L’ostéopathie fonctionnelle est connue pour son action mécanique de rééquilibration des différentes structures du corps, action qui vient en renfort d’un processus permanent d’autoréparation de l’organisme. « Retracer la lésion sans irriter » dénoue les tensions myofasciales et produit des effets psychiques moins connus mais capitaux dans la clinique des troubles post-traumatiques. La prise en charge par ostéopathie fonctionnelle de patients « tout-venants » d’un cabinet privé a servi de pré-recherche qualitative pour repérer les mécanismes psychiques à l’œuvre. Puis la recherche quantitative AIVIO (Aide Intensive aux Victimes par Ostéopathie) a permis une prise en charge prospective randomisée sur plusieurs thérapeutes de victimes d’accident de la voie publique (AVP) recrutées dans un hôpital sur critère d’Etat de Stress Post-traumatique (ESPT) et/ou douleur. Cette recherche a montré l’efficacité d’une telle prise en charge par des résultats cliniques satisfaisants et statistiquement significatifs selon divers questionnaires (MOS SF-36, PCLS, DES, PPAG, BECK 21) Les résultats hautement significatifs concernent la douleur, la vie sociale et la santé psychique pour les victimes d’AVP. La taille des cohortes n’a pas permis de conclure sur l’impact du point de vue biologique, notamment sur l’évolution des taux bas de cortisol, pathognomoniques d’ESPT. L’évolution psychosomatique des patients, montrant trois différents destins, confortent les hypothèses de départ : 1/ Certains troubles anxieux post-traumatiques pourraient être soulagés par le soin du corps lui-même. Eliminer le whiplash et autres tensions myofasciales semble parfois réguler l’irritation neurovégétative et les troubles anxieux. 2/ Le cadre du soin ostéopathique produirait, en plus du travail somatique, un retour tridimensionnel (lieu-temps-niveau de conscience) sur la mémoire épisodique du traumatisme et ses affects liés. La part psychique du traumatisme s’éliminerait par réminiscence du traumatisme dans un état dissociatif paisible ou pendant un moment de sommeil. En cas de résistance au relâchement myofascial, induire délicatement ce processus habituellement spontané et inconscient relancerait le processus d’autoréparation psychique et somatique. L’induction ne parviendrait pourtant pas à diminuer les résistances lorsqu’elles reposent sur la colère, l’angoisse d’origine infantile et sur des difficultés affectives ou socio-économiques majeures. 3/ Dans d’autres cas enfin, le traumatisme corporel donnerait une occasion et un support somatique pour exprimer d’autres souffrances psychonévrotiques. Le symptôme douloureux post-traumatique serait alors maintenu par tension myofasciale. L’écoute active serait parfois suffisante pour libérer cette souffrance somatisée, surtout quand on connaît les mécanismes de défense spécifiques des différentes personnalités psychonévrotiques. Sinon l’approche psychothérapeutique conjointe serait conseillée en cas de névrose plus marquée ou de décompensation d’assises narcissiques fragiles. Du point de vue psychosomatique, nous n’avons pas observé de pensée opératoire ni de refoulement de l’imaginaire. Le symptôme étant déterminé par conservation d’énergie mécanique du traumatisme, il n’est pas métaphorique et ne devrait donc pas être interprété.

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I want to present a prospective evaluation of one-year results in patients undergoing total hip arthroplasty from a minimally invasive antero-lateral approach (THA MIS-AL). And I want also to compare, by means of biochemical markers, the operative invasiveness of standard total hip replacement with that of the minimally invasive anterolateral (MIS-AL) approach.At one year after surgery we evaluated the quality of life by 60 patients using SF-36 questionaire and we compared the results with standard anterolateral approach and regional standard.

INTRODUÇÃO: Diversos ensaios clínicos randomizados (ECR) foram realizados nos últimos anos sobre a eficácia dos agentes biológicos no tratamento da artrite reumatóide (AR). Porém, as revisões sistemáticas sobre o tema ainda geram dúvidas sobre a real eficácia relacionada à capacidade funcional e qualidade de vida. MÉTODOS: O presente estudo sintetizou as evidências geradas pelas revisões sistemáticas que compararam o tratamento realizado com a utilização dos agentes biológicos e o tratamento convencional com a utilização das drogas anti-reumáticas modificadoras da doença de síntese química (DARMDq), considerando a capacidade funcional e qualidade de vida dos pacientes com AR, além de avaliar a qualidade metodológica das revisões sistemáticas recuperadas. Utilizamos as bases de dados PubMed (Medline), EMBASE e Cochrane para realizar o levantamento de revisões sistemáticas com ou sem meta-análises de ECR. Dois pesquisadores de maneira independente realizaram a seleção das revisões sistemáticas, avaliaram a qualidade metodológica utilizando a ferramenta AMSTAR e classificaram a qualidade das evidências pelo GRADE. RESULTADOS: Esta overview incluiu 10 revisões sistemáticas e meta-análises de ECR que avaliaram a capacidade funcional mensurada pelo HAQ e a qualidade de vida mensurada pelo SF-36 (PCF e PCM) em pacientes com AR que utilizaram a terapia com os agentes biológicos comparada a terapia convencional com a utilização das DARMDq. A maioria da revisões sistemáticas apresentaram alta qualidade metodológica avaliada pela ferramenta AMSTAR e a qualidade da evidência variou entre baixa a alta qualidade pelo GRADE. A melhora da capacidade funcional e qualidade de vida observada no período inicial do tratamento (24 semanas) com a terapia biológica, foi de pequena relevância clínica. Esta diferença entre os tratamentos não foi observada no longo prazo (52 semanas), principalmente com os agentes biológicos na forma de monoterapia. CONCLUSÃO: Evidências que variam entre baixa a alta qualidade mostraram que os agentes biológicos apresentaram melhora de baixa relevância clínica na capacidade funcional e qualidade de vida no período inicial do tratamento em comparação à terapia convencional com as DARMDq. Entretanto, não há diferenças entre a utilização da terapia biológica e da terapia convencional a longo prazo / INTRODUCTION: Several randomized clinical trials (RCTs) have been conducted in recent years on the efficacy of biological agents in the treatment of rheumatoid arthritis (RA). However, systematic reviews on this topic still raise doubts about the real efficacy related to functional capacity and quality of life. METHODS: This study synthesized the evidence generated by systematic reviews comparing the treatment with biological agents and the conventional treatment with disease-modifying antirheumatic drugs (DMARD), considering the functional capacity and quality of life of patients with RA, also evaluating the methodological quality of the systematic reviews retrieved. PubMed (Medline), EMBASE and Cochrane databases were searched for systematic reviews with or without RCT meta-analyzes. Two researchers independently carried out the selection of systematic reviews, assessed the methodological quality using the AMSTAR tool and classified the quality of the evidence by GRADE. RESULTS: This overview included 10 systematic reviews and meta-analyzes of RCTs that assessed functional capacity measured by HAQ and quality of life measured by SF-36 (PCS and MCS) in RA patients who used therapy with biological agents compared to conventional therapy with DMARDq. Most of the systematic reviews presented high methodological quality evaluated by the AMSTAR tool and the quality of the evidence ranged from low to high quality by GRADE. The improvement in functional capacity and quality of life observed in the initial period of treatment (24 weeks) with biological therapy presented low clinical relevance. This difference between the treatments was not observed in the long term (52 weeks), mainly with the biological agents in the form of monotherapy. CONCLUSION: Evidence that varied between low to high quality demonstrated that biological agents presented improvement with low clinical relevance of the functional capacity and quality of life during the initial period of treatment compared to conventional therapy with DMARDq. However, there are no differences in the long term between the use of biological therapy and conventional therapy

Title: Comparison of the quality of life of persons diagnosed with intervertebral disc herniation in relation to surgical and conservative treatment. Objectives: The aim of the diploma thesis was the research and evaluation of the quality of life in patients with intervertebral disc lesion with and without surgery, assuming that both monitored groups will be treated with individual rehabilitation treatment. Methods: This research was conducted using a standardized Short Form 36 (SF - 36) questionnaire on quality of life that is conditional to health. The study was conducted at Na Homolce Hospital in a rehabilitation clinic, where appropriate respondents (n = 117) were selected for this research. The group included 59 respondents who underwent surgery and 58 treated conservatively. The survey was attended by respondents aged 27-86. The final results were divided into both health, physical and psychological dimensions in both groups. Two-choice tests were used to compare. For all domains, the assumption of the normal distribution of the two compared selections was rejected, which precluded the use of the two-t-test. For domains where there was no assumption of homogeneity of scattering, the Mann-Whitney test was used to compare. For domains where the assumption of homogeneity was rejected, a Median...

Submitted by Erika Demachki (erikademachki@gmail.com) on 2014-09-08T20:13:04Z No. of bitstreams: 2 Luiz Antônio Batista de Sá - 2013.pdf: 2785841 bytes, checksum: 7b5931974548bfd07b98371e20bbfbce (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-09-08T20:13:04Z (GMT). No. of bitstreams: 2 Luiz Antônio Batista de Sá - 2013.pdf: 2785841 bytes, checksum: 7b5931974548bfd07b98371e20bbfbce (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-02-22 / Introduction: Right ventricular pacing can be deleterious in patients with left ventricular dysfunction, but in patients with normal function the impact of this stimulation and triggering ventricular dyssynchrony clinically relevant is not fully established. Objectives: To evaluate clinical findings of patients with previously normal ventricular function, who underwent implantation of a pacemaker. Methods: We studied prospectively 20 patients (60% male and the average age was 58 years) underwent implantation of a pacemaker with the following inclusion criteria: normal ventricular function defined by echocardiography and the presence of ventricular pacing 90% higher (generator telemetry). We evaluated the following parameters: Class functional (New York Heart Association) 6-minute walk test, dosage of B-type natriuretic peptide (BNP), and conventional echocardiographic and evaluation dyssynchrony and intraventricular (by tissue Doppler, M-mode and pulsed Doppler) and the quality of life assessment by SF-36 Health Survey. The evaluation was done at 10 days (t1), 4 months (t2), 8 months (t3), 12 months (t4) and 24 months (t5). Data were compared over time according to ANOVA repeated measures (rmANOVA). Results: Of the following evaluated data showed no statistically significant variation (p> 0.05): conventional echocardiographic parameters, interventricular and intraventricular dyssynchrony. The six minute walk test, functional class and BNP worsened at the end of two years (p <0.05). Evaluation showed initial improvement in QOL domains: physical functioning, social and general health and worsens at the end of the two years. Conclusion: After 24 months the right ventricular pacing, in patients with normal function, correlated with worsening of ventricular function assessed clinically (class functional walk test and QOL) and measure laboratory (BNP). / Introdução: A estimulação de ventrículo direito pode ser deletéria em pacientes com disfunção ventricular, porém em pacientes com função normal o impacto desta estimulação como fator de dessincronia e desencadeamento de disfunção ventricular clinicamente relevante não é completamente estabelecido. Objetivos: Avaliar a evolução clínica e laboratorial de pacientes, com função ventricular previamente normal, submetidos a implante de marca-passo. Métodos: Durante dois anos foram estudados de forma prospectiva 20 pacientes (60% do sexo masculino) com idade média de 58 anos submetidos a implante de marca-passo com os seguintes critérios de inclusão: função ventricular esquerda normal definida pelo ecocardiograma e presença de estimulação ventricular superior a 90% (telemetria do gerador). Foram avaliados os seguintes parâmetros: classe funcional (New York Heart Association), teste de caminhada de 6 minutos(TC6’), dosagem do hormônio natriurético tipo B (BNP), avaliação ecocardiográfica convencional e com avaliação da dessincronia e intraventricular (através do Doppler tecidual, modo M e Doppler pulsado) e questionário de qualidade de vida (QV) (SF-36). A avaliação foi feita com 10dias (t1), 4 meses (t2), 8 meses (t3), 12 meses (t4) e 24 meses (t5). Os dados foram comparados ao longo do tempo segundo método ANOVA medidas repetidas (rmANOVA). Resultados: Dos dados avaliados os seguintes não apresentaram variação estatística significante (p>0,05): parâmetros ecocardiográficos convencionais, dessincronia intraventricular e interventricular. O TC6, a classe funcional e a dosagem de BNP apresentaram piora ao final dos dois anos (p<0,05). Avaliação de QV mostrou melhora inicial nos domínios: capacidade funcional, aspectos sociais e estado geral de saúde e piora destes parâmetros ao final dos dois anos Conclusão: Após 24 meses a estimulação ventricular direita, em pacientes com função normal, correlacionou com piora da função ventricular avaliada clinicamente (classe funcional, teste de caminhada e QV) e dosagem de BNP.

<p>Validerat; 20101217 (root)</p>

Doctor of philosophy (PhD) / Abstract As one of the most culturally diverse countries in the world, Australia has a high proportion of minority communities. However, its ageing population, particularly within these ethnic minorities, faces a range of barriers or difficulties in gaining access to and using health and aged care services. This study aims to identify the acculturation factors that affect the health status of Iranian-born elderly immigrants to Australia and their utilisation of health and community aged care services. The results of this study will be of value to Iranian elders, their families, and Australian aged health care service providers. The findings could also contribute towards enriched multicultural policy and improved social fairness, access to services, and equity for the aged from different ethnic backgrounds. 302 Iranian migrants aged 65 years who had lived in the Sydney Metropolitan area for at least six months were surveyed via a written questionnaire, face-to-face interviews, and telephone interviews. The results were analysed using SPSS and then compared to the findings from a 1999 survey of NSW elderly. The results indicate that Iranian migrants suffer higher levels of psychological distress and are more limited in their physical functioning than the general population of older Australians. They are in greater need of assistance with activities of daily living, have a lower sense of wellbeing, and are far less likely to utilise aged care services. Iranian migrant who do not speak English at home experience these disadvantages to an even greater extent English language proficiency was the only acculturation factor found to affect whether Iranian elderly utilised health and community aged care services, while ability to engage in activities of daily living (ADL) was the only health variable associated with their utilisation of community supportive aged care services. This variable did not predict the use of community aged care services in the broader sample of NSW respondents. Since limited proficiency in English placed elderly Iranian migrants at greater health risk and impeded their access to necessary assistance, the findings suggest that they would clearly benefit from English classes and from access to health and community care services and information regarding these services in the Farsi language.

In Sweden approximately 25000 distal radius fractures occur annually, which is 37 % of all fractures related to osteoporosis. In this thesis, risk factors for osteoporosis, bone mineral density (BMD) and health-related quality of life (the SF-36) were compared in patients who suffered a distal radius fracture after low energy trauma with a control group matched on the basis of age, gender, and municipality of residence. The aim was also to analyse, among these patients, whether a risk factor questionnaire, tests on dynamic and static balance and a one-leg rise test could identify those, who have osteopenia or osteoporosis, and run a risk of new falls. Moreover, in a three-year follow-up, mortality, the need for in- and outpatient care, and health-related quality of life after radius fracture were investigated and compared between the patients and matched controls. Finally, the effect of a preventive intervention program including patient education and self-training was evaluated. Falls were reported in a risk factor questionnaire and in a fall diary. The patients aged 45-64 years showed lower, although not statistically significant, BMD, compared with the controls of the same age, but there was no difference concerning their history of falls. In contrast, the patients aged 64 years or older had a history of falling more often than the corresponding controls, but no difference in BMD was found. For all other risk factors, except falls, no differences were found between the patients and the controls. The results of the one-leg rise test were associated with those of dynamic and static balance, but none of the functional tests were associated with the number of falls. Decreased height and cigarette smoking were the only risk factors, which predicted osteopenia and osteoporosis. Five patients, although none of the controls, died during the study time. The patients needed statistically significantly more episodes as inpatients than the controls. The patients also had lower SF-36, Role Physical scores, than the controls at three months. This difference disappeared by the time of the follow-up. Both the patients, who participated in a four-week intervention program, “the osteoporosis school” followed by a one-year home-based exercise program, and the controls showed statistically significantly improved dynamic and static balance, ability to walk backwards and to stand on one leg with eyes open and closed at the end of the study. However, no significant differences were found between the patients and the controls in any of the tests, in BMD or in the number of the falls. The thesis shows that, except for the falls in patients aged over 64 years, there were no significant differences between patients and controls with respect to BMD and other risk factors related to osteoporosis. Consequently, in patients aged 45-64 years and older, the underlying cause of a distal radius fracture is more related to falls than to osteoporosis. Furthermore, the thesis shows that the functional tests and the risk factor questionnaire seem to be of limited value for identifying 8 people with a radius fracture, who are at risk of falling or have osteopenia or osteoporosis. If, in spite of this, functional tests on musculoskeletal function are considered for testing of functional ability in patients with a recent radius fracture, the one leg-rise test may be sufficient. There seems to be an increased mortality and morbidity necessitating inpatient care among patients with a recent radius fracture. The osteoporosis school had no significant effect on BMD, balance, muscle strength or falls in this thesis. Therefore, the lack of proven efficacy of the osteoporosis school for the secondary prevention of distal radius fractures highlights the need for more and long-term randomised controlled follow-up studies in this specific population.

Canada’s population is aging rapidly, and understanding living arrangements and their determinants plays a critical role in supporting healthy aging. This thesis examined, using a population-based longitudinal survey, the Canadian Multicentre Osteoporosis Study, the effects of clinically-significant change in physical and mental health on future living arrangements, employing generalized estimating equations logistic regression models. Clinically-significant decline in SF-36 Physical Component Score (PCS) increased likelihood of not remaining community-dwelling, or “aging in place” over stable or improved scores by 41%. SF-36 Mental Component Score (MCS) did not show a statistically significant effect on aging in place. Older age and employment status of retired or unemployed increased likelihood of not aging in place, whereas living with a partner, pursuing moderate or vigorous physical activity, and having children increased the likelihood of aging in place. Study findings will inform social and health policy development to support aging in place in Canada and elsewhere.