Coeliac disease (CD) is a chronic gastrointestinal condition, the only treatment for which is a gluten-free diet (GFD). Following a GFD is restrictive, burdensome, and can impact health-related quality of life (HRQOL). People with CD can experience long delays to diagnosis and evidence suggests large variations in follow-up care, but the relationship between health care experiences and HRQOL is unknown. The main aim of this research was to develop a patient-reported outcome measure and patient experience questionnaire, and use these to investigate the relationship between adults' experiences of health care services and HRQOL in CD. The questionnaires, named the Coeliac Disease Assessment Questionnaire (CDAQ) and the Coeliac Disease Patient Experience Questionnaire (CD-PEQ), were developed following qualitative interviews with adults with CD, and refined with input from experts, and cognitive interviews. The CDAQ was also subject to a translatability assessment to assess its linguistic and cultural translatability, and a cross-sectional survey to assist with item reduction and scale generation. Members of Coeliac UK (n=267) completed the CDAQ and CD-PEQ, together with the SF-36v2 and demographic questions as part of a postal survey. Psychological health, vitality, general health, and dietary burden were found to have the greatest impact on HRQOL, with physical health and social isolation the least affected. HRQOL was found to have a strong correlation with patients' experiences of health care services. Aspects most strongly related were: the provision of information; communication with HCPs; difficulty obtaining prescriptions; and GPs' knowledge. This research has identified aspects of health care services that are strongly related to HRQOL in CD. Health care providers are recommended to focus service improvement efforts on these areas. A reliable and valid disease-specific patient-reported outcome measure and patient experience questionnaire have been developed as part of this study. The CDAQ is suitable for use in research studies, including clinical trials, to assess HRQOL in CD.

nÃo hà / This thesis presents a study on individual values, averages leadership and self-reported performance, promoting interest, raising questions and discussions on organizational behavior of the field with respect to these constructs. The main objective It was to identify the value priorities of the middle leaders and relate them to the professional performance, and the methodological procedure to carry out an exploratory-descriptive study, through the application of a survey, which was scaled using questionnaires: SVS individual values and self-reported performance, both on the Likert scale and deductive logic. The survey was conducted with all individuals who hold positions of medium leaders in a state of Cearà the food industry. Data were collected electronically and analyzed by SPSS software descriptive and statistical factor. The results of value priorities pointed to the motivacionaisBenevolÃncia types associated with compliance, and for those with better self-reported performance combination took different: Grace associated with self-determination. The overall objective was reached because the value priorities of average leaders were identified and related to job performance, checking what motivational types are on top of those with better autoreportado performance. We conclude, therefore, that this trabalhopode contribute with regard to organizational behavior, especially with regard to business management, in addition to emphasizing the importance of the middle leaders in the context of organizational leadership, compreensÃodos its values, its performance and, consequently, motivations / A presente dissertaÃÃo apresenta um estudo sobre valores individuais, mÃdias lideranÃas e desempenho auto-reportado, promovendo interesse, levantando questÃes e discussÃes no campo do comportamento organizacional com relaÃÃo a estes construtos. O objetivo principal deste trabalho foi identificar as prioridades axiolÃgicas das mÃdias lideranÃas e relacionÃ-las ao desempenho profissional, tendo como procedimento metodolÃgico a realizaÃÃo de um estudo exploratÃrio-descritivo, por meio da aplicaÃÃo de uma survey, a qual foi dimensionada utilizando-se os questionÃrios: SVS de valores individuais e desempenho auto-reportado, ambos em escala likert e com lÃgica dedutiva. A pesquisa foi realizada com todos os indivÃduos que ocupam cargos de mÃdias lideranÃas em uma indÃstria de alimentos do estado do CearÃ. Os dados foram coletados por meio eletrÃnico e analisados pelo software SPSS com estatÃstica descritiva e fatorial. Os resultados das prioridades axiolÃgicas apontaram para os tipos motivacionaisBenevolÃncia associado com Conformidade, e para aqueles com melhor desempenho auto-reportado a combinaÃÃo se deu diferente: BenevolÃncia associado com AutodeterminaÃÃo. O objetivo geral do trabalho foi atingido porque as prioridades axiolÃgicas das mÃdias lideranÃas foram identificadas e relacionadas ao desempenho profissional, verificando quais os tipos motivacionais estÃo no topo de quem tem melhor desempenho autoreportado. Conclui-se,portanto, que este trabalhopode contribuir no tocante ao comportamento organizacional, em especial no que tange à gestÃo empresarial, alÃm de ressaltar a importÃncia das mÃdias lideranÃas no contexto da lideranÃa organizacional, da compreensÃodos seus valores, sua performance e, conseqÃentemente, motivaÃÃes.

Este trabalho propõe analisar a forma como se constitui a escrita de alunos de uma turma de 1º ano do ciclo II do ensino fundamental, no momento em que escrevem para atender a demandas institucionais dadas no contexto do Programa Ler e Escrever, da Secretaria Municipal de Educação de São Paulo. Os 26 textos narrativos que compõem seu corpus foram escritos durante o ano letivo de 2010, enquanto atuávamos como professor regente dessa turma, por esse grupo de estudantes, o qual se caracterizava como recém-alfabetizado, com idades entre a pré-adolescência e a adolescência e com histórico de fracasso escolar. De maneira mais específica, os objetivos de nosso trabalho se voltam para a compreensão dos modos como os alunos registram, em seus textos escritos, duas instâncias de diálogo: a) um diálogo que se estabelece com as condições escolares imediatas de produção da escrita e b) um diálogo que se constroi no processo de formulação do texto narrativo, relacionado aos modos de gestão e transmissão do discurso de outrem ou discurso citado no corpo da narrativa. Essa problemática será abordada com base na contribuição fundadora de Bakhtin (1929/2002) e de estudos do texto e do discurso conforme propostos em Jurado Filho (1993). Do ponto de vista de sua metodologia, levando em conta o modo com o qual abordamos os dados, trata-se de uma pesquisa qualitativa, voltada para a análise textual do discurso narrativo em produções escritas de alunos. Além disso, a fim de empreender uma discussão que nos ajude na compreensão da aprendizagem escrita a partir da realidade pedagógica que analisamos, buscaremos referências nos estudos sobre os conceitos de alfabetização e de letramento (SOARES 1998, 2004; MORTATTI, 2004; COLELLO e SILVA LEITE, 2010) e, também, nos autores que têm se debruçado sobre a questão da escrita na escola a partir de uma perspectiva dialógica da linguagem e da compreensão dos espaços de ensino de língua portuguesa como espaços de interação (GERALDI 1984, 1996, 2003; VAL e ROCHA, 2005). / This research proposes to examine the constitution of writing produced by elementary school students at the 1st year of the 2nd cycle, when writing to meet institutional demands as prescribed by the Programa Ler e Escrever (Reading and Writing Program) of the São Paulo City Department of Education. The 26 narrative texts that constitute our body of research were written during the 2010 school year, while we worked as a classroom teacher of these students, by a group of students characterized as newly literate preadolescents and adolescents with a history of school failure. Specifically, the objective of our work is to understand the ways in which students record, in their written texts, two dialogue instances: a) a dialogue which is established with the immediate conditions of writing production at school, and b) a dialogue built on the process of production of narrative texts, related to the modes of management and transmission of the speech of others or speech cited in the body of the narrative. This issue will be addressed based on the founding contribution of Bakhtin (1929/2002) and on text and discourse studies proposed by Jurado Filho (1993). From the point of view of its methodology, taking into account the way in which data was reviewed, we classify this research as qualitative, focused on textual analysis of narrative discourse in written production of students. Furthermore, in order to engage in a discussion which will help us understand the writing learning process in the pedagogical context we reviewed, references will be sought in the studies on the concepts of literacy and lettering (SOARES 1998, 1994; MORTATTI, 2004; COLELLO and SILVA LEITE, 2010), as well as in the work of authors who have been addressing the issue of school writing based on a dialogical perspective of language and on the understanding of the spaces for teaching Portuguese as interaction spaces (GERALDI 1985, 1996; VAL and ROCHA, 2005).

Orientador: Sirio Possenti / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Estudos da Linguagem / Made available in DSpace on 2018-08-06T20:50:09Z (GMT). No. of bitstreams: 1 Fossey_MarcelaFranco_M.pdf: 700627 bytes, checksum: b4e805cd5f2cc0440e63767bdb0513c0 (MD5) Previous issue date: 2006 / Resumo: O trabalho que se segue visa caracterizar, a partir de uma perspectiva discursiva, dois modos distintos de divulgar ciência para leigos em duas revistas de divulgação científica: a Superinteressante e a Pesquisa Fapesp. Partindo de um conhecimento prévio em relação ao público-alvo de cada uma dessas publicações ¿ um público predominantemente jovem e leigo, no primeiro caso, e um público familiarizado com temas de cunho científico, no segundo ¿ buscamos apurar como esses leitores tomam forma a partir de indícios textuais e discursivos. O pressuposto inicial, que tem por base os preceitos teóricos da Análise do Discurso francesa, e mais especificamente a noção de semântica global, tal como proposta por Maingueneau (1984), foi de que, por meio de uma análise de indícios da superfície textual ¿ como o léxico característico e as formas de discurso relatado preferenciais ¿ é possível identificar um suposto leitor, assim como um divulgador e uma imagem de ciência específicos. Isso porque entendemos que discurso e texto são mutuamente dependentes e que, portanto, a escolhas de certos elementos textuais e não de outros são, em boa medida, escolhas discursivamente fundadas ou condicionadas. São, desta perspectiva, indícios de um conjunto de regras que delimita o dizível de cada publicação. Isto é, para além de uma pressuposição editorial por parte das publicações analisadas, procuramos apontar como uma imagem de leitor, de divulgador e de ciência emerge das possibilidades textuais e discursivas dessas revistas. Para tanto, concentramos nossas análises nas reportagens ¿ optamos por selecionar textos cuja temática está centrada em pesquisas realizadas pelas ciências duras ¿ recorrendo a outros gêneros apenas como uma forma de corroborar as hipóteses levantadas no decorrer do trabalho / Abstract: This work aims to characterize, from a discursive approach, two distinct manners of divulging science for general public in two scientific vulgarization magazines: Superinteressante and Pesquisa Fapesp. Taking into account the previous knowledge of who is the target public of each of these magazines ¿ the young layperson, in the first case, and someone closer to the scientific field, in the second case ¿ we describe how this reading public gets ¿materialized¿ through textual and discursive signs. We assumed, based on the French Discourse Analysis, specifically on the notion of global semantic, as proposed by Maingueneau (1984), that by analyzing signs on the textual surface ¿ typical vocabulary or preferred forms of the reported speech, for instance ¿ it is possible to identify the presumed reader, as well as the image of journalist and science emerged from each of these publications. This is a consequence of the understanding that discourse and text are mutually related and, therefore, the use of some textual elements instead of others are, basically, discursive conditioned choices. These choices, from this point of view, point out to the set of discursive rules that circumscribes the ¿speechble¿ of each magazine. This means that, looking beyond any editorial supposition, we tried to demonstrate how it is possible to picture specific images for the reader, the journalist and the science given the textual and discursive possibilities of each of those magazines. For this investigation, we concentrate our analysis on the genre report ¿ particularly texts regarding researches done by ¿hard sciences¿. Other genres are addressed only in order to confirm the hypotheses proposed during the development of this work / Mestrado / Linguistica / Mestre em Linguística

Orientador: Suzy Maria Lagazzi-Rodrigues / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Estudos da Linguagem / Made available in DSpace on 2018-08-11T08:46:28Z (GMT). No. of bitstreams: 1 Albuquerque_MariaEulaliaTomasi_D.pdf: 689421 bytes, checksum: cfd3138c7682a4d39910b08dae8e8a5b (MD5) Previous issue date: 2007 / Resumo: Esta tese tem como objetivo compreender o funcionamento discursivo das denúncias de estupro formuladas nos Termos de Informação para apontar as posições-sujeito que atravessam esses documentos. Perguntamo-nos pelas possibilidades de identificação do sujeito na relação de denúncia de seu corpo violentado, pelos modos de resistência desse sujeito nas condições de produção que determinam o estupro. A perspectiva teórico-analítica adotada foi a da Análise de Discurso materialista. Trabalhamos com o relato do estupro apresentado nesses documentos, considerando as condições de produção e o processo sócio-histórico em que os sentidos são produzidos. Foi importante compreendermos, nesta pesquisa, a relação de alteridade constitutiva do discurso relatado, marcada em diferentes vozes discursivas. Na imbricação dessas vozes analisamos, especificamente, a contradição entre o sujeito-vítima e o sujeito-denunciante, abordando o funcionamento da imputação da responsabilidade do que é dito. Em meio à voz da instituição jurídica que sustenta os Termos de Informação, se produz a ilusão de que é a vítima quem fala / Abstract: This thesis aims at understanding the discursive functioning of rape charges formulated in Terms of Information to highlight the subject-positions that permeate those documents. We ask ourselves about the possibilities of identification of this subject in relation to his abused body and the ways he resists concerning the conditions of production which determine the rape. For that purpose, the analytical and theoretical perspective was provided by the materialistic discourse analysis. We worked with the rape account conveyed through those documents considering both the conditions of production and the historical and social process through which meaning is produced. The understanding of the relation of alterity which is constitutive of the reported discourse and is manifested through the different discursive voices, was of great relevance to this research. In the interrelation of those voices, we particularly analysed the contradiction between the subject as victim and the subject as accuser, addressing the functioning of the imputation of responsability of what is said. Along with the voice of the legal institution that sustains the Terms of Information, the illusion that the victim is the one who speaks is created. / Doutorado / Doutor em Linguística

Introdução: A osteoporose (OP) é doença caracterizada pela fragilidade do osso e, consequentemente, pelo incremento do risco de fraturas. É considerada problema de saúde pública na maioria dos países. Evidências epidemiológicas apontam associação entre variáveis sociodemográficas, variáveis de estilo de vida (como a ingestão de alimentos e de bebidas alcoólicas e hábito de fumar), e indicadores antropométricos (como índice de massa corporal -IMC-) e risco de OP e fraturas osteoporóticas. Objetivo: Estimar a incidência de OP e a prevalência de fraturas referidas, em idosos domiciliados no Município de São Paulo e verificar associação com variáveis sociodemográficas, de estilo de vida, e IMC. Método: analisaram-se dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento) 2000 - 2006, o qual é estudo epidemiológico, longitudinal, de base domiciliar, cuja amostra inicial foi composta por 2143 idosos (&#8805;60 anos), de ambos os sexos, residentes habituais de domicílios urbanos no Município de São Paulo, e selecionados por amostragem probabilística, sendo que 829 idosos (39%) constituíram a amostra de estudo, em 2000, para análise da incidência de OP referida, em 2006, e 1072 idosos (50%) foi a amostra de estudo para análise de prevalência de fraturas após 60 anos referidas, em 2006. Investigou-se a associação entre variáveis sociodemográficas (sexo, grupo etário, vida no campo por 5 anos ou mais durante a infância ou adolescência, escolaridade e etnia), de estilo de vida (ingestão referida de leite e produtos lácteos, ovos e leguminosas, carnes, peixes e aves, frutas e verduras, frequência de ingestão de bebidas alcoólicas, e hábito de fumar); e variável antropométrica (IMC), com relação à referência de OP e fraturas após 60 anos, em 2006. Para verificar associação entre as variáveis categóricas e o desfecho, utilizou-se o teste de Rao & Scott (p<0,05) e a análise de regressão logística univariada (IC95%).O programa Stata, versão 10.1 foi usado para realizar os cálculos estatísticos. Resultados: Houve 114 casos novos de OP referida em 2006, sendo que o coeficiente de incidência (CI) de OP referida foi estimado em 13,93/1000 pessoas-ano (IC95%=11,60 16,87). O CI de OP referida em mulheres foi 22,95/1000 pessoas-ano (IC95%: 19,08 27,87), e 3,34/1000 pessoas-ano (IC95%: 1,85 6,73), em homens.A prevalência de fraturas após os 60 anos referidas foi 17,16%. Sexo feminino (OR= 7,69; p=0,000) e ingestão referida de bebidas alcoólicas < 4 vezes/semana (OR= 2,26; p=0,019), foram fatores de risco para referência de OP. Sexo feminino (OR=2,38;p=0,000), idade avançada (&#8805;75 anos)(OR=1,72; p=0,012), ingestão referida de bebidas alcoólicas < 4 vezes/semana (OR=2,45; p=0,016), referência de OP em 2000 (OR=1,75; p=0,048), e referência de OP em 2006 (OR=2,29; p=0,000), foram fatores de risco para referência de fraturas após 60 anos. Conclusões: sexo feminino, idade avançada foram fatores de risco para OP e fraturas após os 60 anos. Dentre as variáveis modificáveis, a ingestão de bebida alcoólica com frequência &#8805; 4 vezes/semana, esteve negativamente associado à referência de OP e fraturas após 60 anos. / Introduction: Osteoporosis (OP) is a disease characterized by bone fragility and increased risk of fractures. It is considered a public health problem worldwide. Epidemiological studies have found association between sociodemographic, lifestyle and anthropometrical variables and increased risk of OP and osteoporotic fractures. Objetive: To estimate incidence of self-reported OP, in 2006, and prevalence of fractures after the age of 60 year-old, on a sample of elderly individuals from the Município de São Paulo, and verify association between selected variables and outcome. Method: based on data from the SABE Study (health, well-being and aging) 2000 - 2006, which is an epidemiological prospective study of a probabilistic household sample of elderly population ((&#8805; 66 y), of both sexes, from São Paulo City, Brazil. Association between sociodemographic (sex, age, life in rural area for 5 year or more during childhood or adolescence, schooling, and race) lifestyle (reported food intake (milk and dairy products, eggs and legumes, meat, fish and poultry, fruit and vegetables), reported alcoholic beverages intake) and smoking habit; and anthropometrics\' variables, such as body mass index (BMI) and self-reported OP and fractures after the age of 60 year-old, in 2006. Rao & Scott Test was used to verify association between the categorical variables and outcome (p<0,05) as well as simple logistic regression (CI95%). Stata software, version 10.1, was used for statistical calculation. Results: There were 114 new cases of self-reported OP in 2006, and an incidence rate of 13,93/1000 persons-year (IC95%=11,60 - 16,87). In women the incidence rate was 22,95/1000 persons-year (CI95%: 19,08 - 27,87), and in men it was 3,34/1000 persons-year (IC95%: 1,85 - 6,73). Prevalence of self reported fractures after de age of 60 y was estimated in 17,16%. Female sex (OR= 7,69; p=0,000) and frequency of reported alcoholic beverages intake < 4 times/week (OR= 2,26; p=0,019), were risk factors for self-reported OP. Female sex (OR=2,38;p=0,000), advanced age (&#8805;75 y) (OR=1,72; p=0,012), frequency of reported alcoholic beverages intake < 4 times/week (OR=2,45; p=0,016), self-reported OP in 2000 (OR=1,75; p=0,048), and self-reported OP in 2006 (OR=2,29; p=0,000), were risk factors for reporting fractures after the age of 60 years-old Conclusions: female sex, advanced age, were risk factors for reported OP and fractures after 60 y. Among modifiable variables, intake of alcoholic beverages as often as > 4 times/week was negatively associated with reported OP and fractures after the age of 60 y.

Cette thèse se propose d’étudier l’énonciation poétique dans les Poemetti de Giovanni Pascoli. Dans le cadre d’une poésie narrative qui ménage une très large part au discours rapporté, multipliant ainsi les sujets de l’énonciation, le sujet poétique se constitue dans une polyphonie qui, loin d’être l’apanage du roman, interroge aussi bien les formes de narration traditionnelles que le modèle monologique lyrique. Alors que les voix qui traversent ses recueils les plus étudiés, Myricae et Canti di Castelvecchio, participent au développement d’une réflexion métalinguistique comme en témoigne le titre de l’essai fondateur de G. Contini, « Il linguaggio di Pascoli », les voix présentes dans les Poemetti attirent l’attention sur la fonction métadiscursive de la poésie. C’est en s’inscrivant dans un discours partagé et collectif que le sujet biographique et allégorique peut se constituer et échapper au sentiment d’égarement et de solitude qui le définit. Le sujet cherche alors dans la collectivité des voix familiales ou communautaires, locales ou nationales, une réponse au sentiment d’exclusion qui l’habite, en particulier dans la communauté familiale autarcique et idéale du « roman géorgique ». Parler de polyphonie ou d’une forme de dialogisme dans le cadre d’un epos ou dans celui d’une poésie lyrique pourrait paraître paradoxal. L’epos reposerait en effet sur une vision du monde commune aux personnages, au narrateur, et au lecteur. Le lyrisme se fonderait sur l’expression d’une subjectivité individuelle et intime. C’est sans compter sur la volonté de Pascoli de faire de sa voix poétique un point d’orgue entre l’individuel et le collectif. Il veut en effet s’adresser à tous, jusque dans sa poésie autobiographique. La polyphonie qui traduit le rapport que le sujet individuel entretient avec le collectif définit le sujet comme étant toujours et déjà pluriel. Le poète invente alors avec le poemetto un genre novateur qui mêle à la narration d’une histoire commune propre à l’epos, la mise en question de la subjectivité propre au lyrisme. / This thesis aims to study poetic enunciation in Giovanni Pascoli’s Poemetti. Within the framework of a narrative poetry that gives ample space to reported speech, thus multiplying enunciatory subjects, the constitution of the poetic subject occurs via a polyphony which, far from being the prerogative of the novel, interrogates both traditional narrative forms and the monological lyrical model. The title of G. Contini’s foundational essay, « Il linguaggio di Pascoli », indicates that the voices that are heard in Pascoli’s most studied collections, Myricae and Canti di Castelvecchio, participate to the development of a metalinguistic process ; however, the voices that occur in the Poemetti draw attention to poetry’s metadiscursive function. It is its inscription within a shared, collective discourse that enables the biographical and allegorical subject to constitute itself and to overcome the feelings of bewilderment and solitude that define it. The subject then searches for an answer to the feeling of exclusion that haunts him in the collectiveness of family or community voices, either local or national, and especially in the autarkic and ideal family community of the “georgic novel”. It might seem paradoxical to emphasize polyphony and a form of dialogism in the context of an epos, or of lyrical poetry. The epos should indeed presuppose a world-view that is common to the characters, the author and the reader. Lyricism, on the other hand, should be founded upon the expression of an individual and intimate subjectivity. But we should not discount Pascoli’s will to fuse the singular and the collective in his poetic voice. Even his autobiographical poetry is indeed addressed to all. The polyphony, which expresses the individual subject’s relation to the collectivity, defines the subject as being initially and irrevocably plural. Thus the poemetto appears to be an innovative genre that combines the narration of a common story, characteristic of the epos, with the questioning of subjectivy that is specific to lyricism.

Background: Little is known regarding the health-related quality of life among myocardial infarction (MI) survivors in the United States. The purpose of this population-based study was to identify differences in health-related quality of life domains between MI survivors and propensity score matched controls. Methods: This retrospective, cross-sectional matched case-control study examined differences in health-related quality of life (HRQoL) among MI survivors of myocardial infarction compared to propensity score matched controls using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. Propensity scores were generated via logistic regression for MI survivors and controls based on gender, race/ethnicity, age, body mass index (BMI), smoking status, and comorbidities. Chi-square tests were used to compare differences between MI survivors to controls for demographic variables. A multivariate analysis of HRQoL domains estimated odds ratios. Life satisfaction, sleep quality, and activity limitations were estimated using binary logistic regression. Social support, perceived general health, perceived physical health, and perceived mental health were estimated using multinomial logistic regression. Significance was set at p < 0.05. Results: The final sample consisted of 16,729 MI survivors matched to 50,187 controls (n = 66,916). Survivors were approximately 2.7 times more likely to report fair/poor general health compared to control (AOR = 2.72, 95% CI: 2. 43-3.05) and 1.5 times more likely to report limitations to daily activities (AOR = 1.46, 95% CI: 1.34-1.59). Survivors were more likely to report poor physical health > 15 days in the month (AOR = 1.63, 95% CI: 1.46-1.83) and poor mental health > 15 days in the month (AOR = 1.25, 95% CI: 1.07-1.46) compared to matched controls. There was no difference in survivors compared to controls in level of emotional support (rarely/never: AOR = 0.75, 95% CI: 0.48-1. 18; sometimes: AOR = 0.73, 95% CI: 0.41-1.28), hours of recommended sleep (AOR = 1.14, 95% CI: 0.94-1.38), or life satisfaction (AOR = 1.62, 95% CI: 0.99-2.63). Conclusion: MI survivors experienced lower HRQoL on domains of general health, physical health, daily activity, and mental health compared to the general population.

Physical education (PE) at school may play an important role in the process of becoming physically active in the adolescence and in developing a physically active lifestyle. The opportunities for teachers to provide positive physical activity experiences to the student population extend regularly over the school terms. For some students, PE can be the only opportunity they have to be physically active. Therefore it is important that the students become motivated to practice physical activity and know the purpose with physical activity. The overall purpose of this dissertation was to investigate the possibilities to motivate youth, 12-16 years old, to practice physical activity and hopefully to stimulate them to continue to be physically active in young adulthood. The sample consisted of 122 Swedish compulsory school students (12-16 years old), 51 girls and 71 boys, who were either physically inactive, physically active but not formal members of sport clubs, or physically active and members of a sport club. They used a self-monitoring instrument to describe their physical activity and we compared their self-reported physical activity with their actual VO2 capacity and physical status. The self-monitoring instrument was further validated against an activity monitor, RT3. The intervention lasted one and a half years, and four to five years later a follow-up study was done. Using a quasi-experimental design, the three groups of participants were compared with youths who did not use the selfmonitoring instrument. The main findings were that the associations between the accelerometer counts and the activities the students recorded in the self-monitoring instrument were high. The participants in Group 1 (physically inactive) continued exercising nearly to the same extent as during the intervention while youths in a matched control group did not develop regular physical activity habits. Concerning Group 2 (exercisers), participants in the intervention group were more physically active both during the intervention and at follow-up, compared with a matched control group of exercisers who did not use the self-monitoring instrument. In Group 3 (sport team members), there was no difference between the intervention group and a matched control group after the intervention or at follow-up. The conclusion of these main findings was that when someone motivates students to continue being physically active and to change their physical activity patterns in a positive direction, the self-monitoring instrument can be a door-opener for youths who are physically inactive or regularly active outside sports clubs.

Articular cartilage defects in the knee are common, and can result in pain, decreased function and decreased quality of life. Untreated defects are considered to be a risk factor for developing osteoarthritis, a progressive degenerative joint disease with minimal treatment options. To address these issues, various surgical procedures are available to treat articular cartilage defects in the knee. While these procedures overall have positive results, after surgery patients experience large and persistent deficits in quadriceps strength. A contributing factor to this post-surgical weakness is believed to be the extended post-operative non-weight bearing period, with full weight bearing not initiated until approximately 4 – 6 weeks after surgery. During this non-weight bearing period a minimal amount of demand is placed upon the muscle. Subsequently, the quadriceps muscle undergoes a large degree of atrophy with a significant decrease in muscle strength. Muscular strength deficits reduce the knee joint stability, also increasing the risk of osteoarthritis development. Interventions that can be used to facilitate quadriceps strength while protecting the articular cartilage repair are needed. Neuromuscular electrical stimulation (NMES) is an effective post-knee surgery rehabilitation technique to regain quadriceps musculature. In recent years manufactures have been developing knee sleeve garments integrated with NMES allowing for portability of the NMES treatment. The primary aim of this study was to evaluate the effectiveness of a 12-week home-based neuromuscular electrical stimulation treatment on post-surgical clinical outcomes (quadriceps strength, lower extremity function, and patient reported outcomes) after articular cartilage knee surgery. Patients were randomized between a standard of care home-treatment group and a NMES home-treatment group. Patients completed isometric quadriceps strength testing, the Y-balance test, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before surgery and at 3-months after surgery. The secondary aims of this study were to determine the most effective NMES parameters for post-surgical quadriceps strength; and to develop a framework to identify factors that may influence a patient’s adherence to a prescribed therapy program. From our results we can make several conclusions. First, we found only a small number of studies utilize similar parameters for post-surgical quadriceps strength treatments. The majority of the parameters reported in the literature were highly variable between studies. Second, clinicians can utilize the expanded Health Belief Model to identify situational and personal factors unique to a patient that may impact adherence to a prescribed treatment. Clinicians can then implement the proposed interventional strategies to address the identified situational and personal factors. Finally, there was no difference in quadriceps strength, lower extremity function, or self-reported scores at 3-month between a home-based NMES treatment and a standard of care home-based treatment. Patients’ adherence to the treatment protocols may have been a major factor contributing to these results. Utilizing a model, such as the proposed expanded Health Belief Model, may assist clinicians in improving a patients’ adherence to future prescribed home-treatment programs.