Introduction: Achilles tendinopathy can be a chronic disabling condition. Sclerosing injections under ultrasonographic guidance is one method to treat Achilles tendinopathy. Initially good results have later been questioned. Surgery is another treatment option that has been questioned because of varying reported success rate. Aim: We aimed to assess patient- reported outcome in patients suffering from Achilles tendinopathy, treated with sclerosing injections and/or surgery during a 6 ½ year- period. Method: After review of patient records, the Self-reported foot and ankle score (SEFAS) together with an in-house satisfaction questionnaire were mailed to the patients. A SEFAS score of 48 represents normal foot/ankle function. Results: 97 patients (53 women, 44 men, 104 tendons) were included. 69 patients (41 women, 28 men, 75 tendons) returned the questionnaires. The SEFAS values (median and range) were 37.5 (13-48) in patients treated with sclerosing therapy, 42 (15-48) in patients treated surgically and 47 (19-48) in patients that received both treatments. A greater proportion of surgically treated patients were satisfied (90% vs 50%), experienced symptom improvement and were able to return to the previous level of activity. Complications following surgery were wound infections (n=3) and deep vein thrombosis (n=3), two with pulmonary embolism. Following sclerosing injection, there was one complete Achilles tendon rupture. Conclusion: Sclerosing injections seems to be a safe treatment and a positive outcome in 50% of patients might be sufficient to use this therapy in selected patients with Achilles tendinopathy. However, surgical treatments seem more effective but are associated with more severe complications.

A criminalidade é um problema recorrente de grande relevância, o engajamento delituoso de jovens é um fenômeno preocupante e alarmante, de acentuado impacto na sociedade. A população, em geral, tende a acreditar que os jovens estão cada vez mais perigosos e envolvidos no agir antissocial. Faz-se necessário a realização de pesquisas que desvendem a problemática e busquem alternativas e possíveis soluções. No âmbito internacional, os questionários de delinquência autorrevelada são considerados o método mais seguro para indicar a prevalência e frequência de comportamentos delituosos entre os jovens. O objetivo do presente estudo foi, em termos gerais, conhecer o comportamento divergente e delituoso de adolescentes estudantes de instituições de ensino privadas, investigando a associação do fenômeno a variáveis potencialmente relacionadas e ampliar pesquisa anterior realizada junto a jovens de instituições de ensino públicas. Participaram do estudo 324 adolescentes, do sexo masculino, estudantes de três escolas particulares. Foi aplicado o Questionário sobre Comportamentos Juvenis, um instrumento de autorrelato que aborda questões relativas à família, escola, rotina, pares, local de residência e comportamentos divergentes e delituosos. Os resultados indicaram que 60,80% da amostra relatou já ter praticado algum comportamento delituoso e 68,88% algum comportamento divergente. O comportamento delituoso mais frequente foi a lesão corporal, seguido de dano. Quanto aos comportamentos divergentes 52,5% dos adolescentes declararam já ter consumido bebidas alcoólicas. Os adolescentes foram agrupados em 5 clusters de acordo com o nível de engajamento criminal, concluiu-se que 11,11% dos jovens são responsáveis por 81% dos delitos revelados praticados nos últimos 12 meses. Esses são aqueles de engajamento mais grave e que se diferenciaram dos outros agrupamentos pela idade de primeiro delito, pela diversidade e volume de delitos praticados. / Criminality is a relevant social problem. Juvenile delinquency is a worrying and alarming phenomenon with many impacts on society. The population, in general, Believes that young people are increasingly involved on antisocial behaviours. Studies about this, is necessary to looking for alternatives and possible solutions. In international level. Self-Reported delinquency are considered the best method to indicate the delinquency behaviors prevalence and frequency. The aim of the present study is to know the self-reported delinquency in private schools young boys; investigating the association of the phenomenon with potentially related variables and expanding previous research carried out with youngsters of public educational institutions. Thirty-four adolescents, male, private schoolss students from three participated in the study. The Self Reported Delinquency was applied; its a self-report questionnaire that investigating about family, school, routine, peers, place of residence and divergent and criminal behavior. The results indicated that 60.80% of the sample reported some delinquent behavior and 68.88% some problem behavior. The most frequent criminal behavior was hurt someone, followed by damage. Regarding divergent behaviors, 52.5% of adolescents reported having consumed alcoholic beverages. The adolescents were grouped into 5 clusters according to the level of criminal engagement, it was concluded that 11.11% of young people are responsible for 81% of de delinquency practiced in the last 12 months. These group (5) have more serious engagement and that differ from others, about age, diversity and frequency.

Background: Persistent infection with high risk HPV is a necessary but insufficient cause of cervical cancer. Behavioural, viral and host factors modulate the risk of HPV persistence. In this thesis, I explore the role of the vaginal microbiota, a host factor and the presence of multiple HPV infections, a viral factor in HPV persistence. Considering the limited data on the epidemiology of HPV related diseases in low and middle-countries (LMIC), and the limited success of cervical cancer screening strategies in many LMIC, I provide data on the distribution of HPV related diseases in Nigeria and evaluate the acceptability of innovative strategies to increase cervical cancer screening uptake. Methods/Results: To achieve my aims, I implemented a longitudinal cohort study of 1,020 women in Nigeria. I begin my results chapters with two methodological papers. Attrition is an important consideration for every longitudinal cohort, particularly in LMIC, therefore, I present my findings on attrition, determinants of attrition and practical strategies to ensure low attrition in studies conducted in LMIC. Considering that sexual behaviour is an important potential confounder in all HPV studies, and the reliability of self-reported history is often questioned, I present findings on the test-retest reliability of self-reported sexual behaviour history collected in my study. Having found that attrition levels were low and that self-reported sexual behaviour history was generally reliable within my cohort, I present my findings on the association between the vaginal microbiota and persistent hrHPV; and the role of multiple HPV infections in viral persistence. I found that the vaginal microbiota was associated with persistent hrHPV in HIV negative women, but not in HIV positive women; and that multiple HPV infections did not increase the risk of viral persistence when compared to single HPV infections. Next, I present my findings on the prevalence and incidence of anogenital warts in Nigeria, with additional reports on the prevalence of cervical cancer and other HPV associated cancers using data from two population based cancer registries. Finally, I present my findings on the acceptability of innovative strategies to improve cervical cancer screening uptake in Nigeria. I found that Nigerian women had a favorable attitude to the use of HPV DNA based screening as part of routine antenatal care, however attitudes towards the use of self-sampling techniques for HPV based cervical cancer screening varied by religious affiliations. Conclusion: In my thesis, I was able to systematically investigate the epidemiology of HPV infections in a LMIC. I considered the distribution of HPV related diseases, host and viral determinants of HPV persistence and investigated control strategies to reduce the burden of cervical cancer in a LMIC. My results provide useful data for surveillance, monitoring and evaluation of control programs on HPV and cervical cancer in Nigeria and may be useful to cervical cancer control programs in other LMIC.

<p><p>Självkänsla är något vi ständigt bär med oss och den inverkar på vårt agerande samt våra val i livet. Johnson (2003) delar in självkänslan i två delar den inre och yttre, vilka kan kombineras till fyra personligheter. Forskning har visat att självkänslan samvarierar med tendensen till att bruka self-handicapping. Self-handicapping innebär att människan skapar hinder för sig själv påhittade eller verkliga. Etthundrasju studenter fyllde i en enkät bestående av 58 påståenden, vilken mätte inre, yttre självkänsla samt self-handicapping. Deltagarna delades sedermera in i de fyra personligheterna, vilka ställdes mot dess uppmätta tendens till att bruka self-handicapping. Resultatet visade att låg inre och/eller hög yttre självkänsla ökar benägenheten till att använda self-handicapping. Avslutningsvis diskuteras och jämförs resultatets utfall.  </p><p> </p><p> </p><p> </p></p><p> </p>

Självkänsla är något vi ständigt bär med oss och den inverkar på vårt agerande samt våra val i livet. Johnson (2003) delar in självkänslan i två delar den inre och yttre, vilka kan kombineras till fyra personligheter. Forskning har visat att självkänslan samvarierar med tendensen till att bruka self-handicapping. Self-handicapping innebär att människan skapar hinder för sig själv påhittade eller verkliga. Etthundrasju studenter fyllde i en enkät bestående av 58 påståenden, vilken mätte inre, yttre självkänsla samt self-handicapping. Deltagarna delades sedermera in i de fyra personligheterna, vilka ställdes mot dess uppmätta tendens till att bruka self-handicapping. Resultatet visade att låg inre och/eller hög yttre självkänsla ökar benägenheten till att använda self-handicapping. Avslutningsvis diskuteras och jämförs resultatets utfall.

In Healthy People 2010, mental health is listed as a major public health concern as evidenced by an alarming increase in the number of individuals who suffer from mental disorders. Mental disorders are a treatable public health condition. However, health disparities in the treatment of mental disorders are evident. The purpose of this study was to examine factors that affected health outcomes of persons with mental disorders. Two specific aims were addressed: Aim 1: to examine the relationships of population characteristics (predisposing factors and enabling resources), health behaviors (health services use and health practice); and health outcomes (physical health status and mental health status); Aim 2: to determine the differences in the usual source of care and health outcomes between individuals with self-reported mental disorders and individuals without mental disorders. This study was a secondary analysis of existing data collected from 2006 Medical Expenditure Panel Survey Household Component Consolidated file. A sample of U.S. civilian non-institutionalized adults (N=622) was grouped according to three self-reported health conditions: mental disorders (MD), physical illnesses (PI) and co-morbid mental disorders and physical illnesses (CM). This sample was predominantly male, White non-Hispanic and married; had a high school diploma, middle to high income, and private insurance; and preferred office-based clinics as the usual source of care, F(2,29)=5.94, p = .007. No statistically significant differences between groups in usual source of care (p=.069) and physical health status (p=.490) but there was a significant difference in mental health status (p=.001). Participants with CM had a poorer mental health status than those with PI and MD, F (2,619) =21.8, p= .000. The mental health status of individuals with PI was significantly better than that of participants with MD. Awareness of disparities in the usual source of care, health services use, and health outcomes among individuals with mental health conditions is imperative if barriers to care are to be eliminated. Innovative interventions pertinent to decreasing barriers to accessing health care and improving the health outcomes among individuals with MD must be tested. Advocating for mental health care policies that reduce health care services disparities among individuals with self-reported MD must be encouraged.

Background: The prognostic significance of chest pain is well established in patients with coronary artery disease, but still ill defined in primary prevention. Therefore, the aim of our analysis was to assess the prognostic value of different forms of chest pain in a large cohort of primary care subjects under the conditions of contemporary modalities of care in primary prevention, including measurement of serum levels of the biomarker NT-pro-BNP. Design: We carried out a post-hoc analysis of the prospective DETECT cohort study. Methods: In a total of 5570 unselected subjects, free of coronary artery disease, within the 55,518 participants of the cross-sectional DETECT study, we assessed chest pain history by a comprehensive questionnaire and measured serum NT-pro-BNP levels. Three types of chest pain, which were any chest pain, exertional chest pain and classical angina, were defined. Major adverse cardiovascular events (MACEs = cardiovascular death, myocardial infarction, coronary revascularization procedures) were assessed during a 5-year follow-up period. Results: During follow-up, 109 subjects experienced a MACE. All types of reported chest pain were associated with an approximately three-fold increased risk for the occurrence of incident MACEs, even after adjusting for cardiovascular risk factors. Any form of reported chest pain had a similar predictive value for MACEs as a one-time measurement of NT-pro-BNP. However, adding a single measurement of NT-pro-BNP and the information on chest pain resulted in reclassification of approximately 40% of subjects, when compared with risk prediction based on established cardiovascular risk factors. Conclusions: In primary prevention, self-reported chest pain and a single measurement of NT-pro-BNP substantially improve cardiovascular risk prediction and allow for risk reclassification of approximately 40% of the subjects compared with assessing classical cardiovascular risk factors alone.

The purpose of the current study was to investigate the structural relationships among self-reported mathematics achievement, attitudes toward statistics, and statistics outcomes by testing a structural model. The current study utilized a survey design. The participants of study consisted of 247 undergraduate and graduate students enrolled in statistics courses in a university in Turkey. The participants were from different disciplines such as engineering, education, and economics. The Turkish version of the Survey of Attitudes toward Statistics-36&copy / (SATS-36&copy / ) was used to collect data. The SATS-36&copy / assessed six components of statistics attitudes: cognitive competence, value, difficulty, effort, interest, and affect. Higher scores of the six components referred to the more positive attitudes. In addition, the SATS-36&copy / involved additional items to measure students&rsquo / self-reports of mathematics achievement and statistics outcomes. Results of the descriptive statistics analyses revealed that participants of the study had positive attitudes toward statistics except that they had neutral perceptions about the difficulty of statistics and neutral interest in statistics. Statistics outcomes variable was significantly correlated with mathematics achievement, affect, value, interest, and effort variables. Structural equation modeling was used to test the hypothesized structural regression model. Results indicated that affect, value, cognitive competence, and interest variables had large total standardized effects on statistics outcomes variable. Mathematics achievement and the effort variables had small total effects on explaining statistics outcomes. Difficulty had no statistically significant total effect on explaining statistics outcomes. Overall, the hypothesized structural regression model explained 66% of the total variance in statistics outcomes, which was statistically significant.

Background Non-adherence to evidence based secondary prevention medicines (SPM) by coronary heart disease (CHD) patients limits their expected benefits and may result in a lack of improvement or significant deterioration in health. This study explored self-reported non-adherence to SPM, barriers to adherence, and the perception that patients in West Yorkshire have about their medicines in order to inform practice and improve adherence. Methods In this cross-sectional study a specially designed postal survey (The Heart Medicines Survey) assessed medicines-taking behaviour using the Morisky Medicines Adherence 8 items Scale (MMAS-8), a modified version of the Single Question Scale (SQ), the Adherence Estimator (AE), Beliefs about Medicines Questionnaire(BMQ) and additional questions to explore practical barriers to adherence. Patients were also asked to make any additional comments about their medicines-taking experience. A purposive sample of 696 patients with long established CHD and who were on SPM for at least 3 months was surveyed. Ethical approval was granted by the local ethics committee. Results 503 (72%) patients participated in the survey. 52%, 34% and 11% of patients were prescribed at least four, three and two SPMs respectively. The level of non-adherence to collective SPM was 44%. The AE predicted that 39% of those had an element of intentional non-adherence. The contribution of aspirin, statins, clopidogrel, beta blockers, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) to overall non-adherence as identified by the SQ scale was 62%, 67%, 7%, 30%, 22% and 5%, respectively. A logistic regression model for overall non-adherence revealed that older age and female gender were associated with less non-adherence (OR = 0.96, 95% CI: 0.94, 0.98; OR = 0.56, 95% CI: 0.34, 0.93; respectively). Specific concern about SPM, having issues with repeat prescriptions and aspirin were associated with more non-adherence (OR = 1.12, 95% CI: 1.07, 1.18; OR = 2.48, 95% CI: 1.26, 4.90, OR = 2.22, 95% CI: 1.18, 4.17). Other variables were associated with intentional and non-intentional non-adherence. 221 (44%) patients elaborated on their medicines-taking behaviour by providing additional comments about the need for patient tailored information and better structured medicines reviews. Conclusions The Medicines Heart Survey was successful in revealing the prevalence of self-reported non-adherence and barriers to adherence in our population. Healthcare professionals should examine specific modifiable barriers to adherence in their population before developing interventions to improve adherence. Conducting frequent structured medicines-reviews, which explore and address patients' concerns about their medicines and healthcare services, and enable them to make suggestions, will better inform practice and may improve adherence.

Base teórica: A doença de Parkinson (DP) é a segunda enfermidade neurodegenerativa mais frequente, crescendo proporcionalmente com o aumento da idade. É uma doença de comprometimento motor e não motor. Levodopa e agonistas dopaminérgicos (AD) são usados no tratamento da DP, permitindo um controle ótimo dos sintomas nos primeiros anos. Entretanto, em 5 anos, metade dos pacientes terão complicações motoras e nãomotoras induzidas pelo uso de antiparkinsonianos. Manifestações neuropsiquiátricas são frequentes, entre elas depressão, ansiedade, prejuízos cognitivos, sintomas psicóticos e transtorno de descontrole dos impulsos(DI). O DI é uma condição caracterizada pela falência em resistir a impulsos ou tentação de executar atos. O DI está associado ao uso de antiparkinsonianos, em especial, os agonistas dopaminérgicos A identificação desta condição é primordial para seu tratamento e estudo adequados. Na literatura atual, o questionário padrão-ouro foi validado na língua inglesa (QUIP), não existindo uma validação para língua portuguesa. Objetivo: Traduzir e validar o questionário QUIP-CS, em sua versão curta e aplicável no momento presente da DP, para lingua Portuguesa do Brasil Métodos: A versão curta da QUIP (QUIP-CS) foi traduzida para o Português por tradutor juramentado. Após, esta foi avaliada por 5 especialistas em DP no Brasil, sendo sugeridas pequenas correções. A versão corrigida em português foi retrotraduzida para o inglês por 2 tradutores juramentados nativos na língua original da escala (inglês), que compararam suas versões posteriormente, chegando-se a uma nova versão final neste idioma. Esta foi enviada ao autor da escala original, que concordou com esta versão, ou seja, foram mantidas as propriedades semânticas do instrumento. Após, a versão final em Português foi auto-aplicada em 65 indivíduos com diagnóstico de DP em tratamento no ambulatório especializado no HCPA, sendo que, de forma aleatória, para 30 foi aplicado um questionário de avaliação sobre o grau de dificuldade de compreensão de suas perguntas. Resultados: Em uma escala de 1 a 5 pontos, onde 1 era nenhuma compreensão das perguntas e 5, clara compreensão, a média de entendimento pelos pacientes foi de 4,06 +/- 0,69 DP. Conclusão: A avaliação desta versão foi considerada de fácil compreensão pelos próprios pacientes. O artigo para validação da tradução do conteúdo da versão em Português da QUIP-CS está em fase de revisão para publicação. / Background: Parkinson’s disease (PD) is the second most often neurodegenerative disease and proportionally growing with people aging. PD is a disease with motor and nonmotor clinical features. Levodopa and dopaminergic agonists (DA) are used for PD treatment, allowing an exquisite control of the motor symptoms during the first years. However, in five years, half patients will present motor or non-motor complications induced by cronic use of these medications. Neuropsychiatric symptoms are often, for example, depression, anxiety, cognitive impairment, psychotic symptoms and impulse control disorders (ICD). The ICD is characterized by failure on resisting an impulse or on performing an specific act. Identification of the PD affected patients is crucial for proper management and study of this condition. There is an already validated self-reported questionnaire for this purpose, the Parkinson's Disease Impulsive-Compulsive Disorders Questionnaire (QUIP), without equivalent in portuguese language. Objective: To translate and to validate the Portuguese short version of the gold-standard questionnaire for identifying ICDs PD affected patients, applicable at the current moment of PD Methods: QUIP-CS was first translated to Portuguese by a professional translator. This translated version was shown to 5 PD neurologist specialists. in Brazil, being suggested minor modifications on it. This new Portuguese revised version was back translated to English by two independent native English speakers. They were both asked to compare the version one another and checked for differences. Then, they contacted each other and got a final back translated version. This one was sent for the original author, that approved its new version comparing to his original and validated one, with no loss of it’s original properties. The Portuguese corrected version was applied to 65 patients in a random way at PD’s ambulatory at HCPA. From these, 30 were asked to answer a number that would represent their level of QUIP-CS questions’ comprehension. Results: In a 1 to 5 point scale, being 1 no comprehension and 5, total comprehension, the average was 4,06 +/- 0,69 DP. Conclusion: Our results on Portuguese version of QUIP-CS show that QUIP-CS translated and corrected version was easily understood and easily self-applied. The article is under revision to be submitted for publication.