The use of outcome measures by occupational therapists to establish the effectiveness of treatment is important. The Jebsen-Taylor Hand Function Test (JHFT) was identified as a standardised assessment suitable for the evaluation of outcomes related to the treatment of hand function. This study established norms for this test on 120 normal, ethnically diverse South Africans between the ages of 20 and 59 years. Statistically significant differences were found between the original norms published by Jebsen et al (1) and the South African sample for males and females, dominant and non-dominant hands and ethnic groupings. It is postulated that gender and cultural factors may influence the speed with which different groups complete functional tasks and these must be factored in when using the JHFT as an outcome measure in South Africa. The test appears to have limited application as a norm referenced test in South Africa, but may be valuable in determining progress in therapy or research.

Idiopathic tracheal stenosis (ITS) is a rare condition, and diagnosis of exclusion should be suspected in patients with exercise intolerance, wheezing, and dyspnea on exertion with a flow-volume loop suggestive of fixed airway obstruction. We report a case of a 32-year-old asthmatic woman with an existing diagnosis of vocal cord dysfunction and previous normal CT scan of the neck. She continued to have fixed upper airway obstruction on repeated flow-volume loops with persistent wheezing and cough along with occasional stridor and hoarseness of voice despite appropriate management of her asthma. She was finally diagnosed with ITS on a repeat CT scan of the neck for which she underwent laser surgery, steroid injection, and controlled radial expansion balloon dilation with a successful reduction of stenosis. This case illustrates the importance of clinical suspicion for early diagnosis of ITS in poorly controlled asthmatic patients and the relevance of non-surgical management of this condition.

Made available in DSpace on 2014-06-11T19:22:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-15Bitstream added on 2014-06-13T19:48:21Z : No. of bitstreams: 1 ambrozin_arp_dr_botfm.pdf: 169682 bytes, checksum: e35521aad39da34ec6c55a5da6cd12ad (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Algumas variáveis propostas para predizer o risco de complicação pósoperatória (CPO) são a altura no teste da escada (TE) e a distância do teste de caminhada de seis minutos (TC6) e acreditamos que o tempo no teste da escada (tTE) também pode ser utilizado para este fim. Além disso, são utilizados a prova de função pulmonar e os índices pré-operatórios. Objetivo: Determinar se os índices de Torrington e Henderson, American Society of Anesthesiologists, Goldman, Detsky e Charlson, a variável VEF1 da espirometria e as variáveis obtidas nos testes de esforço (TC6 e TE) podem ser preditivos das complicações pós-toracotomia e qual deles seria o melhor preditor dessas complicações. Método: Foram avaliados pacientes com indicação de toracotomia para ressecção pulmonar ou não, maiores de 18 anos. As comorbidades foram obtidas e traçados os índices de Comorbidade de Charlson, de risco de Torrington e Henderson, de Goldman, de Detsky e o ASA. A espirometria foi realizada de acordo com a ATS, em espirômetro Medgraphics Pulmonary Function System 1070. O TC6 foi realizado segundo os critérios da ATS e a distância prevista calculada. O TE foi realizado numa escada à sombra, composta por seis lances, num total de 12,16m de altura. O tTE em segundos percorrido na subida da altura total foi obtido e a partir deste a Potência (P) foi calculada utilizando a fórmula clássica. Também foi estimado o VO2 a partir do tTE (VO2 t) e da P (VO2 P). No intra-operatório foram registradas as complicações e o tempo cirúrgico. E no pós-operatório foram registradas as CPOs. Para análise estatística os pacientes foram divididos em grupos sem e com CPO. Foi aplicado o teste de acurácia para obtenção dos valores preditivos para o TC6 e para o tTE, a curva ROC e dessa o ponto de corte. As variáveis foram testadas para uma possível associação com as CPO pelo teste t de... / Some varieties purposed to predict the postoperative complication (POC) risk are the height in the stair-climbing test (SCT) and the distance in the six minute walk test (6MWT), we also believe that the time on the stair-climbing test can also be used for this purpose. Besides, the pulmonary function test and the preoperative index are also used. Objectives: We aim to determine if the Charlson, Torrington and Henderson, Goldman, Detsky and American Society of Anesthesiologists indexes, the variable FEV1 obtained on the Spirometry and on the Cardiopulmonary Exercise Testing (6MWT, SCT) can be predictive of the complication after thoracic surgery and which one of them would be the best. Method: Patients with indication to thoracic surgery, for resection or not, and older than 18 years old were evaluated. The comorbidities were obtained and the Comorbidity Charlson, Torrington and Henderson risk, Goldman, the Detsky and ASA indexes were calculated. The spirometry was performed according to ATS in Medgraphics Pulmonary Function System 1070. The 6MWT was performed according to the ATS criteria and the predicted distance was calculated. The SCT was performed indoor, on six flights of stairs, which results as a 12,16m climb. The time on the SCT was obtained after finished the stair height total in seconds and the Power (P) was calculated using the class formula. The maximum oxygen uptake (VO2) was estimated from the time of SCT (VO2 t) and the P (VO2 P). In the intraoperative was registered the complication and the surgery time. And in the postoperative was registered the POC. In the statistics analysis, the patients were divided in groups with and without POC. It was applied the accuracy test for the distance 6MWT and for the time in the SCT. We have found the cutoff from the ROC curve. The correlation between the variables and POC were tested using the t test for independent population ... (Complete abstract click electronic access below)

The relative power of goodness-of-fit test statistics has long been debated in the literature. Chi-Square type test statistics to determine 'fit' for categorical data are still dominant in the goodness-of-fit arena. Empirical Distribution Function type goodness-of-fit test statistics are known to be relatively more powerful than Chi-Square type test statistics for restricted types of null and alternative distributions. In many practical applications researchers who use a standard Chi-Square type goodness-of-fit test statistic ignore the rank of ordinal classes. This thesis reviews literature in the goodness-of-fit field, with major emphasis on categorical goodness-of-fit tests. The continued use of an asymptotic distribution to approximate the exact distribution of categorical goodness-of-fit test statistics is discouraged. It is unlikely that an asymptotic distribution will produce a more accurate estimation of the exact distribution of a goodness-of-fit test statistic than a Monte Carlo approximation with a large number of simulations. Due to their relatively higher powers for restricted types of null and alternative distributions, several authors recommend the use of Empirical Distribution Function test statistics over nominal goodness-of-fit test statistics such as Pearson's Chi-Square. In-depth power studies confirm the views of other authors that categorical Empirical Distribution Function type test statistics do not have higher power for some common null and alternative distributions. Because of this, it is not sensible to make a conclusive recommendation to always use an Empirical Distribution Function type test statistic instead of a nominal goodness-of-fit test statistic. Traditionally the recommendation to determine 'fit' for multivariate categorical data is to treat categories as nominal, an approach which precludes any gain in power which may accrue from a ranking, should one or more variables be ordinal. The presence of multiple criteria through multivariate data may result in partially ordered categories, some of which have equal ranking. This thesis proposes a modification to the currently available Kolmogorov-Smirnov test statistics for ordinal and nominal categorical data to account for situations of partially ordered categories. The new test statistic, called the Combined Kolmogorov-Smirnov, is relatively more powerful than Pearson's Chi-Square and the nominal Kolmogorov-Smirnov test statistic for some null and alternative distributions. A recommendation is made to use the new test statistic with higher power in situations where some benefit can be achieved by incorporating an Empirical Distribution Function approach, but the data lack a complete natural ordering of categories. The new and established categorical goodness-of-fit test statistics are demonstrated in the analysis of categorical data with brief applications as diverse as familiarity of defence programs, the number of recruits produced by the Merlin bird, a demographic problem, and DNA profiling of genotypes. The results from these applications confirm the recommendations associated with specific goodness-of-fit test statistics throughout this thesis.

Loss of olfactory function can readily be overlooked in a clinical setting. In most cases, symptomatic patients recover the sense of smell without any treatment due to the intrinsic neuroregenerative capacity in adult olfactory epithelium. The substantial prevalence of olfactory dysfunction following viral infection of the respiratory system leads many clinicians to consider this physical dysfunction as a subjective symptom rather than a diagnostic and pathologic sign amenable to analysis. Better understanding of the mechanisms behind olfactory dysfunction is expected to increase its clinical importance. Through analyzation of human and mouse specimens, one is able to gain insight into viral-induced olfactory dysfunction on a pathophysiologic level. These murine and human models provide a better understanding of mechanisms and reveal potential therapeutic targets. This is becoming increasingly useful considering the high prevalence of olfactory loss among COVID-19 patients. Here, we discuss the process of olfactory loss following viral infection, the possible mechanism of sudden olfactory dysfunction in COVID-19 infection, the possible benefits of clinical smell tests in COVID-19 patients, and a potentially overlooked consequence on olfactory function using dexamethasone in treating COVID-19 patients. We suggest that including smell tests in COVID-19 patients and studying the mechanism underlying olfactory dysfunction could provide potential strategy to prevent COVID-19 infection and spread and reveal potential therapeutic intervention to restore sense of smell. There are 18 sources used for this miniature literature review. All of our resources were chosen for up-to-date information regarding COVID-19 and it’s effect on the olfactory system. The sources were either found during a large PubMed search or recommendations sent from professors. This article just recently underwent a revision. After revision, our conclusions that smell tests would be beneficial in a clinical setting to prevent the spread and reveal therapeutic targets have been supported by the articles listed. This has been submitted and accepted by a peer-reviewed journal.

Pulmonary function testing (PFT) is recommended by guidelines for the diagnosis of chronic obstructive pulmonary disease and the diagnosis and monitoring of asthma. Portable in-office tests offer rural patients and providers information previously more difficult to obtain because of hospital closures, transportation barriers, and cost. This article describes the successful implementation and measurement of in-office PFT in 3 rural primary care offices. Providers were more likely to order a PFT for patients with asthma (33%) than a patient with chronic obstructive pulmonary disease (9.7%). Recommendations include increased staff involvement and repeat education midimplementation.

Thyroid hormone is a master regulator of growth and development in all vertebrates. Thus, disruption of its synthesis and activity can lead to profound consequences. Past decade studies on thyroid function tests have established an efficient guideline for monitoring thyroid diseases, yet a significant proportion of healthcare providers do not defer to it in their practice. The aim of this study is to assess provider practices in the diagnosis and treatment of primary hypothyroidism due to autoimmunity at Boston Children's Hospital (CHB) for a primarily pediatric patient population. Commonly known as Hashimoto's thyroiditis (HT), this is the most common thyroid disease in the world as well as the most common manifestation of human autoimmune endocrine disease. Through CHB's bioinformatics institute, a rich data set was collected to assess the manner in which healthcare providers utilized relevant thyroid function tests (TFTs). This work assessed and confirmed the superior sensitivity of thyroid peroxidase autoantibodies (TPO) relative to thyroglobulin antibodies (TgAb) for diagnosing HT in children. We also verified proper utilization of thyroid stimulating hormone tests to monitor HT but concluded that there is a low utilization efficiency with regards to measurements of thyroid hormones (thyroxine and triiodothyronine). Based upon the observation of unnecessary monetary loss caused by improper TFTs utilization, it can be concluded that reflex testing at CHB may improve provider practices' efficiency for HT monitoring.

Introdução: A Bronquiolite Obliterante Pós-infecciosa (BOPI) é uma síndrome clínica rara e grave caracterizada por sinais e sintomas persistentes de obstrução crônica das pequenas vias aéreas. Objetivos: o objetivo do presente estudo é avaliar a evolução da função pulmonar de uma coorte de acompanhamento de pacientes com BOPI de Porto Alegre, Brasil. Métodos: Foram incluídas crianças, adolescentes com BOPI, de ambos os sexos, em acompanhamento de longo prazo nos ambulatórios de pneumologia pediátrica dos hospitais da Criança Santo Antônio e Materno-Infantil Presidente Vargas, ambos de Porto Alegre, Brasil. Resultados: Quanto à análise das variáveis da função pulmonar, as médias globais dos pontos analisados no tempo para cada variável foram: da CVF foi de 68,8% ± 17,7, do VEF1 foi 48% ± 15, do VEF1/CVF foi 66% ± 17, e do FEF25-75 foi 25,4% ± 14. Longitudinalmente, encontramos que houve melhora estatística e clínica, significativa, da CVF (p=0,04). Já as variáveis VEF1 e o FEF25-75, que refletem melhor o componente obstrutivo, não apresentaram mudanças significativas tanto estatisticamente (p=0,708 e p=0,873 respectivamente) quanto clinicamente, mantendo valores similares no percentual do predito ao longo do tempo. A relação VEF1/CVF sofreu uma mudança estatisticamente significativa (p=0,015), clinicamente explicável pela maior melhora da CVF comparado com o VEF1. Conclusões: Em conclusão, os resultados do nosso estudo sugerem que, em crianças e adolescentes com bronquiolite obliterante pós-infecciosa, o componente obstrutivo da função pulmonar (VEF1 e FEF25-75) sofre poucas modificações significativas, deletérias ou benéficas, ao longo do tempo. A capacidade vital forçada, por outro lado, sofre um aumento progressivo ao longo do tempo que pode ser de grande importância como fator de proteção quando iniciar o declínio fisiológico da função pulmonar na idade adulta. / Introduction: The Post-Infectious Bronchiolitis Obliterans (PIBO) is a rare and serious clinical syndrome characterized by persistent signs and symptoms of small airways’ chronic obstruction. Objectives: The objetive of this study is evaliate the evoluction of pulmonary function in a monitoring cohort of patients with PIBO from Porto Alegre, Brazil. Methods: Children, adolescents with PIBO, of both sexes were included, in long-term monitoring in pediatric pneumology clinics of Santo Antônio children’s hospital and Presidente Vargas maternal and child hospital, both from Porto Alegre, Brazil. Results: Regarding the analysis of the variables of pulmonar function, the global average of ten points analyzed in the time for each variable were: from CVF was 68,8% ± 17,7, from VEF1 was 48% ± 15, from VEF1/CVF was 66% ± 17 and from FEF25-75 was 25,4% ± 14. Lengthwise, we found that there was an statistical and clinical improvement, significant, from CVF (p=0,04). However, the variables VEF1 and the FEF25-75, which better reflect the osbstructive component, don’t show significant changes as statistically (p=0,708 and p=0,873 respectively) as clinically, keeping similar values in percentage of the predicted over time. The relation VEF1/CVF suffered a statistically significant change (p=0,015), clinically explained by the greatest improvement in CVF compared with VEF1. Conclusões: In conclusion, the results of our study suggest that, in children and adolescents with post-infectious bronchiolitis obliterans, the obstructive component of pulmonary function (FEV 1 and FEF 25-75) suffers few significant changes, deleterious or beneficial, over time. The forced vital capacity, on the other hand, suffers a progressive increase over time which can be of great importance as protective factor when start the physiological decline of pulmonary function in adult age.

Introdução: A tolerância ao exercício e os níveis de atividade física tendem a ser reduzidos em pacientes com fibrose cística (FC). Estudos trazem que o nível de atividade física pode estar associado com melhor estado nutricional e com um maiordeclínio da função pulmonar. Com a evolução da doença,o declínio da função pulmonar associado a distúrbios metabólicos e desnutrição, provocam alterações na mecânica respiratória, distúrbios musculoesqueléticos e deformidades torácicas, trazendo prejuízos na qualidade de vida destes indivíduos. Objetivo: Verificar a associação entre gravidade funcional pulmonar, nível de atividade física e variáveis de avaliação postural em adultos com FC. Secundariamente, verificar a correlação entre os parâmetros de atividade física observados pelo acelerômetro e pelo questionário internacional de atividade física (IPAQ) e, verificar a correlação entre os parâmetros de atividade física observados pelos dois instrumentos com a distância percorrida no teste de caminhada de seis minutos (DTC6M) e os parâmetros de avaliação postural.Métodos: Estudo de caráter transversal, aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre. Para a verificação de parâmetros de função pulmonar foi utilizado o exame de espirometria, para a verificação do nível de atividade física foi utilizado o questionário IPAQ e um acelerômetro, para avaliação postural foi utilizada a fotogrametria com auxílio do Software de avaliação postural (SAPO) e, para comparações complementares foi utilizado o teste de caminhada de seis minutos (TC6M). Resultados: Participaram do estudo 28 indivíduos adultos com FC, idade média de 25,1 anos e VEF1 (%) com média de 47,1. O VEF1 se associou com os parâmetros obtidos pelo acelerômetro, avaliação postural e TC6M, porém, não houve associação com os dados obtidos pelo IPAQ. Conclusão: Este estudo demonstrou que o declínio da função pulmonar dos pacientes adultos com FC está associado com maior cifose torácica, menor tempo em atividade física moderada e vigorosa e menor distância percorrida no TC6M. O acelerômetro demonstrou-se ser o melhor instrumento para avaliação da atividade física neste público. / Introduction: Exercise tolerance and levels of physical activity tend to be reduced in patients with cystic fibrosis (CF). Studies suggest that the level of physical activity may be associated with better nutritional status and with larger decline in lung function. With the evolution of the disease, the decline of lung function associated with metabolic disorders and malnutrition, causes alterations in respiratory mechanics, musculoskeletal disorders and thoracic deformities, bringing injury to the individual’s quality of life.Objective: To verify the association between pulmonary functional severity, physical activity level and postural evaluation variables in adults with CF. Secondly, to verify the correlation between the physical activity parameters observed by the accelerometer and the international physical activity questionnaire (IPAQ) and to verify the correlation between the parameters of physical activity observed by the two instruments with the six-minute walking distance (6MWD) and the parameters of postural evaluation. Methods:Cross-sectional study, approved by the Research Ethics Committee of the Hospital de Clínicas, Porto Alegre.The spirometry test was used to verify pulmonary function parameters. The IPAQ questionnaire and an accelerometer were used to assess the level of physical activity, for postural evaluation the photogrammetry was used with the aid of the Postural Evaluation Software (SAPO) and, for further comparisons, the six-minute walk test (6MWT) was used. Results: 28 adult subjects with CF, mean age of 25.1 years and FEV1 (%) with a mean of 47.1 participated in the study. FEV1 was associated with the parameters obtained by the accelerometer, postural evaluation and 6MWT, but there was no association with the data obtained by IPAQ. Conclusion: This study demonstrated that the decline in lung function in adult patients with CF is associated with higher thoracic kyphosis, shorter time in moderate and vigorous physical activity, and shorter distance walked on 6MWT. The accelerometer has been shown to be the best instrument for assessing physical activity in this public.

Bakgrund och Problem: Aktiemarknaden påverkas både av inhemska och utländska faktorer. Därför är det av intresse att se vilka makroekonomiska variabler som påverkar den svenska aktiemarknaden. Anledningen till att Sverige har valts som den geografiska punkten är att det är av intresse att se hur ett litet land som Sverige, som har en öppen ekonomi påverkas av de utvalda makroekonomiska variablerna. Syfte: Syftet med uppsatsen är att med hjälp av information samt analys, studera hur de olika makroekonomiska variablerna påverkar den inhemska aktiemarknaden. Olika faktorer som påverkar aktiemarknaden kommer att lyftas fram för att i sin tur även se till de olika branscherna. Metod: Då data enbart består av hämtning av tidigare information fokuseras det enbart på sekundärdata i form av historiska siffror samt historiska undersökningar. De statistiska tester som tillämpas är Granger Causality test, Johansens Cointegration test, Impulse Response Function test, ADF test, KPSS test, Mulitpel regression. Slutsats: Med de resultat som presenterades i denna studie, skulle vi nog inte kunna säga att vi har ett svar över vilka aktier en investerare ska införskaffa. Dock skulle vi kunna poängtera att den potentiella investeraren bör ha dessa variabler i beaktning vid beslut. Genom att studera dessa variabler kan man få en känsla om vilket håll variablerna kommer att röra sig och på så sätt säga att de kan påverka aktieindexen. Att bara kolla på de makroekonomiska variabler som denna studie belyser räcker inte för att förstå hur aktieindex kommer att se ut i framtiden, men det är en bit på vägen till att förstå aktiemarknadens rörelse.