A asma é uma desordem inflamatória crônica das vias aéreas responsável pelo aumento da responsividade brônquica frente a diversos estímulos. Exercícios aeróbios e respiratórios são estratégias não farmacológicas utilizadas no tratamento de pacientes asmáticos, no entanto, a comparação entre elas nunca foi realizada. Objetivo: Comparar o efeito dos exercícios aeróbio e respiratório no controle clínico da asma (variável primária), aspectos psicossociais, cinemática toracoabdominal e resposta autonômica (variáveis secundárias) em pacientes com asma persistente moderada ou grave. Métodos: Foram incluídos 54 adultos asmáticos divididos, aleatoriamente, nos grupos, respiratório (GR; n=25, 50,6±9,2 anos) e aeróbio (GA; n=29, 49,8±9,7 anos). Todos os pacientes foram submetidos a um programa educacional antes do início do treinamento e, em seguida, os pacientes do GR realizaram exercícios respiratórios baseados em técnicas de Yoga, enquanto os pacientes do GA foram submetidos a um programa de condicionamento físico aeróbio em esteira ergométrica. As intervenções tiveram duração de 24 sessões (2x/semana, 40min/sessão, 3 meses). O controle clínico (ACQ), os fatores de saúde relacionados à qualidade de vida (FRQV), os níveis de ansiedade e depressão (HAD) e os sintomas de hiperventilação (Nijmegen) foram avaliados pré e pós-intervenção e após três meses do final da intervenção. Também foram avaliados: a cinemática toracoabdominal (OEP), o nível de atividade física diária, a função pulmonar, a capacidade física (ISWT) e a modulação autonômica. O Anova de dois fatores para medidas repetidas foi usado para comparação e o nível de significância ajustado para 5%. Resultados: Não houve diferença entre os grupos antes da intervenção. Após a intervenção, o GA mas não o GR alcançou uma diferença clinicamente relevante (> 0,5 escore) no ACQ 6 (GA= 0,69 ± 0,21 vs. GR= 0,38 ± 0,17, respectivamente) e apresentou melhora no AQLQ e nos níveis de sintomas de ansiedade (p < 0,05). Ambos os grupos apresentaram melhoras nos escores de Nijmegen (GA= 6,5 ± 0,8 vs. RG= 3,7 ± 0,9) e na capacidade física (GA= 96 ± 26 vs. GR= 63 ± 17 metros) (p < 0,05). Conclusão: Os resultados do presente estudo sugerem que os pacientes com asma persistente moderada ou grave apresentam benefícios quando submetidos a ambas as estratégias não-farmacológicas. O treinamento aeróbio resultou em maiores benefícios no controle clínico, qualidade de vida, morbidades psicossociais e capacidade física do que o treinamento respiratório, que por sua vez, proporcionou melhora na mecânica e eficiência respiratória. Ambos os treinamentos não exerceram influência sobre a resposta autonômica dos pacientes asmáticos / Asthma is a chronic inflammatory disorder of the airways responsible for the increase in bronchial responsiveness to various stimuli. Aerobic and breathing exercises are nonpharmacological strategies used in the treatment of asthmatic patients, however, the comparison between them has never been performed. Objective: To compare the effect of aerobic and breathing exercises on clinical control (primary outcome), psychosocial aspects, thoracoabdominal kinematics and autonomic response of patients with persistent moderateto- severe asthma (secondary outcome). Methods: Fifty-four patients with moderate or severe persistent asthma were randomized into breathing (BG, n=25, 50.6±9.2 yrs) or aerobic groups (AG, n=29, 49.8±9.7 yrs). BG performed yoga-breathing exercises while AG performed treadmill exercise beginning at 60% of the maximum predicted heart rate. Both interventions lasted 24 sessions (2x/week, 40 min/session, 3 months). Before and after the intervention and 3-months later, patients fulfilled asthma control (ACQ), health related quality of life (HRQoL), depression and anxiety levels (HAD) and hyperventilation symptoms (Nijmegen) questionnaires. Pulmonary function and aerobic capacity (incremental shuttle walking distance; ISWD) were also evaluated. Two-way ANOVA was used and significance level was set at 5%. Results: No difference between groups was detected at baseline (p > 0.05). After intervention, only AG reached a clinically significant difference in the ACQ-6 (p < 0.5) (AG=0.69±0.21 vs. BG=0.38±0.17) and presented improvement in HRQoL and anxiety symptoms (p < 0.05). Both groups had significant improvements in the Nijmegen scores (AG=6.5±0.8 vs. BG=3.7±0.9) and aerobic capacity (AG=96±26 vs. BG=63±17 meters) (p < 0.05). Conclusions: The results of this study suggest that patients with moderate or severe persistent asthma show benefits when subjected to both non-pharmacological strategies. Aerobic training resulted in greater benefits in clinical control, health related quality of life, psychosocial morbidities and aerobic capacity when compared to the breathing training. On the other hand, breathing training led to an improvement in mechanical efficiency and respiration. Both training had no influence on the autonomic response of asthmatic patients

A Apnéia Obstrutiva do Sono (AOS) e a Doença Pulmonar Obstrutiva Crônica (DPOC) são condições clínicas comuns, particularmente na população de idosos, e portanto é de se esperar que um grande número de pacientes com DPOC apresente AOS. Os pacientes portadores da DPOC podem ser divididos em dois tipos clínicos, A e B. O segundo apresenta características clínicas sugestivas da AOS. A prevalência da AOS entre os portadores da DPOC permanece controversa e existem poucos estudos sistemáticos correlacionando a presença da AOS com o tipo clínico da DPOC. Os objetivos primários do nosso estudo foram: (1) determinar a prevalência da AOS em uma população de DPOC e (2) determinar os preditores de risco desta população para AOS. Identificamos 120 pacientes regularmente matriculados no ambulatório de DPOC da Disciplina de Pneumologia da Faculdade de Medicina da Universidade de São Paulo que preenchiam os critérios para o diagnóstico da DPOC segundo definição da American Thoracic Society. Excluímos os pacientes em programa de oxigenoterapia domiciliar (28 pacientes). Realizamos polissonografia nos 50 primeiros pacientes. Todos foram estudados pelos seguintes métodos: mensuração de dados antropométricos e circunferência do pescoço, escala de sonolência de Epworth, avaliação sobre o ronco, questionário de Berlin, gasometria arterial em ar ambiente e vigília e prova de função pulmonar completa com mensuração da capacidade de difusão do monóxido de carbono (DLco). Os pacientes foram classificados em tipo A (DLco < 50% do valor normal previsto e dispnéia como sintoma predominante), B (DLco > 50% do valor normal previsto e tosse crônica com produção de expectoração como sintoma predominante) e misto. A população estudada se constituiu de 40 homens e 10 mulheres, com idade de 64±9 anos, índice de massa corpórea de 24±5 kg/m2 e VEF1 de 43±15% do valor normal previsto. Dezoito pacientes foram classificados em tipo A, 17 em tipo B e 15 em tipo misto. A AOS (índice de apnéia/hipopnéia > 15 eventos/hora) foi encontrada em 14 pacientes (28%). A prevalência da AOS foi maior na DPOC tipo B (47%) do que na DPOC tipo A (p<0,05). A análise de regressão logística multivariada mostrou que a presença de ronco, a grande circunferência do pescoço e a DPOC tipo B foram todos preditores independentes de risco para AOS. Concluímos que a AOS é freqüente entre portadores da DPOC, particularmente na DPOC tipo B / Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases, particularly in elderly patients, and therefore OSA is likely to occur in COPD patients. It was long observed that chronic obstructive pulmonary disease may fall in two distinct clinical pattern: type A (pink puffer) and type B (blue bloater). Type B patients resemble those of patients with OSA. The prevalence of OSA in COPD patients remains controversial and there are few studies that have investigated the presence of OSA according to the clinical characteristics. Our primary aims were: (1) determine the prevalence of OSA in COPD patients and (2) identify predictors for OSA in COPD patients. For this purpose we studied 50 consecutive non-oxygen dependent patients with a diagnosis of COPD as defined by the American Thoracic Society, who were attended at outpatient COPD clinic at a tertiary University Hospital. The patients were then classified as type A, type B and mixed. Type A COPD was defined solely on the basis of by a DLco < 50% of that predicted. Patients with DLco >= 50% were classified as type B only if they had a clear history of chronic cough and sputum production, lasting for at least 3 months per year for 2 years. All patients were studied by full polysomnography. Prior to sleep study, all patients underwent routine pulmonary function testing including measurement of lung volumes and DLco by the single breath technique. The Epworth Sleepiness Scale and Berlin questionnaire were completed. Snoring was considered present if it was loud and frequent. Neck circumference was also determined. There were 40 males (80%), age 64±9 years old, body mass index 24±5 kg/m2, forced expiratory volume in the first second 43±15% of predicted. Eighteen patients were classified as Type A, 17 as Type B and 15 as Mixed. Obstructive sleep apnea (apnea-hypopnea index > 15 events/hour) was observed in 14 (28%) patients. The prevalence of obstructive sleep apnea was significantly higher in Type B patients (47%). Multiple logistic regression analysis showed that presence of snoring, large neck circumference, type B were all independent predictors for OSA. We conclude that OSA is common among COPD patients, particularly among patients with type B pattern

INTRODUÇÃO: A Psicodinâmica é o estudo da interação das forças psíquicas que subsidiam o funcionamento mental. A dinâmica mental interfere na qualidade de vida de um indivíduo, na medida em que modifica a percepção que ele tem da própria existência. O papel da psicodinâmica sobre a qualidade de vida ainda é pouco estudado. OBJETIVOS: Estudar, de forma transversal, a relação entre psicodinâmica e qualidade de vida na população de médicos de Botucatu, para testar a hipótese de que quanto melhor a psicodinâmica do médico melhor a sua qualidade de vida. MÉTODOS: Foram enviados questionários, com carta-resposta, para 602 médicos (população referenciada). As variáveis independentes (Psicodinâmica) foram obtidas por meio de duas escalas: a) Defense Style Questionnaire (DSQ-40), que avalia e classifica os mecanismos de defesa do ego em maduros, neuróticos e imaturos; b) Bell Object Relations and Reality Test Inventory (BORRTI - Forma O), que avalia e classifica as relações objetais (alienação, egocentrismo, vinculação insegura e incapacidade social) em normais e patológicas. As variáveis dependentes (qualidade de vida) foram avaliadas pelo World Health Organization Quality of Life (WHOQOL-Abreviado), que fornece escores para os quatro domínios: físico, psicológico, relações sociais e meio ambiente. As variáveis moderadoras foram obtidas por meio de um questionário sóciodemográfico. A análise estatística foi feita por meio dos seguintes testes: Shapiro-Wilk, Kolmogorov-Smirnov, Mann-Whitney, Coeficiente de Spearman e modelos de regressão linear com resposta Gamma. Foram utilizados os softwares SPSS versão 17, R versão 2.11.0 e Graph Pad versão 5.0. RESULTADOS: Foram respondidos 198 (33%) questionários válidos. Os seguintes resultados foram obtidos: a média (± desvio padrão) de idade foi de 47,6 (± 11,12) anos e o sexo masculino foi de 53,5%. A presença de perfil patológico nas relações objetais do tipo alienação, egocentrismo e vinculação insegura reduziu os escores dos domínios psicológico (p < 0,001) e relações sociais (p < 0,001), da qualidade de vida. A presença do fator imaturo das defesas do ego reduziu os escores dos domínios físico (p < 0,0001) e meio ambiente (p < 0,0001), da qualidade de vida. DISCUSSÃO: Defesas imaturas do ego dificultam a adaptação do indivíduo à vida profissional e conjugal, enquanto que a presença do perfil patológico das relações objetais leva à dificuldade em manter relacionamentos estáveis e à tendência a manipular as pessoas, apresentando-se socialmente inapto. Ou seja, médicos com esse perfil (de defesas e de relações objetais) devem enfrentar dificuldades para conviver com outras pessoas, inclusive com pacientes. Sua qualidade de vida é pior do que a de médicos com defesas maduras do ego e perfil normal de relações objetais. CONCLUSÕES: A psicodinâmica e a qualidade de vida do médico estão significativamente relacionadas. Os escores da qualidade de vida caem à medida que aumentam os escores das defesas imaturas do ego. Médicos com perfil patológico nas relações objetais apresentam menores escores de qualidade de vida, em relação àqueles com perfil normal / INTRODUCTION: Psychodynamics is the study of the psychological forces that underlie mental action. Ego defense mechanisms and object relations are psychodynamic aspects that affect quality of life as they alter people\'s perceptions of their own life. OBJECTIVES: To assess the influence of ego defense mechanisms and object relations on quality of life in a population of physicians, and thus test our hypothesis that mature ego defenses and normal object relations are associated with better physician quality of life. METHODS: In this cross- sectional study, questionnaires and pre-stamped return envelopes were sent to the population of physicians (602 individuals) living in the city of Botucatu, São Paulo. Psychodynamics was evaluated using the following instruments: a) Defense Style Questionnaire (DSQ-40), which assesses and classifies ego defense mechanisms as mature, neurotic, or immature; b) Bell Object Relations and Reality Test Inventory (BORRTI - Forma O), which assesses and classifies object relations (alienation, egocentricity, insecure attachment, and social incompetence) as either normal or pathological. Quality of life was assessed by the World Health Organization Quality of Life (WHOQOL-BREF) that was developed in the context of four domains of quality of life: physical health, psychological health, social relationships, and environment. Demographic data were obtained via a specific questionnaire. Statistical analyses were performed using the tests of Shapiro-Wilk, Kolmogorov-Smirnov, Mann-Whitney, Spearman\'s coefficient, and Gamma linear regression models with SPSS v. 17, R v. 2.11.0 and Graph Pad v. 5.0 software. RESULTS: A total of 198 questionnaires (33%) with valid responses were obtained. Among respondents, mean age was 47.6 ± 11 years, and the rate of males was 53.5%. High BORRTI scores (pathology) on the alienation, egocentricity and insecure attachment subscales were associated with reduced WHOQOL-BREF scores for the psychological health (p < 0,001) and social relationships (p < 0,001) domains. Immature ego defense mechanisms were associated with lower WHOQOL-BREF scores for the physical health (p < 0,0001) and environment (p < 0,0001) domains. DISCUSSION: Immature ego defenses impair adjustment to professional and marital life, while pathological object relations lead to difficulty in sustaining stable relationships and tendency to manipulate others, hence social ineptitude. Physicians with immature defenses and pathological object relations are, therefore, likely to find it hard to relate with other people, including patients. Their quality of life is worse in comparison with that of physicians with mature ego defenses and normal object relations. In the study population, both immature ego defenses and pathological object relations were associated with lower quality of life. CONCLUSIONS: Among physicians, quality of life is influenced by its psychodynamics, herein assessed through ego defense mechanisms and object relations

<p>Uvod: Temperament predstavlja skup psiholo&scaron;kih osobina, to jest način, brzinu i jačinu umnog i emotivnog reagovanja svojstven pojedincu, odnosno njegovu narav, ćud, prirodu. Savremena istraživanja premorbidnog afektivnog tipa temperamenta, govore u prilog njegovog značaja u etiologiji i kliničkoj evaluaciji bolesti zavisnosti. Cilj: Utvrditi i uporediti temperament kod osoba obolelih od mentalnog poremećaja i poremećaja pona&scaron;anja zbog upotrebe opijata i zdrave populacije. Materijal i metode: Istraživanje je urađeno po tipu studije preseka, i obuhvatalo je 200 ispitanika, podeljenih u dve grupe. Ispitivanu grupu činilo je 100 stabilnih zavisnika od opijata na supstitucionoj terapiji metadonom, starosti od 18 do 40 godina, bez komorbidne bolesti iz kruga psihotičnih poremećaja. U kontrolnu grupu uvr&scaron;teno je 100 zdravih osoba &scaron;to sličnijih sociodemografskih karakteristika sa ispitivanom grupom. Njihov temperament je određivan TEMPS-A upitnikom samoprocene. Rezultati: Utvrđeno je statistički značajno če&scaron;će postojanje dominantog temperamenta kod zavisnika, kao i prisustvo depresivnog, ciklotimnog, razdražljivog i anksioznog temperamenta, koji govore u prilog osnovne razlike između zdrave populacije i populacije sa mentalnim poremećajem i poremećajem pona&scaron;anja zbog upotrebe opijata. Zaključak: Afektivni temperament, kao premorbidna karakteristika ličnosti, ima uticaja na nastanak i razvoj zavisnosti od opijata. Stoga je od značaja da se uzmu u obzir osobine hipertimnog temperamenta kao protektivnog ili depresivnog, ciklotimnog, radražljivog i anksioznog temperamenta kao rizičnih faktora u etiologiji, prevenciji i terapiji bolesti zavisnosti.</p> / <p>Introduction: Temperament is a set of psychological characteristics, ie the speed and strength of mind and emotional reactions peculiar to the individual, or his character, temperament, nature. Modern research of the premorbid affective temperament is in favor of its significance in the etiology and clinical evaluation of substance abuse. The Aim: To determine and compare the temperament of people suffering from mental and behavioral disorders due to use of opioids and healthy population. Materials and Methods: The study was cross-sectional, and 200 subjects were included and divided into two groups. The study group included stable opiate addicts on substitution therapy with methadone, aged 18 to 40 years, without co-morbid psychotic disorders. The Control group consisted of 100 healthy individuals with similar sociodemographic data as the Study group. Their temperament was determined with the TEMPS-A auto-questionnaire. Results: Statistical significance of a dominant temperament was more frequently found in the subjects with opioid dependence, as well as in depressive, cyclothymic, anxious and irritable temperament, which leads to the fundamental differences between a healthy population and a population with mental and behavioral disorders due to the use of opioids. Conclusion: Affective temperament, as a premorbid personality trait, has an impact on the occurence and development of opiate dependence. Therefore, it is essential to take into account the characteristics of a hyperthymic temperament as a protective factor or depressive, cyclothymic, irritable and anxious temperament as risk factors in etiology, prevention and treatment of addiction.</p>

<p>Uvod: Reumatoidni artritis (RA) je bolest koja dovodi do ireverzibilnog o&scaron;tećenja zglobova usled čega je neophodno pri postavljanju dijagnoze započeti lečenje. TNF-alfa inhibitori predstavljaju revolucionarno otkriće u lečenju RA, pri čemu su najče&scaron;će kori&scaron;ćeni Etanercept i Adalimumab. Oni nisu efikasni kod svih pacijenata kod kojih se primene, a mehanizmi gubitka odgovora nisu jasni. Cilj rada je odrediti uticaj Etanercepta i Adalimumaba na aktivnost bolesti (merenjem DAS28 SE i DAS28 CRP skora) i funkcionalni status pacijenata (merenjem HAQ-DI upitnika), broj bolnih i otečnih zglobova pre i tokom godinu dana primene ovih lekova, kao i utvrditi povezanost koncentracije Etanercepta i Adalimumaba u krvi sa vrednostima DAS28 SE u momentu odreĎivanja koncentracije leka. Praćena je i učestalost neželjenih efekata kod pacijenata lečenih sa ova dva leka. Ispitan je i uticaj primene Metotreksata na nivoe lekova u krvi, kao i doza Metotreksata pre i 6 meseci nakon uvoĎenja Etanercepta ili Adalimumaba. Metode: Studija je sprovedena u Specijalnoj bolnici za reumatske bolesti i Klinici za nefrologiju i kliničku imunologiju, Kliničkog centra Vojvodine u Novom Sadu i obuhvatila je 88 pacijenata kod kojih je postavljena dijagnoza RA, od kojih je 49 bilo lečeno Etanerceptom, a 39 Adalimumabom. Analizirana je medicinska dokumentacija, a nakon početka primene TNF-alfa inhibitora svim ispitanicima je u toku godinu dana svaka tri meseca raĎena kontrola koja je podrazumevala anamnezu i fizički pregled, analizu biohemijskih nalaza krvi, merena je aktivnost bolesti merenjem indeksa aktivnosti bolesti DAS28 SE i DAS28 CRP i raĎena procena funkcionalnog statusa tako &scaron;to je pacijent popunjavao HAQ-DI upitnik. Rezultati: Aktivnost RA merena DAS28 SE i DAS28 CRP indeksima, funkcionalni status meren HAQ-DI upitnikom, broj bolnih i otečenih zglobova i vrednosti reaktanata akutne faze značajno su veći pre početka terapije Etanerceptom i Adalimumabom i smanjuje se tokom prvih 6 meseci lečenja ovim lekovima i potom se taj efekat terapije održava do kraja perioda praćenja. Nema statistički značajne razlike u poreĎenju Etanercepta i Adalimumaba u odnosu na učestalost neželjenih dejstava. Doza Metotreksata je statistički značajno manja 6 meseci nakon upotrebe biolo&scaron;kog leka Etanercept i Adalimumab. Pacijenti lečeni Metotreksatom uz Adalimumab imali su statistički značajno veće nivoe leka, nego oni koji ga nisu koristili. Zaključak: TNF-alfa inhibitori ne dovode do zaustavljanja bolesti kod svih pacijenata kod kojih se primene. Mehanizam gubitka odgovora na terapiju TNF-alfa inhibitorima nije jasan. Kako bi se donela najbolja odluka za pacijenta, neophodno je odrediti nivo leka u krvi, kao i nivo antitela na lek prilikom svake promene stanja pacijenta. Za sada nema dovoljno studija koje ukazuju da li postoji veza izmeĎu ekspresije TNF-alfa gena i nivoa TNF-alfa u krvi, te da li bi se merenjem TNF-alfa u krvi mogla korigovati terapija i doza TNF-alfa inhibitora &scaron;to će verovatno biti predmet budućih istraživanja.</p> / <p>Rheumatoid Arthritis (RA) is a disease that leads to irreversible joint damage, which makes necessary to start treatment when the diagnosis is set. TNF-alpha inhibitors represent a revolutionary discovery in the treatment of RA, and the most commonly used are Etanercept and Adalimumab. They are not effective in all patients, and the mechanisms of loss of response are not clear. The aim of this study is to determine the effect of Etanercept and Adalimumab on disease activity (by measuring DAS28 SE and DAS28 CRP score) and the functional status of patients (by measuring the HAQ-DI questionnaire), the number of painful and swollen joints before and during the first year of administration of these drugs. Also, it was determined a correlation between the concentration of Etanercept and Adalimumab in blood and the values of DAS28 SE at the moment of drug concentration measurement. The incidence of adverse effects in patients treated with these two drugs was also observed. It was examined the effect of Methotrexate on drug levels in the blood as well as the dose of Methotrexate before and 6 months after the introduction of Etanercept or Adalimumab. Methods: The study was conducted at the Special Hospital for Rheumatic Diseases and the Clinic of Nephrology and Clinical Immunology, Clinical Center of Vojvodina in Novi Sad. It included 88 patients with RA, 49 were treated with Etanercept and 39 with Adalimumab. Medical documentation was analyzed, and during the first year of TNF-alpha inhibitor administration, every three months were done anamnesis and physical examination, analysis of blood biochemical findings, measurements of the disease activity with DAS28 SE and DAS28 CRP score and a functional status assessment with the HAQ-DI questionnaire. Results: Disease activity measured by DAS28 SE and DAS28 CRP scores, functional status measured with HAQ-DI questionnaire, number of painful and swollen joints and acute phase reactant values are significantly higher before Etanercept and Adalimumab therapy and decreased during the first 6 months of treatment with these drugs and then this effect of therapy is maintained until the end of the monitoring period. There is no statistically significant difference in the comparison of Etanercept and Adalimumab with respect to the frequency of adverse events. The dose of Methotrexate was statistically significantly lower for 6 months after the use of Etanercept and Adalimumab. Patients treated with Methotrexate and Adalimumab had statistically significantly higher drug levels than those who did not use it. Conclusion: TNF-alpha inhibitors are not effective in all patients who used them. The mechanism of loss of response to TNF-alpha inhibitors is not clear. In order to make the best decision for the patient, it is necessary to determine the drug level in the blood as well as the level of antibodies to the drug in each change in the patient&#39;s condition. For now, there are not enough studies to indicate whether there is a link between expression of the TNF-alpha gene and the level of TNF-alpha in the blood, and whether the measurement of the TNF-alpha in blood could be used for therapy correction and change of dose of TNF-alpha inhibitor, which is likely to be the subject of the future research.</p>

O escorregamento epifisário proximal do fêmur (EEPF) é a afecção do quadril mais comum na adolescência e se caracteriza pela excentricidade da epífise em relação à metáfise. Deformidades anatômicas residuais e efeitos secundários no mecanismo abdutor podem estar associados à perda de força abdutora. Objetivamos avaliar a função da musculatura abdutora do quadril após tratamento cirúrgico com osteotomia femoral basocervical e cervicoplastia e comparar os resultados com indivíduos saudáveis. Vinte e quatro pacientes com EEPF moderado ou grave foram submetidos à osteotomia femoral basocervical e cervicoplastia entre 2012 e 2015, e foram avaliados prospectivamente com seguimento mínimo de um ano (idade média 14,9 ± 1,6 anos). O grupo controle foi composto por 15 indivíduos saudáveis sem sintomas no quadril (16,5 ± 2,5 anos). Avaliamos a amplitude de abdução passiva dos quadris, força concêntrica dos músculos abdutores do quadril por meio de dinamometria isocinética a 60°/s e a 120°/s, teste de Trendelenburg, e a pontuação dos questionários Harris Hip Score (HHS) e 12-Item Short-Form Health Survey (SF-12). Um subgrupo de sete pacientes foi submetido à avaliação longitudinal aos seis, 12 e 24 meses de pós-operatório. No seguimento final, comparamos a função abdutora dos quadris com escorregamentos moderados e graves submetidos à osteotomia basocervical e cervicoplastia, com escorregamentos contralaterais mais leves, submetidos à fixação in situ, quadris contralaterais sem EEPF, e grupo controle. No subgrupo avaliado longitudinalmente, houve melhora significativa na força muscular abdutora dos quadris durante os dois anos de seguimento (60º/s, p=0,048; 120º/s, p=0,001). O seguimento final médio de todos os pacientes foi de 1,6 ± 0,6 anos. Quadris com EEPF apresentaram a média de pico de torque abdutor diminuída quando comparados aos quadris contralaterais sem escorregamento (60º/s, p=0,004; 120º/s, p<0,001) e aos quadris dos indivíduos controles (60º/s, p<0,001; 120º/s, p<0,001). Após a osteotomia basocervical e cervicoplatia, os quadris apresentaram média de pico de torque abdutor (60°/s, p=0,63; 120º/s, p=0,99) e amplitude de abdução passiva (p=0,5) semelhante aos quadris fixados in situ. Houve correlação positiva significativa entre médias de pico de torque abdutor e a amplitude de abdução passiva do quadril (coeficiente de Spearman, 0,36; p<0,001). O sinal de Trendelenburg foi ausente em 91,6% dos pacientes no tempo final de seguimento. As médias das pontuações dos questionários dos pacientes no seguimento final foram de 94.8 ± 7.3 para o HHS; 52.6 ± 6.8 e 57.6 ± 4.6 para os componentes físico e mental do SF-12, respectivamente. Concluímos que o restabelecimento de força de mecanismo abdutor é progressivo nos dois anos após osteotomia basocervical e cervicoplastia, porém a força não foi restabelecida aos níveis normais. Um ano não foi suficiente para recuperação da força abdutora. Os resultados da osteotomia basocervical realizada em quadris com EEPF moderado e grave foram comparáveis aos resultados de quadris com desvio inicial significativamente menores submetidos à fixação in situ. / Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescence and is characterized by the eccentricity of the epiphysis in relation to the metaphysis. The condition is associated with loss of abductor strength as a consequence of residual anatomical deformities and secondary effects in the abductor mechanism. We aimed to evaluate the abductor muscle function after the surgical treatment with basicervical femoral osteotomy and head-neck osteochondroplasty, comparing with healthy control individuals. Twenty-four patients with moderate or severe SCFE underwent basocervical femoral osteotomy and osteochondroplasty between 2012 and 2015, and were prospectively evaluated with a minimum follow-up of one year (mean age: 14.9 ± 1.6 years). The control group consisted of 15 individuals without hip symptoms (16.5 ± 2.5 years). We evaluated the passive range of hip abduction, concentric strength of the hip abductor muscles by means of isokinetic dynamometry at 60°/s and 120°/s, Trendelenburg test, Harris Hip Score (HHS) and 12-item short-form health survey (SF-12). A subset of seven patients underwent to longitudinal evaluation at six, 12 and 24 postoperative months. At the final follow-up, we compared the abductor function of the hips with moderate and severe slips submitted to basocervical osteotomy and cervicoplasty, with less severe contralateral slips submitted to in situ fixation, contralateral hips without SCFE, and control group. The subgroup assessed longitudinally had a significant improvement in the abductor muscular strength of the hips during two years of follow-up (60º/s, p = 0.048, 120º/s, p = 0.001). The mean final follow-up of all patients was 1.6 ± 0.6 years. The mean peak abductor torque was decreased in hips with SCFE when compared to the contralateral non-slip side (60º/s, p = 0.004; 120º/s, p <0.001); and control individuals (60º/s, p<0.001; 120º/s, p<0.001). After a basicervical osteotomy and osteochondroplasty, hips had a mean abductor torque (60º/s, p=0.63; 120º/s, p=0.99) and range of abduction (p=0.5) similar to hips pinned in situ. Abduction strength had significant positive correlation with the passive range of abduction (Spearman\'s coefficient, 0.36; p<0.001).The Trendelenburg signal was absent in 91.6% of the patients at the final follow-up. The mean HHS at the final follow-up was 94.8 ± 7.3; and the physical and mental components of the SF-12 were 52.6 ± 6.8 and 57.6 ± 4.6. We conclude that the restoration of abductor strength is progressive in two years following basicervical osteotomy and osteochondroplasty. One year was not enough for the restoration of the abductor strength. The outcomes of the basicervical osteotomy performed in hips with moderate and severe SCFE were comparable to in situ fixation performed in much less severe slips.

No description available.

Objectifs - Les changements dans le monde du travail ont entraîné une augmentation de l’insécurité de l’emploi perçue chez les travailleurs, avec des conséquences négatives sur leur bien-être. Cette thèse vise à contribuer à la littérature sur l’insécurité de l’emploi en présentant trois études portant sur des aspects qui doivent être étudiés davantage : les expériences personnelles et subjectives d’insécurité, ses conséquences sur certains résultats de bien-être général, les ressources et les stratégies de coping pour y faire face comme facteurs qui peuvent réduire les perceptions et les conséquences de l’insécurité de l’emploi. Méthodologie - Les données ont été recueillies au moyen d’une approche multi-méthode, consistant en : une étude qualitative par entretiens biographiques, une étude quantitative par questionnaire auto-compilé et une étude par journaux de bord. Résultats - Dans l’ensemble, les résultats montrent que l’insécurité de l’emploi est une perception subjective et que les personnes dans la même situation peuvent rapporter différents niveaux d’insécurité. Les facteurs liés à la capacité des personnes à activer les ressources, personnelles et contextuelles, et à mettre en place des stratégies de coping efficaces contribuent à déterminer les niveaux d’insécurité perçus et ses conséquences sur le bien-être général et les trajectoires de vie. Limites – En général au niveau méthodologique les trois études ne permettent pas d’établir la direction de la relation entre les variables observées, elles utilisent des mesures d’auto-évaluation et une méthode d’échantillonnage de convenance. Implications pratiques - Les résultats de cette thèse encouragent le développement de l’accompagnement individuel et de l’orientation professionnelle et des pratiques d’assistance afin d’aider les personnes: a) à réfléchir sur leurs objectifs personnels et de travail; b) à identifier les meilleurs moyens d’activer les ressources personnelles et contextuelles; c) à élaborer des stratégies d’adaptation efficaces pour faire face à l’insécurité de l’emploi, aux transitions professionnelles et préserver leur bien-être. / Purpose – The changes in the labour market have led to an increase in perceived job insecurity among workers, with negative consequences on their wellbeing. This thesis aims to contribute to the literature on job insecurity by presenting three studies that deepen several aspects that need to be explored further: the personal and subjective experiences of job insecurity, its consequences on some general wellbeing outcomes, resources and coping strategies as factors that may reduce job insecurity perceptions and consequences. Design/Methodology – Data were collected through a multi-method approach, consisting of a qualitative study through biographical interviews, a quantitative study through a self-reported questionnaire and a diary-study. Results – Overall, findings show that job insecurity is a subjective perception and that people in the same situation can report different levels of insecurity. Factors related to the ability of people to activate resources, personal and contextual, and to put in place effective coping strategies contribute to determine to what extent job insecurity is perceived and its consequences on general well-being and trajectories in life. Limitations – Limitations of this thesis concern the methodology: in general, the three studies do not allow to state any direction of causality between the studied variables, they all use self-reported measures and a convenience sampling method. Practical implications – The results of this thesis encourage the development of practices of career support and career guidance, at individual level, in order to help people: a) to reflect on their personal and professional goals; b) to identify their best ways to activate personal and contextual resources; c) to develop effective coping strategies to address job insecurity, work transitions and to preserve their well-being. / Obiettivi – I cambiamenti avvenuti nel mondo del lavoro hanno determinato nei lavoratori un aumento dell’insicurezza lavorativa percepita, con conseguenze negative sul loro benessere. Questa tesi si propone di contribuire alla letteratura sull’insicurezza lavorativa presentando tre studi che indagano alcuni aspetti che necessitano approfondimento: i vissuti personali e le esperienze soggettive d’insicurezza, le sue conseguenze su alcuni risultati di benessere generale, le risorse e le strategie di coping come fattori che possono ridurre le percezioni e le conseguenze dell’insicurezza lavorativa. Metodologia – I dati sono stati raccolti attraverso un approccio multi-metodo, composto da uno studio qualitativo tramite interviste biografiche, uno studio quantitativo tramite questionari auto-compilati e un diary-study. Risultati – Nell’insieme i risultati evidenziano che l’insicurezza lavorativa è una percezione soggettiva e che persone nella stessa situazione possono riportare diversi livelli d’insicurezza. Fattori legati alla capacità delle persone di attivare risorse, personali e contestuali, e di mettere in atto strategie di coping efficaci concorrono nel determinare i livelli d’insicurezza lavorativa percepita e le sue conseguenze su benessere generale e traiettorie di vita. Limiti – I limiti di questa tesi riguardano la metodologia: in generale tutti e tre gli studi non permettono di affermare la direzione di casualità tra le variabili osservate, utilizzano misure self-report e un metodo di campionamento di convenienza. Implicazioni pratiche – I risultati di questa tesi incoraggiano la messa a punto di interventi e pratiche di sostegno e orientamento alla carriera, a livello individuale, in modo da aiutare le persone: a) a riflettere sui loro obiettivi personali e di lavoro b) ad identificare i modi migliori per attivare risorse personali e contestuali c) a mettere a punto strategie di coping efficaci per affrontare l’insicurezza lavorativa, le transizioni lavorative e preservare il proprio benessere.

Multidimensional forced-choice questionnaires can reduce the impact of numerous response biases typically associated with Likert scales. However, if scored with traditional methodology these instruments produce ipsative data, which has psychometric problems, such as constrained total test score and negative average scale inter-correlation. Ipsative scores distort scale relationships and reliability estimates, and make interpretation of scores problematic. This research demonstrates how Item Response Theory (IRT) modeling may be applied to overcome these problems. A multidimensional IRT model for forced-choice questionnaires is introduced, which is suitable for use with any forced-choice instrument composed of items fitting the dominance response model, with any number of measured traits, and any block sizes (i.e. pairs, triplets, quads etc.). The proposed model is based on Thurstone's framework for comparative data. Thurstonian IRT models are normal ogive models with structured factor loadings, structured uniquenesses, and structured local dependencies. These models can be straightforwardly estimated using structural equation modeling (SEM) software Mplus. Simulation studies show how the latent traits are recovered from the comparative binary data under different conditions. The Thurstonian IRT model is also tested with real participants in both research and occupational assessment settings. It is concluded that when the recommended design guidelines are met, scores estimated from forced-choice questionnaires with the proposed methodology reproduce the latent traits well.

Självskattningsformulär utgör ett viktigt kliniskt redskap för både utredning och intervention av röstproblem men i nuläget är tillgången till olika formulär i Sverige begränsad då antalet validerade svenska översättningar är få. Syfte med studien var att översätta och preliminärt validera The Voice Symptom Scale (VoiSS) som består av 30 frågor tilldelade komponenterna Nedsättning, Emotionellt och Fysiskt. Den svenska versionen av VoiSS framtogs genom ”Forward-backward Translation” med en efterföljande pilotstudie. Sammanlagt deltog 203 vuxna individer som rekryterades via webb- och pappersenkät. Av dessa uppgav 86 deltagare att de upplevde röstbesvär. Resultaten visade på tydliga gruppskillnader där gruppen Med upplevda röstproblem genererade högre genomsnittliga svarspoäng än gruppen Utan upplevda röstproblem. Inga överlappningar kunde konstateras. En principalkomponentanalys (PCA) var i stort sett förenlig med en trekomponentstruktur som tillsammans med gruppseparationen visade på hög konstruktvaliditet. Vidare noterades samstämmighet mellan den svenska versionen och VoiSS-originalet. Sensitivitets- och specificitetsvärden bekräftade en hög diagnostisk validitet. Slutsatsen drogs att formuläret med god validitet förmår att diagnosticera upplevelse av röstproblem. Den preliminära valideringen visade således att den svenska versionen av VoiSS kan användas som ett instrument vid utredning av röstproblem men att ytterligare forskning behövs för att säkerställa formulärets användbarhet i klinisk verksamhet. / Self-assessment questionnaires are important clinical instruments for both investigation and intervention of voice problems but at date access to various questionnaires in Sweden is limited due to few validated translations. The objective of this study was to translate and preliminary validate the Voice Symptom Scale (VoiSS) consisting of 30 questions assigned Impairment, Emotional and Physical. The Swedish version of VoiSS was developed through ”Forward-backward Translation” followed by a pilot study. The questionnaire was completed by a total of 203 adults who were recruited by web and paper survey. Out of these, 86 participants experienced voice problems. Obvious group differences were observed in that the group With experienced voice problems generated higher mean scores than the group Without experienced voice problems. No overlaps were observed. A principal component analysis (PCA) was largely consistent with a three component structure that, combined with the group separation, affirmed high construct validity. Moreover, concurrence between the Swedish version and the VoiSS-original was found. Calculated values of sensitivity and specificity confirmed a high diagnostic validity. The conclusion was made that the self-assessment questionnaire with good validity was able to diagnose experience of voice problems. In conclusion, preliminary validation showed that the Swedish version of VoiSS can be used as a diagnostic tool in assessing voice problems. However, more research needs to be done to ensure the questionnaires adaptation to clinical context.