Introdução: A dissecção endoscópica submucosa (ESD) de neoplasias superficiais extensas de esôfago pode evoluir com altas taxas de estenose pós operatória, resultando em uma importante piora na qualidade de vida. Diversas terapias estão disponíveis para prevenir essa complicação. Entretanto, até o momento, nenhuma revisão sistemática e metanálise foram realizadas para avaliar esses resultados. Métodos: Uma revisão sistemática e metanálise foram realizadas utilizando as bases de dados eletrônicas Medline, Embase, Cochrane, LILACS, Scopus e CINAHL. Ensaios clínicos e estudos observacionais foram pesquisados de março de 2014 a fevereiro de 2015. Os termos pesquisados foram: endoscopy, ESD, esophageal stenosis, e esophageal stricture. Três estudos retrospectivos e quatro prospectivos (três randomizados) foram selecionados. Um total de 249 pacientes com diagnóstico de neoplasia superficial de esôfago, submetidos a ESD de pelo menos dois terços da circunferência do órgão foram incluídos. Foram selecionados estudos comparando diversas técnicas para prevenir a estenose de esôfago após extensa ESD. Resultados: Foram realizadas diferentes metanálises com ensaios clínicos randomizados (RCT), ensaios clínicos não randomizados (non- RCT) e uma análise global. Nos RCT (três estudos, n=85), a terapia preventiva diminuiu o risco de estenose (diferença de risco = - 0,36, IC 95% - 0,55 a - 0,18, p = 0,0001). Dois estudos (um randomizado e um não randomizado, n = 55) demonstraram que a terapia preventiva diminui o número médio de dilatações (diferença média = - 8,57, IC 95% - 13,88 a - 3,25, p < 0,002). Não houve diferenças significativas em três RCT em relação à taxa de complicações entre pacientes submetidos à terapia preventiva e aqueles não submetidos (diferença de risco = 0,002, IC 95% -0,09 a 0,14, p = 0,68). Conclusão: O uso da terapia preventiva após extensa ESD no esôfago, reduz o risco de estenose e o número de dilatações endoscópicas para resolução da estenose, sem aumentar o número de complicações / Background: Endoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significant decrease in quality of life. Several therapies are performed to prevent this complication. However, they have not yet been compared in a systematic review. Methods: A systematic review of the literature and meta-analysis were performed using the Medline, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, endoscopic submucosal dissection, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (3 randomized) cohort studies were selected. They involved 249 patients with superficial esophageal neoplasia who underwent ESD of at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophageal stenosis post-ESD. Results: Were realized different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (3 studies, n=85), preventive therapies decreased the risk of stenosis (risk difference = -0.36, 95% CI= -0.55 to -0.18, p = 0.0001). Two studies (1 randomized, 1 non-randomized, n = 55) showed that preventive therapies lowered the average number of endoscopy dilatations (mean difference = -8.57, 95% CI = -13.88 to -3.25, p < 0,002). There were no significant differences in the 3 RCT studies (n=85) with regards to complication rates between patients with preventive therapies and those without (risk difference = 0.02, 95% CI = -0.09 to 0.14, p = 0.68). Conclusion: The use of preventive therapies after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications

El objetivo del presente estudio es realizar una revisión sistemática de las tendencias del diseño metodológico usadas en los artículos de investigación cuya temática principal es la satisfacción laboral del profesorado universitario. Se identifican las tendencias sobre el método de investigación; la condición del instrumento de medición; las técnicas para la recolección de información, las de muestreo y las estadísticas usadas en el análisis. Luego de una búsqueda sistemática en Proquest y Redalyc (bases de datos bibliográficas), según criterios de inclusión y exclusión, se analizaron 49 artículos publicados entre el 2000 y el 2016. Esta revisión permitió identificar que casi la mitad de los artículos seleccionados pertenecen a los últimos 6 años (44.9%), lo cual revela sumo interés sobre el tema. El enfoque metodológico más frecuente es el cuantitativo (89.8%); predomina la adaptación de los instrumentos (53.1%); y se mencionan las propiedades psicométricas de validez y confiabilidad en un 42.9%. El muestreo probabilístico y no probabilístico se usa con la misma frecuencia (36.7%); asimismo, en un 83.3% se utiliza la estadística descriptiva. Sin embargo, para el análisis inferencial se evidenció un mayor uso de pruebas estadísticas paramétricas que las no paramétricas. Los resultados evidencian que existen múltiples formas para realizar el diseño metodológico, tanto en el uso del instrumento de recolección de datos como en el uso de métodos de análisis de información. / This study aims to perform a systematic review of the trends of the methodological design used in research articles whose main theme is the job satisfaction of the university teaching staff. The trends on the research method, the condition of the measurement instrument, the techniques for the collection of information, the sampling techniques, and the statistical techniques used in the analysis are identified. After a systematic search in Proquest and Redalyc (bibliographyc databases), according to inclusion and exclusion criteria, 49 articles published between 2000 and 2016 were analyzed. This review allowed us to identify that almost half of the articles selected belong to the last six years (44.9%), which reveals a great interest in the subject. The most frequent methodological approach is the quantitative one (89.8%), the adaptation of the instruments predominates (53.1%), and the psychometric properties of validity and reliability are mentioned at 42.9%. A probabilistic and non-probabilistic sampling is used with the same frequency (36.7%); likewise, descriptive statistics are used in 83.3%. However, for the inferential analyses, there was greater use of parametric statistical tests than nonparametric ones. The results show that there are multiple ways to carry out the methodological design, both in the use of the data collection instrument and in the use of information analysis methods. / Revisón por pares

Made available in DSpace on 2016-07-27T14:20:51Z (GMT). No. of bitstreams: 1 Ana Clara Mateus Carvalho.pdf: 1879198 bytes, checksum: ae953bb0af178950a93d266949b5b1c9 (MD5) Previous issue date: 2015-10-15 / This thesis is organized in two articles that aim to contribute to the construction of Brazilian psychometric parameters of regulation for the use of Zulliger Test Comprehensive System (ZSC) for children and adolescents. The first article consists of a literature review of the use of Zulliger Test in a population consisting of children and adolescents in Brazilian samples with no date limits. The databases searched were BVSPsi, Scielo, PubMed, Medline, PsycNet, Web of Science, BDTD and repositories of theses and dissertations of USF, UFMG, UFU, UFRGS, PUC RS, UFSC, USP and UnB. Nine publications were found in accordance with the inclusion and exclusion criteria. The publications found date from the 1960s until 2013, with the vast majority of them being from Southeast region of Brazil. The studies cover the assessment of cognitive and emotional development, interpersonal relationships, creativity, affection, cooperation, integration, anxiety, depression and psychometric data obtained with the application of Zulliger test in children and adolescents. The second article consists of a standard performance survey of a sample of children and adolescents between the ages of 7 and 14. The study included 304 children from public and private schools in the state of Goiás, which were divided into age groups and compared regarding age, sex and the kind of school they attend. For this, comparative analyzes and a survey of the descriptive statistics of ZSC s performance were made. The results showed that cognitive development increases with age, thus teens showed more mature thinking than children who showed immaturity and fantasy. Regarding gender, females showed a mindset more adequate to social expectations a better ability to control feelings, however girls demonstrated less ability to control and handle situational control than male participants. In regards to the school origin, children and adolescents from private schools manifested a better capacity to experience affection, to produce ideas, and to use intellectualization to deal with conflict. Public school students demonstrated a greater situational anxiety, also a better capacity to modulate emotion and having a more adequate self-perception. Thereby, these two articles have contributed by gathering scientific data regarding the instrument in a sample of children and adolescents, through literature review or elaborating standards for this age group. / A presente dissertação está organizada em dois artigos que têm como objetivo contribuir para a construção de parâmetros psicométricos brasileiros de normatização quanto ao uso do Teste de Zulliger Sistema Compreensivo (ZSC) para crianças e adolescentes. O primeiro artigo consiste em um levantamento bibliográfico do uso do Teste de Zulliger na população infantojuvenil, em amostras brasileiras, sem limites de data. As bases de dados pesquisadas foram BVS-Psi, Scielo, PubMed, Medline, PsycNet, Web of Science, BDTD e repositórios de teses e dissertações das universidades USF, UFMG, UFU, UFRGS, PUC RS, UFSC, USP e UnB. Nove publicações foram encontradas seguindo os critérios de inclusão e exclusão. As publicações encontradas datam desde a década de 1960 até 2013, sendo a maioria delas da região sudeste. Os estudos abarcam a avaliação do desenvolvimento cognitivo e emocional, relacionamento interpessoal, criatividade, afetividade, cooperação, integração, ansiedade, depressão e dados psicométricos do Teste de Zulliger em crianças e adolescentes. O segundo artigo consiste no levantamento do desempenho padrão de uma amostra de crianças e adolescentes de 7 a 14 anos. Participaram deste estudo 304 crianças de escolas públicas e particulares do estado de Goiás, que foram divididas em grupos etários e comparadas quanto a idade, sexo e origem escolar. Para isso, foram realizadas análises comparativas e levantamento da estatística descritiva do desempenho no ZSC. Os resultados apontaram que o desenvolvimento cognitivo aumenta conforme a idade; sendo assim, os adolescentes demonstraram um pensamento mais maduro e menos fantasioso do que as crianças. Em relação ao sexo, as meninas demonstraram pensamento mais adequado às expectativas sociais e melhor capacidade de controlar as emoções, porém revelaram menor controle e manejo do estresse situacional do que os meninos. Quanto à origem escolar, os alunos de escolas particulares manifestaram maior capacidade de vivenciar afetos, produzir ideias e utilizar do recurso da intelectualização para lidar com situações de conflito. Os alunos de escolas públicas demonstraram mais ansiedade situacional, maior capacidade de modular a emoção e autopercepção mais adequada. Desse modo, os dois artigos contribuíram com o levantamento de informações científicas a respeito do instrumento em uma amostra de crianças e adolescentes, seja por meio da revisão da literatura ou da elaboração de dados normativos para essa faixa etária.

Increasing symptom awareness, encouraging help-seeking, and facilitating timely referral are key for improving cancer outcomes, particularly for cancers such as oesophageal and gastric (stomach), where five-year survival is less than 20%. In this research, I used multiple methods to explore factors that influence timely diagnosis of these cancers from a patient's perspective, with a particular focus on health literacy (accessing, understanding and using health information, and navigating healthcare systems). I started by exploring current knowledge in this field before conducting a systematic review investigating health literacy in the timely diagnosis of symptomatic cancer. Literature was searched from January 1990-May 2017 using six bibliographic databases. I screened 2304 titles/abstracts, assessed 26 full-text papers and included three, although they were methodologically weak, therefore limiting the conclusions. To examine pathways to diagnosis for oesophageal and gastric cancer, I conducted a questionnaire study of newly diagnosed patients across two hospitals in the East and North East of England. 127 participants were recruited (39.6% recruitment rate), aged 44-96 (median 71); 102 male (80%). Most had oesophageal cancer (n=102, 80%); 64 (50%) of the total cohort were late-stage at diagnosis. Common pre-diagnostic symptoms varied between cancers (oesophageal: difficulty swallowing (n=66, 65%), painful swallowing (n=55, 54%); gastric: fatigue/tiredness (n=20, 80%), weight loss (n=13, 52%)). The questionnaire included two domains (engagement, understanding) of the Health Literacy Questionnaire with participants demonstrating high health literacy (mean 4.18 and 4.28, score 1-5). The median time from noticing the trigger symptom (prompting help-seeking) to diagnosis was 81 days (IQR 45-137.5, n=107). Twenty-six participants were purposively sampled, from questionnaire respondents, for face-to-face interviews (aged 55-88, 18 male, 15 with oesophageal cancer). I undertook thematic analysis to explore participant accounts of their pathways to diagnosis, identifying that the symptom nature was important for appraisal, while health literacy ability influenced the health system interval. Descriptions of 'heartburn', 'reflux' and 'indigestion' differed between participants, suggesting these terms may introduce uncertainty in relation to symptom experience. This is the first study to explore the role of health literacy in the timely diagnosis of symptomatic cancer, and pathways to diagnosis for oesophageal and gastric cancers, from a patient's perspective. Findings provide important insights for the development of targeted awareness campaigns and strategies enhancing GP symptom exploration.

Made available in DSpace on 2016-04-27T18:12:01Z (GMT). No. of bitstreams: 1 Treyce Rosemary Christina Vicente De Lucca.pdf: 621082 bytes, checksum: 976547f43ddfde8be8502364209a9de4 (MD5) Previous issue date: 2013-07-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This Project is part in the line of research in Language and Subjectivity Of Postgraduate Program In Speech Pathology Of Pontifícia Universidade Católica de São Paulo (PUC-SP). It is a deployment of The Literacy Project and their Avatars, associated to the Observatory Education Program (OBEDUC). The writing acquisition by the child is beyond the age, since the subject, to be regarded as reader and writer, goes through a process that includes findings, successes and failures. Are the effects of these errors and successes that the child submit or not the rules of language and assume a tongue. Objective: Evaluate the therapeutic speech permissive intervention when compared with the prescriptive, optional and interdictive models of the use of reading and writing in learners with learning difficulties. Methodology: Type of study: A systematic review of randomized clinical trials and quasirandomized clinical trials. Search strategy: the following databases were searched: MEDLINE, CENTRAL, EMBASE LILACS, PSYCINFO e ERIC. Discernment for selection studies: clinical trials that evaluated any speech therapy techniques for learners with learning difficulties. Data collection and analysis: the extraction and evaluation of methodological quality of included studies performed by two independent reviewers. Results: 637 references were identified by the mean databases, resulting in 12 studies selected. In these studies was possible evidence a diversity regarding the efficacy of interventions. It is possible notice one or more means of intervention at the same search. In the selected studies there is not a significative differences concerning the sex of the research subjects. Most of the subjects analyzed were children or teenagers between 0 to 15 years of old. This is an expected factor, once this is the chronological age for the formation of a reader and a writer. Conclusion: It is possible note that the interventions practices are used by audiologists are not described of the way that are proposed by organizational model of the language symptoms in Speech. It was observed that all interventions are improvements related to learning, but we highlight the need for further studies to prove the efficacy, since research was found improvements by itself, beyond the same research suggest the need for future studies to validation of the results obtained / Este projeto insere-se na linha de pesquisa Linguagem e Subjetividade do Programa de Estudos Pós-Graduados em Fonoaudiologia da Pontifícia Universidade Católica de São Paulo (PUC-SP). Trata-se de um desdobramento do projeto A Alfabetização e seus Avatares, vinculado ao programa Observatório de Educação (OBEDUC). A aquisição da escrita pela criança está para além da faixa etária, dado que o sujeito, para ser considerado leitor e escritor, passa por um processo que inclui descobertas, erros e acertos. São pelos efeitos desses erros e acertos que a criança se submete ou não às regras da linguagem e assume uma língua. Objetivo: Avaliar a intervenção terapêutica fonoaudiológica permissiva quando comparada aos modelos prescritivos, facultativos e interditivos do uso da leitura e da escrita em alfabetizandos com dificuldades de aprendizagem. Metodologia: Tipo de estudo: Revisão sistemática de ensaios clínicos randomizados e quase-randomizados. Estratégia de busca: Foram pesquisadas as seguintes bases de dados: MEDLINE, CENTRAL, EMBASE LILACS, PSYCINFO e ERIC. Critério para a seleção dos estudos: Os ensaios clínicos que avaliaram quaisquer técnicas fonoaudiológicas em alfabetizandos com dificuldades de aprendizagem. Análise e coleta de dados: A extração e a avaliação da qualidade metodológica dos estudos incluídos realizada por dois revisores independentes. Resultados: 637 referências foram identificadas pelas principais bases de dados, resultando em 12 estudos incluídos, nos quais se constatou provável diversidade referente às eficácias das intervenções. É possível notar um ou mais meios de intervenção em uma mesma pesquisa. Nos estudos selecionados, não houve diferenças significantes referentes ao sexo dos sujeitos analisados. A maioria deles eram crianças ou adolescentes, na faixa etária de 06 a 15 anos de idade, sendo este um fator esperado, uma vez que esta é a idade cronológica para constituição de um leitor e escritor. Conclusão: É possível notar que as práticas de intervenção utilizadas pelos fonoaudiólogos não são descritas da maneira como proposto pelo modelo de organização dos sintomas de linguagem em Fonoaudiologia. Foi observado que todas as intervenções apresentam melhoras referentes à aprendizagem, mas destacamos a necessidade da realização de outros estudos para comprovação de suas efetividades, uma vez que foram encontradas pesquisas que obtiveram esta melhora, além das mesmas apontarem a necessidade de estudos futuros para validação dos resultados obtidos

Introdução: Com o avanço das tecnologias para saúde, novas opções terapêuticas estão emergindo, incluindo aquelas direcionadas para doenças raras, e cuja eficácia e segurança são de difícil determinação quando utilizados os métodos originalmente delineados para as doenças frequentes. Nesse caso, as revisões sistemáticas sobre os tratamentos existentes para doenças raras, cujos custos são elevados, são importantes para o processo de tomada de decisões a fim de definir o perfil de pacientes que mais provavelmente responderão positivamente a cada tratamento. A mucopolissacaridose tipo I (MPS I) é uma doença autossômica recessiva causada pela ausência ou deficiência da atividade da hidrolase lisossomal alfa-L-Iduronidase, com amplo espectro clínico e envolvimento multissistêmico. A terapia de reposição enzimática (TRE) intravenosa (IV) com laronidase a 0,58 U / kg / infusão semanal está atualmente aprovada para tratar estes pacientes em diferentes cenários clínicos. O objetivo do presente estudo foi avaliar a eficácia e segurança da TRE IV com laronidase para o tratamento de pacientes com MPS I. Métodos: Revisão sistemática da literatura com buscas realizadas no Clinical Trials, MEDLINE / PubMed, EMBASE, LILACS e Cochrane Library. A pesquisa foi limitada aos ensaios clínicos publicados até 31 de dezembro de 2015. O primeiro critério de inclusão foi o de ser um ensaio clínico randomizado (ECR) comparando laronidase a placebo; se fossem identificados menos de 5 ECR, seriam incluídos também ensaios abertos e não randomizados, controlados ou não (quasi-experimentais) (≥ 5 pacientes) que avaliassem resultados relevantes definidos a priori. A revisão sistemática foi conduzida de acordo com a Colaboração Cochrane, e a meta-análise foi feita pelas diretrizes PRISMA. Em relação aos desfechos para os quais a meta-análise não pode ser realizada, aqueles com classificação GRADE igual ou superior a MODERADO foram considerados como indicadores de evidência sobre a eficácia ou segurança. Resultados: A fase de seleção encontrou 613 artigos. Durante a primeira fase de seleção, 66 artigos duplicados foram eliminados, e 547 artigos foram selecionados, dos quais 155 tiveram texto completo ou resumo avaliado para elegibilidade. Destes trabalhos, o número final de artigos incluídos chegou a nove para a síntese qualitativa (apenas dois ECR). Quatro estudos foram incluídos na meta-análise, sendo possível realizá-la para os seguintes desfechos: ocorrência de eventos adversos relacionados ao ratamento ou infusão (65%), leves na maioria dos casos (rash, urticaria e febre), desenvolvimento de anticorpos IgG para a laronidase (88%), índice de apnéia-hipopnéia [média de mudança = 0,05 (IC 95% -10,3, 10,4)], glicosaminoglicanos urinários (GAGs) [média de mudança = - 65,5 μg / mg creatinina (IC 95% -68,8, -62,3)], tamanho do fígado [média de mudança = -31.03% (IC 95% -36,1, -25,9)], índice de massa do ventrículo esquerdo [média de mudança = 0,49 (IC 95% -2,3, 3,3)], distância coberta no Teste de Caminhada de 6 minutos [média de mudança = 17,25 (IC 95% -6,64, 41,13)]. Em relação aos desfechos para os quais a meta-análise não pode ser realizada, encontramos evidência de benefício da laronidase em relação à flexão de ombros. Conclusões: Como esperado para doenças raras, encontramos poucos ensaios clínicos sobre laronidase e esses estudos eram bastante heterogêneos, especialmente na forma de avaliação dos desfechos, impedindo que a maioria das variáveis fosse meta-analisada. Os nossos resultados sugerem que a laronidase IV é eficaz em reduzir a excreção de GAGs urinários e a hepatomegalia associada à MPS I, e em aumentar o grau de flexão do ombro desses pacientes. A laronidase também parece ser segura nas populações estudadas, geralmente com eventos adversos leves. Acreditamos que esta metodologia proposta, incluindo estudos com outros delineamentos além de ECR, é capaz de avaliar de forma adequada a evidência disponível para doenças raras, como mostram os resultados obtidos. / Background: With the advancement of health technologies, new therapeutic options are emerging, including those targeted at rare diseases, and whose efficacy and safety are difficult to determine when using the methods originally designed for frequent illnesses. In this case, systematic reviews of existing high-cost rare disease treatments are important for the decision-making process in order to define the profile of patients who are most likely to respond positively to each treatment. Type I mucopolysaccharidosis (MPS I) is an autosomal recessive disease caused by the absence or deficiency of the lysosomal hydrolase alpha-L-Iduronidase activity, with broad clinical spectrum and multisystemic involvement. Intravenous (IV) enzyme replacement therapy (ERT) with 0.58 U / kg / weekly infusion laronidase is currently approved to treat these patients in different clinical settings. The objective of the present study was to evaluate the efficacy and safety of IV ERT with laronidase for the treatment of patients with MPS I. Methods: A systematic literature review was performed by searching the ClinicalTrials.gov, MEDLINE/PubMed, EMBASE, LILACS, and Cochrane Library databases. The search was limited to clinical trials published until December 31, 2015. The first inclusion criterion was being a randomized controlled trial (RCT). If fewer than five RCTs were identified, open-label and nonrandomized trials, controlled or uncontrolled (quasi-experimental), including ≥ 5 patients, and evaluating relevant outcomes defined a priori, were also included. The systematic review was conducted according to Cochrane Collaboration, while the meta-analysis followed the PRISMA guidelines. Outcomes not included in meta-analysis with a GRADE classification of moderate or better were deemed indicative of evidence of efficacy or safety. Results: The selection phase retrieved 613 articles. During the first phase of selection, 66 duplicated entries were excluded and 547 articles were screened, of which 155 had the abstract or full text read for assessment of eligibility. Of these papers, nine (only two RCTs) were ultimately included for qualitative synthesis. Four papers were included in the meta-analysis, which was performed for the following outcomes: occurrence of treatment-emergent or infusion-related adverse events (65%), mild in most cases (rash, urticaria, and fever), development of IgG antibodies to laronidase (88%), apnea-hypopnea index [mean change 0.05 (95%CI -10.3, 10.4)], urinary glycosaminoglycans (GAGs) [mean change -65.5 μg/mg creatinine (95%CI -68.8, -62.3)], liver size [mean change -31.03% (95%CI -36.1, -25.9)], left ventricular mass index [mean change 0.49 (95%CI -2.3, 3.3)], and distance covered in the 6-minute walk test [mean change 17.25 m (95%CI -6.64, 41.13)]. Among the outcomes not included in meta-analysis, we found evidence for benefit of laronidase regarding shoulder flexion. Conclusions: Our results suggest, as expected for rare disorders, that there are few studies on this issue published in the literature, and this studies are very heterogeneous, mainly concerning the way outcomes are evaluated, preventing most variables to be meta-analyzed. Our findings suggest that IV laronidase effectively reduces the urinary GAG excretion and hepatomegaly associated with MPS I and can improve shoulder flexion in these patients. Laronidase also appears to be safe in the studied population, with generally mild adverse events. We believe that this proposed methodology, including studies with other designs besides ECR, is capable of adequately assessing the available evidence for rare diseases, as shown by the results obtained.

O trabalho da odontologia no sistema público de saúde brasileiro é marcado por procedimentos puramente clínicos. Com a implantação da Estratégia Saúde da Família passou-se a exigir uma postura diferenciada, com o intuito de promover a saúde bucal por meio de atividades educativas. Na população adolescente se torna ainda mais necessária essa postura, devido ao distanciamento que o adolescente costuma ter do serviço de saúde, bem como a resistência a atividades de prevenção. Assim sendo, o objetivo geral desse estudo é identificar os estudos de intervenção sobre educação em saúde bucal para adolescentes existentes na literatura nos últimos 10 anos. Para tal, foi realizada uma revisão sistemática da literatura, considerando intervenções referentes à educação para a saúde bucal de adolescentes, em três idiomas (inglês, português e espanhol) e foi pesquisada a literatura dos últimos 10 anos. A identificação dos artigos foi feita através de busca bibliográfica na base de dados PUBMED/Medline e LILACS/Bireme utilizando como descritores adolescent; dental health education, education; oral health. Dois examinadores realizaram a estratégia de busca e, quando necessário, um terceiro examinador também foi contatado. Após a leitura dos títulos, resumos e artigos completos, os estudos foram avaliados quanto à qualidade. Foram encontradros 894 artigos na estratégia de busca, e, após a leitura dos títulos, resumos e a do estudo completo e, seguindo critérios de inclusão e exclusão previamente definidos, 24 artigos foram eleitos para análise final. Das 24 publicações analisadas, 14 eram em inglês, 06 em espanhol e 04 em português. Quanto à base de dados, 12 artigos foram do PUBMED/Medline e 12 da LILACS/Bireme. O ano de 2012 foi o que teve mais publicações referentes ao tema e o Brasil foi o país com mais estudos realizados. O tamanho da amostra e as estratégias utilizadas para a execução da intervenção foram diversos. A grande maioria dos estudos foi eficaz no desenvolvimento das atividades educativas com adolescentes. Os questionários e os exames bucais foram as medidas de desfecho mais utilizadas. Quanto à qualidade, a maioria dos estudos analisados foi de qualidade intermediária ou pobre, sendo que apenas 4 estudos foram considerados de boa qualidade. Os dados coletados são de grande relevância para a atuação dos profissionais na atenção primária em saúde e na condução de atividades educativas em saúde bucal com a população adolescente. Esse estudo tem potencial para instrumentar o trabalho educativo em saúde bucal, otimizando os resultados e promovendo uma maior efetividade das ações educativas para o público adolescente. / The work of dentistry in the Brazilian public health system is marked by purely clinical procedures. With the implementation of the Family Health Strategy, it was necessary to adopt a differentiated approach in order to promote oral health through educational activities. In adolescents, this position is even more necessary due to the adolescents' distancing from the health service, as well as resistance to prevention activities. Thus, the general objective of this study is to identify intervention studies on oral health education for adolescents, published in the literature in the past 10 years. For this, a systematic review of the literature was carried out considering interventions for oral health education of adolescents in three languages (English, Portuguese and Spanish) and the literature of the past 10 years was researched. The identification of the articles was done through bibliographic search in the database PUBMED/Medline and LILACS/Bireme using as keywords "adolescent; Dental health education; Oral health". Two examiners performed the search strategy and, when necessary, a third examiner was also contacted. After reading titles, abstracts and articles in full, the studies were evaluated for their qualities. A total of 894 articles were found in the search strategy, and after reading their titles, abstracts and the study in its entirety, 24 articles were selected for final analysis, following previously defined inclusion and exclusion criteria. Of the 24 publications analyzed, 14 were in English, 06 in Spanish and 04 in Portuguese. As for the database, 12 articles were from PUBMED/Medline and 12 were from LILACS/Bireme. The year of 2012 was the one that had more publications related to the subject and Brazil was the country with more studies realized. The size of the sample and the strategies used to carry out the intervention were diverse. The vast majority of studies were effective in the development of educational activities with adolescents. The questionnaires and oral examinations were the most used outcome measures. Regarding their qualities, the majority of studies analyzed were of intermediate or poor quality, and only 4 studies were considered of good quality. The data collected are of great relevance for the professionals' performance in the primary health care and in the conduction of educational activities in oral health with the adolescent population. This study has the potential to implement educational work in oral health, optimizing the results and promoting greater effectiveness of educational actions for the adolescent public.

A escassez de sistemas consolidados de reciclagem de veículos no Brasil e o grande volume de veículos em final de vida (VFVs) junto aos pátios do Departamento Estadual de Trânsito do Rio Grande do Sul - DETRAN/RS serviram de base para o desenvolvimento desta dissertação. Em face disso, o objetivo deste trabalho foi desenvolver um sistema de reciclagem de VFVs ambientalmente mais sustentável, a partir de exemplos globais de melhores práticas adotadas, atendendo à legislação vigente do país. Para tanto, a presente dissertação é composta por dois estudos fundamentados em revisões sistemáticas e em estudos de caso. Inicialmente, como resultado da primeira revisão sistemática, foi realizada a comparação de sistemas de gestão de reciclagem de veículos, identificados em 25 países. Essa comparação possibilitou ampliar o conhecimento de tecnologias e de procedimentos adotados em diferentes realidades, permitindo a proposição de oito políticas a serem adotadas em âmbito nacional, bem como três ações de melhoria ao atual sistema do DETRAN/RS. Em seguida, a segunda revisão sistemática permitiu a proposição de um sistema ambientalmente adequado para reciclagem de VFVs, que sirva de base para a futura padronização de processos de reciclagem, visando a potencial criação de centros especializados em reciclagem de veículos (CERVs). Diante do exposto, os resultados da pesquisa demonstraram que o tema da reciclagem de veículos está inserido num cenário mais amplo, necessitando da participação de todos os stakeholders envolvidos no processo, a exemplo: (i) das montadoras e fabricantes de peças, no desenvolvimento de tecnologias automotivas; (ii) dos entes federados, na criação de legislações mais rígidas e específicas, com foco na economia circular; e (iii) da sociedade na busca de produtos eco-amigáveis. Por fim, conclui-se que, associado às políticas e ações de melhoria sugeridas, a adoção do sistema ambientalmente adequado para reciclagem de VFVs proposto, poderá acelerar a criação de um ambiente favorável para o desenvolvimento e a consolidação da reciclagem no país. / The scarcity of consolidated vehicle recycling systems in Brazil and the huge amounts of endof- life vehicles (ELVs) at the Transit State Department of Rio Grande do Sul - DETRAN/RS courtyards served as the basis for the development of this Masters dissertation. Therefore, the objective of the work was to develop an environmentally more sustainable ELVs recycling system, based on global adopted best practices, without disregarding the country's current legislation. So, this dissertation is composed of two studies based on systematic reviews and on case studies. Initially, as a result of the first systematic review, a comparison of vehicle recycling management systems was carried out, identified in 25 countries. This comparison allowed the increasing of the knowledge about technologies and procedures adopted in different realities, making possible a proposal of educational policies to be adopted at national level, as well as three improvement actions for the current system of the DETRAN/RS. Subsequently, a second systematic review allowed a proposal for a suitable environmentally recycling system for the ELVs, which serves as the basis for a standardization of recycling processes, aiming the potential creation of specialized centers for such processes (CERVs). Considering this, the research results showed that the theme of product recycling is inserted in a broader scenario, requiring participation of all stakeholders involved in the process, such as: (i) the automakers and parts manufacturers, in the automotive technologies development; (ii) the federal entities, in the creation of more rigid and specific legislation, focusing on the circular economy; and (iii) the society in the search for eco-friendly products. Finally, it is concluded that, associated with the suggested policies and improvement actions, the adoption of the proposed environmentally appropriate system for the recycling of the ELVs, may accelerate the creation of a favorable way to the develop and consolidate the recycling in our country.

Depression is common in people with coronary heart disease (CHD) and is associated with worse physical outcomes. The nature of the causal association between CHD and depression, and the mechanism underpinning the association of depression with worse physical outcomes, remains unclear. Perseverative negative thinking may contribute to the development of depression in people with CHD. The aim of this thesis was to investigate the prospective association of perseverative negative thinking with depression, anxiety and worse physical outcomes in people with CHD, and to explore factors that may mediate this association. First, a systematic review identified 30 studies, of which the majority found an association between measures of perseverative negative thinking and subsequent depression, anxiety or emotional distress in people with long term conditions. Studies that controlled for covariates showed more mixed results, though the majority (15 / 25) still supported a significant association, with effects being small in magnitude. Findings were limited mainly to the association of rumination and/or catastrophizing with subsequent depression, and study quality was limited. Next, in an observational prospective cohort study 169 inpatients and outpatients with recent acute coronary syndrome (ACS) completed self-report assessments of rumination (Ruminative Responses Scale brooding subscale), worry (Penn State Worry Questionnaire), depression (Patient Health Questionnaire-8), anxiety (Beck Anxiety Inventory), and health-related quality of life (EuroQol-5D health-related quality of life, Seattle Angina Questionnaire) after hospitalisation, and at 2 month and 6 month follow-up. Additionally, assessments of potential mechanistic factors (social support, problem solving, instrumental behaviours and negative cognitive biases) were made. Baseline brooding was a significant independent predictor of depression at 6 months after controlling for the effects of important confounding variables, accounting for 2% of the variance. Findings suggested that the association of brooding with depression may be explained by deficits in problem solving ability. Rumination and problem solving may provide useful targets for the development of evidence-based interventions to improve depression among people with CHD, although the findings presented here fall short of proving a causal relationship. Future trials could be used to investigate the causal nature of the association of rumination and problem solving with depression in people with ACS.

Violence against Indigenous women is a major public health concern worldwide and Canada is no exception. Multiple forms of violence inform the broader context of violence against Indigenous women. Nurses are likely to encounter Indigenous women in a variety of settings, but evidence suggests that nurses may lack understandings of violence. This thesis explored the following question: How does extant qualitative research conducted in Canada, contribute to understanding the health and wellbeing of First Nations, Métis and Inuit (Indigenous) women who have experienced violence? During the development of this thesis, significant gaps were highlighted including underrepresentation of Inuit women in the literature, limited focus on health promotion, and lack of methodological approaches to systematic reviews that were participatory and inclusive of the community. Therefore, a secondary aim of this thesis was to privilege perspectives of Inuit women and their communities, by developing a study protocol for a collaborative and community centered approach to reviewing and assessing the extant literature. A configurative and inductive approach based on thematic synthesis was used to systematically search, retrieve, analyze and synthesize extant literature. Post-colonial feminist theory and intersectionality were used as theoretical lenses to emphasize intersections between multiple forms of violence and locate the problem within the broader context of colonization and oppression. Sixteen studies were included in this review, fifteen qualitative and one mixed methods study. Four themes with subthemes emerged based on analysis and synthesis of findings in the included studies: 1) ruptured connections between family and home, 2) that emptiness… my spirit being removed, 3) seeking help and feeling unheard, and 4) a core no one can touch. These themes represent interconnected pathways that influenced health among Indigenous women, and have implications for healthy public policy, clinical practice, and nursing education.