O objetivo principal desta dissertação foi avaliar a percepção de qualidade de vida relacionada à saúde (QVRS) de adolescentes do 6 ano do ensino fundamental de escolas públicas e privadas do Rio de Janeiro, São Gonçalo e Niterói. Para tal, foi realizado um estudo transversal da linha de base (2010) do Estudo Longitudinal de Avaliação Nutricional de Adolescentes ELANA- com 807 adolescentes entre 10 e 17 anos pertencentes ao 6 ano do ensino fundamental de duas escolas públicas de Niterói e quatro escolas privadas do Rio de Janeiro e São Gonçalo. As informações que subjazem a pesquisa foram obtidas através do autopreenchimento da versão reduzida do instrumento Kidscreen, com 27 itens e 5 dimensões (Saúde e Atividade Física, Bem-estar Psicológico, Autonomia e Relação com os Pais, Amigos e Apoio Social e Ambiente Escolar). Testes T de Student foram usados para avaliar a percepção diferencial de QVRS estratificada por rede de ensino, sexo, faixa etária e posição econômica. Além disso, modelos de regressão linear foram implementados com vista à avaliação de diferentes cenários de percepção de QVRS segundo combinações das variáveis selecionadas para especificação de subgrupos (modelagem de predição). Os resultados apontam para diferenças significativas na percepção de cada dimensão da QVRS entre os subgrupos selecionados ainda que a maior parte dos adolescentes possua uma percepção positiva das mesmas. Destaca-se o subgrupo tipo de escola, onde a percepção de QVRS entre os adolescentes das escolas privadas apresentou-se melhor em comparação aos de escolas públicas em todas as suas dimensões. Ademais, os adolescentes mais velhos (12 a 17 anos), os de escola pública e/ou aqueles com menor posse de bens apresentaram valores considerados ruins ou negativos na dimensão Autonomia e Relação com os Pais. Os cenários de projeção apresentados sugerem certa vulnerabilidade a uma menor QVRS entre alguns dos subgrupos estudados, a saber, as meninas de escolas públicas e com menor posse de bens (Dimensão Saúde e Atividade Física); os adolescentes mais próximos da fase adulta e desfavorecidos economicamente (Bem-estar Psicológico); os estudantes de escolas públicas com menor posse de bens (Autonomia e Relação com os Pais); os meninos de escolas públicas (Amigos e Apoio Social) e os meninos na segunda fase da adolescência (Ambiente Escolar). Espera-se que a divulgação dos resultados desta dissertação possa contribuir com as discussões no campo da saúde coletiva sobre a temática da QVRS, mediante o incentivo de políticas intersetoriais de promoção da saúde escolar, focalizando prioritariamente os subgrupos mais vulneráveis a uma menor QVRS.

O objetivo principal desta dissertação foi avaliar a percepção de qualidade de vida relacionada à saúde (QVRS) de adolescentes do 6 ano do ensino fundamental de escolas públicas e privadas do Rio de Janeiro, São Gonçalo e Niterói. Para tal, foi realizado um estudo transversal da linha de base (2010) do Estudo Longitudinal de Avaliação Nutricional de Adolescentes ELANA- com 807 adolescentes entre 10 e 17 anos pertencentes ao 6 ano do ensino fundamental de duas escolas públicas de Niterói e quatro escolas privadas do Rio de Janeiro e São Gonçalo. As informações que subjazem a pesquisa foram obtidas através do autopreenchimento da versão reduzida do instrumento Kidscreen, com 27 itens e 5 dimensões (Saúde e Atividade Física, Bem-estar Psicológico, Autonomia e Relação com os Pais, Amigos e Apoio Social e Ambiente Escolar). Testes T de Student foram usados para avaliar a percepção diferencial de QVRS estratificada por rede de ensino, sexo, faixa etária e posição econômica. Além disso, modelos de regressão linear foram implementados com vista à avaliação de diferentes cenários de percepção de QVRS segundo combinações das variáveis selecionadas para especificação de subgrupos (modelagem de predição). Os resultados apontam para diferenças significativas na percepção de cada dimensão da QVRS entre os subgrupos selecionados ainda que a maior parte dos adolescentes possua uma percepção positiva das mesmas. Destaca-se o subgrupo tipo de escola, onde a percepção de QVRS entre os adolescentes das escolas privadas apresentou-se melhor em comparação aos de escolas públicas em todas as suas dimensões. Ademais, os adolescentes mais velhos (12 a 17 anos), os de escola pública e/ou aqueles com menor posse de bens apresentaram valores considerados ruins ou negativos na dimensão Autonomia e Relação com os Pais. Os cenários de projeção apresentados sugerem certa vulnerabilidade a uma menor QVRS entre alguns dos subgrupos estudados, a saber, as meninas de escolas públicas e com menor posse de bens (Dimensão Saúde e Atividade Física); os adolescentes mais próximos da fase adulta e desfavorecidos economicamente (Bem-estar Psicológico); os estudantes de escolas públicas com menor posse de bens (Autonomia e Relação com os Pais); os meninos de escolas públicas (Amigos e Apoio Social) e os meninos na segunda fase da adolescência (Ambiente Escolar). Espera-se que a divulgação dos resultados desta dissertação possa contribuir com as discussões no campo da saúde coletiva sobre a temática da QVRS, mediante o incentivo de políticas intersetoriais de promoção da saúde escolar, focalizando prioritariamente os subgrupos mais vulneráveis a uma menor QVRS.

This study empirically compares the Classical Test Theory (CTT) and the Partial Credit Model (PCM) of Rasch focusing on the invariance of item parameters. The invariance concept which is the consequence of the principle of specific objectivity was tested in both CTT and PCM using the results of learners who wrote the National Senior Certificate (NSC) Mathematics examinations in 2010. The difficulty levels of the test items were estimated from the independent samples of learn- ers. The same sample of learners used in the calibration of the difficulty levels of the test items in the PCM model were also used in the calibration of the difficulty levels of the test items in CTT model. The estimates of the difficulty levels of the test items were done using RUMM2030 in the case of PCM while SAS was used in the case of CTT. RUMM2030 and SAS are both the statistical softwares. The analysis of variance (ANOVA) was used to compare the four different design groups of test takers. In cases where the ANOVA showed a significant difference between the means of the design groups, the Tukeys groupings was used to establish where the difference came from. The research findings were that the test items' difficulty parameter estimates based on the CTT theoretical framework were not invariant across the different independent sample groups. The over- all findings from this study were that the CTT theoretical framework was unable to produce item difficulty invariant parameter estimates. The PCM estimates were very stable in the sense that for most of the items, there was no significant difference between the means of at least three design groups and the one that deviated from the rest did not deviate that much. The item parameters of the group that was representative of the population (proportional allocation) and the one where the same number of learners (50 learners) was taken from different performance categories did not differ significantly for all the items except for item 6.6 in examination question paper 2. It is apparent that for the test item parameters to be invariant of the group of test takers in PCM, the group of test takers must be heterogeneous and each performance category needed to be big enough for the proper calibration of item parameters. The higher values of the estimated item parameters in CTT were consistently found in the sample that was dominated by the high proficient learners in Mathematics ("bad") and the lowest values were consistently calculated in the design group that was dominated by the less proficient learners. This phenomenon was not apparent in the Rasch model. / Mathematical Sciences / M.Sc. (Statistics)

This study empirically compares the Classical Test Theory (CTT) and the Partial Credit Model (PCM) of Rasch focusing on the invariance of item parameters. The invariance concept which is the consequence of the principle of specific objectivity was tested in both CTT and PCM using the results of learners who wrote the National Senior Certificate (NSC) Mathematics examinations in 2010. The difficulty levels of the test items were estimated from the independent samples of learn- ers. The same sample of learners used in the calibration of the difficulty levels of the test items in the PCM model were also used in the calibration of the difficulty levels of the test items in CTT model. The estimates of the difficulty levels of the test items were done using RUMM2030 in the case of PCM while SAS was used in the case of CTT. RUMM2030 and SAS are both the statistical softwares. The analysis of variance (ANOVA) was used to compare the four different design groups of test takers. In cases where the ANOVA showed a significant difference between the means of the design groups, the Tukeys groupings was used to establish where the difference came from. The research findings were that the test items' difficulty parameter estimates based on the CTT theoretical framework were not invariant across the different independent sample groups. The over- all findings from this study were that the CTT theoretical framework was unable to produce item difficulty invariant parameter estimates. The PCM estimates were very stable in the sense that for most of the items, there was no significant difference between the means of at least three design groups and the one that deviated from the rest did not deviate that much. The item parameters of the group that was representative of the population (proportional allocation) and the one where the same number of learners (50 learners) was taken from different performance categories did not differ significantly for all the items except for item 6.6 in examination question paper 2. It is apparent that for the test item parameters to be invariant of the group of test takers in PCM, the group of test takers must be heterogeneous and each performance category needed to be big enough for the proper calibration of item parameters. The higher values of the estimated item parameters in CTT were consistently found in the sample that was dominated by the high proficient learners in Mathematics ("bad") and the lowest values were consistently calculated in the design group that was dominated by the less proficient learners. This phenomenon was not apparent in the Rasch model. / Mathematical Sciences / M.Sc. (Statistics)

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The field of medicine is regularly faced with the challenge of utilizing information that is complicated or difficult to characterize. Physicians often must use their best judgment in reaching decisions or recommendations for treatment in the clinical setting. The goal of this thesis is to use innovative statistical tools in tackling three specific challenges of this nature from current healthcare applications. The first aim focuses on developing a novel approach to meta-analysis when combining binary data from multiple studies of paired design, particularly in cases of high heterogeneity between studies. The challenge is in properly accounting for heterogeneity when dealing with a low or moderate number of studies, and with a rarely occurring outcome. The proposed approach uses a Rasch model for translating data from multiple paired studies into a unified structure that allows for properly handling variability associated with both pair effects and study effects. Analysis is then performed using a Bayesian hierarchical structure, which accounts for heterogeneity in a direct way within the variances of the separate generating distributions for each model parameter. This approach is applied to the debated topic within the dental community of the comparative effectiveness of materials used for pit-and-fissure sealants. The second and third aims of this research both have applications in early detection of breast cancer. The interpretation of a mammogram is often difficult since signs of early disease are often minuscule, and the appearance of even normal tissue can be highly variable and complex. Physicians often have to consider many important pieces of the whole picture when trying to assess next steps. The final two aims focus on improving the interpretation of findings in mammograms to aid in early cancer detection. When dealing with high frequency and irregular data, as is seen in most medical images, the behaviors of these complex structures are often difficult or impossible to quantify by standard modeling techniques. But a commonly occurring phenomenon in high-frequency data is that of regular scaling. The second aim in this thesis is to develop and evaluate a wavelet-based scaling estimator that reduces the information in a mammogram down to an informative and low-dimensional quantification of the innate scaling behavior, optimized for use in classifying the tissue as cancerous or non-cancerous. The specific demands for this estimator are that it be robust with respect to distributional assumptions on the data, and with respect to outlier levels in the frequency domain representation of the data. The final aim in this research focuses on enhancing the visualization of microcalcifications that are too small to capture well on screening mammograms. Using scale-mixing discrete wavelet transform methods, the existing detail information contained in a very small and course image will be used to impute scaled details at finer levels. These "informed" finer details will then be used to produce an image of much higher resolution than the original, improving the visualization of the object. The goal is to also produce a confidence area for the true location of the shape's borders, allowing for more accurate feature assessment. Through the more accurate assessment of these very small shapes, physicians may be more confident in deciding next steps.