977 resultados para Evaluation Studies as Topic
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Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.
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Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.
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Mosquito nets treated with long-lasting insecticide (LLINs), when used in compliance with guidelines of the World Health Organization, may be effective for malaria vector control. In 2012, approximately 150,000 LLINs were installed in nine municipalities in the state of Rondônia. However, no studies have assessed their impact on the reduction of malaria incidence. This study analyzed secondary data of malaria incidence, in order to assess the impact of LLINs on the annual parasite incidence (API). The results showed no statistically significant differences in API one year after LLIN installation when compared to municipalities without LLINs. The adoption of measures for malaria vector control should be associated with epidemiological studies and evaluations of their use and efficiency, with the aim of offering convincing advantages that justify their implementation and limit malaria infection in the Amazon Region.
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Dissertao para obteno do Grau de Mestre em Engenharia Biomdica
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Dissertation presented to obtain the Ph.D. degree in Biology/ Molecular Biology
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INTRODUCTION AND OBJECTIVES: To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting. METHODS: A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature. RESULTS: Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of 610. Thus the incremental cost per life year saved is 4780 and the incremental cost per QALY is 5517. CONCLUSIONS: The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel.
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Dissertao Apresentada na Faculdade de Cincias e Tecnologia da Universidade Nova de Lisboa para obteno do grau de Mestre em Cincias da Conservao, especializao em Pintura
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RESUMO: Objetivo: Este trabalho teve como objetivo contribuir para o processo de adaptao cultural do Neck Disability Index (NDI), atravs da anlise da sua unidimensionalidade e do estudo da sua fiabilidade (consistncia interna e fiabilidade teste-reteste), validade de constructo e poder de resposta. De igual forma pretendeu-se caraterizar a interveno realizada pela fisioterapia e os resultados obtidos em pacientes com Dor Cervical Crnica (DCC). Introduo: A dor cervical um problema cada vez mais comum nos pases industrializados, constituindo uma das trs condies mais frequentemente reportadas por queixas de origem msculo-esqueltica. A sua incidncia um fenmeno em crescimento, com custos implicados para a sociedade. Desta forma reconhece-se a importncia de um instrumento que monitorize a evoluo da incapacidade funcional associada DCC. O NDI atualmente o instrumento de avaliao mais recomendado para avaliar a incapacidade funcional associada dor cervical. Foi traduzido e adaptado lngua portuguesa, mas data no foi realizada nenhuma avaliao das suas propriedades psicomtricas. Por outro lado, apesar de a literatura referir que os servios de Fisioterapia so extremamente procurados por indivduos com DCC, em Portugal, a informao sobre a sua prtica nesta condio clnica escassa ou mesmo inexistente. Assim, e sendo a incapacidade nas atividades funcionais uma das variveis de maior impacto da DCC e ao mesmo tempo um dos resultados principais da interveno da Fisioterapia, importa por um lado possuir instrumentos capazes de avaliar o nvel de incapacidade funcional e a sua mudana, e por outro, aferir qual a interveno realizada pela Fisioterapia e quais os resultados obtidos. Metodologia: Realizou-se um estudo de coorte prospetivo com uma amostra de convenincia, do tipo no probabilstico, constituda por 88 pacientes com DCC de origem msculo-esqueltica e causa no traumtica referenciados para 6 servios de fisioterapia / medicina fsica e de reabilitao de clnicas e centros de reabilitao, sendo elegveis todos os pacientes que cumprissem os critrios de incluso e excluso estabelecidos. Os pacientes foram avaliados em trs momentos pr-definidos: antes do incio das sesses de fisioterapia ou na 1 semana de tratamento; 4 a 7 dias aps a 1 avaliao; e 7 semanas aps o incio da fisioterapia. Para verificao da unidimensionalidade do NDI, procedeu-se a uma Anlise Fatorial Exploratria. As propriedades psicomtricas do NDI avaliadas foram a Fiabilidade (consistncia interna e fiabilidade teste-reteste), a Validade de Constructo e o Poder de Resposta. Posteriormente procedeu-se caraterizao da prtica da fisioterapia quanto s modalidades utilizadas, nmero de sesses de tratamento e durao do episdio de cuidados. Adicionalmente descreveu-se os resultados obtidos aps a interveno da fisioterapia ao nvel da dor e incapacidade. Resultados: os resultados obtidos foram positivos e significativos, com a confirmao da unidimensionalidade do NDI, sendo que em todos os critrios seguidos o fator mnimo retido foi de um. Na avaliao da consistncia interna o valor obtido foi acima do mnimo aceitvel ( Cronbach = 0,77), enquanto o valor de fiabilidade teste-reteste foi elevado (CCI =0,95). De igual forma, os resultados foram positivos para a validade de constructo, obtendo-se uma associao positiva do NDI com a Escala Numrica da dor (END). O valores de poder de resposta reportaram uma rea Abaixo da Curva de 0,63 (IC 95%=0,51-0,75), com valor de Diferena Mnima Clinicamente importante de 5,5 pontos (sensibilidade = 69,6%; especificidade = 43,6%). Relativamente interveno de fisioterapia em casos de DCC verificou-se que as caractersticas da prtica da fisioterapia reportadas neste relatrio so de difcil comparao ou anlise dada a escassez ou inexistncia de trabalhos publicados sobre este assunto em pacientes com DCC. No entanto, neste estudo, encontraram-se redues significativas na intensidade da dor e incapacidade funcional aps a interveno de fisioterapia (z= -7,16; p<0,001 e t= 10,412, p<0,05, respetivamente). Concluso: Os resultados do presente estudo revelam que o NDI-VP possui uma boa Fiabilidade, Validade de Constructo e Poder de Resposta. Revela ainda que a interveno da fisioterapia em casos de DCC, apesar da escassez de trabalhos publicados, proporciona uma reduo significativa dos nveis de dor e incapacidade em pacientes com DCC.--------------- ABSTRACT:Objective: the aim of this study was to contribute for the process of cultural adaption of the Neck Disability Index (NDI), through the analysis of his unidimensionality and the study of his reliability (internal consistency and test-retest reliability), construct validity and responsiveness. At the same time it pretends to characterize the intervention performed by physical therapy and the results in patients with Chronic Neck Pain (CNP). Introduction: neck pain is a common problem in the industrialized countries, since is one of the three most reported conditions by complaints with musculoskeletal origin. His incidence is a growth phenomena that implicate great costs to society. Therefore the importance of an instrument that monitories the evolution of the functional disability associated to CNP is recognized. Nowadays, NDI is the instrument most recommended to evaluate functional disability associated to neck pain. It has been translated and adapted to portuguese but, till now, no evaluation of his psychometric proprieties has been completed. In the other hand, despite literature refers that physical therapy services are extremely searched by patients with neck pain, in Portugal, the information about practice in this clinical condition is very few or inexistent. Therefore, and since disability in the functional activities is one of the variables with most impact of CNP and, at the same time, one of the main results of physical therapy interventions, its important to have instruments capable of evaluate the level of functional disability and his change, and also calculate which intervention of physical therapy is most appropriate and his results. Methodology: it was used a prospective cohort study with a convenience sample, non-probabilistic, consisting of 88 patients with CNP of musculoskeletal origin and non-traumatic cause, referred to 6 physical therapy services of clinics and rehabilitation centers, and fulfilled the inclusion and exclusion criteria established. Patients were evaluated in three pre-defined moments: before the beginning of physical therapy or during the first week of treatment; 4 to 7 days after the first evaluation; and 7 weeks after beginning of physical therapy. To verify NDI unidimensionality, we run an Exploratory Factorial Analysis. NDI psychometric proprieties evaluated were reliability (internal consistency and test-retest reliability), construct validity and responsiveness. Subsequently, it was proceeded the characterization the practice of physical therapy regarding to the modalities used, the number of treatment sessions and duration of the episode of care. Additionally it was described the results obtained after the intervention of the physical therapy, the level of pain and the disability. Results: results were positive and significant, with the confirmation of the NDI unidimensionality, since in every followed criteria the minimal retained factor was one. In the evaluation of internal consistency the value was above the minimal accepted ( Cronbach = 0,77), and the test-retest reliability value was high (CCI =0,95). Results were positive to construct validity, with an positive association of the NDI with Numeric Rating Scale (NRS). Responsiveness values reported an Area Under Curve (AUC) of 0,63 (IC 95%=0,51-0,75) with a Minimal Important Detectable Change (MIDC) of 5,5 points (sensitivity = 69,9%; specificity = 43,6%). Regarding physical therapy interventions in CNP, it was verified that the physical therapy characteristics reported are difficult to compare or analyze since there are very few published studies about this topic. However, in this study, significant reductions were founded in pain intensity and functional disability after intervention(z= -7,16; p<0,001 and t= 10,412, p<0,05, respectively).Conclusion: present study results reveals that NDI has an good reliability, construct validity and responsiveness. It also reveals that physical therapy intervention in CNP, beside few studies published, result in a significant reduction of pain and disability levels in patients with CNP.
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BACKGROUND/AIMS: In Portugal, so far, there is no study or even accurate data on the prevalence of diabetic retinopathy (DR), based on a large representative sample and on a long-term follow-up. The objective of our study was to determine the prevalence of DR based on a national screening community-based programme. METHODS: A 5-year retrospective analysis of the RETINODIAB screening programme results was implemented in Lisbon and Tagus Valley area between July 2009 and October 2014. We estimated the prevalence of retinopathy for all patients with type 2 diabetes and studied the association between known risk factors and retinopathy emergence at their first screening. RESULTS: Throughout this period, from a total of 103102 DR readable screening examinations, 52739 corresponded to patients who attended RETINODIAB screening at entry. Globally, DR was detected in 8584 patients (16.3%). Of these, 5484 patients (10.4%) had mild non-proliferative (NP) DR, 1457 patients (2.8%) had moderate NPDR and 672 (1.3%) had severe NPDR. Finally, 971 patients (1.8%) had proliferative DR requiring urgent referral to an ophthalmologist. The presence of any DR, non-referable DR or referable DR was strongly associated with increasing duration of diabetes and earlier age at diagnosis. CONCLUSIONS: The prevalence rate of DR in our study (16.3%) was slightly lower than other published international data. The RETINODIAB network proved to be an effective screening programme as it improved DR screening in Lisbon and Tagus Valley surrounding area
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Background: Rett disorder (RD) is a progressive neurodevelopmental entity caused by mutations in the MECP2 gene. It has been postulated that there are alterations in the levels of certain neurotransmitters and folate in the pathogenesis of this disease. Here we re-evaluated this hypothesis. Patients and Methods: We evaluated CSF folate, biogenic amines and pterines in 25 RD patients. Treatment with oral folinic acid was started in those cases with low folate. Patients were clinically evaluated and videotaped up to 6 months after therapy. Results: CSF folate was below the reference values in 32% of the patients. Six months after treatment no clinical improvement was observed. Three of the four patients with the R294X mutation had increased levels of a dopamine metabolite associated to a particular phenotype. Three patients had low levels of a serotonin metabolite. Two of them were treated with fluoxetine and one showed clinical improvement. No association was observed between CSF folate and these metabolites, after adjusting for the patients age and neopterin levels. Conclusion: Our results support that folinic acid supplementation has no significant effects on the course of the disease. We report discrete and novel neurotransmitter abnormalities that may contribute to the pathogenesis of RD highlighting the need for further studies on CSF neurotransmitters in clinically and genetically well characterized patients.
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Dissertation submitted in Faculdade de Cincias e Tecnologia of Universidade Nova de Lisboa for the degree of Master of Biomedical Engineering
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Dissertao para obteno do Grau de Mestre em Engenharia do Ambiente
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Dissertao para obteno do Grau de Doutor em Engenharia Fsica
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Dissertation to obtain a Master Degree in Molecular Genetics and Biomedicine
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Dissertao para obteno do Grau de Mestre em Engenharia do Ambiente Perfil Gesto e Sistemas Ambientais
