Thesis (M.Med.Sc.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 84-92). Also available in print.

Thesis (doctoral)--Rijksuniversiteit te Utrecht.

Thesis (M.S.)--University of Wisconsin. School of Nursing, 1975. / eContent provider-neutral record in process. Description based on print version record.

Project (D. Min.)--Perkins School of Theology, Southern Methodist University, 1977. / Includes bibliographical references (leaves 62-63).

Thesis (Ph.D. in Immunology) -- University of Colorado at Denver and Health Sciences Center, 2005. / Typescript. Includes bibliographical references (leaves 91-100). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (M. CM)--Hong Kong Baptist University, 2006. / Dissertation submitted to the School of Chinese Medicine. Includes bibliographical references (leaves 43-45).

Thesis (MNutr)--Stellenbosch University, 2011 / ENGLISH ABSTRACT: Introduction Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune disorder characterized by inflammation of the joints and surrounding tissue causing pain, swelling and stiffness. Studies suggest that aspects of the diet may alleviate symptoms and decrease the risk of complications. The scientific basis for a role of dietary therapy in RA has grown although there is still no consensus on the optimum diet. It has been shown that persons with RA tend to have a poor nutritional status; and rheumatoid cachexia, the loss of body cell mass, occurs in nearly two-thirds of all patients with RA. The study aimed to establish what RA patients are practicing and their perceptions regarding the effect of diet, nutritional supplements, medication and complementary and alternative medicines (CAM) and therapies on their symptoms as well as determining their body composition and the possible presence of rheumatoid cachexia. Methodology The study design was a cross-sectional study with an analytical component. The study population consisted of adult (18 years or older) RA patients in the Cape Metropole from the private and public sector. An interviewer-administered questionnaire was used followed by the measurement of weight, height, waist circumference and skinfold thickness. Information was also gathered from the medical records. Results The sample size comprised of 251 RA patients (n=201 public sector; n=50 private sector). The mean body mass index (BMI) was 30.3 kg/m2 for females and 26.6 kg/m2 for males. BMI was used to classify obesity (n=133; 45.9%), overweight (n=66; 26.8%), normal weight (n=63; 25.6%) and underweight (n=4; 1.6%). Waist circumference measurement classifications showed a substantially increased risk for metabolic complications in 51.8% of participants (n=127) and an increased risk in 21.2% of participants (n=52). Just over half of the participants (n=65; 55.6%) had an unhealthy high body fat percentage classification. Rheumatoid cachexia was seen in 10.3% participants (n=12). Low fat-free mass (Fat-free mass index <10th percentile) was seen in 21% participants (n=24) and obesity (Fat mass index >90th percentile) was seen in 27% of participants (n=31). Twenty nine percent of participants (n=73) believed that certain types of food could improve their symptoms of RA and 60% of participants (n=151) believed that certain foods worsened their symptoms. Sixty four percent of participants (n=161) thought that nutritional supplements or complementary and alternative medicines and therapies could improve their symptoms of RA and 98% (n=246) of participants used nutritional supplements. The most frequently used supplements included folic acid (n=218; 91.6%), calcium (n=182; 76.5%), vitamin D (n=185; 77.7%), omega-3 fatty acids (n=48; 64.9%) and multivitamin and mineral preparations (n=22; 29.7%). Conclusion The obesity and waist circumference figures were unacceptably elevated in this population and the body composition of these RA patients should be highlighted as a concern. The high prevalence of risk factors for cardiovascular disease (CVD) need to be urgently addressed since CVD is the leading cause of mortality in RA patients. This study highlights the important role of the intra-professional team, including the dietitian, in the management of RA patients. / AFRIKAANSE OPSOMMING: Inleiding Rumatoïede artritis (RA) is 'n chroniese, inflammatoriese, outo-immuun siekte wat gekenmerk word deur inflammasie van die gewrigte en omliggende weefsel en veroorsaak pyn, swelling en styfheid. Studies dui daarop dat aspekte van die dieet simptome kan verlig en die risiko van komplikasies kan verminder. Die wetenskaplike basis vir die rol van dieetterapie in RA het gegroei, hoewel daar nog geen konsensus aangaande die optimale dieet is nie. Dit is al bewys dat persone met RA geneig is om 'n swak voedingstatus te hê; en rumatoïede cachexia, die verlies van liggaam selmassa in byna twee-derdes van alle pasiënte met RA voorkom. Die doel van die studie was om te bepaal wat RA-pasiënte se praktyke en persepsies ten opsigte van die uitwerking van dieet, voedselaanvullings, medikasie en aanvullende of alternatiewe medisyne (CAM) en terapieë op hul simptome het, sowel as om hul liggaamsamestelling en die moontlike teenwoordigheid van rumatoïede cachexia te bepaal. Metodiek Die studie ontwerp was 'n dwarssnitstudie met 'n analitiese komponent. Die studiepopulasie het bestaan uit volwassene (18 jaar of ouer) RA pasiënte uit die privaat en openbare sektore in die Kaapse Metropool. Onderhoude was gevoer met behulp van vraelyste. Gewig, lengte, middelomtrek en velvoudikte was ook gemeet. Inligting was ook versamel uit mediese rekords. Resultate Die steekproefgrootte het uit 251 RA pasiënte (n=201 openbare sektor, n=50 privaat sektor) bestaan. Die gemiddelde liggaamsmassa-indeks (LMI) was 30.3 kg/m2 vir vroue en 26.6 kg/m2 vir mans. LMI was gebruik om vetsug te klassifiseer (n=133; 45.9%), asook oorgewig (n=66; 26.8%), normale gewig (n=63; 25.6%) en ondergewig (n=4; 1.6%). Klassifikasie van middelomtrek metings het 'n aansienlike verhoogde risiko vir metaboliese komplikasies in 51.8% van die deelnemers (n=127) en 'n verhoogde risiko in 21.2% van die deelnemers (n=52) getoon. Net meer as die helfte van die deelnemers (n=65; 55.6%) het 'n ongesonde hoë liggaamsvet persentasie klassifikasie getoon. Rumatoïede cachexia was by 10.3% van die deelnemers (n=12) gevind. Lae vetvrye massa (vetvrye massa indeks <10de persentiel) was by 21% deelnemers (n=24) en vetsug (vet massa indeks >90ste persentiel) in 27% van die deelnemers (n=31) teenwoordig. Nege-entwintig persent van die deelnemers (n=73) het geglo dat sekere voedselsoorte hul simptome van RA kon verbeter en 60% van die deelnemers (n=151) was van mening dat sekere kosse die simptome kon vererger. Vier-en-sestig persent van die deelnemers (n=161) het gedink dat voedingsaanvullings of aanvullende en alternatiewe medisyne en terapieë hulle simptome van RA kon verbeter en 98% (n=246) van die deelnemers het voedingsaanvullings gebruik. Die mees algemene gebruikte aanvullings was foliensuur (n=218; 91.6%), kalsium (n=182; 76.5%), vitamien D (n=185; 77.7%), omega-3 vetsure (n=48, 64,9%) en multi-vitamien en mineraal preparate (n=22; 29.7%). Gevolgtrekking Die vetsug en middelomtrek syfers was onaanvaarbaar verhoog in die studiepopulasie en die liggaamsamestelling van hierdie RA pasiënte is 'n bekommernis. Die hoë voorkoms van risikofaktore vir kardiovaskulêre siekte (KVS) moet dringend aangespreek word, aangesien die KVS die grootste oorsaak van sterfte in RA pasiënte is. Hierdie studie beklemtoon die belangrike rol van die intra-professionele span, met inbegrip van die dieetkundige, in die bestuur van RA pasiënte.

The objectives of the study were to determine the incidence of falls, the prevalence of fear of falling and fall risk factors and consequences in adults with rheumatoid arthritis (RA). 559 community dwelling adults with RA, aged 18 to 88 years (mean age 62; 69% female) participated in this prospective cohort study. Patients were recruited from four outpatient clinics in the Northwest of England and followed for 1 year after clinical assessment, using monthly falls calendars and telephone calls. Outcome measures included fall occurrence, reason for fall, type and severity of injuries, fractures, fall location, lie-times, use of health services and functional ability. Risk factors for falls included lower limb muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue and medication. Data on demographics, vision, co-morbidities, history of surgery, fractures, and joint replacements were also recorded.535 participants followed for one year had a total of 598 falls. 36.4% participants (95% CI 32% to 41%) reported falling with an incidence rate of 1313/1000 person-years at risk or 1.11 falls per person. Over one third of the falls were reportedly caused by hips, knees or ankle joints giving way. Over half of all the falls resulted in moderate injuries, including head injuries (n=27) and fractures (n=26). Univariate logistic regression showed that falls risk was independent of age and gender. A history of falls in the previous one year was a strong medical fall predictor with an odds ratio (OR) for a single fall=3.3 and for multiple falls OR=4.3. Fear of falling was an important self-reported psychological predictor, with the risk increasing by 10% with each point above 7 (up to 28) in the Short FES-I score. The inability to complete the Four Test Balance Scale due to poor balance was a strong postural fall predictor (OR 2.3). The most significant functional predictor of falls was the functional Health Assessment Questionnaire score, and each additional point attained in the score (1-4) nearly doubled the risk of further falls. Multivariate logistic regression revealed that when taken in combination with other factors, a history of multiple falls in the previous one year was the most significant predictive risk factor (OR=5.3) and overall the model accounted for 71% of variation. The most significant modifiable risk factors were swollen and tender lower limb joints (hip, knee and ankle) (OR=1.7), psychotropic medication (OR=1.8) and increasing fatigue (OR=1.13) with this model accounting for 68% of variation. Adults of all ages with RA are at high risk of falls and fall-related injuries, fractures and head injuries. In clinical practice, high risk falls patients with RA can be identified by asking whether patients have fallen in the past year. The management of swollen and tender lower limb joints, fatigue and consideration of psychotropic medicines may be the most effective strategy to reduce falls in this group of patients. Fear of falling, pain, lower limb strength and poor balance are other useful clinical indicators that may be modified to prevent falls.

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting an estimated 1% of the global population. Joint protection is one intervention with some quality evidence of efficacy for RA self-management. However, joint protection education is often provided only in urban centres during Arthritis Self-Management Programs (ASMPs) in classroom sessions at designated times. These programs, therefore, may not be available to all who need them. Providing and testing more accessible methods of delivering joint protection education to people living with RA may improve accessibility. Aims: (i) To develop a virtual world (VW) intervention available via the Internet in Second Life®, that aims to improve the knowledge of joint protection among people with RA and (ii) to undertake a pilot randomised controlled trial (RCT) to assess the feasibility of conducting a subsequent large scale RCT. Methods: First, qualitative interviews with occupational therapists and clients living with RA who had previous experiences teaching or taking arthritis self-management programmes were undertaken and thematically analysed. This analysis informed the design of the VW joint protection education intervention. Second, the intervention was constructed and tested with these same participants. Their feedback helped refine the VW intervention and select assessment tools for the pilot RCT. Third, in a pilot RCT, three primary methods of advertising and invitation were used to recruit subjects: (i) poster invitations with take-home paper copies from clinical settings; (ii) direct messages to Twitter® users living with RA; and (iii) online discussion forums. Participants were recruited after contacting the principal investigator, reading an invitation letter and giving written informed consent. Participants were randomised to intervention or (30-day) waiting list control group, and completed a series of measures. These were completed after 30 days of program access for the treatment group and on enrolment in the study for the control group. Survey completion was online and included piloted knowledge-based questions about joint protection, validated during the second phase of the study with occupational therapists who were experts in joint protection education. A higher score was indicative of better joint protection knowledge. Standardized measures used on the survey included the Arthritis Impact Measurement Scale, Short Form, version II (AIMS2SF) and Pain Self-Efficacy Questionnaire (PSEQ). Results: It was possible to develop a VW education program focused on RA and joint protection based on the content identified by participants in the first part of the study and test with the tools selected. The program developed included input from client users, following the theorectical basis of occupational therapy as a client-centred practice. Additionally, the program developed applied principles of adult-learning and the recommendations of existing programs regarding chronic disease management. Recruitment of 50 participants for the pilot RCT was challenging, taking 6 months with low response rates for all three methods. The poorest response rates were to poster and paper invitations in clinical settings. The most effective means of recruitment was via electronic bulletin boards, such as blogs. All subjects, once randomised to the control or intervention group completed the online questionnaire. However, adherence to the intervention was poor; only 15 out of 25 randomised reported using the program. On the other hand, all 15 who used the program indicated that this medium was acceptable to learn about joint protection, despite 5/15 of these subjects reporting some difficulty accessing the program. All participants completed the three questionnaires (knowledge, impact, pain self-efficacy) and these may be useful in a definitive RCT. Although the main purpose of using Intention to Treat Analysis in pilot studies is to practice and check that analysis is feasible, there was a positive statistically significant difference between the treatment (x̄=52.8%) and control (x̄=24%) group scores on a test of joint protection knowledge using an independent samples t-test (F value, 20.8 p < 0.05) comparing joint protection knowledge scores after the treatment group had access to the program for 30 days. A higher score was indicative of better joint protection knowledge. The difference between the two groups was considerable, with the intervention group score mean being more than double that of the control group. Given the magnitude of this difference between groups, a smaller difference between groups would also be worth finding. The difference between groups for the AIMS2SF and PSEQ were not statistically significant using an independent samples t-test (F values, 0.5 and 0.2) but there was some suggestion that the intervention group scored more favourably on some of the subscales more relevant to joint protection on both the AIMS2SF and PSEQ, particularly noteworthy was a higher score pertaining to ability to carry out work on both measures. In a definitive trial a sample size of 1250 participants would give 80% power to find a difference of 28.8% on joint protection knowledge, weighted score of 1.8 on the AIMS2SF and overall score of 1.8 on the PSEQ at 5% level of significance. Smaller samples would be required if the PSEQ was dropped as a measure in a future study. Sample sizes of 14 and 558 would be required for the joint protection knowledge and AIMS2SF respectively at the same level of power and significance. Conclusion: A VW intervention to improve joint protection knowledge has been developed and is worth testing further. The intellectual contribution of the creation of this program using this methodology is that an occupational therapy based study using client input and priniciples of adult learning to create the intervention has been conducted, applying client-centred practice in research, which is, in reality, present in a minority of studies at this time. A full RCT would be feasible, though very challenging, given the numbers of subjects required for recruitment, most likely recruiting via the Internet on relevant RA focus sites, such as RA bloggers, and using the same outcome measures as in this study. A sample size of 1250 could feasibly be recruited in 36 months if a full time study were undertaken with suggestions discussed to assist with future study recruitment. However, given the number of study dropouts at enrolment seen in this study, close to double this number would be needed, entailing a recruitment period of up to 72 months, or 6 years, making a full RCT less practical. A future study may need to consider either a longer enrolment period, different outcome measures as well as address the limitations of this study, including the limited time of enrolment in this pilot RCT. However, longer enrolment duration would increase the amount of time required for a future full RCT, reducing the feasibility of a future study. Findings from this study indicate that the program developed would likely to be useful to people who are not able to access the urban centred classroom based program. On the other hand, those participants who used the program incurred no costs, appeared to have no risks or detrimental impact with possible improvement in knowledge and self-efficacy. Now the intervention has been developed, refinement, maintenance, and use is low cost for service providers, so it could be used routinely now for those who prefer it to ASMPs with an ongoing preference trial.

Made available in DSpace on 2015-07-22T20:50:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-31 / Objetivo: Avaliar a efetividade e segurança do treinamento proprioceptivo na melhora da capacidade funcional em pacientes com artrite reumatóide. Métodos: Revisão Sistemática utilizando a metodologia da Colaboração Cochrane. Estratégia de busca: As bases pesquisadas foram: Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (1966 to 2008) via PubMed, EMBASE (1980 to 2008), LILACS (1982 to 2008), CINAHL (1982 to 2008), PEDro e Scirus. Também realizamos busca manual em anais de congressos, listas de referências de artigos publicados e contatos com especialistas. Não houve restrição de idioma. Critérios de Seleção: ensaios clínicos randomizados ou ensaios clínicos controlados comparando o treinamento proprioceptivo com alguma outra intervenção ou com nenhuma intervenção, em pacientes com artrite reumatóide, de acordo com os critérios do Colégio Americano de Reumatologia (ACR).de 1987 Coleta de dados e análise: Dois revisores independentemente avaliaram títulos e/ou resumos para critérios de inclusão e para risco de viés. Resultados: A pesquisa eletrônica identificou 864 estudos. Para esta busca, 17 estudos descreveram exercícios gerais em pacientes com artrite reumatóide como o principal tópico. Após analisá-los, observamos que o principal desfecho foi a melhora na força muscular, resistência, e exercícios dinâmicos (natação, caminhada, etc). Portanto nós não encontramos nenhum estudo investigando os efeitos do treinamento proprioceptivo isolado em pacientes com artrite reumatóide, não foi possível incluir nenhum dado em relação ao tópico escolhido em nossa revisão sistemática. Conclusão: Não houve nenhum estudo disponível avaliando a eficácia do treinamento proprioceptivo em pacientes com artrite reumatóide. A efetividade e segurança do treinamento proprioceptivo em melhorar a capacidade funcional destes pacientes permanece desconhecido. / Objective: To assess the effectiveness and safety of balance training (proprioceptive training) to improve functional capacity in patients with rheumatoid arthritis. Methods: Systematic review with Cochrane methodology. Search strategy: Databases Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (1966 to 2008) via PubMed, EMBASE (1980 to 2008), LILACS (1982 to 2008), CINAHL (1982 to 2008), PEDro e Scirus. We also carried out a handsearching and contact professional associates of the eligible studies when necessary. There was no language restriction. Selection criteria: All eligible randomised controlled trials or controlled clinical trials comparing balance training (proprioceptive training) with any other intervention or with no intervention, in patients with rheumatoid arthritis of according to the 1987 American College of Rheumatology (ACR) criteria. Data collection e analysis: Two reviewers independently assessed titles and/or abstracts for inclusion criteria and for risk of bias. Results: The electronic search identified 864 studies. From this search, 17 studies described general exercises in rheumatoid arthritis patients as the main topic. After analysing them, we observed that the main outcomes were improvement in muscle strength, endurance, and dynamic exercises (swimming, walking, etc). As we did not find any studies investigating the effects of proprioceptive training alone in patients with rheumatoid arthritis, it was not possible to include any data regarding the chosen topic in our systematic review. Conclusion: There is no research available examining the efficacy of balance training in patients with rheumatoid arthritis. The effectiveness and safety of balance training to improve functional capacity of these patients remains unclear, however, it is suggested that future research should give more importance to the balance training by either increasing the number and duration of sessions or investigating its efficacy alone. / TEDE / BV UNIFESP: Teses e dissertações