Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Obsessive-compulsive disorder (OCD) contributes to significant distress and chronic individual and societal impairment (e.g., DuPont et al., 1995; Ruscio et al., 2010). Despite the effectiveness of existing exposure-based therapies, some clients do not achieve symptom reduction or remission (Öst et al., 2015). Thus, identification of the mechanisms of change in treatment and more focused interventions are warranted to improve intervention effectiveness (e.g., Zvolensky et al., 2006). Distress intolerance may be an important but understudied mechanism of change in treatment for OCD. The current study replicated and extended previous findings that were limited by a small sample size (Macatee & Cougle, 2015), lack of focus on OCD specifically (McHugh et al., 2014; Bornovalova et al., 2012; Williams et al., 2013), and the use of non-clinical participants (Cougle et al., 2011; Macatee & Cougle, 2015) by using a residential and intensive outpatient sample of patients diagnosed with OCD. The current study found that reductions in DI accounted for significant improvement in OCD severity beyond changes in biological sex, anxiety change, depression change. Further, reductions in DI significantly contributed to OCD treatment response. Limitations and future directions were discussed.

Recent evidence indicates that the proportion of young people developing significant psychosocial problems is increasing (Rutter, 1995). This thesis focuses upon a small percentage of the growing number of adolescents who experience significant psychopathology; adolescents admitted to a regional inpatient psychiatric unit. Chapter 1 provides the theoretical background to the thesis; reviewing the literature on both the methodology and outcome of studies conducted with adolescents in inpatient adolescent psychiatric services. It suggests that future investigations take account of the practical impossibility of conducting high quality, standard double-blind control trials in such settings and outlines four empirical alternatives to such designs; evaluation of components of the therapy employed in residential settings; the use of problem-oriented case records; prediction of outcome across time; investigating the reasons for the effectiveness of established predictors of outcome. The next four chapters describe a series of studies utilising the last three of these suggested approaches in a cohort of adolescents admitted to a regional psychiatric unit. Chapter 2 is a cross-sectional study describing the sample upon which the remainder of the thesis is based. It focuses principally upon describing the psychopathology of the adolescents from three perspectives; that of the adolescent, their parents and the therapeutic team. It examines the interrelationships between mood, behaviour and family functioning. Chapter 3 describes the results of an investigation into the relationships between selfesteem, autobiographical memory, attributional style, social problem-solving and the experience of depression and hopelessness. Chapter 4 examines the clinical effectiveness of the treatment at the unit as assessed by problem severity as rated by adolescents and their parents and standardised measures of mood and self-esteem. Chapter 5 examines to what extent outcome can be predicted on the basis of initial problem severity, mood and cognitive style (autobiographical memory, attributional stye, problem-solving and selfesteem). Each chapter is written as a separate paper with abstract, literature review, method, results and discussion; however, reference to the overall findings is made throughout for ease of reading. The final chapter draws together themes from the whole thesis and discusses the psychological processes which mediate change during the adolescent treatment programme described here. It concludes that the cognitive and meta-cognitive processes which mediate change are best understood as related to internal working models derived from attachment experiences. A model for understanding individual variation in these processes is outlined and strategies for testing the proposed model are advanced.

Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Introdução: A degeneração da articulação patelofemoral é uma patologia relativamente comum, ocorrendo em 5% a 9% dos pacientes com artrose isolada do joelho. Avanço progressivo do processo degenerativo acompanhado de dor, rigidez articular e considerável limitação funcional são achados comumente presentes, tornando-se, muitas vezes, necessária a adoção de intervenções cirúrgicas. O tratamento cirúrgico para pacientes jovens, apresentando estágio avançado de artrose isolada da articulação patelofemoral, permanece controverso. Diversas técnicas cirúrgicas, incluindo liberação do retináculo lateral, avanço da tuberosidade tibial, implante autólogo de condrócitos, patelectomia, artroplastia patelofemoral e artroplastia total do joelho têm sido empregadas, apresentando ampla variação nos índices de sucesso. Além disso, a rotina pós-operatória e a necessidade de imobilização e proteção do reparo, após alguns procedimentos, tendem a repercutir nos resultados funcionais finais e no retorno às atividades de vida diária. Não há solução perfeita para o tratamento cirúrgico da artrose patelofemoral isolada. As opções terapêuticas disponíveis até proporcionam resultados funcionais aceitáveis, mas os problemas inerentes a cada uma delas não podem ser considerados desprezíveis. Algumas das cirurgias sem implantes artificiais costumam comprometer, significativamente, a morfologia articular, com resultados estéticos bastante desconfortáveis, principalmente para pacientes do sexo feminino. As cirurgias com implantes, por outro lado, agregam um custo adicional significativamente alto, na forma do valor intrínseco desses implantes, já que os demais custos hospitalares são equivalentes aos procedimentos convencionais. Dessa forma, o desenvolvimento de um procedimento cirúrgico alternativo, capaz de promover alívio das queixas álgicas, melhora funcional, reabilitação precoce e resultado estético aceitável traria não somente grandes benefícios para os pacientes com artrose patelofemoral em estágios avançados de comprometimento articular, como também certo alívio para os gestores das secretarias municipais de saúde no que se refere ao alto custo dos implantes. Objetivo: Avaliar os resultados funcionais de pacientes com artrose patelofemoral submetidos a uma nova técnica cirúrgica, artroplastia de interposição retinacular. Material e Métodos: O estudo descreve uma série de 11 casos de pacientes com diagnóstico de artrose patelofemoral isolada, submetidos à artroplastia de interposição retinacular no Serviço de Ortopedia e Traumatologia do Hospital de Clínicas de Porto Alegre, que foram avaliados quanto à função e movimento articular do joelho durante o pré e o pós-operatório. O tempo de seguimento pós-operatório foi de, no mínimo, 2 anos. A avaliação da função foi realizada utilizando-se a Escala de Atividades de Vida Diária para Análise do Joelho. As amplitudes de movimento de flexão e extensão do joelho foram mensuradas por meio de um goniômetro universal. Foram comparados os resultados obtidos durante o pré e pós-operatório. Resultados: Após um período médio de seguimento de 25,9 meses (entre 24 e 29 meses), 10 dos 11 pacientes apresentaram melhora nos resultados funcionais. A média de escores da Escala de Atividades de Vida Diária para Análise do Joelho foi 34,0 ± 12,4 (IC 95%=25,7- 42,3) antes da cirurgia e 55,8 ± 11,2 (IC95%=48,3-63,4) após a cirurgia, apresentando uma melhora estatisticamente significativa (p<0,001). O paciente que não evidenciou melhora funcional pós-operatória apresentou progressão da artrose tibiofemoral e, após 2 anos de pós-operatório, foi submetido à artroplastia total do joelho. Não foi observado aumento estatisticamente significativo na amplitude de movimento de flexão e extensão do joelho após a cirurgia. Conclusão: A artroplastia de interposição retinacular proporcionou bons resultados funcionais em pacientes com artrose da articulação patelofemoral, podendo ser uma alternativa cirúrgica para pacientes jovens e de meia idade com processo degenerativo articular em estágio avançado. / Introduction: The degeneration of the patellofemoral joint is a relatively common patology. Patellofemoral artrhosis occurs in between 5% and 9% of patients with knee arthrosis. The frequent clinical findings observed in the presence of progressive degenerative process are pain, joint stiffness, and considerable functional impairment, which many a time requires surgical intervention. Yet, in the case of young patients in an advanced stage of isolated patellofemoral arthrosis, surgical approaches to treatment are surrounded by controversy. Several surgical techniques have been employed to varying degrees of success, including lateral reticular release, advancement of tibial tuberosity, autologous chondrocyte implantation, patellectomy, patellofemoral arthroplasty and total knee arthroplasty. Besides, the different postoperative routines adopted, at times followed by periods of immobilization and protection of the surgical repair performed, tend to lead to different functional outcomes and to influence the resumption of daily living activities. There is no ideal solution to the surgical treatment of isolated patellofemoral arthrosis. The therapeutic alternatives available do indeed manage to produce acceptable outcomes, but the issues inherent to each choice cannot be ignored. Some surgical procedures that do not use artificial implantations usually compromise significantly the joint morphology, and follow-up involves undesired esthetic results, specially for female patients. Conversely, surgeries that use implantations impose rising additional costs expressed by the intrinsic values of the implantation, as the other hospital expenditures are equivalent to conventional medical procedures. Therefore, the development of an alternative surgical procedure that promotes pain relief, functional improvements, with an early rehabilitation and an acceptable esthetic result, would bring not only substantial benefits to patients who suffer from patellofemoral arthrosis with advanced commitment of the joint, but also a certain relief to health authorities as regards high implantation costs. Aim: To evaluate the functional outcomes of patients with patellofemoral arthrosis who underwent a new surgical technique, retinacular interposition arthroplasty. Materials and methods: The present study is a case series. Eleven patients with positive diagnosis for isolated patellofemoral arthrosis who underwent to retinacular interposition arthroplasty were evaluated in the Orthopedics and Traumatology Service of Hospital de Clínicas de Porto Alegre for function and articular range of motion of the knee during the preand postoperative period. Follow-up was at least 2 years. The evaluation of function was carried out using the Knee Outcome Survey Activities of Daily Living Scale. The range of flexion and extension motion were measured by means of a goniometer. Pre- and postoperative results were compared. Results: After an average follow-up period of 25.9 months (between 24 and 29 months), 10 of the 11 patients showed improved functional outcomes. Average scores obtained by the Knee Outcome Survey Activities of Daily Living Scale was 34.0 ± 12.4 (CI 95% = 25.7 – 42.3) before surgery and 55.8 ± 11.2 (CI 95% = 48.3 – 63.4) after surgery, with a statistically significant improvement (P < 0.001). One patient did not present any functional improvement, and presented a progression of the femorotibial arthrosis. Two years after the end of the postoperative period, the patient underwent total knee arthroplasty. No statistically significant increase was observed in motion of knee flexion and extension after the surgery. Conclusion: Retinacular interposition arthroplasty afforded good functional results in patients with isolated arthrosis of the patellofemoral joint. The technique may be a surgical alternative for young and middle-aged patients who suffer from articular degenerative process at advanced stage.

Objetivo: Avaliar em pacientes submetidos à cirurgia de correção de ptose palpebral e dermatocálase: a) o nível de associação de medidas propedêuticas pré-operatórias (função do músculo levantador da pálpebra superior (FMLPS), distância margem palpebral superior ao centro da pupila (DMR1) e altura do sulco palpebral (AS), com a magnitude de desinserção do tendão do músculo levantador da pálpebra superior (MLPS). b) A influência da idade, sexo, presença de ectrópio/entrópio e cirurgia ocular prévia na magnitude de desinserção do tendão do MLPS. c) Avaliar as diferenças das medidas propedêuticas palpebrais pré e pós-operatórias . d) Avaliar a presença de desinserção do MLPS na pálpebra não-ptótica de pacientes com ptose unilateral. e) Avaliar a presença de desinserção do MLPS em pálpebras com DMR1 normal. Metodologia: Desenho do estudo: Série de casos, não comparativo, prospectivo. Casuística: Quarenta e quatro pacientes com ptose palpebral e dermatocálase foram incluídos. Intervenção: Exploração do tendão do MLPS durante a blefaroplastia em pacientes com ptose e dermatocálase. Nos casos de desinserção, o tendão foi refixado ao tarso. Desfechos analisados: Avaliação do nível de associação das medidas propedêuticas pré-operatórias (além de sexo, idade, diabetes, cirurgia ocular prévia, presença de ectrópio/entrópio e queixa de ptose) na magnitude de desinserção do MLPS. Foram utilizados modelos uni e multivariados. A interação entre as variáveis foi testada no modelo multivariado e também foi realizada a avaliação da diferença entre as medidas de FMLPS, DMR1 e AS antes e depois da intervenção. A dependência entre os olhos foi corrigida por meio de equações de estimações generalizadas. Correlação de Pearson foi utilizada para quantificar a dependência entre os olhos para FMLPS, DMR1 e AS. Resultados: A média de desinserção do tendão do MLPS foi de 5,47 mm ± 3,02 para o olho direito e 5,99 mm ± 2,60 para o esquerdo. Com exceção da queixa de ptose e da FMLPS, todas as variáveis testadas foram estatisticamente associadas à magnitude de desinserção do tendão do MLPS. Quando todas elas entraram em um modelo multivariado, somente a DMR1 e a AS foram estatisticamente preditoras da magnitude de desinserção do tendão do MLPS. Houve diferença estatisticamente significante entre a FMLPS antes e depois da cirurgia, sendo a excursão do MLPS mais limitada após a cirurgia, diminuindo, em média, 1,1 mm (p < 0,001). As medidas pré e pós-operatórias de DMR1 e AS foram estatisticamente diferentes, com melhora no pós-operatório, sendo que DMR1 aumentou, em média, 1,6 mm e a AS diminuiu, em média, 3,97mm (p < 0,001). Encontrou-se correlação significante entre os olhos para todas as variáveis propedêuticas analisadas antes e depois da cirurgia. O mesmo foi encontrado para a correlação quanto ao grau de desinserção nos dois olhos (p > 0,01). Conclusões: a) Das medidas pré-operatórias, DMR1 e AS foram as que mais se associaram à magnitude de desinserção do tendão do MLPS, sendo que houve interação entre as duas medidas para esta associação no modelo multivariado de análise. b) Idade, sexo, cirurgia ocular prévia e presença de ectrópio/entrópio estiveram associados ao grau de desinserção, mas somente no modelo univariado de análise. c) Houve aumento significativo das medidas de DMR1 no pós-operatório, diminuição da AS e da FMLPS. d) Houve quatro pacientes com ptose unilateral. Dois deles apresentaram desinserção do MLPS no olho sem ptose. e) Foram encontrados oito pacientes com medidas de DMR1 normais em um ou ambos os olhos. Destes, somente um não apresentou qualquer desinserção do MLPS / Purpose: To evaluate on patients who underwent to ptosis and dermatochalasis correction: a) the association of pre-operatory propedeutic measures (upper eyelid levator muscle function (UELMF), margin reflex distance (MRD1), and eyelid crease height (ECH)) on the amount of upper eyelid levator muscle (UELM) disinsertion. b) The association of gender, age, previous surgery, and ectropion/entropion were analyzed as predictive factors for the amount of upper eyelid levator muscle disinsertion. c) To evaluate the differences of eyelid propedeutic measures before and after surgery. d) To evaluate the amount of UELM disinsertion in the normal eyelids of patients with unilateral ptosis. e) To evaluate the amount of UELM disinsertion in patients with normal MRD1. Methods: Design of the study: prospective non comparative case series study. Population: Forty four patients with blepharoptosis and dermatochalasis were enrolled. Intervention: Exploration of the levator tendon (LT) during blepharoplasty and ptosis correction and in case of its disinsertion, the tendon was reattached to the tarsus. Outcome Measured: Margin reflex distance (MRD1), upper eyelid levator muscle function (UELMF), eyelid crease height (ECH), gender, age, diabetes, previous surgery, ectropion/entropion, and ptosis complaint were analyzed as predictive factors for the amount of upper eyelid levator muscle disinsertion. Both the uni and multivariate approaches were tested and for the latter, interaction from variables was also evaluated. The differences between UELMF, MRD1, ECH before and after surgery were evaluated bilaterally. Dependency between both eyes was corrected by generalized estimating equations. Pearson correlation was used to evaluate the dependency of the two eyes regarding UELMF, MRD1 and ECH. Results: The mean levator tendon disinsertion was 5.47 mm ± 3.02 for the right eye and 5.99 mm ± 2.60 for the left. For univariate models, with the exception of the complaint of ptosis and eyelid function, all variables were statistically related to the amount of disinsertion of the upper eyelid levator tendon. For the multivariate model, when all variables were considered, only MRD1 and ECH were significantly associated with the amount of disinsertion. There was a statistical significant difference between the measures of UELMF before and after surgery with excursion decreasing a mean value of 1.1 mm after the procedure (p < 0,001). Measures of MRD1 showed an increase in a mean of 1.6 mm and ECH decreased in a mean of 3.97 mm (p < 0,001). We had found a significant correlation between both eyes for all eyelid propedeutic variables analyzed, both before and after surgery. Correlation of the propedeutic measures before surgery, between the two eyes, was stronger for the group without previous surgery. The same results for correlation was found for the amount of disinsertion (p < 0.001). Conclusions: a) From the pre-operatory measures, MRD1 and ECH were the most important variables regarding association with the amount of UELM tendon disinsertion. A very important interaction was found between these two variables on the multivariable analysis model. b) Gender, age, diabetes, previous surgery, and presence of ectropion/entropion were associated with the amount of disinsertion but only on the univariable model of analysis. c) There was an increase on the measures of MRD1, ECH and UELMF decreased. d) Four patients had unilateral ptosis. Two of those patients presented UELM disinsertion on the eye without ptosis. (e) Eight patients had normal values for MRD1 in one or both eyes, from those, only one had no disinsertion

Abstract Depression is a common consequence of stroke and it is known to be associated with deterioration of quality of life. However, only limited information is available on the relationships between depression and communicative and cognitive disorders. Moreover, the present knowledge of the determinants of the domains of quality of life is limited, and little is known of e.g. the changes in sexual behaviour of stroke patients and their spouses. This prospective study was carried out to evaluate the prevalence of post-stroke depression and aphasia and to study their interrelationships and neuropsychological and functional correlates. The particular aim of the study was to investigate the domain-specific quality of life, and to assess its clinical and sociodemographic correlates, and to study the impact of stroke on the sexual functions of stroke patients and their spouses. The study consisted of 156 first-ever stroke patients. Depression was diagnosed in 53% of the patients at 3 months and in 42% of the patients at 12 months post-stroke according to DSM-III-R-criteria. One third of the patients were aphasic, 70% of them at 3 months and 62% at 12 months after stroke suffering from depression. Among the aphasic patients the prevalence of major depression increased from 11% to 33% during the 12 months follow-up. There was an association between post-stroke depression and cognitive impairment, the domains most likely to be defective being memory, non-verbal problem solving, and attention and psychomotor speed. The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia. The quality of life of the patients was low at 3 months after the stroke, and it did not improve during the follow-up of a year. The test domains most often impaired were Physical functioning, Physical role limitations, Vitality and General health. Depression, although mostly minor, and being married emerged as significant independent contributors to low score value of Vitality and Physical role limitations. All the analyzed aspects of sexuality were commonly decreased as a consequence of stroke both in the patients and their spouses. Nocturnal erections were impaired in 21 (55%) of the male patients. The present results demonstrate that more than half of the patients after stroke suffer from depression and the frequency of major depression seems to increase over time, especially among the aphasic patients. Both depression and aphasia increase the liability of cognitive deficits. Stroke affects various dimensions of quality of life extensively, and the most important determinants entailing low quality of life seem to be depression, and, interestingly, being married. As a part of quality of life, sexual function and satisfaction with sexual life are impaired both in stroke patients and spouses. These findings call for multidimensional evaluation of stroke patients and provide new challenges for stroke rehabilitation.

Abstract The aims of this study were to estimate the prevalence of autism in Northern Finland and to assess retrospectively the associations of autistic disorder with identified medical conditions and additional disabilities in this defined population of children and adolescents with autistic disorder. In order to find out the factors influencing the outcome, the methods of treatment/habilitation and the interventions used were studied in detail. The last aim was to elicit reliable information for decision-makers as well as ideas for giving support and, because of the presumed better outcome, saving resources in the long run. The data were collected from hospital records and the records of the central institutions for the intellectually disabled in the Provinces of Oulu and Lapland in 1996–1997. The age-specific prevalences obtained in this study showed the prevalence to be lowest, i.e. 6.1 per 10 000, in the oldest age group of 15- to 18-year-old adolescents and highest, i.e. 20.7 per 10 000, in the age group of 5- to 7-year-old children, when the criteria of ICD-10 and DSM-IV were used. In this study, almost 50% of the autistic cases had a tested IQ above 70. Associated medical disorders or associated disorders of known or suspected genetic origin were diagnosed in 12.3%. Other associated medical disorders were epilepsy, hydrocephalus, fetal alcohol syndrome and cerebral palsy. Severe impairment of vision was evident in 3.7%. The most common therapies were physiotherapy and speech, occupational and music therapy. 43.9% of the children and adolescents with autism received specific training according to the TEACCH (Treatment and Education of Autistic and related Communication-Handicapped Children), 10.2% according to the Lovaas and 30.5% according to the Portage program. Antiepileptic medication had been prescribed to 23.9% and psychopharmacals to 14.9% of the individuals with autistic disorder (AD). About three- to fourfold prevalence of AD in Northern Finland was found when compared to 16 years ago. Early, effective and regular interventions in autism have a good impact and should be provided as early as possible to children with autism. Based on the poorer prognosis of those without any early intervention, it can be anticipated that these methods will save resources in the long run.

Abstract The treatment of hip fractures in the elderly has been under debate for decades. There is a lack of standardisation of treatment and rehabilitation and also concerning the measurements and follow-up times in studies on treatment. Two patient series with cervical hip fractures treated with Austin Moore hemiarthroplasty in Finland and hook pin osteosynthesis in Sweden were compared using matched-pair analysis in view of different age groups. Hip fracture treatments in six hospitals in Finland and one in Great Britain were surveyed. The adequacy of a short four-month follow-up was studied by comparing outcomes at four months and one year. Standardised Audit of Hip Fractures in Europe data collection sets were tested and used in three studies. Osteosynthesis resulted in lower one-year mortality but a higher reoperation rate in patients aged 55–75 years and was associated with a lesser need for walking aids, less pain and lower four-month mortality in patients aged 76–80 years. There were some differences in the patient characteristics and the methods of treatment between Great Britain and Finland. In Great Britain, more patients returned to their own homes, but one-year mortality after trochanteric fractures was higher. Hip fracture treatments and outcomes were quite similar between the six Finnish hospitals. There was a slight difference in adjusted postoperative mobility and mortality in two hospitals compared to the others. Six of the ten functional domains and residential status remained unchanged, while walking ability and four functional domains improved between four months and one year. The standardised data set was a practical and reliable way to acquire a great variety of information on hip fracture patients, treatments and outcomes. Hook pin osteosynthesis can be recommended for patients with cervical hip fractures younger than 80 years, whereas older patients can also be safely treated with Austin Moore hemiarthroplasty. The characteristics and outcomes of hip fracture patients were rather similar between Finland and Great Britain and between the different Finnish hospitals irrespective of the variety of methods used in treatment. Standardised Audit for Hip Fractures in Europe is a reliable data collection set and suitable as a basis of hip fracture surveys, audits and registers. Four-month follow-up is justified as the shortest feasible alternative in studies on rehabilitation and residential status after hip fractures.

The present study pursued two objectives in the context of a randomized clinical trial of cognitive-behavioral therapy with parent (CBT/P) and group (GCBT) involvement. The first objective was to examine the variability in treatment outcome. There were three specific aims within the first objective, to evaluate: (1) youth characteristics (age, depressive, and externalizing disorders) as moderators of treatment outcome; (2) the differential outcome of the treatment approaches as a function of youth characteristics; and (3) the relative efficacy of the treatment approaches at each level of the moderators. The second objective was to evaluate the efficacy of anxiety treatments along secondary depressive symptoms and externalizing behaviors. There were five specific aims within the second objective, to evaluate: (1) whether anxiety treatment yields reductions in secondary problems, (2) the efficacy of anxiety treatments in reducing secondary problems as a function of approach and youth characteristics, (3) whether reductions in anxiety symptoms significantly mediate changes in secondary problems, (4) the directionality of change in the hypothesized mediated relations, and (5) whether the hypothesized mediated relations are moderated by treatment approach and youth characteristics. The specific aims were pursued using data collected from 183 youth and their mothers. Research questions were tested using multiple regressions and structural equation modeling. Age, depressive, and externalizing disorders were significant moderators. CBT/P relative to GCBT lowered anxiety more for younger than older youth. GCBT relative to CBT/P lowered anxiety more for older than younger youth. GCBT relative to CBT/P lowered anxiety more for depressed youth than non-depressed youth. GCBT relative to CBT/P lowered anxiety less for externalizing youth than non-externalizing youth. Treatment reduced depressive symptoms and externalizing problem behaviors. Reductions in anxiety mediated changes in depressive symptoms and externalizing problem behaviors. Reversed directionality was found in the relation between social anxiety and depressive symptoms. In CBT/P the direction of change was from depressive to social anxiety. The opposite was true in GCBT. Reductions in social anxiety mediated posttreatment changes in depressive symptoms in GCBT but not CBT/P. The reverse was true at follow-up. Reductions in social anxiety mediated changes in depressive symptoms for girls but not boys.