental study and a clinical study, both preceded by a targeted literature review. The first study is a narrative review exploring the neurophysiological mechanisms of spinal manipulation to relieve spine pain. The second article describes the results of an experimental trial on healthy individuals, where we examined the mechanisms of pain inhibition following a spinal manipulation targeting a spinal segment sensitized by the topical application of capsaicin The third article is a narrative review examining the effectiveness of spinal manipulation for the treatment of spine pain. The fourth article describes the results of a randomized placebo-controlled trial with individuals suffering from chronic primary low back pain. In this study, we examined whether the relief of chronic primary low back pain by a chiropractic intervention is accompanied by an attenuation of pathological processes contributing to nociplastic pain. The results indicate that a single spinal manipulation can mitigate segmental mechanical hyperalgesia observed with the experimental model of persistent pain. This suggests that spinal manipulations could act on pathological processes that lead to chronic pain. These results are consistent with the pain reduction observed in patients with chronic primary low back pain receiving spinal manipulations. Furthermore, low back pain relief was accompanied by a reduction in mechanical hyperalgesia and in pain catastrophizing. Overall, these results indicate that a chiropractic intervention including spinal manipulations is efficacious in reducing chronic primary low back pain, and that this effect could in part stem from a reduction in processes contributing to nociplastic pain. This reinforces clinical recommendations on the use of chiropractic for the relief of chronic primary low back pain. Further studies will be needed to clarify the neurophysiological and anti-inflammatory mechanisms of spinal manipulations.

Traditionellt utvärderas effekter av kognitiv träning med objektiva prestationsmått. Syftet med uppsatsen var att undersöka självskattad exekutiv funktion som ett alternativt mått för att utvärdera effekter av kognitiv träning. Som utfallsmått valdes The behavior rating inventory of executive functioning - self report (BRIEF-SR). Vidare användes blandad design med för- och eftermätning samt tre oberoende grupper. Gymnasieelever (n = 63) delades in i; aktiv träningsgrupp, aktiv placebogrupp och passiv kontrollgrupp. Tränings- och placebogruppen genomförde datoriserad kognitiv träning med respektive utan adaptiv svårighetsgrad. ANCOVA med arbetsminneskapacitet som kovariat visade inga signifikanta träningseffekter på självskattade exekutiva funktioner, oavsett grupptillhörighet. Sammantaget kan BRIEF-SR vara ett lämpligt instrument vid utvärdering av kognitiv träning när ekologisk validitet prioriteras. Resultaten diskuteras avseende inverkan av tid mellan för- och eftermätning, population och förväntanseffekter. / Performance based measures have been the Golden standard when evaluating effects of cognitive training. By using The Behavior Rating Inventory of Executive Functioning-Self Report (BRIEF-SR), this thesis aimed to explore self- rating scales as an alternative when evaluating effects of cognitive training. A sample of high school students (n = 63) and a mixed- effect model with pre- and post-measurements were chosen. The students were divided into three groups: active training, training with placebo or passive control. The two groups in training practiced with a computerized cognitive training program. The two training groups practiced with an adaptive and non-adaptive computer program, respectively.  With working memory as covariate ANCOVA reported no significant effects on self-rated executive functions independent of group condition. In sum, if ecological validity is of priority BRIEF-SR can be considered when measuring effects following cognitive training. In addition the results are discussed with regards to time between pre- and post-measurements, population and effects of expectancy. / Effekter av kognitiv träning på skolprestationer och självreglering av beteende (dnr 1,2009/0 018,5-0)

Parque Científico y Tecnológico (PACYT, Science and Technology Park) is a large-scale R+D project that seems to be framed in a Smart City plan for Concepción, Chile, which the media has presented as “the Chilean Silicon Valley” (Araus, 2015; Tele13, 2019) and promises to bring not only research and development opportunities for the city but also thousands of direct and indirect jobs (Estudio Interdiseño, 2018; la Tercera, 2015) carried out by PACYT Corporation. Nonetheless, voices have raised to question the construction of the 91 hectares initiative, and some of them have even organized in citizen groups targeting the creation of the urban complex, which actively share information contesting the PACYT through social media, and coordinate activities to protest and spread the word. This is the study case to be analyzed in the present research, which aims to explore and understand, on the one hand, the reasons that have led to the organization of citizens contesting the PACYT project, and on the other hand, the way the project has been advertised and developed in relationship to the city's inhabitants. It intends to make a novel contribution to the field of Urban Studies, both in the areas of Critical Smart Urbanism and Postcolonial Studies, which in this case collide in Latin America, part of the Global South, while opening a discussion around the topic of citizens contesting urban developments with a Smart City background, where few incursions have been made and more specifically in the Latin American context, where the Smart City seems to have a particular interpretation. With that in mind, the current research tries to dig into an under-studied territory, and in doing so, it plans to bring to the table the relevance of studying the approach and way of developing Smart Cities’ ideas in Latin American, and to put focus on what city’s inhabitants have to say about those developments and what their interests are, using the lenses of the right to the city and the understandings coming from urban social movements and conflicts. In that sense, the research outputs are to question the form in which Smart City projects are being implemented in Latin America and to find possible guidelines to incorporate the city’s inhabitants in the development of them elsewhere, with that in mind, future research can be supported by this investigation, which encourages further studies both in the described fields and territory. To do so, the current investigation explores and unwrap theories regarding the mentioned fields and focuses on analyzing the case making use of mixed methods research, by executing qualitative and quantitative methodological tools to reach relevant data that helps to answer the research inquiries. In that sense, the results show that it can be confirmed that the nature of the PACYT, i.e. its R+D purposes and origins linked to a Smart City plan to transform the city into smartness, does not play a relevant role in the development of the conflict that has emerged between the PACYT management, and the people opposed to its construction, but several aspects explain the urban social conflict and that will be explored in the present work. / <p><strong>Acknowledgment.</strong></p><p>First of all, I would like to thank all the interviewees that decided to share their thoughts in the present study, as well as to all the people that participated in the survey; without your contribution, it would have not been possible for me to reach my research goals and to count on with the rich material I have. On the other hand, I want to thank people from academia, such as my peers, who have given me advice and stamina, to my tutor, who has contributed with his wisdom, and to my mentor at university, who has kept me on track and provided me with valuable insights. I am grateful to these people for helping me with my willpower and effectiveness. Finally, I need to thank those surrounding me, like my family for supporting me from the distance, my partner for being here to contain and take care of me, and my dog for always being around me and spreading his love and joy.</p>