Objectives: To complete the validation and to study the psychometric properties of the Brazilian Portuguese version of the Vocal Fatigue Index (IFV). Material and methods: This is a validation study of a diagnostic instrument utilizing a cross-sectional design and phases with quasi-experimental design. The total sample was composed of 212 participants, divided into two groups: Dysphonic Group and Vocally Healthy Group. All participants answered the VFI protocol. Data analysis consisted of the following steps: exploratory factor analysis, validity analysis, reliability analysis, sensitivity analysis, receiver operating characteristic, and area under the curve analysis. Results: The Brazilian Portuguese version of the VFI called Índice de Fadiga Vocal-IFV, has 17 items and four factors. The IFV is a valid, reliable and sensible instrument to measure the self-perception of vocal fatigue. The threshold values for each factor was: 4.50 for tiredness and voice impairment; 3.50 for avoidance of voice use; 1.50 for physical discomfort and 8.50 for improvement of voice symptoms with rest. The threshold value for the total score was 11.50. Conclusion: The Brazilian Portuguese version of the VFI is a valid instrument to assess the self-perception of vocal fatigue, especially in dysphonic individuals.

Objectives To complete the validation and to study the psychometric properties of the Brazilian Portuguese version of the Vocal Fatigue Index (IFV). Material and methods This is a validation study of a diagnostic instrument utilizing a cross-sectional design and phases with quasi-experimental design. The total sample was composed of 212 participants, divided into two groups: Dysphonic Group and Vocally Healthy Group. All participants answered the VFI protocol. Data analysis consisted of the following steps: exploratory factor analysis, validity analysis, reliability analysis, sensitivity analysis, receiver operating characteristic, and area under the curve analysis. Results The Brazilian Portuguese version of the VFI called Índice de Fadiga Vocal-IFV, has 17 items and four factors. The IFV is a valid, reliable and sensible instrument to measure the self-perception of vocal fatigue. The threshold values for each factor was: 4.50 for tiredness and voice impairment; 3.50 for avoidance of voice use; 1.50 for physical discomfort and 8.50 for improvement of voice symptoms with rest. The threshold value for the total score was 11.50. Conclusion The Brazilian Portuguese version of the VFI is a valid instrument to assess the self-perception of vocal fatigue, especially in dysphonic individuals.

Physical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participated in the study. Post-surveys indicated most learners: (1) prefer to use standardized patients (SPs) and soft-embalmed cadavers in their physical examination courses, (2) increased their confidence in performing the Lachman exam on real patients, and (3) enhanced their Lachman technique. SPs ultimately cannot volitionally reproduce the physical exam findings of ACL deficiency. Consequently, learners cannot accurately identify positive versus negative examination findings. Thiel-embalmed cadavers are a valuable resource for physical examination education. (Journal of Surgical Orthopaedic Advances 30(2):112-115, 2021).

Syfte: I denna kvantitativa och kvalitativa studie var syftet att inhämta förståelse för sjuksköterskor som arbetar med att undervisa tuberkulospatienter och deras kunskap om tuberkulos. Syftet var även att undersöka sjuksköterskestudenters kunskap om tuberkulos. Metod: Studien utfördes i Sydafrika i provinsen KwaZulu-Natal på ett sjukhus, en klinik samt ett universitet. Kvantitativ metod med frågeformulär användes för att undersöka kunskapen hos sjuksköterskor och sjuksköterskestudenter. För att undersöka hur sjuksköterskor undervisar tuberkulospatienter användes en kvalitativ metod med intervjuer. Svaren från frågeformulären sammanställdes separat så att mönster i materialet kunde upptäckas och så att resultatet från sjuksköterskor och sjuksköterskestudenter kunde jämföras. Intervjumaterialet analyserades med hjälp av innehållsanalys. Resultat: Resultatet från frågeformuläret visade att det eventuellt finns en brist i sjuksköterskor och sjuksköterskestudenters kunskap om tuberkulos. I intervju- resultatet framkom det var och när patientundervisning ägde rum. Vidare framkom det att sjuksköterskorna ansåg det vara viktigt att kommunicera med patienten på ett respektfullt sätt, att lyssna på patienten, ställa frågor och ta reda på om patienten förstått. Sjuksköterskorna uttryckte också att det fanns ett behov av att anställa mer personal, ha tillgång till mer undervisningsmaterial, ha fler mottagningsrum samt bättre väntrum.Slutsats: Det gick inte med säkerhet att fastslå att resultatet från frågeformulären visar på kunskapsbrist hos sjuksköterskor och sjuksköterskestudenter, vad gäller tuberkulos. Om det finns en kunskapsbrist riskerar tuberkulospatienter att bli felinformerade. Intervjuresultatet visade att den patientundervisning som bedrivs på sjukhuset och kliniken i stora drag liknar den patientundervisning som förespråkas i litteraturen. Dock finns det utrymme för förbättringar i form av utökad sjukvårdspersonal, undervisningsmaterial och bättre faciliteter. / Aim: In this quantitative and qualitative study the aim was to gain understanding of nurses working with educating tuberculosis-patients and their knowledge of tuberculosis. The aim was also to investigate nursing students´ knowledge of tuberculosis.Method: The study was conducted in South Africa in the province of KwaZulu-Natal, at a hospital, a clinic and a university. A quantitative method with questionnaires was used to investigate the nurses and nursing students´ knowledge of tuberculosis. In order to investigate how nurses educate the tuberculosis-patients, a qualitative method with interviews was used. The replies from the questionnaires were separately compiled so that a pattern in the material could be discovered and so that the replies from the nurses and the nursing students could be compared. The interview-material was analyzed through content analysis.Results: The result from the questionnaires showed that there might be a gap in the nurses and nursing students´ knowledge of tuberculosis. The interview results showed where and when patient education took place. It also showed that nurses thought it was important to communicate with the patients in a respectful way, to listen, ask questions and to find out if the patient has understood. The nurses also expressed a need for hiring more personnel, more educating equipment, more counseling rooms and better waiting rooms.Conclusions: It could not be established for certain that the results from the questionnaires show that the nurses and nursing students have a lack of knowledge of tuberculosis. If however there is a lack of knowledge, the tuberculosis-patients are at risk of being misinformed. The interview results showed that the patient education done at the hospital and the clinic had many aspects in common with the patient education recommended in literature. However, there is room for improvements through hiring more healthcare personnel, access to more educating material and through better facilities.

The purposes of this study were to validate the writing section of the Eiken Can-Do Questionnaires used in this study and the second purpose was to determine the effects of ten affective orientations (i.e., Desire to Write English, Attitude Toward Learning to Write English, Motivational Intensity, Instrumental Orientation for Writing in English, L2 Writing Anxiety, L2 Writing Self-Confidence, Willingness to Communicate in L2 Writing, Self-Esteem, Cognitive Competence, and General Self-Worth), on the participants’ responses to the Eiken Can-Do Questionnaires. This purpose is valuable because little is known about the relationship between Can-Do Questionnaire and affective variables investigated in this study. The final purpose of this study was to develop Can-Do Questionnaires as an internal measure for a university writing class. The participants of this study were 204 university students studying in two private universities in Tokyo, Japan. The first instrument was the writing section of the Eiken Can-Do Questionnaire; this questionnaire served as the outside measure in this study. The second, six out of nine essays written by the students were assessed as a measure of their writing ability in English. The Affective Orientation Questionnaire was administered to measure ten Affective Orientations. The questionnaire and essay data were analyzed using the Rasch rating scale. All of the participants completed the Background Questionnaire and Affective Orientation Questionnaire in April 2010 and 2011 and completed the writing section of the Eiken Can-do Questionnaire in April, July, and December 2010 and 2011. six writing assignments were produced by 179 out of the 204 participants wrote during the 2010 and 2011 academic year, and the relationships among the variables were analyzed using Structural Equation Modeling. The results indicated that the use of the Eiken Can-Do Questionnaires as the proficiency level measure was appropriate for this group of university students. The Eiken Can-Do Questionnaires were predictors of Motivation and L2 Self-Confidence. Motivation was a predictor of WTC in L2 Writing. Therefore, it should be noted that the Eiken Can-Do Questionnaires had an indirect effect with WTC in L2 Writing. The result implies that through having Eiken Can-Do questionnaires and Classroom Can-do Questionnaires to achieve their future goals, their English classes and their future learning objectives were connected.　 It is necessary to provide students with adequate practice and guidance in using the Eiken Can-Do Questionnaires in order to promote a deeper understanding of their purposes and uses. / Teaching & Learning

Non-nutritive sweeteners (NNS) are frequently used as substitutes for added sugars. NNS are difficult to study due to the inability to accurately measure the amounts individuals consume, as well as limitations in study design and methods, including reliance on observational study designs, the use of diet soda as a proxy of total NNS intake, and the grouping of NNS into a single category rather than studying NNS as individual products. New dietary assessment methods and improved study design and methods are needed to advance researchers' abilities to study NNS and their impact on consumers' health. The objectives of this dissertation were to 1) determine validity and reproducibility of a novel NNS food frequency questionnaire (NNS-FFQ), 2) develop methodology for an objective NNS urinary biomarker, 3) identify an appropriate carrier for NNS intake in studies, and 4) examine the literature on the relationship between NNS and weight-related outcomes based on study design and methods. Objectives 1 and 2: participants (n=125) completed three 24-hr dietary recalls, the NNS-FFQ, and 2 24-hr urine samples. NNS intake via NNS-FFQ and recalls were compared using Bland-Altman analyses, with agreement levels ranging from 92.7-99.2% for individual NNS types and total intake. The NNS biomarker methodology was developed using ultra performance liquid chromatography (UPLC-MS/MS), which analyzes each sample for the presence of NNS and related metabolites. This method observed a range from very strong presence of NNS to not detectable, indicating that this biomarker could identify specific NNS consumption (n=9). Objective 3: a sensory evaluation (n=67) was conducted to identify if applesauce or water was a more appropriate carrier for NNS for future interventions. Applesauce was preferred (sucralose=83.6%; aspartame=79.1%; stevia=74.6%) significantly more than water (p≤0.001), indicating that applesauce could be used as an acceptable carrier of NNS in research studies. Objective 4: a systematic literature review focusing on study design and methods used in investigations on NNS and weight-related outcomes found that 81% of RCT had improved weight outcomes, while 76% of observational studies had higher weight outcomes. Improving NNS study design and methods will increase the quality of research conducted on NNS and related health outcomes. / Ph. D. / Artificial sweeteners [non-nutritive sweeteners (NNS)] are often used to replace added sugars. NNS are difficult to study due to the inability to accurately measure the amounts individuals consume, as well as limitations in study design and methods, including reliance on observational study designs, the use of diet soda to represent total NNS intake, and the grouping of NNS into a single category rather than studying NNS as individual products. New dietary assessment tools and improved study design and methods are needed to allow researchers better to study NNS and their impact on health. The objectives of this dissertation were to 1) to determine the ability of a NNS food frequency questionnaire (NNS-FFQ) to measure typical NNS intake, 2) develop methodology for an objective NNS urinary biomarker, 3) identify an appropriate carrier for NNS intake in studies, and 4) to review the currently available research on the relationship between NNS and weight status. Objectives 1 and 2: 125 participants completed three 24-hr dietary recalls, the NNS-FFQ to measure usual NNS intake, and 24-hour urine samples for a NNS biomarker. Amounts of NNS that consumers reported in recalls were compared to amounts reported in the NNS-FFQ, with the tools finding similar NNS amounts in participants’ diets. The NNS biomarker methodology was developed using ultra performance liquid chromatography (UPLC-MS/MS). This rapid method measures the presence of NNS and related products (saccharin, acesulfame potassium, sucralose, steviol glucuronide, and erythritol) in urine. Among 9 participants, this method identified wide differences, ranging from strong presence of NNS to not measureable. Objective 3: participants (n=67) completed a sensory evaluation (taste testing) study to identify a more appropriate food or beverage (applesauce or water) for NNS (sucralose, aspartame, and stevia) to be mixed with in research studies. Applesauce was preferred over water for all sweeteners (>74%), indicating that applesauce would be an acceptable NNS carrier. Objective 4: a systematic review on study design and research methods used in studies on NNS and weight-related outcomes. Improving NNS measurement tools and study design methods will improve the quality of research that can be conducted on NNS and related health outcomes.

No / Medicines management services provided by community pharmacists have been proposed as one means to ensure that patients receive all the medicines they may benefit from in the English National Health Service. These services may also offer ways of addressing the historic under-utilization of community pharmacists' clinical skills and expertise. Medicines management services differ significantly from the dispensing and medicines sales roles traditionally associated with community pharmacy, particularly in relation to the provision for pharmacists to make recommendations to both patients and doctors about pharmacological treatment and lifestyle management. This paper describes patients' experiences of a medicines management service provided by community pharmacists for people with coronary heart disease, delivered in England. It draws on findings from semistructured, face-to-face interviews with 49 patients recruited from pilot sites delivering the service. Findings suggest that although patients cautiously welcomed the opportunity to consult with a pharmacist about their medicines, they had reservations about them making recommendations about treatment, and many still regarded the doctor as the health professional 'in charge' of their medicines. The implications of these findings are discussed in light of the developing sociological literature on pharmacy and medicines usage.

No / This study explores GP tutor views of a nationally derived list of quality criteria for undergraduate and postgraduate practice-based teaching. Whilst these published criteria provided a means of benchmarking locally, an evaluation of utility in practice required further exploration. This educational evaluation was conducted within a West Yorkshire locality as a means of supporting their practice-based primary care education. A survey approach using an online Likert scaled questionnaire was distributed to all GP tutors with an additional opportunity for free text qualitative comments. Data were analysed using an online reporting package for survey results (MarketSight) and thematic analysis of qualitative data. Key findings were that in general all the criteria were rated having a high level of importance with 83% of GPs claiming they would find such a list important in directing their learning and teaching approach. The opinions on out-of-hours experiences for medical students were also interesting as they differed greatly. These findings will be of interest to those involved in the organisation and delivery of medical education within primary care as the list of criteria could act as a structural guide for directing medical student teaching, learning and its quality assurance. Implications for further research include the utility of core criteria and the exploration of out-of-hours experience for medical student education.

La grossesse est depuis longtemps reconnue comme étant déterminante de la santé future de la mère et de l’enfant. Durant cette période, la qualité de l’alimentation de la mère peut jouer un rôle important dans le déroulement de la grossesse. D’ailleurs, durant cette période, des apports alimentaires jugés inadéquats ont souvent été associés à un risque élevé de développer certaines complications, telles que le diabète gestationnel. L’étude des associations existant entre l’alimentation et des variables de la santé peut cependant être affectée par une évaluation imprécise des apports alimentaires réels des femmes enceintes. Le rappel de 24 heures administré à de multiples reprises a le potentiel d’évaluer de façon précise l’alimentation des femmes enceintes, mais sa version traditionnelle est souvent critiquée en raison du temps qu’elle nécessite ainsi que des nombreux biais induits par la présence d’un interviewer. Pour pallier ce problème, de nouvelles méthodes d'évaluation alimentaire standardisées et complètement automatisées ont été développées. Ces dernières se sont avérées valides dans la population générale, cependant, la précision de ces outils n’a été étudiée que très rarement auprès des femmes enceintes. Le présent mémoire évalue la validité du R24W, un outil Web de rappel de 24 heures, au sein d’une population de femmes enceintes. Éventuellement, cette validation permettra l’utilisation de cet outil dans le cadre d’études épidémiologiques durant la grossesse ainsi que dans la prise en charge nutritionnelle des femmes enceintes. / Pregnancy has long been recognized as a determinant of the mother’s and infant’s future health. Among other factors, the mother's diet is known to have a great impact on many pregnancy-related outcomes. In fact, inadequate dietary intakes have often been associated with a high risk of developing adverse pregnancy outcomes, such as gestational diabetes. The evaluation of potential associations between diet and health variables may, however, be affected by an imprecise assessment of pregnant women’s actual dietary intakes. Multiple administrations of a 24-hour dietary recall have the potential to accurately assess the diet of pregnant women, but its traditional version is often criticized for the time it requires and the many biases induced by the presence of an interviewer. To overcome this problem, new standardized and fully automated food assessment methods have been developed. These were recognised as valid in the general population, however, their precision during pregnancy has not yet been fully assessed. This thesis assesses the validity of the R24W, a Web-based 24- hour dietary recall, among pregnant women. Eventually, this validation will allow to use this dietary assessment tool in future epidemiological studies as well as for the nutritional management of pregnant women in a clinical context.

La pratique de l’activité physique réduit considérablement le risque de survenue des accidents vasculaires cérébraux (AVC). Elle est aussi utilisée en tant que stratégie thérapeutique pour maximiser la récupération fonctionnelle pendant la réadaptation des survivants d’un AVC. Dès lors, il est important de suivre le niveau d’activité physique des personnes saines et des survivants d’un AVC. Le suivi du niveau d’activité physique dépend de la disponibilité d’outils valides et fiables pour la mesure et l’évaluation de l’activité physique. Malheureusement, le manque de pareils outils est observé au Bénin, un pays francophone de l’Afrique. Aussi dans les circonstances de pays à ressources financières limitées comme le Bénin, les questionnaires, méthodes subjectives de mesure de l’activité physique, sont les méthodes les plus utilisées en raison de leur faible coût et de leur facilité de mise en place. Le Questionnaire International de l’Activité Physique (IPAQ) est un outil fréquemment utilisé pour mesurer le niveau d’activité physique des sujets sains et de différents groupes de patients. Toutefois, ce questionnaire, à notre connaissance n’est pas validé dans le contexte de pays francophone d’Afrique comme le Bénin. Le but de ce mémoire de maîtrise était d’adapter et de valider IPAQ chez les personnes saines et les survivants d’un AVC au Bénin. En conséquence, nous avons procédé à l’adaptation du questionnaire IPAQ selon la culture et le français parlé au Bénin, en nous basant sur les méthodes reconnues. Ensuite, la validité convergente et la fidélité test-retest de la version expérimentale béninoise du questionnaire ont été examinées à partir d’un échantillon de 60 sujets sains et de 60 sujets post AVC recrutés au Bénin. Les résultats de l’étude démontrent une excellente validité convergente et une excellente fidélité test-retest de la version béninoise de IPAQ pour la mesure de l’activité physique des personnes saines et des survivants d’un AVC. / The practice of physical activity significantly reduces the risk of stroke. It is also used as a therapeutic strategy to maximize functional recovery during the rehabilitation of stroke survivors. Therefore, it is important to monitor the level of physical activity of healthy people and stroke survivors. Tracking the level of physical activity depends on the availability of valid and reliable tools for measuring and assessing physical activity. Unfortunately, the lack of such tools is observed in Benin, a French-speaking country in Africa. Also, in the circumstances of countries with limited financial resources such as Benin, questionnaires, subjective methods of measuring physical activity, are the most used methods because of their low cost and ease of implementation. The International Physical Activity Questionnaire (IPAQ) is a frequently tool used for measuring the level of physical activity of healthy subjects and different groups of patients. However, this questionnaire, to our knowledge, is not validated in the context of French-speaking African countries as in the context of Benin. The goal of this Master thesis was to adapt and validate IPAQ in healthy people and stroke survivors in Benin. Consequently, following well-established methods, we adapted the IPAQ according to the culture and specific linguistic aspects of French as spoken in Benin. Then, the convergent validity and test-retest reliability of the Beninese experimental version of the questionnaire were examined from a sample of 60 healthy subjects and 60 post-stroke subjects recruited in Benin. The results of the study show excellent convergent validity and excellent test-retest reliability of the Benin version of IPAQ for measuring the physical activity of healthy people and stroke survivors.