Orientador: Célia Marisa Rizzatti Barbosa / Texto em português e inglês / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T14:59:30Z (GMT). No. of bitstreams: 1 Stefanelli_ViniciusCobos_M.pdf: 4235468 bytes, checksum: ecfb59c5553ab09169e805022c5d6485 (MD5) Previous issue date: 2013 / Resumo: A técnica de strain-counterstrain (SCS) é uma das mais utilizadas no tratamento osteopático, proporcionando grande alívio dos sintomas desencadeados por pontos gatilhos miofasciais (PGM), porém poucas são as evidências científicas sobre seus efeitos imediatos e ao longo de um tratamento para pacientes sintomáticos. Este estudo objetivou avaliar os efeitos imediatos e tardios da SCS nos músculos mastigatórios de pacientes com disfunção temporomandibular (DTM). Para isso foram selecionadas 21 mulheres (25,52±4,11) diagnosticadas com DTM, as quais foram divididas aleatoriamente em dois grupos: grupo tratado (n=11) que recebeu a SCS para os PGMs dos músculos temporais, masseteres, pterigóideos mediais e digástricos; e grupo placebo (n=10) que recebeu uma técnica sem efeito terapêutico para os PGMs dos mesmos músculos. As voluntárias passaram por quatro sessões de tratamento, uma vez por semana e foram avaliadas antes (Pré), imediatamente após (Pós) a primeira sessão e de 48 a 72 horas após a quarta e última sessão (Final). Como método de avaliação utilizou-se o limiar de dor a pressão (LDP), amplitude de abertura bucal (AAB) e a eletromiografia de superfície (EMGs). O LDP foi coletado nos seguintes pontos: masseter, temporais e pólo lateral da articulação temporomandibular (ATM). A coleta do sinal eletromiográfico foi realizada nos seguintes músculos: masseteres, parte anterior dos temporais e supra-hioideos. Como resultado foi possível observar aumento do LDP entre as fases Pós e Final (p<0,05), e Pré e Final (p<0,05), e aumento da AAB entre as fases Pré e Pós (p<0,05), e Pré e Final (p<0,001) para o grupo tratado. Para o grupo placebo não foram observadas diferenças significativas, assim como para os resultados da EMGs em ambos os grupos / Abstract: Strain-counterstrain (SCS) is one of the most commonly technique used in osteopathic treatment, providing great relief of symptoms unleashed by myofascial trigger points (MTrPs). However there are few scientific evidence about its about its immediate effects and over a treatment for symptomatic patients. This study aimed to evaluate the effects of SCS in masticatory muscles of patients with temporomandibular disorders (TMD). Twenty one TMD women (mean age 25.52 ± 4.11) were randomly divided in two groups: treated group (n = 11) which received the SCS for MTrPs of temporal, masseter, medial pyterigoid and digastric muscles; and placebo group (n = 10) which received a non therapeutic technique for MTrPs of the same muscles. The volunteers underwent four treatment sessions, once a week and were evaluated before (Pre), immediately after the first session (Post), and 48 to 72 hours after the fourth session (Final). Outcomes measurement were pressure pain threshold (PPT), range of mouth opening (RMO) and electromyography (EMG). The LDP was collected at points painful in these types of patients: masseter, temporal, lateral pole temporomandibular joint (TMJ). The collect of the sEMG signal was conducted in the following muscles: masseter, anterior part of the temporal and supra-hyoid. It was observed an increase of PPT between Post and Final (p <0.05) and Pre and Final (p <0.05) phases for most points assessed, an increase of RMO between Pre and Post (p <0.05), and Pre and Final (p <0.001) phases in the treated group. In placebo group no significant differences were observed as well as the results of EMG in both groups / Mestrado / Anatomia / Mestre em Biologia Buco-Dental

Osteopathic physician (D.O.) residency programs that do not achieve accreditation under the new Single Accreditation System (SAS) standards by June 30, 2020 will lose access to their share of more than $9,000,000,000 of public tax dollars. This U.S. Centers for Medicare & Medicaid Services (CMS) funding helps sponsoring institutions cover direct and indirect resident physician training expenses. A significant financial burden would then be shifted to marginal costs of the residency program’s sponsoring institution in the absence of CMS funding. The sponsoring institution’s ability or willingness to bare these costs occurs during a time when hospital operating margins are at historic lows (Advisory.com /Daily Briefing /May 18, 2017 | The Daily Briefing / Hospital profit margins declined from 2015 to 2016, Moody's finds). Loss of access to CMS funding may result in potentially cataclysmic reductions in the production and availability of primary care physicians for rural and urban underserved populations. Which osteopathic residency programs will be able to survive the new accreditation requirement changes by the 2020 deadline? What are some of the defining attributes of those programs that already have achieved “initial accreditation” under the new SAS requirements? How can the osteopathic programs in the process of seeking the new accreditation more effectively “pivot” by learning from those programs that have succeeded? What are the potential implications of SAS to both access and quality of health care to millions of Americans? This report is based upon a study that examined and measured how osteopathic physician residency programs in the U.S. are accommodating the substantive structural, financial, political and clinical requirements approximately half way through a five-year adaptation period. In 2014, US Graduate Medical Education (GME) physician program accreditation systems formally agreed to operate under a single accreditation system for all osteopathic (D.O) and allopathic (M.D.) programs in the U.S. Since July 1, 2015, the American Osteopathic Association (AOA) accredited training programs have been eligible to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation. This agreement to create a Single Accreditation System (SAS) was consummated among the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM) and ACGME with a memorandum of understanding. As this research is published, the ACGME is transitioning to be the single accreditor for all US GME programs by June 30, 2020. At that time, the AOA would fully relinquish all its GME program accreditation responsibilities. The new SAS operates under published ACGME guidelines and governance. Business policy and health care resource allocation question motivated this research. Failure of osteopathic programs to “pivot” to the new standards could result in fewer licensed physicians being produced in the high demand primary care field. Potential workforce shortage areas include urban and especially rural populations (CRS Report 7-5700 R44376 Feb 12, 2016). Large physician shortages already have been projected to care for a rapidly aging US population without considering the impact of the GME accreditation changes currently underway (Association of American Medical Colleges 2017 Key Findings report www.aamc.org/2017projections). The goal of this research is to provide osteopathic GME programs practical insights into characteristics of a sample of osteopathic GME programs that have successfully made the “pivot” into SAS requirements and been accredited by ACGME and those that have not. The study seeks to better understand the experiences, decisions, challenges and expectations directly from osteopathic programs directors as they strive to meet the realities of the new SAS requirements. Do programs that are already accredited differ significantly from those that have not? How do characteristics such as program size, geographic locations, clinical program components, program sponsor structure, number and experience of faculty and administration, cost planning and perceived benefits of the movement to SAS factor into successfully meeting the new requirements before the 2020 closing date? A cross-sectional research survey was designed, tested and deployed to a national sample of currently serving osteopathic GME program directors. The survey elicited data about each program’s “pivot” from AOA GME accreditation practices and guidelines to the new Single Accreditation System (SAS). The survey instrument was designed to obtain information about patterns in osteopathic GME program curricula, administrative support functions, faculty training, compliance requirements and program director characteristics shared by those programs that have been granted “initial accreditation” by the Accreditation Council for Graduate Medical Education (ACGME) who administer SAS. Thirty five (35) osteopathic GME program directors responded to the 26 question survey in June 2017. Descriptive statistics were applied and central tendency measures determined. The majority of survey respondents were Doctors of Osteopathic Medicine (D.O.s) from specialty residency programs sponsoring an average of 16 residents. Respondents were mostly non-profit, urban, multi-facility health system locations with an existing affiliation with a research college or university. About half of the programs had completed some form of fiscal due diligence related to the potential cost impact of SAS. None of those surveyed reported utilizing outside consultants to assist in the SAS “pivot” process. Most programs plan to keep the same number of residents while others expressed an interest in expanding or contracting. None of the respondents planned to close their program. The dichotomous dependent variable (DV) was whether or not the Osteopathic GME program had “achieved or not yet achieved initial SAS accreditation” at the time of the survey. A cross tabulation analysis of the DV with potential predictive variables (IV) was conducted and Chi-square and various exact significance tests were applied to gage goodness of fit. Results were grouped into categories that aligned with the five research questions and hypotheses. Several characteristics were shared by those programs that achieved SAS. GME sponsor institutions that currently have dually accredited programs by the AOA and ACGME seemed to be at a distinct advantage. Although they represented a smaller number of total survey respondents (20%), all primary care program participants reported SAS achievement. Directors reported an average of six (6) full-time paid faculty members teaching in their programs and twice that number of preceptor volunteers in the total sample. Realization of any operational cost savings or efficiencies as a result of moving to a single accreditation system was a principle concern for the majority (86%) of GME program director respondents, regardless of current accreditation status, although most felt SAS would result in offering medical student graduates access to all accredited US GME residency and fellowships programs.

Introduction : L’allaitement maternel est recommandé par les instances nationales et internationales pour ses bénéfices sur la santé des mères et des enfants. Près de neuf mères sur dix initient l’allaitement au Québec. Pour celles qui arrêtent dans le premier mois, une sur deux met en cause des problèmes mécaniques de succion chez le bébé en dépit du support de consultantes en lactation (CL). Les ostéopathes, dans le monde entier, reçoivent ces bébés. Cependant, peu d’études scientifiques sont publiées sur la contribution de cette profession à ce sujet. L’objectif primaire de cette étude était de déterminer l’efficacité d’un traitement ostéopathique, couplé à des consultations d’allaitement usuelles, chez les nouveau-nés ayant des difficultés mécaniques de succion. Méthode : Un essai contrôlé randomisé en simple aveugle portant sur 97 dyades maman-bébé référées par des CL a été réalisé. Les dyades étaient réparties en deux groupes : intervention ostéopathique ou soins usuels. Quatre temps de mesure sur une période de 10 jours, ont permis de déterminer l’efficacité de la succion pré et post intervention, l’intensité de la douleur chez la mère ainsi que tout effets secondaires perçus. Les lésions ostéopathiques ont été colligées afin de dresser un profil. Des tests-t, des Chi-carrés ainsi que des modèles de régression ont permis l’analyse des différences entre les deux groupes à l’étude. Résultats : Les bébés ayant reçu l’intervention ostéopathique ont montré une efficacité de succion cliniquement et statistiquement supérieure au groupe de soins usuels (p<0.001). Les analyses n’ont pas montré de différence statistiquement significative entre les groupes quant à la douleur ressentie par la mère aux différents temps de mesure. Cependant, à 3 jours post intervention, les mères du groupe intervention ont perçu une diminution significative de leur douleur (p=0.001). Un profil des bébés recrutés a pu être dressé avec des dysfonctions en postérieur du crâne chez 84,5% d’entre eux. Aucun effet secondaire grave ni sévère n’a été rapporté. Conclusion : L’ostéopathie couplée à un suivi par des CL, semble une approche prometteuse pour les dyades mère-bébé ayant des difficultés mécaniques de succion. D’autres recherches seraient à prévoir pour bonifier l’intervention ostéopathique en terme de moment, de bébés pouvant profiter de ce type de suivi, et aussi la documentation des zones en lésion. / Abstract: Background: National and international policies recommend breastfeeding for its benefits on mothers’ and infants’ health. In Quebec, almost nine out of ten mothers initiate breastfeeding with their baby but half of these stop during the first month, due to biomechanical sucking difficulties, and this, despite increasing support from lactation consultants (LC). Osteopaths worldwide work with these babies, but there is little empirical evidence for this type of treatment. The primary objective of this study was to determine the efficacy of an osteopathic treatment coupled with usual lactation consultations on infants’ identified as having biomechanical sucking difficulties. Methods: A single blind randomized controlled trial including 97 mother-infant dyads referred by LC. The dyads were randomized into two groups: osteopathic intervention or usual care. Four measurement times over a 10-day period (pre and post intervention) allowed for the determination of the babies’ ability to latch, the intensity of pain felt by mothers as well as any perceived side effects. Osteopathic lesions were documented in an effort to establish a profile T-tests and Chi-square tests as well as regression models were used to compare groups. Results: Babies having received the osteopathic intervention showed a clinically and statistically significant increase (p<0.001) in their ability to latch compared to the usual care group. Analyses did not show any statistically significant difference between groups with regard to the pain felt by mothers at the different measurement times. However, 3 days post intervention, the mothers in the intervention group perceived a significant decrease in their level of pain (p=0.001). A profile of osteopathic dysfunctions in these babies was generated with 84,5% of them found to have a posterior skull dysfunction. No serious or severe side effects were reported. Conclusion: Osteopathic treatment coupled with lactation consultations seem to be a promising avenue for mother-infant dyads with biomechanical sucking dysfunctions. Further research is needed to optimize osteopathic treatment in terms of targeting babies, timing and duration of interventions and also to better document and standardize areas with osteopathic lesions.

L’ostéopathie connaît une popularité croissante au Québec. Cependant, la collaboration interprofessionnelle (CIP) entre les médecins et les ostéopathes est un phénomène relativement nouveau et encore peu étudié. Cette étude mixte séquentielle explicative vise à : 1) décrire la situation actuelle au Québec en termes de collaboration entre les médecins et les ostéopathes impliqués auprès de la clientèle pédiatrique et 2) explorer les facteurs facilitants et les barrières à la CIP. Méthodologie : Le volet quantitatif a été réalisé à l’aide de questionnaires postaux destinés à tous les médecins et ostéopathes œuvrant auprès d’une clientèle pédiatrique. Vingt et un entretiens semi-dirigés ont par la suite été réalisés. Les données recueillies dans les questionnaires ont été analysées à l’aide de statistiques descriptives et de modèles de régression alors qu’une analyse thématique a été effectuée pour le contenu des entretiens. Résultats : Au total, 274 médecins (14 %) et 297 ostéopathes (42 %) ont complété les questionnaires. Dix de ces médecins et 11 ostéopathes ont participé aux entretiens. Les références en ostéopathie sont associées à la présence d’une relation professionnelle (rapport de cote (RC) 4,10 (intervalle de confiance (IC) à 95 % 2,12; 7,95), p < 0,001), aux consultations personnelles (RC 2,58 (IC 95 % : 1,35; 4,93), p = 0,004), à la pratique en milieu non hospitalier (RC 1,89 (IC 95 % :1,03; 3,47), p = 0,040) et à la connaissance du rôle de l'ostéopathe (RC 1,22 (IC 95 % :1,01 ; 1,47), p = 0,042). Les facteurs facilitants additionnels mentionnés sont les expériences positives rapportées par les parents, la formation antérieure en santé et l’expertise en pédiatrie de l’ostéopathe, le respect des limites professionnelles et la complémentarité des soins, la sécurité perçue de l'ostéopathie ainsi que les demandes de communications interprofessionnelles émises par les parents. Le langage, la difficulté de vulgarisation, le contexte organisationnel et légal, l'incertitude quant aux rôles, la rareté des interactions interprofessionnelles et les données probantes limitées dans le domaine ostéopathique constituent les principales barrières à la CIP. Conclusion : Une certaine collaboration existe déjà entre les médecins et ostéopathes, mais l’optimisation de cette collaboration pose encore plusieurs défis. Dans le contexte actuel de processus d’encadrement de la profession d’ostéopathe par l’Office des professions du Québec et de la création d’un premier programme universitaire, ces résultats pourront guider les efforts visant la promotion d’une collaboration productive et des soins sécuritaires axés sur le patient. / Abstract: Osteopathy is growing in popularity in Quebec. Interprofessional collaboration (IPC) between physicians and osteopaths is a new phenomenon and information about it is scarce. This explanatory sequential mixed-methods study aimed to 1) describe current collaborative practices between physicians and osteopaths involved with pediatric patients and 2) explore enablers of and barriers to the development of IPC. Methods: Postal questionnaires about collaborative practices were first sent to all physicians and osteopaths working with pediatric patients in Quebec. Semi-structured individual interviews were then conducted with a subset of 21 participants. The data collected in the questionnaires were analyzed using descriptive statistics and regression models, while a thematic analysis was carried out for the content of the interviews. Results: A total of 274 physicians (14%) and 297 osteopaths (42%) completed the survey while 10 of those physicians and 11 osteopaths were purposely selected for interviews. Osteopathic referral was positively associated with having a professional relationship (odds ratio [OR] 4.10 (95% confidence interval [CI] 2.12; 7.95), p < 0.001), personal consultation (OR 2.58 (95% CI 1.35; 4.93), p = 0.004), community-based practice (OR 1.89 (95% CI 1.03; 3.47), p = 0.040), and knowledge about role of osteopathy (OR 1.22 (95% CI 1.01; 1.47), p = 0.042). Additional enablers identified by respondents include: positive experiences reported by parents; the osteopath having had pediatric experience or previous training as an allied health practitioner; mutual respect for professional boundaries and complementarity; perceived safety of osteopathy; and parents’ requests for interprofessional communication. The main barriers to IPC include: language; difficulties communicating findings of osteopathic palpation assessment; organizational and legal contexts; uncertainty regarding one another’s roles, lack of interprofessional interactions; and limited scientific evidence. While some collaboration currently exists between physicians and osteopaths, optimizing these relationships and interactions still poses several challenges. In the current context of the pending regulation and standardization of osteopathic training in Quebec, these results could be used to guide efforts to promote productive collaboration and safe patient-oriented care.

<p><h1>ABSTRACT</h1> <h1>Individuals with spinal cord injuries (SCI) are prone to significant alterations in vascular structure and function. This study was designed to examine the effects of osteopathic treatment on mean leg (MLBF) blood flow and skin temperature in the lower extremities of individuals with chronic SCI compared to able-bodied (AB) individuals. Methods: Nine individuals (age 44 ± 17.5 years) with a chronic SCI (C6-T12; AIS A-B; 3.7 ± 4.6 years post-injury) and six AB individuals (38.3 ± 9.7 years) participated. The protocol consisted of 1 interview session and 3 osteopathic treatment sessions. Doppler ultrasound measured the diameter and mean blood velocity in the CFA before (Pre) and after (Post) each session. Skin temperatures were measured using skin thermistors at three different sites on the left leg. Change scores were calculated and measured as post-treatment minus pre-treatment. Results: A two-way ANOVA revealed an increase in flow of 16±2 ml/min within the SCI group and a decrease in flow of 25±2 ml/min in the AB group (p = 0.04). There was also a smaller reduction in skin temperature in individuals within the SCI versus AB (left thigh: SCI, -0.5±0.2° C; AB, -1.2±0.2°C, p(left foot: SCI, -0.1±0.4°C; AB, -1.8±0.4°C, pAll treatments resulted in small increases in MLBF in the SCI group versus small decreases in the able-bodied group and smaller skin temperature decreases in the SCI versus the decreases in the AB group, potentially indicating reduced skin temperature reactivity. These findings emphasize the potential for different physiological responses to interventions in individuals with SCI compared to AB individuals.</h1></p> / Master of Science in Kinesiology

Résumé : Dans la sclérodermie systémique (ScS), les contractures aux mains, pour lesquelles il n'existe aucun traitement prouvé, sont courantes et associées à de l'incapacité de la main, globale et au travail. Toutefois, quelques études sur les effets d'interventions comprenant des techniques manuelles ont montré des résultats prometteurs. Ainsi, le but de l'étude était d'explorer les effets d’un traitement ostéopathique sur la fonction de la main, des symptômes globaux de la maladie et le statut fonctionnel de personnes atteintes de ScS. Une série d'études à cas uniques (A[indice inférieur 1]-B-A[indice inférieur 2]) fut réalisée. Six participantes atteintes de ScS ont été recrutées parmi la cohorte du Groupe de recherche canadien sur la sclérodermie à deux sites (Hôpital général juif de Montréal et Centre hospitalier universitaire de Sherbrooke). Les participantes ont reçu neuf séances hebdomadaires d’ostéopathie semi-standardisées, ciblées sur les membres supérieurs, le thorax et la base du crâne. Des mesures répétées pendant les trois phases de l'étude ont été prises à une fréquence bihebdomadaire pour la raideur aux mains (RM) et les symptômes de douleur, dyspnée et fatigue; et hebdomadaire pour l'amplitude de mouvement des doigts (AMD), la fonction de la main (FM) et l'incapacité globale (IG). L'épaisseur/rigidité de la peau main/avant-bras (ÉPMA), l'incapacité au travail (IT) et la qualité de vie reliée à la santé (QVS) ont été mesurées à trois temps (avant et après l'intervention, ainsi qu'au suivi à un mois). Les variables à mesures répétées ont été représentées sur des graphiques linéaires soumis à des analyses visuelles, complétées du test Sheward's two Standard Deviation Band. Les différences ont été calculées pour les variables mesurées à trois temps. Toutes les participantes (n=6) ont montré une amélioration des variables reliées à la fonction manuelle (RM, AMD et FM), sauf pour l'ÉPMA (n=4). La majorité des participantes ont montré une amélioration des symptômes (douleur n=6, fatigue n=4 et dyspnée n=3/4) et des variables reliées au statut fonctionnel (IG n=5/5, IT n=4, score résumé physique n=6 et mental n=4 de la QVS). La plupart des effets se sont maintenus au suivi à un mois. Lorsque la comparaison était possible, presque toutes les améliorations observées ont été supérieures aux différences minimales cliniquement importantes suggérées pour cette population. Ces résultats suggèrent que l'ostéopathie pourrait être efficace pour réduire l'incapacité découlant des contractures aux mains de personnes souffrant de ScS, et devraient être vérifiés dans un essai clinique randomisé. // Abstract : In systemic sclerosis (SSc), hand contractures are common and associated with hand, global and work disability. There are no known effective treatments, although there have been a few promising studies with manual therapies. Our aim was to explore the effects of osteopathy on hand function, disease symptoms and functional status in SSc patients. A series of single case studies (A[subscript 1]-B-A[subscript 2] was undertaken. Six female SSc patients with hand contractures were recruited among subjects enrolled in the Canadian Scleroderma Research Group cohort at 2 sites (Jewish General Hospital, Montreal and Centre hospitalier universitaire de Sherbrooke, Sherbrooke). Participants received 9 weekly semi-standardized sessions of osteopathy targetted on upper limbs, thorax and cranial base. Repeated measures were taken during the three phases of the study, twice a week for hand stiffness and disease symptoms of pain, dyspnea and fatigue; and once a week for range of motion of fingers, hand disability and global disability. Upper limbs skin score, work disability and health-related quality of life were measured at baseline, after treatments and at 1-month follow-up. Data for each variable with repeated measures were represented on simple line graphs and visually interpreted, completed by the Sheward's two Standard Deviation Band test. Differences were calculated for variables measured at 3 time points. All participants (n=6) showed improvement in variables related to hand function (hand stiffness, range of motion of fingers and hand disability), except for upper limbs skin score (n=4). The majority of participants showed improvement in disease symptoms (pain n=6, fatigue n=4, et dyspnea n=3/4) as well as variables related to functional status (global disability n=5/5, work disability n=4, physical n=6 and mental n=4 component summary of health-related quality of life). Most improvements were maintained at 4 week follow up. When the comparison was possible, almost all observed improvements were higher than the minimal clinically important differences suggested for this population. These findings suggest that osteopathy may be effective in reducing disability from hand contractures in SSc. A randomized controlled trial is needed to confirm these results.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / This doctoral thesis involved the study of three groups of neoplasms that affect bones of dogs (primary bone neoplasms, bone metastases, and multicentric neoplasms with bone involvement) and a bone lesion, often paraneoplastic, known as hypertrophic osteopathy. The study of primary bone neoplasms covered important pathological and epidemiological aspects for the diagnosis of this group of tumors, with emphasis on osteosarcomas. It was retrospectively performed, covering a period of 22 years. Reports of biopsy and necropsy cases of dogs received at the Laboratório de Patologia Veterinária, Universidade Federal de Santa Maria (LPVUFSM) were analyzed. Out of the 90 primary bone neoplasms diagnosed in this period, 89 were malignant. Osteosarcoma was the most prevalent (86.7%) neoplasm. Regarding osteosarcomas, most cases occurred in large and giant breed dogs, between six and 10 years of age. The neoplasms predominantly involved the appendicular skeleton and were 3.5 times more prevalent in the forelimbs than in the hindlimbs. The predominant histologic subtype was the osteoblastic. For the study of neoplasms that comprise the second and third groups, i.e., neoplasms with bone metastases or with bone involvement by multicentric neoplasms, a prospective study was conducted over a period of three years. The skeleton of 110 dogs, with 118 malignant neoplasms of different origins received in the necropsy service of the LPV-UFSM were examined for bone lesions. Twenty-one cases of bone metastases or bone involvement by multicentric neoplasms (19.1%) were detected. In general, the bone lesions affected more female dogs. However, when mammary gland neoplasms were not considered, the distribution of cases according to the sex was very similar. The mean age was 9-years-old and dogs of different breeds were affected. The mammary gland was the primary site of most bone metastases, followed by neoplasms of the musculoskeletal and respiratory systems. Most metastases were observed grossly and occurred in multiple bones. However, in 23% of the cases metastases could only be observed microscopically. Vertebrae and humerus were the mosdt frequently affected bones. Simultaneously, seven cases of hypertrophic osteopathy, diagnosed in a period of 11 years at the LPV-UFSM, were retrospectively and prospectively studied. Affected dogs had clinical signs of bone involvement and lesions mainly in the long bones of the limbs. The lesions consisted of periosteal bone neoformation, detected on radiographs, bone inspection during necropsy, and with great level of detail, in macerated bone specimens. The bone proliferation was partially circumferential and occurred mainly in the diaphysis of long bones. It consisted of bone trabeculae of irregular size and thickness, which were arranged perpendicularly to the original cortical bone. In all cases, the lesions of hypertrophic osteopathy were associated with lung neoplasms (primary or metastatic). In two of the seven cases, the lung metastases were of primary bone sarcomas and, in one case, there was a primary lung osteosarcoma (extra-skeletic). / Esta tese envolveu o estudo de três grupos de neoplasmas que afetam os ossos de cães (neoplasmas ósseos primários, metástases ósseas e neoplasmas multicêntricos com envolvimento ósseo) e uma alteração óssea, muitas vezes paraneoplásica, conhecida como osteopatia hipertrófica. O estudo dos neoplasmas ósseos primários envolveu aspectos epidemiológicos e patológicos importantes para o diagnóstico deste grupo de tumores, com ênfase nos osteossarcomas. Foi realizado de forma retrospectiva, compreendo um período de 22 anos. Foram analisados laudos de casos de biópsias e necropsias de cães recebidos no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM). Dos 90 neoplasmas ósseos primários diagnosticados neste período, 89 eram malignos, sendo os osteossarcomas os mais prevalentes (86,7%). Em relação aos osteossarcomas, a maioria dos casos ocorreu em cães de raças grandes e gigantes e entre seis e 10 anos de idade. Os neoplasmas envolvendo o esqueleto apendicular predominaram e foram 3,5 vezes mais prevalentes nos membros anteriores que nos posteriores. O subtipo histológico predominante foi o osteoblástico. Para o estudo dos neoplasmas que compreenderam o segundo e o terceiro grupos, ou seja, neoplasmas com metástases ósseas ou o envolvimento ósseo em neoplasmas multicêntricos, foi realizado um estudo prospectivo durante um período de três anos. Neste período, cães provenientes do serviço de necropsias do LPV-UFSM foram avaliados. O esqueleto de 110 cães portadores de 118 neoplasmas malignos de diferentes origens foi examinado em busca de lesões ósseas. Foram encontrados vinte e um casos de metástases ou neoplasmas multicêntricos com envolvimento ósseo (19,1%). Em geral, as lesões ósseas afetaram mais as fêmeas. No entanto, quando os neoplasmas originados na glândula mamária foram desconsiderados, a distribuição dos casos de acordo com o sexo foi muito semelhante. Foram afetados cães com idade média de 9 anos e de diferentes raças. A glândula mamária foi a origem da maioria dos tumores que metastatizaram para os ossos, seguida do sistema músculo-esquelético e respiratório. A maioria das metástases foi detectada macroscopicamente e ocorreu em múltiplos ossos. Entretanto, em 23% dos casos as metástases só puderam ser observadas microscopicamente. Dentre os ossos afetados, vértebras e úmero foram os mais frequentemente acometidos. Paralelamente foram estudados, de forma retrospectiva, sete casos de osteopatia hipertrófica diagnosticados em um período de 11 anos no LPV-UFSM. Os cães afetados apresentavam sinais clínicos indicativos de envolvimento ósseo e lesões macroscópicas principalmente nos ossos longos dos membros. As lesões consistiram de neo-formação óssea periosteal, detectada em exame radiográfico, na inspeção óssea durante a necropsia e, com grande nível de detalhamento, em espécimes ósseos macerados. A proliferação óssea observada era parcialmente circunferencial e ocorreu principalmente na diáfise dos ossos longos. Era constituída por trabéculas ósseas de tamanho e espessura irregulares que estavam dispostas de forma perpendicular ao córtex ósseo original. Em todos os casos, as lesões de osteopatia hipertrófica foram associadas a neoplasmas pulmonares (primários ou metastáticos). Em dois dos sete casos, as metástases pulmonares eram de sarcomas ósseos e, em um caso, havia um osteossarcoma primário pulmonar (extraesquelético).

Background: Work-related stress (WRS) is associated with musculoskeletal pain (MSP), changes in the autonomic nervous system (ANS) and anxiety. Objective: To determine the feasibility of a follow-up study and treatment efficacy of the Reaset Approach on MSP, ANS and State-Trait anxiety. Methods: 15 subjects with WRS and MSP were assigned into 3 groups (Body, Head-Neck, Head-Neck-Body). Each group received a single 25 minute ‘Reaset Approach’ intervention. Heart rate variability (HRV), electro-dermal activity (EDA), State Trait Anxiety (STAI) and MSP were measured. Results: HRV parameters: SDNN increased in 13 of 15 subjects while SD1 and SD2 increased in 12 of 15 subjects. EDA reduced in 10 of 14 subjects. State Anxiety reduced in all subjects and Trait Anxiety reduced in 14 of 15 subjects. MSP reduced in all subjects after the intervention and were still lower three days afterwards. Conclusions: This pilot study determined that a follow-up study can ensue provided minor modifications are implemented and that the ‘Reaset Approach’ has an influence on the ANS, anxiety and MSP. Results do differ between groups. The intervention groups including the head and neck modalities demonstrated better results. / Hintergrund: Arbeitsbedingter Stress (ABS) ist verbunden mit muskelschmerzen, Veränderungen im autonomen Nervensystem (ANS) und Angst. Ziel: Machbarkeit einer Follow-up-Studie und Wirksamkeit der Behandlung des Reaset Ansatzes auf ANS, Muskelschmerzen und State und Trait- Angst bestimmen. Methoden: 15 Patienten mit ABS und Muskelschmerzen wurden in 3 Gruppen eingeteilt (Körper, Kopf-Hals, Kopf-Hals-Körper). Jede Gruppe erhielt eine einzige 25 Minuten dauernde 'Reaset Approach’-Behandlung. Herzfrequenzvariabilität (HRV), elektro-dermale Aktivität (EDA), State-Trait-Angstsinventar (STAI) und Muskelschmerzen (SF-MPQ) wurden gemessen. Ergebnisse: Die HRV-wert: SDNN ist bei 13 von 15 Probanden erhöht, während SD1 und SD2 bei 12 von 15 Probanden zugenommen hat. EDA war bei 10 von 14 Probanden reduziert. Die State-Angst hat bei allen Probanden und die Trait-Angst bei 14 der 15 Probanden abgenommen. Muskelschmerzen waren bei alle Probanden anschließend an und drei Tage nach der Intervention reduziert. Schlussfolgerung: Diese Pilotstudie hat gezeigt, dass eine Follow-up-Studie fortgesetzt werden kann, sofern kleinere Änderungen durchgeführt werden. Die 'Reaset Approach’ hat einen günstigen Einfluss auf die ANS, State-Trait-Angst und Muskelschmerzen. Ergebnisse zwischen den Gruppen sind unterschiedlich. Die Interventionsgruppen mit einschließlich der Kopf-Hals-Modalitäten zeigten bessere Ergebnisse..

Background: Work-related stress (WRS) is associated with musculoskeletal pain (MSP), changes in the autonomic nervous system (ANS) and anxiety. Objective: To determine the feasibility of a follow-up study and treatment efficacy of the Reaset Approach on MSP, ANS and State-Trait anxiety. Methods: 15 subjects with WRS and MSP were assigned into 3 groups (Body, Head-Neck, Head-Neck-Body). Each group received a single 25 minute ‘Reaset Approach’ intervention. Heart rate variability (HRV), electro-dermal activity (EDA), State Trait Anxiety (STAI) and MSP were measured. Results: HRV parameters: SDNN increased in 13 of 15 subjects while SD1 and SD2 increased in 12 of 15 subjects. EDA reduced in 10 of 14 subjects. State Anxiety reduced in all subjects and Trait Anxiety reduced in 14 of 15 subjects. MSP reduced in all subjects after the intervention and were still lower three days afterwards. Conclusions: This pilot study determined that a follow-up study can ensue provided minor modifications are implemented and that the ‘Reaset Approach’ has an influence on the ANS, anxiety and MSP. Results do differ between groups. The intervention groups including the head and neck modalities demonstrated better results.:I. Abstract (En) III II. Abstract (De) IV III. Table of Contents V IV. Index of figures VIII V. Index of tables IX VI. Index of abbreviations X 1 Introduction 1 2 Background 2 2.1 Work-related musculoskeletal pain 2 2.2 Work-related stress 3 2.3 Osteopathy and the autonomic nervous system 3 2.4 Stress, pain and osteopathy 4 3 Questions 6 3.1 Feasibility 6 3.2 Treatment effect 6 4 Methods 7 4.1 Study design 7 4.2 Participants 8 4.2.1 Inclusion criteria 8 4.2.2 Exclusion criteria 8 4.2.3 Recruitment 8 4.2.4 Randomization 10 4.3 Parameters 11 4.3.1 Heart rate variability 11 4.3.2 Electro-dermal activity 11 4.3.3 State anxiety 11 4.3.4 Trait anxiety 12 4.3.5 Perceived pain 12 4.4 Measuring Instruments 13 4.4.1 Heart rate variability 13 4.4.2 Electro-dermal Activity 13 4.4.3 State-Trait Anxiety Inventory 13 4.4.4 Short-Form McGill Pain Questionnaire 13 4.5 Interventions 14 4.5.1 Intervention ‘B’: Body 14 4.5.2 Intervention ‘HN’: Head and Neck 16 4.5.3 Intervention ‘HNB’: Head, Neck and Body 16 4.6 Study flow 18 4.7 Statistics 20 5 Results 21 5.1 Autonomic nervous system: Heart rate variability 21 5.1.1 SDNN 22 5.1.2 SD1 25 5.1.3 SD2 28 5.2 Autonomic Nervous System: Electro-dermal activity 31 5.3 Anxiety 34 5.3.1 State anxiety 34 5.3.2 Trait anxiety 37 5.4 Musculoskeletal pain 39 5.4.1 Visual analogue scale 40 5.4.2 Total Short-Form McGill Pain Questionnaire 43 6 Discussion 46 6.1 Discussion of the method 46 6.2 Discussion of the results 50 6.2.1 Autonomic nervous system 50 6.2.1.1 Heart rate variability 50 6.2.1.2 Electro-dermal activity 51 6.2.2 Anxiety 51 6.2.2.1 State anxiety 51 6.2.2.2 Trait Anxiety 52 6.2.3 Musculoskeletal pain 52 6.3 Suggestions for future research 53 7 Conclusion 54 8 Literature 55 9 Addendum 63 9.1 Table: SF-MPQ with Sensory, Affective and Evaluative dimension 63 9.2 Patient Information Sheet 64 9.3 Structured telephone interview 70 9.4 Structured pre-treatment interview 72 9.5 SF-MPQ permission 73 9.6 SF-MPQ 74 9.7 STAI License 76 9.8 STAI forms Y-1 and Y-2 77 / Hintergrund: Arbeitsbedingter Stress (ABS) ist verbunden mit muskelschmerzen, Veränderungen im autonomen Nervensystem (ANS) und Angst. Ziel: Machbarkeit einer Follow-up-Studie und Wirksamkeit der Behandlung des Reaset Ansatzes auf ANS, Muskelschmerzen und State und Trait- Angst bestimmen. Methoden: 15 Patienten mit ABS und Muskelschmerzen wurden in 3 Gruppen eingeteilt (Körper, Kopf-Hals, Kopf-Hals-Körper). Jede Gruppe erhielt eine einzige 25 Minuten dauernde 'Reaset Approach’-Behandlung. Herzfrequenzvariabilität (HRV), elektro-dermale Aktivität (EDA), State-Trait-Angstsinventar (STAI) und Muskelschmerzen (SF-MPQ) wurden gemessen. Ergebnisse: Die HRV-wert: SDNN ist bei 13 von 15 Probanden erhöht, während SD1 und SD2 bei 12 von 15 Probanden zugenommen hat. EDA war bei 10 von 14 Probanden reduziert. Die State-Angst hat bei allen Probanden und die Trait-Angst bei 14 der 15 Probanden abgenommen. Muskelschmerzen waren bei alle Probanden anschließend an und drei Tage nach der Intervention reduziert. Schlussfolgerung: Diese Pilotstudie hat gezeigt, dass eine Follow-up-Studie fortgesetzt werden kann, sofern kleinere Änderungen durchgeführt werden. Die 'Reaset Approach’ hat einen günstigen Einfluss auf die ANS, State-Trait-Angst und Muskelschmerzen. Ergebnisse zwischen den Gruppen sind unterschiedlich. Die Interventionsgruppen mit einschließlich der Kopf-Hals-Modalitäten zeigten bessere Ergebnisse..:I. Abstract (En) III II. Abstract (De) IV III. Table of Contents V IV. Index of figures VIII V. Index of tables IX VI. Index of abbreviations X 1 Introduction 1 2 Background 2 2.1 Work-related musculoskeletal pain 2 2.2 Work-related stress 3 2.3 Osteopathy and the autonomic nervous system 3 2.4 Stress, pain and osteopathy 4 3 Questions 6 3.1 Feasibility 6 3.2 Treatment effect 6 4 Methods 7 4.1 Study design 7 4.2 Participants 8 4.2.1 Inclusion criteria 8 4.2.2 Exclusion criteria 8 4.2.3 Recruitment 8 4.2.4 Randomization 10 4.3 Parameters 11 4.3.1 Heart rate variability 11 4.3.2 Electro-dermal activity 11 4.3.3 State anxiety 11 4.3.4 Trait anxiety 12 4.3.5 Perceived pain 12 4.4 Measuring Instruments 13 4.4.1 Heart rate variability 13 4.4.2 Electro-dermal Activity 13 4.4.3 State-Trait Anxiety Inventory 13 4.4.4 Short-Form McGill Pain Questionnaire 13 4.5 Interventions 14 4.5.1 Intervention ‘B’: Body 14 4.5.2 Intervention ‘HN’: Head and Neck 16 4.5.3 Intervention ‘HNB’: Head, Neck and Body 16 4.6 Study flow 18 4.7 Statistics 20 5 Results 21 5.1 Autonomic nervous system: Heart rate variability 21 5.1.1 SDNN 22 5.1.2 SD1 25 5.1.3 SD2 28 5.2 Autonomic Nervous System: Electro-dermal activity 31 5.3 Anxiety 34 5.3.1 State anxiety 34 5.3.2 Trait anxiety 37 5.4 Musculoskeletal pain 39 5.4.1 Visual analogue scale 40 5.4.2 Total Short-Form McGill Pain Questionnaire 43 6 Discussion 46 6.1 Discussion of the method 46 6.2 Discussion of the results 50 6.2.1 Autonomic nervous system 50 6.2.1.1 Heart rate variability 50 6.2.1.2 Electro-dermal activity 51 6.2.2 Anxiety 51 6.2.2.1 State anxiety 51 6.2.2.2 Trait Anxiety 52 6.2.3 Musculoskeletal pain 52 6.3 Suggestions for future research 53 7 Conclusion 54 8 Literature 55 9 Addendum 63 9.1 Table: SF-MPQ with Sensory, Affective and Evaluative dimension 63 9.2 Patient Information Sheet 64 9.3 Structured telephone interview 70 9.4 Structured pre-treatment interview 72 9.5 SF-MPQ permission 73 9.6 SF-MPQ 74 9.7 STAI License 76 9.8 STAI forms Y-1 and Y-2 77