Objetivos: Avaliar os desfechos da ressecção endoscópica em comparação à cirurgia no tratamento dos adenomas de papila. Métodos: Foi realizada uma revisão sistemática com metanálise de acordo com as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). As bases de dados Medline, Embase, Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) foram escaneadas. Os estudos incluíram pacientes com adenoma de papila e dados de comparação dos tratamentos endoscópico e cirúrgico para os seguintes desfechos: Ressecção primária completa; Sucesso primário; Recorrência; Sucesso final; e Complicações. A análise foi baseada em modelos de efeito randômico e fixo. Resultados: Cinco estudos de coorte retrospectivo foram selecionados, com um total de 465 pacientes. Todos os estudos tinham dados de ressecção primária completa disponível, mostrando uma diferença favorável ao tratamento cirúrgico (Diferença de riscos = -0,22; Intervalo de confiança de 95% = -0,41 a -0,04). Dados de Sucesso primário também foram identificados em todos os cinco estudos. A análise mostrou que a abordagem cirúrgica supera o tratamento endoscópico neste desfecho (DR = -0,13; IC 95% = -0,24 a -0,02). Dados de recorrência foram encontrados em todos os estudos (465 pacientes), com benefício para o tratamento cirúrgico (DR = 0,12; IC 95% = 0,01 a 0,22). Analisando o desfecho de Sucesso final, disponível em todos os estudos, não encontramos diferença entre as duas abordagens terapêuticas (DR = -0,06; IC 95% = -0,15 a 0,04). Três estudos (251 pacientes) apresentaram dados de complicação, e a análise não mostrou diferença entre os tratamentos endoscópico e cirúrgico (DR = -0,15; IC 95% = -0,53 a 0,23), sem a possibilidade de descartar o viés de seleção para este desfecho. Conclusões: Considerando os desfechos de ressecção primária completa, sucesso primário e recorrência na comparação do tratamento cirúrgico com o tratamento endoscópico para adenomas de papila, a abordagem cirúrgica tem resultados significativamente melhores. Com relação ao sucesso final, não houve diferença entre os dois tratamentos. No desfecho das taxas de complicação, esta revisão sistemática não permite uma conclusão confiável devido à presença de alta heterogeneidade e provável viés de publicação nesta comparação / Objectives: To address the outcomes of endoscopic resection compared to surgery in the treatment of ampullary adenomas. Methods: A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Medline, Embase, Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were scanned. Studies included patients with ampullary adenomas and comparison data considering endoscopic treatment and surgery for the following outcomes: Complete primary resection; Primary success; Reccurence; Final success; and Complications. The analysis were based on both random and fixed effects model. Results: Five retrospective cohort studies were selected, with 465 patients. All five studies had complete primary resection data available, showing a difference that favours surgical treatment (Risk Difference = -0.22, 95% Confidence Interval = -0.41 to -0.04). Primary success data were identified in all five studies too. Analysis showed that surgical approach overcome endoscopic treatment in this outcome (RD = -0.13, 95% CI = -0.24 to -0.02). Recurrence data was found in all studies (465 patients), with benefit for the surgical treatment (RD = 0.12, 95% CI = -0.01 to 0.22). Analyzing the final success outcome, available in all studies, we found no difference between the two therapeutic approaches (RD = -0.06, 95% CI = -0.15 to 0.04). Three studies (251 patients) presented complication data and analysis shown no difference between the approaches (RD = -0.15, 95% CI = -0.53 to 0.23), not discarding the possibility of presence of selection bias for this outcome. Conclusions: Considering complete primary resection, primary success and recurrence outcomes, surgical approach achieves significantly better results. Regarding the final success, there was no difference between the two treatments. Addressing complication data, this systematic review does not allow for a reliable conclusion due to the presence of high heterogeneity and likely publication bias in this comparison

Purpose: The purpose of this study was to evaluate the effectiveness of triaging patients with motion-provoked dizziness into a benign paroxysmal positional vertigo (BPPV) clinic. Method: A retrospective chart review was performed of veterans who were tested and treated for BPPV in a triaged BPPV clinic and veterans who were tested and treated for BPPV in a traditional vestibular clinic. Results: The BPPV triage clinic had a hit rate of 39%. On average, the triaged BPPV clinic reduced patient wait times by 23 days relative to the wait times for the traditional vestibular clinic while also reducing patient costs. Conclusion: Triaging patients with BPPV is one method to improve access to evaluation and treatment and a mechanism for the effective use of clinic time and resources.

Background Health education programs that are aimed at improving individuals' skills to self-manage are increasingly recognised as a critical component of chronic disease management. Despite the apparent need for such interventions, current studies show inconsistent results regarding program effectiveness, with meta-analyses indicating only marginal effects for some disease groups. A closer examination of these studies however suggests that the magnitude and inconsistency of the findings may be related to the types of outcomes that were assessed rather than specific disease groups. Where self-report measures were used, results tended to be smaller and inconsistent. It is therefore possible that current studies do not adequately reflect program effects because self-report outcomes have a high risk to be confounded by a range of potential biases. Objective The aim of this thesis was to identify and quantify the potential influence of biases in the measurement of change in chronic disease self-management interventions using self-report. Methods The research design targeted the processes that individuals undergo when filling out questionnaires and whether this has an influence on their self-report outcomes. This was achieved by developing a three-group research design. The Health Education Impact Questionnaire (heiQ) was used to collect outcomes data. While pretest questionnaires were identical across groups, three questionnaire versions were randomly distributed at posttest. One of the groups filled out traditional posttest questions (n=331), whereas the other two groups were asked to provide data in addition to posttest questions, with one group providing transition questions (n=304) and one providing retrospective pretest data (n=314). Resulting datasets were further examined for possible confounding effects through response shift and social desirability bias. Through the random allocation of the heiQs it was ensured that data were not influenced by potential intra-group effects. Results The thesis revealed that the design of the posttest questionnaire significantly influenced people's ratings of their posttest levels. In particular, when participants were asked to provide ratings of their retrospective pretest levels in addition to their posttest levels, the latter scores were significantly higher than those of participants who did not perform this additional task. Subsequent analyses however suggested that these differences could neither be explained by response shift nor by social desirability bias. Conclusions This research has provided important insight into the measurement of outcomes of chronic disease self-management interventions. While the threat to the validity of traditional pretest-posttest data due to confounding effects through response shift and social desirability biases could not be supported, the thesis has highlighted that the cognitive task that subjects are asked to perform when providing data at posttest significantly influenced their self-reported outcomes. Given that previous research has predominantly focused on other aspects of validity - such as applying control group designs to circumvent common threats to internal and external validity - this study suggests that more attention must be paid to the design of questionnaires. The thesis concludes that further research, in particular into the influence of cognitive tasks on obtained scores, is important to improve the interpretation of self-report outcomes data derived from participants of self-management interventions.

BACKGROUND: Human papilloma virus (HPV) in patients with esophageal carcinoma has previously been studied with an average detection rate of 15%, but the role of HPV in relation to survival is less clear. In cervical cancer, lung cancer and tonsil cancer HPV viral load is a predictive factor for survival and outcome of treatment. The primary aim was to study the spectrum of high-risk HPV types in esophageal tumors. Secondary, as a pilot study we investigated the association between HPV status and the survival rates. METHODS: We compared both the presence and the viral load of high-risk HPV types 16, 18, 31, 33, 39, 45, 52, 58, and 67 in relation to clinical data from patients with esophageal carcinoma. Survival data and tumor samples were retrieved from 100 patients receiving treatment at the Department of Oncology, Uppsala Hospital, Uppsala, Sweden. The tumor samples were investigated for HPV viral load using real-time PCR. RESULTS: HPV 16 was detected in 16% of the patients; no other HPV type was detected. HPV 16 infection had no significant effect on survival (p = 0.72). Also, HPV 16 did not improve survival after treatment (radiotherapy or chemotherapy). CONCLUSION: Only HPV 16 was detected among the patients. HPV 16 in esophageal carcinoma patients did not influence survival or improve therapy response. However, given the size of the study there is a need to examine a larger cohort in order to understand in more detail the effect of high risk HPV types in esophageal carcinoma. / <p>De två första författarna delar förstaförfattarskapet.</p>

Essay 1: (with Henrik Jordahl and Panu Poutvaara) We present and test a theory of prospective and retrospective pocketbook voting. Focusing on two large reforms in Sweden, we establish a causal chain from policies to sizeable individual gains and losses and then to voting. The Social Democrats proposed budget cuts affecting parents with young children before the 1994 election, but made generous promises to the same group before the 1998 election. Since parents with older children were largely unaffected we use a difference-in-differences strategy for identification. We find clear evidence of prospective pocketbook voting. Voters respond to campaign promises but not to the later implementation of the reforms. / Essay 2: This essay presents a detailed analysis of voters' response to municipality and regional level unemployment and economic growth, in Swedish general elections from 1985 to 2002, using data on 284 municipalities and 9 regions. The preferred specification suggests that an increase in regional growth or a reduction in regional unemployment by one percentage point is associated with an increase in the support for the national government by about 0.6 and 1.0 percentage points. Changes in unemployment and growth at the municipality level seem to have muchsmaller effects on government support. / Essay 3: One prediction from cognitive dissonance theory is that the act of voting makes people more positive toward the party or candidate they have voted for. Following Mullainathan and Washington (2008), I test this prediction by using exogenous variation in turnout provided by the voting age restriction. I improve on previous studies by investigating political attitudes, measured just before elections, when they are highly predictive of voting. In contrast to earlier studies I find no effect of voting on political attitudes. This result holds for a variety of political attitudes and data from both Sweden and the United States. / Essay4: (with Niclas Berggren and Henrik Jordahl) We conduct an extensive robustness analysis of the relationship between trust and growth by investigating a later time period and a bigger sample than in previous studies. In addition to robustness tests that focus on model uncertainty, we systematize the investigation of outlier influence on the results by using the robust estimation technique Least Trimmed Squares. We find that when outliers (especially China) are removed, the trust-growth relationship is no longer robust. On average, the trust coefficient is half as large as in previous findings.

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Contexte: À date, il existe peu de données sur l’adhésion, la persistance et les coûts associés aux antidépresseurs selon le type d’assurance médicament (privé ou public). Objectif: Comparer selon le régime d’assurance médicament (privé ou public), l'adhésion, la persistance et les coûts des antidépresseurs. Méthodes de recherche: Une étude de cohorte appariée a été réalisée en utilisant des bases de données du Québec. Sujets: Nous avons sélectionné 194 patients assurés par un régime privé et 1923 patients assurés par le régime public de la Régie de l’assurance maladie du Québec (RAMQ) (18-64 ans) qui ont rempli au moins une ordonnance pour un antidépresseur entre décembre 2007 et septembre 2009. Mesures: L’adhésion, mesurée sur une période d’un an, a été estimée en utilisant le proportion of prescribed days covered (PPDC). Un modèle de régression linéaire a été utilisé afin d’estimer la différence moyenne en PPDC entre les patients assurés par un régime privé et ceux assurés par le régime public de la RAMQ. La persistance a été comparé entre ces deux groupes avec un modèle de régression de survie Cox, et le coût mensuel d'antidépresseurs ($ CAN) a été comparé entre ces deux groupes en utilisant un modèle de régression linéaire. Résultats: Le PPDC parmi les patients assurés par un régime privé était de 86,4% (intervalle de confiance (IC) 95%: 83,3%-89,5%) versus 81,3% (IC 95%: 80,1%-82,5%) pour les patients assurés par le régime public de la RAMQ, pour une différence moyenne ajustée de 6,7% (IC 95%: 3,0%-10,4%). La persistance après un an parmi les patients assurés par un régime privé était de 49,5% versus 18,9% pour les patients assurés par le régime public de la RAMQ (p <0,001), et le rapport de risque ajusté était de 0,48 (IC 95%: 0,30-0,76). Comparativement aux patients assurés par le régime public de la RAMQ, les patients ayant une assurance privée ont payé 14,94 $ CAD (95% CI: $12,30-$17,58) de plus par mois en moyenne pour leurs antidépresseurs. Conclusion: Les patients assurés par un régime privé avaient une meilleure adhésion, persistance, mais avaient aussi un plus haut coût pour leurs antidépresseurs que ceux assurés par le régime public de la RAMQ. Cette différence de coûts peut être due aux différentes exigences de paiement en pharmacie entre les deux régimes ainsi qu’aux limites des honoraires des pharmaciens imposés par le régime public. / Background: The influence of the type of drug insurance on adherence, persistence and cost of antidepressants is not well known. Objective: To compare adherence, persistence and cost of antidepressants in patients with private and public drug insurance. Research Design: A matched cohort study was conducted using prescription claims databases from Quebec, Canada. Subjects: 194 privately and 1923 publicly insured patients (18-64 years) who filled at least one prescription for an antidepressant between December 2007 and September 2009. Measures: Adherence over one year was estimated using the proportion of prescribed days covered (PPDC). The difference in mean PPDC between patients with private and public drug insurance was estimated with a linear regression model. Persistence was compared between the groups with a Cox regression model, and the monthly cost of antidepressants (CAD$) was compared between the two groups using linear regression. Results: The PPDC was 86.4% (95% CI: 83.3-89.5) in patients with private and 81.3% (95%CI: 80.1-82.5) in patients with public drug insurance and the adjusted mean difference was 6.7% (95% CI: 3.0-10.4). Persistence was 49.5% in patients with private and 18.9% in patients with public drug insurance at one year (p<0.001), and the adjusted hazard ratio was 0.48 (95%CI: 0.30-0.76). Patients privately insured paid 14.94$ CAD (95% CI: 12.30; 17.58) more per month on average for their antidepressants. Conclusion: Better adherence and persistence and higher costs were observed in privately insured patients. Cost difference might be due to different pharmacy payment requirements and pharmacists’ honorary restrictions under the public plan.

Views on the nature and relevance of science education have changed significantly over recent decades. This has serious implications for the way in which science is taught in secondary schools, particularly with respect to teaching emerging topics such as biotechnology, which have a socio-scientific dimension and also require novel laboratory skills. It is apparent in current literature that there is a lack of adequate teacher professional development opportunities in biotechnology education and that a significant need exists for researchers to develop a carefully crafted and well supported professional development design which will positively impact on the way in which teachers engage with contemporary science. This study used a retrospective case study methodology to document the recent evolution of modern biotechnology education as part of the changing nature of science education; examine the adoption and implementation processes for biotechnology education by three secondary schools; and to propose an evidence based biotechnology professional development model for science educators. Data were gathered from documents, one-on-one interviews and focus group discussions. Analysis of these data has led to the proposal of a biotechnology professional development model which considers all of the key components of science professional development that are outlined in the literature, as well as the additional components which were articulated by the educators studied. This research is timely and pertinent to the needs of contemporary science education because of its recognition of the need for a professional development model in biotechnology education that recognizes and addresses the content knowledge, practical skills, pedagogical knowledge and curriculum management components.

No description available.

The issue of the vertical /or horizontal operation of the Bill of Rights (chapter 3) is a controversial one. The interim constitution deals with this controversy in a subtle way by avoiding direct horizontal operation of Chapter 3. Instead, it provides for the so-called 'seepage to horizontal relationships' in terms of section35{3). This apparently was a political compromise between the pro-vertical only and the pro-horizontal groups. The human rights history of this country justifies a Bill of Rights that would have both vertical and horizontal operation. However, in section 35 (3) there is potential for the values enshrined in the constitution and Chapter 3, and the spirit hereof, to permeate and filter through the entire legal system in all it's applications. It would seem, however, as demonstrated by the decision in De Klerk v Du Plessis, that the extent to which this filtering process will benefit individuals in their private relations, will depend on the interpretation given to section 35 (3) by the courts. If courts, as it happend in De Klerk's case fail to realise the full import of section 35 ( 3) aspects of the existing law which are unjust could remain and the process of creating a just, open and democratic society will be hampered. / Constitutional, International and Indigenous Law / LL.M.