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[pt] Nesta tese, trabalhou-se com a modelagem Rasch visando a apresentar alternativas mais práticas e de melhor qualidade em termos de medida, para dois cenários distintos. O primeiro está relacionado ao fato de que medir conhecimento é algo muito complexo e de difícil entendimento para profissionais que não são da área da psicometria. Por meio de experimentos envolvendo modelos da família Rasch, apresentamos a aplicabilidade e as potencialidades dessa modelagem para atender a novas demandas de avaliação em larga escala no Brasil. O segundo cenário relaciona-se à busca de medir, de modo o mais imparcial possível, itens de produção escrita, em que a nota recebida pelos alunos é influenciada pela subjetividade dos corretores, ou seja, corretores lenientes beneficiam alunos e corretores severos penalizam alunos. Diante desses dois cenários, esta tese tem os seguintes objetivos: (i) trazer para o âmbito das avaliações realizadas no Brasil uma modelagem matemática mais simples que aquela atualmente adotada, visando uma melhor comunicação com os professores, e; (ii) a possibilidade de operar não apenas com itens de múltipla escolha, corrigidos de forma automática, mas também com itens de produção escrita, em que a subjetividade dos corretores (severidade) é controlada pelo modelo psicométrico, gerando medidas de melhor qualidade. Para isso, utilizou-se a modelagem Rasch com multifacetas, abordando, por meio de casos práticos, as vantagens dessa modelagem em relação a outras metodologias atualmente adotadas no país. Assim, para a alcançarmos o primeiro objetivo, confrontamos a modelagem Rasch com multifacetas com a modelagem de três parâmetros logísticos em um estudo de efeito contexto em testes compostos por diferentes modelos de cadernos e com mais de uma disciplina avaliada por caderno e, para o segundo, comparamos as medidas de proficiência através da Rasch com multifacetas com as notas médias das duplas correções dadas pelos corretores aos alunos em testes do tipo redação. A partir dos resultados encontrados, concluímos que a Rasch com multifacetas pode ser utilizada de forma alternativa ou concomitante com as avaliações que utilizam a modelagem de três parâmetros logísticos, produzindo resultados mais rápidos e de entendimento mais fácil por parte dos professores e que, no caso de redações, as proficiências obtidas pela Rasch com multifacetas apresentaram medidas com melhores indicadores de fidedignidade e validade, quando comparadas com as medidas de notas via Teoria Clássica do Teste, sendo, portanto, uma alternativa mais viável para esse tipo de avaliação. Conclui-se essa tese apresentando situações de empregabilidade das metodologias estudadas. / [en] In this thesis, we worked with Rasch modeling, aiming to present more practical alternatives and better quality in terms of measurement, for two different scenarios. The first one is related to the fact that measuring knowledge is something very complex and difficult to understand for professionals who are not in the psychometrics area. Through experiments involving the Rasch family models, we present the applicability and the potentiality of this model to adequately comply with the new demands of the large-scale evaluation in Brazil. The second scenario is related to the search of measuring, in the most impartial way possible, written production items which grade received by the subjectivity of the raters (severity), that is, lenient raters benefit students and severe raters penalize them. In view of these two scenarios, this thesis has the following objectives: (i) to bring to the scope of the evaluations carried out in Brazil a simpler mathematical modeling than the currently adopted, aiming at a better communication with the teachers; and (ii) the possibility of operating not only with multiple choice items, corrected automatically, but also with written production items, in which the subjectivity of the raters (severity) is controlled by the psychometric model, generating better quality measures. For this, Many-Facet Rasch Measurement was used, approaching, through practical cases, the advantages of this modeling in relation to other methodologies currently adopted in the country. Thus, in order to reach the first objective, we confronted Many-Facet Rasch Measurement with the modeling of three logistic parameters in a study of context effect in tests composed by different models of test books and with more than one discipline evaluated by test book and, for the second one, we compared the measures of proficiency through the Many-Facet Rasch Measurement with the average scores of the double corrections given by the raters to the students in tests of the essay type. From the results found, we conclude that the Many-Facet Rasch Measurement can be used in an alternative or concomitant way with the evaluations that use the three logistic parameters model, producing faster results and easier to understand by the teachers and that, in the case of essays, the measures of proficiency obtained by Many-Facet Rasch Measurement presented measures with better reliability and validity indicators, when compared to the grading measures through the Classical Theory of Testing, being, therefore, a more viable alternative for this type of evaluation. This thesis concludes with situations of usability of the methodologies studied.

Ce mémoire porte sur la validité et la fidélité de l’Échelle d’Évaluation des Dimensions du Comportement - version parent- (EDC-P) (Poirier, Tremblay, Perreault, Morizot, Maranda et Freeston, 1998). L’EDC-P est un outil d’évaluation qui permet de détecter la présence de troubles du comportement (TC) chez les enfants. L’objectif principal de l’étude consiste à déterminer dans quelle mesure la perception d’un parent telle que recueillie par l’EDC-P est un prédicteur valide d’un critère diagnostique ou légal établissant qu’un enfant présente un TC. Les données indiquent que la performance de l’EDC-P est satisfaisante. De plus, les analyses de sensibilité et de spécificité montrent que l’échelle classe correctement 89%des enfants TC (N=90) et 80% des enfants sans TC (N=90). Par ailleurs, la fidélité inter-juges est examinée entre l’évaluation parentale et celle de l’enseignant de l’enfant TC (N=52). Tel qu’observé dans la littérature, le degré d’accord entre ces deux répondants est relativement faible(Achenbach, McConaughy & Howell, 1987). En somme, les propriétés psychométriques de l’EDC-P s’avèrent satisfaisantes pour l’évaluation et le dépistage des TC dans différents milieux institutionnels.

La schizophrénie est une pathologie fréquente et grave qui touche environ 1% de la population adulte jeune et constitue un problème majeur de santé public. Son mode évolutif reste marqué par la chronicité et la fréquence des rechutes. Depuis les années 1950 l'apport des neuroleptiques, puis celui des neuroleptiques atypiques présentant une meilleure tolérance neurologique, a considérablement modifié la prise en charge des patients souffrant de schizophrénie. Toutefois, les effets latéraux des neuroleptiques ont toujours constitués une des principales limites de cet apport thérapeutique la seconde étant l'importance des non réponses au traitement voire des résistances. Le pourcentage d'échec au traitement en phase aigue reste encore très élevé sans que l'on soit capable de prédire le risque de non réponse en fonction du traitement choisi. En pratique clinique, le choix thérapeutique se fait souvent de façon empirique. L'utilisation de critères diagnostics fiables et harmonisés (DSMIV) ainsi que l'approche de la réponse au traitement à l'aide d'outils de mesures dimensionnels (PANSS, BPRS, CGI) ont permis de réaliser une progression majeure dans l'abord de la recherche clinique dans la schizophrénie. En particulier les critères associés au pronostic évolutif ont pu être mieux appréhendés. Des facteurs prédictifs cliniques et précliniques d'une mauvaise réponse au traitement chez les patients principalement traités par des neuroleptiques conventionnels ont été décrits : l'âge de début de la maladie, la durée d'évolution sans traitement et la gravité de l'atteinte pour des critères cliniques. La pharmacogénétique étudie les mécanismes d'origine génétique impliqués dans la réponse aux médicaments et permet de mettre en évidence des critères prédictifs individuels en termes d'efficacité des traitements. Les données pharmacogénétiques concernant la réponse aux neuroleptiques sont présentées au cours de ce travail à travers une revue de la littérature. Les travaux effectués dans ce domaine concernent en particulier les hypothèses pharmacodynamiques et les gènes impliqués dans la synthèse des récepteurs aux monoamines. Les carences méthodologiques des 1ères études réalisées; en particulier en termes d'homogénéité ethnique des populations étudiées et d'évaluation du phénotype, expliquent que peu de résultat soient répliqués à ce jour. Dans une cohorte de patients schizophrènes caucasiens traités par olanzapine ou rispéridone et évaluée prospectivement pour l'efficacité et la tolérance du traitement, nous avons recherché des critères cliniques et socio-démographiques permettant de prédire la réponse au traitement. L'âge précoce de début des troubles et la durée de la maladie sont des prédicteurs individuels de la mauvaise réponse au traitement. Nous avons également étudié l'implication de variants génétiques du transporteur de la noradrénaline, inhibé par l'olanzapine et la rispéridone, dans l'efficacité des traitements antipsychotiques. Nous avons observé l'implication de 2 polymorphismes de ce transporteur dans la décroissance des symptômes positifs sous traitement. Ces travaux ont permis de confirmer la difficulté de prédire la réponse au traitement dans la schizophrénie sans développer des marqueurs biologiques fiables. L'apport de la pharmacogénétique semble une voie essentielle dans cette perspective.

This study focuses on the development of an objective, automated method to extract clinically useful information from sustained vowel phonations in the context of Parkinson’s disease (PD). The aim is twofold: (a) differentiate PD subjects from healthy controls, and (b) replicate the Unified Parkinson’s Disease Rating Scale (UPDRS) metric which provides a clinical impression of PD symptom severity. This metric spans the range 0 to 176, where 0 denotes a healthy person and 176 total disability. Currently, UPDRS assessment requires the physical presence of the subject in the clinic, is subjective relying on the clinical rater’s expertise, and logistically costly for national health systems. Hence, the practical frequency of symptom tracking is typically confined to once every several months, hindering recruitment for large-scale clinical trials and under-representing the true time scale of PD fluctuations. We develop a comprehensive framework to analyze speech signals by: (1) extracting novel, distinctive signal features, (2) using robust feature selection techniques to obtain a parsimonious subset of those features, and (3a) differentiating PD subjects from healthy controls, or (3b) determining UPDRS using powerful statistical machine learning tools. Towards this aim, we also investigate 10 existing fundamental frequency (F_0) estimation algorithms to determine the most useful algorithm for this application, and propose a novel ensemble F_0 estimation algorithm which leads to a 10% improvement in accuracy over the best individual approach. Moreover, we propose novel feature selection schemes which are shown to be very competitive against widely-used schemes which are more complex. We demonstrate that we can successfully differentiate PD subjects from healthy controls with 98.5% overall accuracy, and also provide rapid, objective, and remote replication of UPDRS assessment with clinically useful accuracy (approximately 2 UPDRS points from the clinicians’ estimates), using only simple, self-administered, and non-invasive speech tests. The findings of this study strongly support the use of speech signal analysis as an objective basis for practical clinical decision support tools in the context of PD assessment.

The main aim of the presented diploma thesis was to record objective and subjective changes after therapy with DNS concept in a group of 13 people with LBP. Moiré projection topography was used to record postural changes after 5.5 week therapeutic intervention. It was not clear, whether DNS exercise would help them to achieve visible postural changes and whether this technique is able to record these changes, which would mean that it is a suitable option for objectivisation of therapies focusing on correction of stabilisation and postural functions. Pedoscan was used for further objectivisation of the effect of DNS concept. The chosen correlate of the mentioned objective evaluation was Oswestry disability index, evaluating limitations of common everyday activities resulting from pain in the lower back, and the Numeric pain scale. Patients underwent 5 hour-long physiotherapeutic lessons, the recommended frequency of exercises in the household environment was 3-4 times per day. The probands exercised with the use of DNS concept according to the individual examination findings, especially in the area of the integrated spine stabilisation system. The data were statistically elaborated by Wilcoxon Signed-Rand test, which a non-parametric variant of the pair T-test. It is obvious from the results that...

Title: A systematic review of pain assessment tools Objectives: The aim of this thesis is to create a systematic review of the most widely used multidimensional tools (questionnaires) for assessing pain in patients with nonspecific pain of the cervical and lumbar spine. From the available sources, describe their use, the purpose it was generated for, their reliability, validity, and finally arrange the questionnaires from the most used and assess their advantages and disadvantages for use in clinical practice of physiotherapist. Method: The thesis is processed through a systematic review. The subject of the thesis are pain evaluating tools, especially in the cervical and lumbar spine. The studies containing questionnaires used to assess pain in the cervical and lumbar spine were searched out. Data extraction was carried out according to pre-specified criteria. Unsatisfactory studies were excluded. After the relevant questionnaires selection a content analysis of each tool was conducted, built a systematic review of the most commonly used questionnaires and their critical evaluation. Results: On the basis of the entire set of relevant studies I described and evaluated 14 questionnaires. Five of them are designed specifically for low back pain. They are the Roland Morris Disability Questionnaire,...

<p>The aim with this thesis was to study cardiovascular disease and hypertension, use of drugs and health from an epidemiological perspective. Various methods - self-rated health (SRH), health related quality of life (HRQL) - the 36-item short form questionnaire (SF-36) - and health utility measurements - the rating scale (RS) and the time-trade off (TTO) methods - were employed.</p><p>Data from the Swedish Adoption/Twin Study of Aging (SATSA) in 1984, 1987, 1990, and 1993 as well as a general population survey conducted in Uppsala County in 1995 were used.</p><p>Persons who have cardiovascular disease, both with and without drug treatment, were found to have a lower SRH as compared to others in the population. Longitudinal analyses showed that SRH was relatively stable over time among persons with cardiovascular disease. Both having a low SRH and having cardiovascular disease were associated with a higher mortality rate.</p><p>Hypertensives were found to have a lower HRQL than do others in the general population as measured by the SF-36. The lowest scoring was found in the general health perception scale (GH), whereas role emotional (RE) and mental health (MH) were the scales least affected by hypertension.</p><p>Nearly 20 percent of the antihypertensive drug users reported side effects.The pattern of side effects was similar to that reported in clinical trials. Both hypertension itself and the drug treatment were found to have an impact on the patient's health-state utility as measured by the RS. Comparative analyses showed that health utilities and psychometric quality-of-life instruments were only moderately correlated among hypertensives. </p><p>The results also showed that inequalities in HRQL were present with respect to several sociodemographic factors. </p><p>In summary, this thesis revealed that persons with cardiovascular disease and/or with hypertension experience poorer health than others in the population. The poor health may be caused both by the disease and/or the drug treatment. The results in this thesis also suggested that special attention and care should be directed to persons with cardiovascular disease and/or hypertension reporting ill health. This especially is important given that low HRQL can be a riskfactor for subsequent cardiovascular events or complications which in turn might result in higher mortality rate.</p>