Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 2001. / Typescript. Bibliography: leaves 82-94. Also available online.

Apesar de constituírem parte fundamental da prática clínica em psiquiatria e saúde mental, as psicoterapias ainda são pouco investigadas do ponto de vista científico. Este estudo tem o objetivo de examinar as preferências de profissionais da saúde mental em relação às escolas de psicoterapia ao longo da história e investigar a aplicação clínica corrente de uma das abordagens psicoterápicas mais praticadas na atualidade. Tanto quanto sabemos, este é o primeiro estudo a conduzir uma revisão sistemática e metaregressão que examina as prevalências globais de orientações teóricas entre psicoterapeutas ao longo dos últimos 50 anos, e especialmente na ultima década, conforme apresentado no primeiro artigo. A utilização no momento atual de intervenções cognitivo-comportamentais para um amplo espectro de transtornos psiquiátricos e outras condições médicas foi o objeto de estudo do segundo artigo. Por meio de busca computadorizada de artigos da literatura em bancos de dados eletrônicos, conduzimos uma revisão sistemática de pesquisas realizadas com profissionais de saúde que investigaram sobre suas afiliações a escolas psicoterápicas publicadas no período entre 1960 e 2012. Sessenta artigos que apresentavam dados originais com porcentagens específicas de preferências dos terapeutas por uma das 5 escolas de psicoterapia de maior preferência foram incluídos na análise. Posteriormente foi realizada uma segunda revisão sistemática de todos ensaios clínicos randomizados (ECRs) publicados no ano de 2014 que descreviam a comparação de uma intervenção cognitivo-comportamental com outra forma de intervenção psicossocial ou tratamento médico. Trezentos e noventa e quatro ECRs foram identificados e incluídos na análise final. Os dados analisados no primeiro estudo demostram que na ultima década a terapia cognitivo-comportamental (TCC) é o modelo teórico praticado por cerca de 28% dos psicoterapeutas pesquisados, seguido pela abordagem eclética/integrativa praticada por cerca de 23% dos profissionais. A orientação teórica psicanalítica e psicodinâmica foi endossada por 15% dos profissionais de saúde pesquisados. No segundo estudo, dados extraídos de artigos publicados no ano de 2014 revelaram que cerca de 58.000 indivíduos foram submetidos a intervenções cognitivas e comportamentais para tratamento de 22 diferentes diagnósticos médicos e psiquiátricos. Conforme esperado, 20% dos ensaios abordaram tratamentos para transtornos depressivos. Outras condições médicas, como tratamentos para dores e fadiga crônicas, e sintomas colaterais de tratamentos para o câncer, foram tratadas com intervenções cognitivas e comportamentais em 75 estudos, 19% do total. Um em cada 4 estudos foi feito em grupo; 65/394 estudos realizaram intervenções via computador; e quase todos (95% do total) foram realizados em países de alta renda econômica. Há um interesse crescente na utilização do modelo cognitivo-comportamental de psicoterapia por parte dos profissionais de saúde mental. Desde que iniciou sua trajetória, esta abordagem foi a única dentre as 5 estudadas que apresentou aumentos sistemáticos na porcentagem de terapeutas que professavam sua utilização na prática clinica. Um grande número de resultados de ECRs realizados em um único ano, com amostras de estudos conduzidos em todos quadrantes do planeta, relatando sua utilização cada vez mais abrangente para diferentes condições clínicas, demonstra a tendência de consolidação definitiva das terapias cognitivas comportamentais em nosso arsenal terapêutico. / Despite being an essential part of clinical practice in psychiatry and mental health, psychotherapies are still poorly investigated from a scientific point of view. This study aims to examine the endorsements of mental health professionals to psychotherapeutic orientations throughout history and to investigate the current clinical applications of one of the most practiced psychotherapeutic approaches. To our knowledge, this study is the first one to conduct a systematic review and meta-regression examining the prevalence of theoretical orientations amongst psychotherapists worldwide in the last 50 years, particularly in the last decade, as presented in the first article. The current uses of cognitive-behavioral interventions in a wide scope of psychiatric and other medical disorders was the second article focus. From a computerized literature search, we conducted a systematic review of the literature identifying any research conducted with health professional published in the period between January 1960 and December 2012. Sixty papers containing original data about the single preferred orientation of psychotherapists for one of the five most endorsed schools of psychotherapy were included in the final analysis. Then a second systematic review of the literature of all published papers in the year of 2014 describing randomized controlled trials that compared cognitive behavioral therapies with another form of psychosocial intervention or medical treatment was conducted. Three hundred ninety four studies were identified and included in the final analysis. The analysis of the data from the first study shows that in the last decade cognitive-behavioral therapy is the theoretical model practiced by around 28% of the researched psychotherapists, followed by the eclectic/integrative approach preferred by around 23% individuals. The psychoanalytic and psychodynamic theoretical orientation was endorsed by 15% of health professionals. In the second study, extracted data from papers published in the year of 2014 revealed that around 58,000 individuals underwent cognitive and behavioral interventions for the treatment of 22 different medical and psychiatric diagnoses. As expected, treatments for depressive disorders were the focus in 20% of trials. Other medical conditions, as chronic pain and fatigue, and collateral symptoms of cancer treatments, and insomnia, were treated with cognitive behavioral interventions in 75 studies, 19% of total. One in every 4 studies conducted group treatments; 65/394 studies performed computer-assisted psychosocial interventions; and almost all (95% of total) were conducted in high-income economy countries. There is a growing interest by mental health professionals in the cognitivebehavioral model. Since its appearance, this approach was the only one amongst the 5 studied that showed systematic increases in the percentages of therapists’ endorsements. The high number of randomized clinical trials conducted in a single year, with study samples from all planet quadrants, reporting an increasingly widespread use for different clinical conditions, demonstrates a definite consolidation of cognitive behavioral therapies in our therapeutic arsenal.

Apesar de constituírem parte fundamental da prática clínica em psiquiatria e saúde mental, as psicoterapias ainda são pouco investigadas do ponto de vista científico. Este estudo tem o objetivo de examinar as preferências de profissionais da saúde mental em relação às escolas de psicoterapia ao longo da história e investigar a aplicação clínica corrente de uma das abordagens psicoterápicas mais praticadas na atualidade. Tanto quanto sabemos, este é o primeiro estudo a conduzir uma revisão sistemática e metaregressão que examina as prevalências globais de orientações teóricas entre psicoterapeutas ao longo dos últimos 50 anos, e especialmente na ultima década, conforme apresentado no primeiro artigo. A utilização no momento atual de intervenções cognitivo-comportamentais para um amplo espectro de transtornos psiquiátricos e outras condições médicas foi o objeto de estudo do segundo artigo. Por meio de busca computadorizada de artigos da literatura em bancos de dados eletrônicos, conduzimos uma revisão sistemática de pesquisas realizadas com profissionais de saúde que investigaram sobre suas afiliações a escolas psicoterápicas publicadas no período entre 1960 e 2012. Sessenta artigos que apresentavam dados originais com porcentagens específicas de preferências dos terapeutas por uma das 5 escolas de psicoterapia de maior preferência foram incluídos na análise. Posteriormente foi realizada uma segunda revisão sistemática de todos ensaios clínicos randomizados (ECRs) publicados no ano de 2014 que descreviam a comparação de uma intervenção cognitivo-comportamental com outra forma de intervenção psicossocial ou tratamento médico. Trezentos e noventa e quatro ECRs foram identificados e incluídos na análise final. Os dados analisados no primeiro estudo demostram que na ultima década a terapia cognitivo-comportamental (TCC) é o modelo teórico praticado por cerca de 28% dos psicoterapeutas pesquisados, seguido pela abordagem eclética/integrativa praticada por cerca de 23% dos profissionais. A orientação teórica psicanalítica e psicodinâmica foi endossada por 15% dos profissionais de saúde pesquisados. No segundo estudo, dados extraídos de artigos publicados no ano de 2014 revelaram que cerca de 58.000 indivíduos foram submetidos a intervenções cognitivas e comportamentais para tratamento de 22 diferentes diagnósticos médicos e psiquiátricos. Conforme esperado, 20% dos ensaios abordaram tratamentos para transtornos depressivos. Outras condições médicas, como tratamentos para dores e fadiga crônicas, e sintomas colaterais de tratamentos para o câncer, foram tratadas com intervenções cognitivas e comportamentais em 75 estudos, 19% do total. Um em cada 4 estudos foi feito em grupo; 65/394 estudos realizaram intervenções via computador; e quase todos (95% do total) foram realizados em países de alta renda econômica. Há um interesse crescente na utilização do modelo cognitivo-comportamental de psicoterapia por parte dos profissionais de saúde mental. Desde que iniciou sua trajetória, esta abordagem foi a única dentre as 5 estudadas que apresentou aumentos sistemáticos na porcentagem de terapeutas que professavam sua utilização na prática clinica. Um grande número de resultados de ECRs realizados em um único ano, com amostras de estudos conduzidos em todos quadrantes do planeta, relatando sua utilização cada vez mais abrangente para diferentes condições clínicas, demonstra a tendência de consolidação definitiva das terapias cognitivas comportamentais em nosso arsenal terapêutico. / Despite being an essential part of clinical practice in psychiatry and mental health, psychotherapies are still poorly investigated from a scientific point of view. This study aims to examine the endorsements of mental health professionals to psychotherapeutic orientations throughout history and to investigate the current clinical applications of one of the most practiced psychotherapeutic approaches. To our knowledge, this study is the first one to conduct a systematic review and meta-regression examining the prevalence of theoretical orientations amongst psychotherapists worldwide in the last 50 years, particularly in the last decade, as presented in the first article. The current uses of cognitive-behavioral interventions in a wide scope of psychiatric and other medical disorders was the second article focus. From a computerized literature search, we conducted a systematic review of the literature identifying any research conducted with health professional published in the period between January 1960 and December 2012. Sixty papers containing original data about the single preferred orientation of psychotherapists for one of the five most endorsed schools of psychotherapy were included in the final analysis. Then a second systematic review of the literature of all published papers in the year of 2014 describing randomized controlled trials that compared cognitive behavioral therapies with another form of psychosocial intervention or medical treatment was conducted. Three hundred ninety four studies were identified and included in the final analysis. The analysis of the data from the first study shows that in the last decade cognitive-behavioral therapy is the theoretical model practiced by around 28% of the researched psychotherapists, followed by the eclectic/integrative approach preferred by around 23% individuals. The psychoanalytic and psychodynamic theoretical orientation was endorsed by 15% of health professionals. In the second study, extracted data from papers published in the year of 2014 revealed that around 58,000 individuals underwent cognitive and behavioral interventions for the treatment of 22 different medical and psychiatric diagnoses. As expected, treatments for depressive disorders were the focus in 20% of trials. Other medical conditions, as chronic pain and fatigue, and collateral symptoms of cancer treatments, and insomnia, were treated with cognitive behavioral interventions in 75 studies, 19% of total. One in every 4 studies conducted group treatments; 65/394 studies performed computer-assisted psychosocial interventions; and almost all (95% of total) were conducted in high-income economy countries. There is a growing interest by mental health professionals in the cognitivebehavioral model. Since its appearance, this approach was the only one amongst the 5 studied that showed systematic increases in the percentages of therapists’ endorsements. The high number of randomized clinical trials conducted in a single year, with study samples from all planet quadrants, reporting an increasingly widespread use for different clinical conditions, demonstrates a definite consolidation of cognitive behavioral therapies in our therapeutic arsenal.

Introdução: Muitos pacientes com zumbido também apresentam algum grau de perda auditiva associada e o uso de próteses auditivas pode ser uma boa opção para melhorar ambos os sintomas. Porém, na prática clínica, a oclusão do meato acústico externo pelo molde da prótese auditiva pode até piorar o zumbido em alguns casos. A literatura apresenta poucos estudos sobre a real influência da ventilação do molde da prótese auditiva na percepção do zumbido. Objetivo: avaliar a resposta do zumbido à prótese auditiva retro-auricular com dois tipos de ventilação no molde (molde aberto e ventilação de alívio) em pacientes com perda auditiva neurossensorial simétrica após um mês de uso. Métodos: 50 pacientes atendidos no Grupo de Pesquisa em Zumbido com zumbido bilateral e perda auditiva neurossensorial simétrica de grau leve a severo foram submetidos a um ensaio clínico randomizado cego crossover. Destes, 26 pacientes iniciaram o ensaio utilizando próteses auditivas com molde aberto (ventilação de 4mm) e 24 iniciaram usando molde com ventilação de alívio (ventilação de 1mm). Após 30 dias de teste com o primeiro tipo de molde e um período de wash-out (15 dias), o tipo de molde foi trocado e o segundo molde foi usado por mais 30 dias. O zumbido foi avaliado de modo qualitativo (classificado em melhora, inalterado e piora) e quantitativo (variação de 0 a 10 de uma escala numérica). Resultados: A melhora do zumbido foi observada em 82% dos casos com pelo menos um tipo de molde e não houve diferença significante na diminuição do incômodo com o zumbido nas avaliações qualitativa e quantitativa com ambos os moldes. Apesar disto, 66% dos pacientes preferiram o molde aberto. Conclusão: A curto prazo, a melhora do zumbido por meio da prótese auditiva em pacientes com perda auditiva neurossensorial simétrica de grau leve a severo não depende do tamanho da ventilação do molde auricular / Introduction: Most tinnitus patients also have some degree of associated hearing loss, and the use of hearing aids is an option to improve both symptoms. In daily practice, the occlusion of the external meatus by the earmold during hearing aids fitting may enhance the tinnitus perception. However, the literature lacks studies about the real influence of the earmold ventilation on tinnitus perception. Objective: to evaluate the tinnitus response to the BTE hearing aids using two types of ventilation (open mold and relief ventilation) in patients with symmetric sensorineural hearing loss after one month usage. Methods: 50 patients attended in our Tinnitus Clinic who presented bilateral tinnitus and mild to severe symmetric sensorineural hearing loss underwent a randomized blind crossover clinical trial. Among them, 26 first used BTE hearing aids with open molds (4mm ventilation) and 24 first used hearing aids with relief ventilation mold (1mm ventilation). After 30 days using the first mold and a 15-day wash-out period, the type of earmold was changed in a crossover way and the second mold was used for another 30-day-period. Tinnitus evaluation was performed by a qualitative way (classified in improvement, unchanged and worsening) and by a quantitative way (variation of a numeric scale from 0 to 10). Results: Tinnitus improvement was observed by 82% of the patients with at least one type of earmold and there was no significant difference in the decrease of tinnitus discomfort by both, quantitative and qualitative evaluation. Despite the similar tinnitus control, 66% of the patients preferred to acquire the hearing aids with open mold. Conclusion: In a short-term evaluation, the tinnitus improvement by the use of hearing aids in patients with mild to severe symmetric sensorineural hearing loss does not depend on the size of earmold ventilation

Abstract The nature of symptoms and signs of sciatica, genetic factors, and efficacy of periradicular infiltration were studied in 160 nonoperated patients with unilateral sciatica of 3 to 28 weeks duration. Back and leg pain (100-mm VAS), disability (Oswestry), and quality-of-life (NHP) were evaluated. ENMG and 1.5-T MRI were performed on every patient. Presence of the Trp2 and Trp3 alleles of collagen IX was determined from blood samples. After informed consent, patients were randomized for periradicular infiltration with either methylprednisolone-bupivacaine, or saline. The final follow-up assessment was 1 year after the intervention. Economic analysis was based on data gathered from the patients, medical records and the National Insurance Register. At baseline, symptoms of sciatica did not correlate with the type of displacement of the symptomatic disc in MRI, or the presence of the Trp2 or Trp3 alleles. In the case of the Trp2 allele, there was a non-significant tendency for the presence of a radial tear at the L4–5 level. A significant genotype-phenotype association was found for the Trp3 allele: 15 of 34 (44%) patients with the Trp3 allele were positive for thoracolumbar Scheuermann's disease in MRI compared to 19% for sciatic patients without the allele (p = 0.003). Periradicular infiltration with methylprednisolone-bupivacaine produced a significant treatment effect compared to saline at 2 weeks for leg pain, straight leg raising, lumbar flexion and patient satisfaction. At 6 months, saline was superior to steroid in back and leg pain. By 1 year, 18 patients in the methylprednisolone group and 15 in the saline group had received surgical treatment. Subgroup analysis revealed that the short-term effect of the steroid treatment was most pronounced for contained herniations and symptomatic lesions situated at the L4–5 (or L3–4) disc level. Patients with a contained herniation were less likely to undergo back surgery when receiving the steroid treatment and they also had significantly fewer days on sick leave from 3 to 6 months. Counter-effectiveness was most pronounced for extrusions. The results indicate that disability among sciatic patients may be present even when MRI findings are minor; and vice versa, prominent MRI findings may not associate with any symptoms. However, MRI seems to be useful for identifying patients with the Trp3 allele. On the basis of the treatment intervention results, periradicular infiltration with a combination of steroid and anaesthetic may be recommended for sciatica as it offers at least short-term pain relief. Furthermore, in the case of contained herniations the steroid injection is cost-effective and may also prevent surgery. However, this subgroup analysis calls for a verification study.

The dissertation compiles a series of essays which describes effects of various institutional variations randomized across a sample of 500 villages in Afghanistan in 2007. The first essay examines the institutional effects of the creation of democratically-elected, gender-balanced village development councils across 474 village councils. The creation of councils is found to have no effects on the structure and function of local governance or on how male villagers perceive local governance quality. However, council creation provokes increased local governance activity among paramilitary commanders – who experience broad-based improvements in public perceptions – and improves perceptions of local governance quality among women. The results indicate that externally-imposed de jure reforms do not substantially alter institutional outcomes, but may provoke countervailing responses by political authorities seeking to benefit from the institutional change. The second essay examines the effects of direct democracy on the alignment between public resource allocation decisions and citizen preferences. Using data from 250 villages, the study compares decision outcomes produced by secret-ballot referenda with outcomes produced by public meetings led by an elected village council. The results indicate that while elites do exert influence over outcomes produced by public meetings, their preferences do not determine the outcomes of referenda, which are influenced primarily by citizen preferences. Referenda are also found to improve citizen satisfaction, which is particularly low where elites exert undue influence over outcomes. The third essay examines whether the inclusion of villages in Afghanistan‘s largest development program affects counter-insurgency outcomes, such as individual perceptions of well-being, attitudes towards government, and the occurrence of violent incidents in surrounding areas. The program is found to affect all three measures, but only in areas with low levels of initial violence. The results indicate that development programs can limit the onset of insurgencies in relatively secure areas, but are not effective in improving attitudes to government and reducing violence where insurgents are already active. / Government

Clinical trials in kidney transplantation suffer from several major issues including: 1) Unfeasibility due to low short-term event rates of hard outcomes and 2) Reliance on a composite outcome that consists of unequal endpoints that may generate misleading results. This thesis attempts to explore and apply methods to solve these issues and ultimately, improve kidney transplantation trials. We present a secondary analysis of the ACE trial in kidney transplant using composites with alternative graft function surrogate endpoints. Typically, kidney transplant trials—including the ACE trial— use a time-to-event composite of death, end-stage renal disease (ESRD), and doubling of serum creatinine. Instead of doubling of serum creatinine, we investigated the use of percentage declines of estimate glomerular filtration rate (eGFR) within a time-to-event composite of death and ESRD. Additionally, we present an application of an innovative analysis method, the win ratio approach, to the ACE trial as a way of lessening concerns associated with unequal composite endpoints. Composites of death, ESRD, and either a 40%, 30% or 20% decline in eGFR did not alter original ACE trial results, interpretations, or conclusions. The win ratio approach, and the presentation of a win ratio, generated very comparable results to a standard time-to-event analysis while lessening the impact of unequal composite endpoints and making fewer statistical assumptions. This research provides a novel, trial-level application of alternative endpoints and analysis techniques within a kidney transplant trial setting.

No description available.

No description available.

Bakgrund: Hälsorelaterad livskvalitet är av stor betydelse för välbefinnandet hos den åldrande befolkningen, och styrketräning kan vara en potentiell metod att förbättra den hälsorelaterade livskvaliteten hos äldre individer. Syfte: Syftet med denna litteraturöversikt är att sammanställa effekterna av regelbunden styrketräning på hälsorelaterad livskvalitet hos personer över 60 år. Metod: En systematisk litteraturöversikt genomfördes i den medicinska databasen PubMed, innehållande randomiserade kontrollerade studier publicerade på engelska under de senaste 10 åren. Studierna inkluderade äldre individer (minst 60 år) och jämförde styrketräning med en kontrollgrupp utan intervention. Studiernas enskilda kvalitet granskades med TESTEX och studiernas sammanlagda evidens bedömdes med GRADEstud. Resultat: Åtta studier med ett totalt deltagarantal på 542 inkluderades. Kvaliteten på studierna varierade från 7-14 av 15 poäng på TESTEX-skalan varav 12 poäng ansågs visa på hög tillförlitlighet. Endast 4 av studierna ansågs vara av hög tillförlitlighet och inkluderades i det sammanlagda resultatet. Evidensstyrkan av de sammanlagda studierna blev i sin tur låg ++, då det förekom bristande samstämmighet och precision i studierna. Tre av 4 studier som inkluderades i det sammanlagda resultatet visade på en positiv effekt av styrketräning på hälsorelaterad livskvalitet, den fjärde studien visade inte några statistiskt signifikanta mellangruppsskillnader. Slutsats: Regelbunden styrketräning kan ha en positiv effekt på hälsorelaterad livskvalitet hos äldre individer, men mer forskning krävs för att dra definitiva slutsatser. Ytterligare högkvalitativa randomiserade studier behövs för att stärka evidensen och fastställa rekommendationer för styrketräning hos äldre. / Background: Health-related quality of life is essential for the well-being of the agingpopulation, and resistance training is a potential approach to enhance the health-relatedquality of life in older individuals. Aim: This literature review aims to summarize the effects of resistance training onhealth-related quality of life in individuals aged 60 and above. Method: A systematic literature review was conducted in the medical database PubMed,including randomized controlled trials published in English within the past 10 years. Theincluded studies involved older individuals (at least 60 years) and compared resistancetraining to a non intervention control group. The quality of the individual studies wereexamined using TESTEX and the evidence of the combined studies results was determinedusing GRADEstud. Results: Eight studies were included with a total of 542 participants. The quality of theindividual studies varied from 7-14 out of 15 points on the TESTEX-scale wherein 12 pointswas considered to show high reliability.Only four of them were considered to be of high quality and were included in the summarizedresult. The combined evidence was deemed as low ++, due to the studies lack of consensusand precision. Three out of four studies included in the summarization found a positive effectof resistance training on health-related quality of life, while the fourth one did not show anystatistically significant differences. Conclusion: Consistent resistance training may have a positive effect on health-relatedquality of life in older individuals, but more research is needed to draw definitiveconclusions. Additional high-quality randomized trials are needed to strengthen the evidenceand establish recommendations for resistance training in the elderly.