Métodos convencionais para a confecção de próteses totais envolvem uma série de procedimentos técnicos complexos. No entanto, métodos simplificados podem ser tão efetivos quanto os convencionais, porém é importante que a mastigação não sofra influências deletérias. Assim, o objetivo deste estudo foi comparar um método simplificado de confecção de próteses totais a outro convencional, tendo como variáveis a performance e a habilidade mastigatórias. A amostra foi formada por pacientes desdentados solicitando tratamento com próteses totais duplas. Os participantes foram divididos aleatoriamente em dois grupos: Grupo S (n=17), que recebeu próteses confeccionadas por um método simplificado, e Grupo C (n=18), que recebeu próteses confeccionadas de forma convencional. Após 3 meses da instalação das próteses, a performance mastigatória foi avaliada por um método colorimétrico, utilizando duas biocápsulas como alimento teste, após 20 e 40 ciclos mastigatórios, e a habilidade mastigatória dos participantes foi avaliada por meio de questionário (Questionário HM) e escala visual analógica (EVA). Foi feita referência dos resultados a um grupo de participantes dentados, Grupo DN (n=17). Os três grupos foram comparados por meio de testes adequados à distribuição dos dados (α=5%). A performance mastigatória foi similar nos grupos C e S e representou 31% daquela encontrada no grupo DN. A habilidade mastigatória foi semelhante para S e C independente do método de análise, sendo que algumas questões do questionário HM, analisadas isoladamente, tiveram maior ocorrência de respostas favoráveis para o primeiro. Conclui-se que métodos simplificados de confecção de próteses totais são capazes de reabilitar a mastigação de maneira comparável ao método convencional, tanto fisiologicamente como segundo as percepções do paciente. / Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones and mastication should not be further impaired. Therefore, this study aimed to compare a simplified method and a conventional protocol for complete denture fabrication, in terms of masticatory performance and ability. A sample was formed by edentulous patients requesting treatment with maxillary and mandibular complete dentures. Participants were randomly allocated into two groups: Group S (n=17), which received dentures fabricated by a simplified method, and Group C (n=18), which received conventionally fabricated dentures. After 3 months following insertion, masticatory performance was evaluated by means of a colorimetric assay based on chewing two capsules as test food during 20 and 40 cycles. Masticatory ability was assessed by means of a questionnaire (HM) with dichotomous answers and a single question answered by means of a visual analogue scale (VAS). A third group (DN, n=17) formed by dentate volunteers served as an external comparator. Results for the three groups were compared by means of statistical tests suitable for the distribution of data (α=5%). Groups C and S presented similar masticatory performance which corresponded to 31% of group DN. Results for masticatory ability showed similarity between S and C, regardless of the assessment method, though some isolate items of the HM questionnaire showed more favorable results for the first group. It can be concluded that simplified methods for complete denture fabrication are able to restore masticatory function to a level comparable to the conventional protocol, physiologically and according to patient perceptions.

A retenção de próteses totais removíveis por mini-implantes é uma modalidade de tratamento relativamente recente, com potencial de minimizar o trauma pós-operatório e reduzir custos associados. Este estudo buscou comparar a qualidade de vida relacionada à saúde bucal e satisfacão do paciente, bem como dor e desconforto pós-operatórios, decorrentes da instalação de mini-implantes (dois ou quatro) ou dois implantes de dimensões regulares para a retenção de sobredentaduras mandibulares. Cento e vinte participantes edentados (media etária 59,5±8,5 anos) foram alocados aleatoriamenteem três grupos conforme o tratamento recebido: (GI) quatro mini-implantes, (GII) dois mini-implantes, ou (GIII) dois implantes regulares. Sete dias após a instalação dos implantes, os participantes responderam questões (Escala visualanalógica - EVA de 100 mm) referentes à dor, edema e desconforto durante mastigação, fala e higiene, considerando as experiências vividas durante os períodos avaliados. Antes das intervenções e passados 3 e 6 meses da instalação das sobredentaduras, a qyalidade de vida relacionada à saúde bucal foi avaliada por meio do questionário OHIP-EDENT, e a satisfação analisada por perguntas específicas respondidas emu ma EVA de 100 mm. Os grupos foram comparados por meio de ANOVA para dois fatores ou Equações de Estimação Generalizadas (EEG) (α=0,05). Todos os participantes (GI: 38; GII: 42; GIII: 40) foram analisados após sete dias da instalação dos implantes instalação para dor e desconforto pós-operatório, e 112 responderam às questões sobre qualidade de vida relacionada à saúde bucal e satisfação de paciente. Ao 6º dia, GI sentiu dor significantemente maior que GII e GIII. GI também notou maior dificuldade para a prática de higiene oral que GIII durante o 1º dia. Não houve diferença significante entre os grupos para outras questões e períodos. Os achados para o OHIP-EDENT indicam que tanto os grupos tratados com dois ou quatro mini-implantes levaram a uma maior QVSB, comparados aos implantes convencionais. Aos três e seis meses, encontramos que os três grupos tratados com quatro mini-implantes estavam mais satisfeitos que os que receberam dois implantes convencionais e dois mini-implantes resultaram em valores intermediários. Conclui-se que o uso de quatro mini-implantes induz maior dor pós-operatória ao sexto dia que a inserção de dois mini-implante ou implantes convencionais, bem como higiene oral mais difícil ao primeiro dia. Além disso, o tratamento com sobredentaduras retidas por mini-implantes é comparável ao padrão de tratamento para o edentulismo, de acordo com as perspectivas do paciente. O tratamento por dois ou quatro mini-implantes alcança resultados similares ou mesmo discretamente superiores em termos de qualidade de vida relacionada à saúde bucal ou satisfação do paciente, comparado aos implantes convencionais / The retention of removable dentures by mini-implants is a relatively recent treatment modality, and may lead to minimal postoperative trauma and reduced costs. This study aimed to compare oral health-related quality of life and patient satisfaction, as well as postoperative pain and discomfort, following the insertion of mini-implants (two or four) or two standard-size implants for the retention of mandibular overdentures. One hundred and twenty edentulous participants (mean age 59.5±8.5 years) were randomly allocated into three groups according to received treatment: (GI) four mini-implants, (GII) two mini-implants, or (GIII) two standard implants. Seven days after implant insertion, patients answered questions (100-mm VAS Visual Analog Scale) relating to pain, swelling, and discomfort with chewing, speech and hygiene, considering their experiences during the 1st and 6th day. Before the interventions and after 3 and 6 months following insertion, OHRQoL was evaluated by means of the OHIP-EDENT questionnaire and patient satisfaction was analyzed by a specific questionnaire answered on a 100-mm VAS. Groups were compared by two-way ANOVA or Generalized Estimating Equations (GEE) (α=0.05). All participants (GI: 38; GII: 42; GIII: 40) were analyzed after seven days of postoperative pain and discomfort, and 112 answered questions regarding oral health-related quality of life and patient satisfaction. At the 6th day, GI felt significantly higher pain than GII and GIII. GI also reported more difficulty in performing oral hygiene practices than GIII during the 1st day. There was no significant difference between groups for the other questions and periods. The findings from OHIP-EDENT indicate that both two and four mini-implants led to better OHRQoL, compared to two conventional implants. At three and six months, we found that the group treated with four mini-implants was more satisfied than the two conventional implants and two mini-implants was presented intermediate values. It can be concluded that the use of four mini-implants induces more intense postoperative pain at the 6th day than the insertion of two mini- or conventional fixtures, as well as more difficult oral hygiene on the 1st day. Furthermore, the treatment by mini-implant overdentures is comparable to the standard of care for edentulism, according to the patient perspective. Treatment by either two or four mini-implants achieve similar or even slightly better OHQoL and satisfaction compared to two conventional implants

INTRODUÇÃO: A terapia de ressincronização cardíaca(TRC) tem se mostrado alternativa eficiente para pacientes com Insuficiência Cardíaca (IC) em uso terapia medicamentosa otimizada, com fração de ejeção reduzida e QRS largo. Apesar dos resultados positivos em pacientes de diversas etiologias, dados a despeito do efeito dessa terapia na cardiopatia chagásica são extremamente raros na literatura. OBJETIVOS: Avaliar a evolução clínica e funcional de pacientes chagásicos submetidos à terapia de ressincronização cardíaca, por meio de estudo clínico randomizado. CASUÍSTICA E MÉTODOS: Foram incluídos pacientes com cardiopatia chagásica, em Classe funcional II, III ou IV da NYHA, em uso de terapia medicamentosa otimizada, fração de ejeção <= 35% e duração do QRS largo. O presente estudo clínico é prospectivo, de intervenção, randomizado, cego, com crossover e comparou as respostas clínicas e funcionais após duas fases: período de 2 meses com a TRC ligada e período de 2 meses com a TRC desligada. As variáveis analisadas foram distância percorrida no teste de caminhada de 6 minutos, classe funcional (NYHA), pontuação no teste de qualidade de vida do questionário de Minnesota, pontuação no teste de capacidade funcional no questionário SF 36, pico de extração de oxigênio no teste cardiopulmonar e fração de ejeção do ventrículo esquerdo. RESULTADOS: Foram randomizados 34 pacientes sendo que seis não conseguiram completar as duas fases do estudo. A média da distância percorrida no Teste de Caminhada de 6 minutos foi 60 metros maior no grupo TRC ligada (500,3 versus 439,8 metros; p<0,01), o teste de Qualidade de Vida (Questionário de Minnesota) apresentou escores estatisticamente melhores nos pacientes com TRC ligada (diferença entre os dois grupos de 12,2 pontos, p<0,05). A Capacidade Funcional avaliada pelo questionário SF 36 apresentou resultado a favor da TRC ligada (p<0,01). De modo semelhante, a Classe Funcional (NYHA) média foi significativamente inferior neste grupo (p<0,05). As variáveis estudadas no Teste Cardiopulmonar e os parâmetros Ecocardiográficos não atingiram diferenças com significância estatística entre os dois grupos. CONCLUSÃO: Os resultados encontrados neste estudo suportam o valor terapêutico da TRC em indivíduos com insuficiência cardíaca de etiologia chagásica com QRS largo. A estimulação biventricular promoveu melhora significativa dos sintomas, qualidade de vida, capacidade funcional e da distância percorrida no teste de caminhada. Estudos subsequentes são necessários para avaliação dos efeitos clínicos a longo prazo e o impacto em mortalidade desta modalidade terapêutica nos pacientes com cardiopatia chagásica. / BACKGROUND: Cardiac Resynchronization Therapy (CRT) has been shown one effective alternative for patients under optimal medical therapy, reduced ejection fraction (EF) and wide QRS. Despite the positive results in patients of several etiologies, data from this therapy in Chagas heart disease are extremely rare in the literature. OBJECTIVES: To evaluate the clinical and functional results of Chagas patients undergoing CRT through a randomized clinical trial. METHODS: There were included patients with Chagas cardiomyopathy, functional class II, III or IV of NYHA, under optimal drug therapy, EF <= 35% and wide QRS. This prospective, randomized, blinded, crossover study compared the clinical and functional responses after two phases: a two-month period of CRT-on and a two-month period of CRT-off. The outcomes analyzed were: walked distance in 6 minutes, functional class (NYHA), quality of life by the Minnesota Living with Heart Failure Questionnaire score, functional capacity by the questionnaire SF 36 score, Oxygen Extraction Peak in Cardiopulmonary Test and EF of the Left Ventricle. RESULTS: Thirty four patients were randomized but six patients failed to complete both study periods. The average distance walked in 6 minutes was 60 meters higher in CRT-on group (500.3 vs. 439.8 meters, p <0.01), the Quality of Life (Minnesota Questionnaire) showed scores significantly better in patients with CRT- on (difference of scores between the two groups: 12.2, p <0.05). The functional capacity assessed by the SF-36 questionnaire showed better results in favor of CRT-on group (p <0.01). Similarly, the functional class (NYHA) was significantly lower in this group (p <0.05). The variables studied in Cardiopulmonary Testing and Echocardiographic parameters did not reach statistical significance between the two groups. CONCLUSION: The results of this study support the therapeutic value of CRT in patients with heart failure due to Chagas disease with wide QRS. The biventricular pacing significantly improved symptoms, quality of life, functional capacity and the distance walked in 6 minutes. Further studies are needed to evaluate the clinical long-term effects and the impact on mortality of this therapeutic modality in patients with Chagas heart disease.

Orientador: Andrea Carvalho De Marco / Coorientador: Dimas Renó de Lima / Banca: Symone Cristina Teixeira / Banca: Cibelle Barbosa Lopes / Resumo: A hipersensibilidade dentinária é uma das complicações mais comuns entre os pacientes após o tratamento periodontal. Recentemente a terapia com o uso de laser de baixa intensidade foi introduzida como uma nova modalidade de tratamento e tem proporcionado resultados benéficos. Foi realizado um estudo clínico controlado, randômico, duplo-cego, de boca dividida com o objetivo de comparar a efetividade do uso do verniz tópico Fluoreto de sódio 5%, do Laser GaAlAs 780 nm e da combinação do Fluoreto de sódio 5% e o Laser GaAlAs 780 nm para o tratamento de hipersensibilidade dentinária. Os Grupos foram divididos em Grupo Controle (C), Grupo Fluoreto de sódio 5% (F), Grupo Laser GaAlAs 780 nm (LLLT), e o Grupo Fluoreto de sódio 5% + Laser GaAlAs 780 nm (F+LLLT). A aplicação do verniz foi realizada com pinceis do tipo "microbrush", e para cada elemento dental cinco pontos receberam a LLLT, com dose de 52,5 J/cm2 (70mW e 30 segundos) ou 2,1 J por ponto; 6 segundos por ponto. A hipersensibilidade primária foi registrada pela escala analógica visual (VAS: 0-10) para quantificar a dor subjetiva após estímulo com "spray de gelo" no baseline, e após o tratamento nos intervalos de 24 horas e 30 dias. Todos os dados foram analisados estatisticamente pela análise de variância ANOVA. Para cada um dos três tempos de avaliação foi efetuada uma comparação entre os 4 grupos (por meio da ANOVA oneway) com complementação pelos testes de Tukey e Bartlett a fim de verificar as diferenças estatísticas e... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Dentin hypersensitivity is one of the most common complications among patients after periodontal treatment. Recently the low level laser therapy has been introduced as a new treatment modality and has provided beneficial results. A split-mout, double-blind, randomized, controlled clinical trial was conducted with the aim of compare the effectiveness of the topical varnish 5% Sodium Fluoride, Laser GaAlAs 780 nm and the combination of 5% Sodium Fluoride and the Laser GaAlAs 780 nm for the treatment of dentin hipersensitivity. The groups were divided in Control Group (C), Sodium Fluoride at 5% Group (F), Laser Group GaAlAs 780 nm (LLLT), and Sodium Fluoride at 5% Group + GaAlAs Laser 780 nm (F + LLLT). The application of the varnish was realized with "microbrush", and for each dental element, five points was received LLLT. The dose was 52.5 J / cm2 (70mW and 30 seconds) or 2.1 J per point, 6 seconds per point. Primary hypersensitivity was be recorded by visual analogue scale (VAS: 0-10) to quantify subjective pain after the stimulus with "ice spray" at baseline, and after treatment at 24-hour and 30-day intervals. All data was analyzed statistically by analysis of variance ANOVA. For each of the three evaluation times a comparison was made between the 4 groups (through the oneway ANOVA) with complementation by the Tukey's and Bartlett's tests in order to verify the statistical differences between groups. The level of significance will be 5%. After statistical analysis the resul... (Complete abstract click electronic access below) / Mestre

Background: Infant immunization pain is not currently well managed despite effective strategies. Objective: To determine the effectiveness of tactile stimulation when added to a combination of pain-reducing interventions in infants undergoing immunization. Methods: Healthy infants aged 4-6 months undergoing immunization in primary care were randomized to tactile stimulation or usual care. All infants also received pain-relieving interventions. A validated measure of acute pain in infants, the Modified Behavioral Pain Scale (MBPS), was the primary outcome. Results: Altogether, 120 infants participated. Characteristics did not differ (p > 0.05) between those allocated to tactile stimulation and usual care groups. Mean MBPS pain scores did not differ between groups: 8.2 (1.1) vs. 8.0 (1.3); p = 0.57, respectively. Conclusions: Parent-led tactile stimulation did not improve pain relief in infants when added to other interventions. Parental attention could have been focused on tactile stimulation, preventing parents from performing appropriate soothing activities. Additional investigation of the effectiveness of clinician-led tactile stimulation is recommended.

Background: Infant immunization pain is not currently well managed despite effective strategies. Objective: To determine the effectiveness of tactile stimulation when added to a combination of pain-reducing interventions in infants undergoing immunization. Methods: Healthy infants aged 4-6 months undergoing immunization in primary care were randomized to tactile stimulation or usual care. All infants also received pain-relieving interventions. A validated measure of acute pain in infants, the Modified Behavioral Pain Scale (MBPS), was the primary outcome. Results: Altogether, 120 infants participated. Characteristics did not differ (p > 0.05) between those allocated to tactile stimulation and usual care groups. Mean MBPS pain scores did not differ between groups: 8.2 (1.1) vs. 8.0 (1.3); p = 0.57, respectively. Conclusions: Parent-led tactile stimulation did not improve pain relief in infants when added to other interventions. Parental attention could have been focused on tactile stimulation, preventing parents from performing appropriate soothing activities. Additional investigation of the effectiveness of clinician-led tactile stimulation is recommended.

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. Since access to diabetes prevention programs is limited in Thailand, especially in rural areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective and sustainable. Therefore, the main objective of this program is to build capacity for chronic disease prevention in Thailand through application of learning technologies in the education, support and accreditation of community health care workers (CHCWs). This program stems from established partnerships among: The University of Waterloo (UW), Department of Health Studies and Gerontology; Institute of Nutrition, Mahidol University (INMU); The Office of Disease Prevention and Control 10 Chiang Mai province; Ministry of Public Health (MOPH), Thailand and UW, Centre for Teaching Excellence (CTE) . The development of the community-based diabetes prevention education program in Chiang Mai, Thailand was informed by in-depth interviews with health care professionals (n=12) and interviews (n=8) and focus groups (n = 4 groups, 23 participants) with community volunteers, screened as at-risk for diabetes. Coded transcripts from audio-taped interviews or focus groups underwent qualitative analysis by hand and using NVivo software. Health care professionals identified opportunities to integrate health promotion/ disease prevention into CHCWs’ duties. However, they also identified potential barriers to program success as motivation for regular participation, and lack of health policy support for program sustainability. Health care professionals supported an education program for CHCWs and recommended small-group workshops, hands-on learning activities, case studies and video presentations that bring knowledge to practice within their cultural context; CHCWs should receive a credit for continuing study. Community volunteers lacked knowledge of nutrition, diabetes risk factors and resources to access health information. They desired two-way communication with CHCWs. A tailored diabetes prevention education program was designed based on this formative research. Learning modules were delivered over eight group classes (n=5/class) and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including video-taped lectures, readings, monthly newsletters, and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing based on an exam that was pilot tested with 32 CHCWs from a district outside of the 5 districts in semi-urban Chiang Mai province from which the 69 participating CHCWs (35 intervention, 34 control) were randomly selected. The program was implemented over four months. Three quarters of participants attended all eight classes and no participant attended fewer than six. Online support and materials were accessed 3 – 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally relevant, and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (SD) of 56.5% (6.26) to 75.5% (6.01) (P < .001). The effect of the program on knowledge of CHCWs was compared between intervention and control communities at baseline and the end of the program. Overall, the knowledge at baseline of both groups was not significantly different (56.5% (6.26) intervention versus 54.9% (6.98) control) and all CHCWs scored lower than 70%. The lowest scores were found in the “understanding of nutritional recommendations” section (mean score = 28% in intervention and 30% in control CHCWs). After 4 months, CHCWs in the intervention group demonstrated improvement relative to the control group (75.5% (6.01) versus 57.4% (5.59), respectively, p <.001, n=69). The percent of CHCWs achieving a total score of 70% was 77% (27/35) in intervention and 0% in control groups. The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand. Ultimately, prevention of chronic diseases and associated risk factors should be enhanced.

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. Since access to diabetes prevention programs is limited in Thailand, especially in rural areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective and sustainable. Therefore, the main objective of this program is to build capacity for chronic disease prevention in Thailand through application of learning technologies in the education, support and accreditation of community health care workers (CHCWs). This program stems from established partnerships among: The University of Waterloo (UW), Department of Health Studies and Gerontology; Institute of Nutrition, Mahidol University (INMU); The Office of Disease Prevention and Control 10 Chiang Mai province; Ministry of Public Health (MOPH), Thailand and UW, Centre for Teaching Excellence (CTE) . The development of the community-based diabetes prevention education program in Chiang Mai, Thailand was informed by in-depth interviews with health care professionals (n=12) and interviews (n=8) and focus groups (n = 4 groups, 23 participants) with community volunteers, screened as at-risk for diabetes. Coded transcripts from audio-taped interviews or focus groups underwent qualitative analysis by hand and using NVivo software. Health care professionals identified opportunities to integrate health promotion/ disease prevention into CHCWs’ duties. However, they also identified potential barriers to program success as motivation for regular participation, and lack of health policy support for program sustainability. Health care professionals supported an education program for CHCWs and recommended small-group workshops, hands-on learning activities, case studies and video presentations that bring knowledge to practice within their cultural context; CHCWs should receive a credit for continuing study. Community volunteers lacked knowledge of nutrition, diabetes risk factors and resources to access health information. They desired two-way communication with CHCWs. A tailored diabetes prevention education program was designed based on this formative research. Learning modules were delivered over eight group classes (n=5/class) and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including video-taped lectures, readings, monthly newsletters, and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing based on an exam that was pilot tested with 32 CHCWs from a district outside of the 5 districts in semi-urban Chiang Mai province from which the 69 participating CHCWs (35 intervention, 34 control) were randomly selected. The program was implemented over four months. Three quarters of participants attended all eight classes and no participant attended fewer than six. Online support and materials were accessed 3 – 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally relevant, and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (SD) of 56.5% (6.26) to 75.5% (6.01) (P < .001). The effect of the program on knowledge of CHCWs was compared between intervention and control communities at baseline and the end of the program. Overall, the knowledge at baseline of both groups was not significantly different (56.5% (6.26) intervention versus 54.9% (6.98) control) and all CHCWs scored lower than 70%. The lowest scores were found in the “understanding of nutritional recommendations” section (mean score = 28% in intervention and 30% in control CHCWs). After 4 months, CHCWs in the intervention group demonstrated improvement relative to the control group (75.5% (6.01) versus 57.4% (5.59), respectively, p <.001, n=69). The percent of CHCWs achieving a total score of 70% was 77% (27/35) in intervention and 0% in control groups. The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand. Ultimately, prevention of chronic diseases and associated risk factors should be enhanced.

Policy makers in education and international development have lately gravitated toward the randomized controlled trial (RCT)—an evaluation design that randomly assigns a sample of people or households into an intervention group and a control group in order to measure the differential effect of the intervention—as a means to determine program impact. As part of federal regulations, the U.S. Department of Education and the U.S. Agency for International development explicitly declared a preference for the RCT. When advocating for adopting the RCT model as the preferred evaluation tool, policy makers point to the success story of medical trials and how they revolutionized medicine from Medieval charlatanry to a modern life-saving discipline. By presenting a more nuanced account of the role of the RCT in medical history, however, this study finds that landmark RCTs were accompanied with challenges, Evidence-Based Medicine had rightful critics, and opportunistic biases in drug trials apply equally to education policy and international development. This study also examines the recent privileged role of the RCT in education and international development, concluding that its initial promise was not entirely born out when put into practice, as the national Reading First Initiative exemplifies. From a comparative perspective, the RCT movements also encountered major RCT critics, whose voices were not initially heard. These voices, however, seem to have contributed to a swing of the pendulum away from RCT primacy back towards greater methodological pluralism. A major conclusion of this study is that policy makers should exercise great caution when using RCTs as a policy evaluation tool. This conclusion is arrived at via considering RCT biases, challenges, and limited generalizability; understanding its interpretive-qualitative components; and broadening the overall methodological repertoire to better enable evaluations of macro-policy interventions. / text

Purpose: Transitioning into retirement may be a suitable period to help adults establish an active lifestyle. One innovative approach to promote PA may be through multimedia-based programs. This experiment aimed to explore the feasibility DVD and videogame-based exercise programs in promoting physical activity (PA) in adults transitioning into retirement. Underlying motivations, functional fitness, quality of life, and elicited beliefs from participating in the exercise programs were also explored. Methods: Twenty-seven adults were randomized into either a nine-week exercise DVD (n = 9), exergame (n = 9), or waitlisted control group (n = 9). Main outcomes include adherence was based on attendance during the in-lab component and participant logs during the in-home component. PA levels were measured through accelerometery and assessed at baseline, four-, nine- and 12-weeks. Secondary outcomes related to motivation were assessed at baseline, three- and nine-weeks. Tertiary outcomes such as physiological/functional fitness and quality of life outcomes were assessed at pre- and post-intervention. Results: During the in-lab portion, t-tests showed that adherence was slightly higher in the exergame group than the DVD group (t16 = -0.06, p = .96; d = .31). Repeated measures of analysis showed that the group x time interaction for moderate-to-vigorous physical activity (MVPA) (F2,24 = 0.87, p = .52; η2 = .05), while overall PA saw negligible changes (F2,24 = 0.16, p = .85; η2 = .01). At the end of the intervention, overall adherence was similar between both exercise groups (t16 = -0.06, p = .96; d = .03). The group by time interaction effect yielded a moderate effect size for MVPA (F2,24 = 1.07, p = .36; η2 = .08) and overall PA (F2,24 = 1.11, p = .35; η2 = .08). Overall PA only increased in the exergame group (d = .74). The exergame group saw major decreases in instrumental attitude (d = .64), injunctive norm (d = .79), perceived behavioural control (d = .40) and intention (d = .90). Both exercise groups enhanced strength, mobility, and aerobic endurance outcomes (d = .33-.98), as well as several quality of life domains (d = .32-.89). At the post-intervention follow-up, both exercise groups were more active than the control group (d = .49-1.03). Two-thirds of the DVD group adopted DVD-based exercise, while a third of exergame group adopted videogame-based exercise. Conclusions: With a high adoption rate, DVD-based exercise programs may be a feasible and acceptable approach to promote PA levels. Participants in both groups were generally satisfied, indicating that the exercise program was enjoyable, comprehensive, and a simple and convenient way to exercise at home. Improvements to important functional and quality of life domains were also identified. Further research will be required to fully test the effectiveness of exercise DVDs and exergames on adherence and PA behaviour in adults transitioning into retirement. / Graduate / 0384 / christopher.yao7@gmail.com