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Mobley, Erin M. "Challenges unique to adolescent and young adult cancer care: factors affecting barriers in access to care." Diss., University of Iowa, 2019. https://ir.uiowa.edu/etd/6807.
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Adolescents and young adults (AYAs) ages 15-39 with cancer have experienced stagnant survival rates for the past 30 years in comparison to those older or younger diagnosed with cancer. Survival disparities for this population may be due to biologic factors, lack of consistent and effective access to care, and unique psychosocial needs of this age group, and taken together, present an opportunity for health policy intervention. Of particular interest are barriers most important to AYAs themselves, appropriate and timely clinical trial enrollment, and the ability to preserve fertility prior to initiating treatment. These barriers may be more difficult to overcome for AYAs that are from rural areas, those that may be un- or under- insured, of lower socioeconomic status or educational attainment, and other social determinant of health related-factors.
In this dissertation, I examined the factors that drive the challenges encountered by AYAs with cancer and discuss potential solutions to overcome these challenges. The first aim of this dissertation establishes which challenges or aspects of the cancer experience are most important to AYAs using a mixed methods approach. The second and third aims build off of challenges identified in aim one using quantitative methods. In aim two, AYA clinical trial enrollment in the United States is examined using a nationally-representative sample with a specific focus on rural disparities. In aim three, historical utilization of fertility preservation consultations and procedures are studied among AYAs treated a single institution serving a rural population.
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Jones, Lindsey. "A parent training program combining discrete trial training and incidental teaching in the home environment." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0003113.
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Mehlitz, Philipp-Mathias [Verfasser]. "Safety profile of CAP7.1 obtained during Phase I Trial in adult patients with refractory malignancies / Philipp-Mathias Mehlitz." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2016. http://d-nb.info/1121007368/34.
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Yip, Fung-ping, and 葉鳳萍. "Comparison of hormone profiles in Chinese adult epilepsy patients treated with Sodium Valproate or lamotrigine monotherapy: a prospective randomised trial." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B4175797X.
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Jacobson, Candice. "A retrospective analysis of factors used to assess fitness to stand trial in adult male defendants referred for psychiatric observation." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24502.
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Background. A court orders a forensic observation of a defendant to determine a defendant's fitness to stand trial and/or ability to appreciate wrongfulness of action (criminal responsibility) at the time of the alleged offence. Fitness to stand trial is the focus of this review rather than criminal responsibility. In this instance, the court requests an expert to determine whether the defendant's current mental state would significantly impair his or her ability to participate meaningfully in his or her own trial. In South Africa, this process involves multiple assessments by a multidisciplinary forensic psychiatry team in a dedicated forensic psychiatry unit. However, at present no standardised format has been adopted for such an evaluation, the findings of which may have dire consequences for the individual being assessed. Furthermore, there is a paucity of current literature on fitness to stand trial evaluation. Objectives. To establish whether fitness to stand trial is adequately assessed in the Western Cape, South Africa. A further objective is to establish whether mental illness is the sole factor that differentiates defendants fit to stand trial from those who are found not fit to stand trial, and whether defendants with mental illness are less likely to be asked the relevant questions to determine fitness to stand trial than those without mental illness. Methods. A descriptive, retrospective review was conducted (via the application of a checklist) of clinical records of the last 100 male defendants' ≥18 years of age admitted to the Valkenberg Hospital Forensic Psychiatry Unit prior to March 2015. Results. 30 defendants (30%) were found to have a psychiatric diagnosis. Of the 30 defendants, all were noted to have a serious mental illness (mostly psychotic disorder or cognitive impairment) and were found not fit to stand trial. Seventy (70%) of the defendants were found fit to stand trial by the expert panel. From the findings, it was noted that the forensic team asked and recorded the necessary factors to determine fitness to stand trial in 56% of the study population (based on frequency of responses: n = 894), with 32% of questions not appearing to have been addressed at all (especially those pertaining to role players in court and a defendant's understanding of his rights). Furthermore, various questions appeared to have been indirectly addressed in fewer than 50% of defendants. No significant difference was noted in how the forensic team conducted its assessments between those defendants found to have a serious mental illness and those without serious mental illness. Conclusion. The results of the study suggest the need for a more in-depth review of the forensic evaluation process in the Western Cape to further ascertain the benefits of using a checklist during the evaluation process. Furthermore, additional research would assist in determining the factors contributing to a number of questions not having been addressed and the consequences thereof.
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Yip, Fung-ping. "Comparison of hormone profiles in Chinese adult epilepsy patients treated with Sodium Valproate or lamotrigine monotherapy a prospective randomised trial /." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B4175797X.
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Pachankis, John E., Stacey L. Williams, Kriti Behari, Sarah Job, Erin M. McConocha, and Stephenie R. Chaudoir. "Brief Online Interventions for LGBTQ Young Adult Mental and Behavioral Health: A Randomized Controlled Trial in a High-Stigma, Low-Resource Context." Digital Commons @ East Tennessee State University, 2020. https://doi.org/10.1037/ccp0000497.
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OBJECTIVE: To identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions-expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee. METHOD: In consultation with sexual minority young adults (n = 10) and stakeholders (n = 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (Mage = 23.68, SD = 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up. RESULTS: Compared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d = 0.48) and general psychological distress (d = 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d = 0.62) and drug abuse (d = 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control. CONCLUSION: Brief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Sharma, Dhiraj. "The Impact of Financial Incentives on Academic Achievement and Household Behavior: Evidence from a Randomized Trial in Nepal." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1300977995.
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Littlejohn, Meagan. "Gain-Framed Messaging to Promote Adult Sport: An Exploration of the Effects of Efficacy-Enhancing Messages on Psychological and Behavioural Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35531.
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To understand how to better stimulate adult sport engagement, this study investigated effects of gain-framed messages (GFM; Rothman & Updegraff, 2010) on psychological/behavioural outcomes, with or without efficacy-enhancing messages (Latimer et al., 2010). Eligible adults (30-69 years-old) were randomly assigned to one of two experimental conditions (‘GFM alone’ or ‘GFM plus efficacy-enhancing messages’), or a control condition. Participants (N = 232; 62.5% female) completed baseline/screening measures, watched their messaging intervention and reported outcomes one-week later (Time 2), and responded one-month later (Time 3). Comparing the experimental conditions showed non-significant differences for all outcomes, indicating no added benefit of efficacy-enhancing messages. Collapsing the experimental groups and comparing against the control showed significant group-by-time interactions for three ‘outcome expectancies’ (travel, social affiliation, stress relief), with reports higher among experimental participants. Results also indicated that moderate-to-vigorous physical activity significantly decreased at Time 3 within the control, but remained constant among experimental participants.
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Smith, Reuben Nathanael. "Perioperative comparison of the agreement between a portable fingertip pulse oximeter vs. a conventional bedside pulse oximeter in adult patients (COMFORT trial)." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29680.
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Background: Low-cost, portable fingertip pulse oximeters are widely available to health professionals and the public. They are often not tested to ISO standards, or only undergo accuracy studies in healthy volunteers under ideal laboratory conditions. This study aims to pragmatically evaluate the agreement between one such device and a conventional bedside pulse oximeter in a clinical setting, in patients with varied comorbidities and skin pigmentations. Methods: A single-centre equipment comparison study was conducted. Simultaneous measurements were obtained in 220 patients with both a Contec CMS50D Fingertip Pulse Oximeter and a Nihon Kohden Life Scope MU-631 RK conventional bedside monitor. Peripheral oxygen saturations (SpO₂) and pulse rates were documented, and patient skin tone was recorded using the Fitzpatrick scale. Data was assessed using a Bland-Altman analysis with bias, precision and limits of agreement (LOA) calculated with 95% confidence intervals. A priori acceptability for LOA was determined to be 3%, in keeping with international standards. Results: Mean difference (therefore bias) between the conventional and fingertip oximeters for all data was -0,55% (95% CI -0,73 to -0,36%). Upper and lower limits of agreement (95% CI) were 2,16 (1,84 to 2,47) and -3,25 (-3,56 to -2,94) %. Regression analysis demonstrated worsening agreement with decreasing SpO₂. When samples were separated into “normal” (SpO₂ ≥ 93%) and “hypoxaemic” (SpO₂ < 93%) groups, the normal range displayed acceptable agreement between the two oximeters (bias -0,20 with LOA 2,20 to -2,27%), while the hypoxaemic group fell outside the study’s a priori limits. Heart rate measurements had mean difference (LOA) of -0,43 (-5,61 to 4,76) beats per minute. The study was not powered to detect difference among the skin tones, but demonstrated no trend for this parameter to alter the SpO₂ measurements. Conclusions: During normoxia, portable fingertip pulse oximeters are reliable indicators of SpO₂ and pulse rates in patients with various comorbidities in a pragmatic clinical context. However, they display worsening agreement with conventional pulse oximeters during hypoxaemia. Skin tones do not appear to adversely affect measurements.
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Lee, Todd Allen. "Comparison of the cost-effectiveness of triamicinolone acetonide (azmacort HFA) and fluticasone propionate (flovent) in adult asthmatics in randomized controlled equivalence trial /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/7956.
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Ltayef, Hanan. "A mixed method study of the factors influencing the validity of medical and medication histories obtained from potential healthy adult clinical trial participants." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31564.
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Background: The medical histories of patients are data picked up by a doctor by making inquiries of the patient and of other individuals who know the individual and can give a reasonable response. In clinical trials, obtaining an accurate medical and treatment history is also an important factor in establishing whether or not a person is an eligible participant, and thereafter supports the assessment of any change in health during the trial, for example, the assessment of adverse events (AEs). Study objectives: To understand discrepancies between the medical histories from online self-reports, electronic medical records, and in-depth interviews of those applying to be part of an adult volunteer database for clinical trials; explore ways of engaging with potential volunteers, such that self-reported medical histories are as comprehensive as possible; explore the feasibility of accessing electronic records for those responding to advertisements. Methodology: This study was designed as mixed methods, with sequential explanatory design collecting quantitative and qualitative data and nested in an existing adult volunteer database. people from the Cape Town community were invited to join the database, in response to an advertisement and through a link to the database website; particularly those who were potentially eligible for a typical healthy volunteer trial, and who reported different information to that obtained from the electronic records. Results: 38 people responded to the online questionnaire, the majority being female. According to the online self-report questionnaire, ten people (10/38; 26.3%) had chronic medical conditions; mostly HIV (7/10; 70%). We accessed the Western Cape electronic medical records for only 8/38 (21%). Comparing the online questionnaire with the medical records, it was found that 25% of respondents had no difference in information. 10/38 people (26.3%) agreed to participate and were available for an in-depth interview. The main findings were: 1) a very low response rate to the advertisement, 2) people in this community are willing to consider taking part in clinical research, but have different understandings of what that means, 3) there were discrepancies between online self-reported health and medication data and what was found in a pilot database of electronic public health records and during a face-to-face interview, 4) the reason for these differences, as perceived by participants, included forgetting some information, feeling it was not relevant or important to report because of the attributes of the online questionnaire and 5) these participants had no concerns about us accessing their electronic medical records. Conclusion: Our study provides some evidence for optimal places to advertise for an adult volunteer database, and the appropriate wording and format of both the advertisements and the online questionnaire. More efforts are needed to educate the general public on understand the meaning of clinical trials. Electronic medical records may be accessed to help understand potential participants’ eligibility for trials, but the feasibility of accessing such data timeously may need further negotiation.
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Radl, James. "Field and Bioassay Evaluations of Elm Flea Weevil (Orchestes steppensis Korotyaev) Adult Feeding Preference and Larval Mine Presence among New American (Ulmus americana) and Hybrid Elm (Ulmus spp.) Cultivars." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu153191097403527.
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Albahrani, Marwah M. M. H. S. "Total salivary fluoride concentrations of healthy adult subjects following toothbrushing with different formulations of fluoridated toothpastes with and without post-brushing water rinsing : a double blinded randomised controlled trial." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/18699/.
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Background: Caries prevalence has declined significantly since the introduction of fluoridated toothpastes. There have been a number of developments with regards to specific active fluoride ingredients but not enough evidence to support one over the other. Aim: To compare the salivary fluoride concentrations of different fluoride formulations in the form of toothpaste: fluoride-free (0 ppmF), sodium fluoride (1,450 ppmF), sodium monofluorophosphate (1,450 ppmF), sodium fluoride and monofluorophosphate combined (1,450 ppmF), stannous fluoride and sodium fluoride combined (1,450 ppmF) and amine fluoride (1,400 ppmF) with and without post-brushing water rinsing. Design: Study registered with ClilincalTrials.gov public database (NCT02740803). In vivo double-blinded randomised controlled trial measuring salivary fluoride concentrations following brushing with six toothpaste formulations. Power calculation was performed using PASS11.0 software and the total sample size of 120 was recruited in this study. Participants brushed with 1.0g of one of six different formulations of toothpastes either with or without water rinsing post-brushing. Participants were randomly assigned to groups using an online random team generator. Saliva was collected at six different times (baseline and at 1, 15, 30, 60 and 90 minute(s) post-brushing). Samples were analysed using a fluoride ion-specific sensitive electrode connected to an ion analyser. Codes were broken after data analysis. Data analysis was performed using IBM SPSS 23 software. Results: Demographic characteristics were not significant variables (p > 0.05). Time, toothpaste formulation and rinsing methods had significant effects (p < 0.05). In general, amine fluoride toothpaste resulted in significantly higher salivary fluoride concentrations at 90 minutes than control groups, in both rinsing and non-rinsing groups. Sodium monofuorophosphate toothpaste did not result in significant difference compared to control group at any time point, in both rinsing and non-rinsing groups. Conclusion: The results of this study supports the current recommendation of no rinsing post-brushing. It also supports the previous literature in that amine fluoride resulted in significantly higher fluoride concentrations.
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Suzumura, Erica Aranha. "Efeito da manobra de recrutamento alveolar em pacientes com síndrome da angústia respiratória aguda: revisão sistemática e metanálise." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-18062015-143438/.
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Objetivo: Avaliar o efeito das manobras de recrutamento alveolar em desfechos clínicos de pacientes com síndrome da angústia respiratória aguda (SARA). Métodos: Busca nas bases eletrônicas MEDLINE, EMBASE, LILACS, CINAHL, CENTRAL, Scopus, and Web of Science (até Julho de 2014), sem limite de idioma, por ensaios clínicos randomizados avaliando o efeito das manobras de recrutamento alveolar versus tratamento padrão sem manobras de recrutamento em pacientes adultos com SARA. Quatro duplas de revisores avaliaram de maneira independente a elegibilidade e o risco de viés dos estudos e extraíram os dados de interesse. Realizamos metanálise dos dados por meio de modelos de efeitos aleatórios. Foi utilizada análise sequencial de trials para estabelecer limiares de significância estatística para a metanálise cumulativa considerando nosso desfecho primário (mortalidade hospitalar) para limitar o erro tipo I global por análises múltiplas. Utilizamos sistema GRADE para avaliar a qualidade da evidência. Resultados: Foram incluídos 10 ensaios clínicos randomizados (1594 pacientes, 612 eventos). O risco relativo (RR) de óbito nos pacientes tratados com manobras de recrutamento em comparação ao controle foi de 0,84 (intervalo de 95% de confiança [IC95%] 0,74-0,95; I2=0%), embora a qualidade da evidência tenha sido considerada baixa devido ao risco de viés nos estudos incluídos e à evidência indireta (ou seja, a evidência disponível não responde diretamente nosso objetivo primário, pois os pacientes no grupo experimental receberam outras intervenções ventilatórias que podem ter impactado no desfecho, além das manobras de recrutamento). Não houve diferença no risco de barotrauma (RR 1,11; IC95% 0,78-1,57; I2=0%) ou necessidade de terapia de resgate para hipoxemia (RR 0,76; IC95% 0,41-1,40; I2=56%). A maioria dos estudos não demonstrou diferenças entre os grupos nos desfechos: tempo de ventilação mecânica, tempo de internação na UTI e no hospital. A análise sequencial de ensaios clínicos demonstrou que a evidência cumulativa sobre o efeito das manobras de recrutamento na mortalidade hospitalar de pacientes com SARA é precisa quando considerado um erro tipo I de 5%, mas é imprecisa quando considerado um erro tipo I de 1%. Conclusão: A evidência atual sugere que as manobras de recrutamento alveolar reduzem o risco de óbito hospitalar em pacientes com SARA, sem aumento do risco de eventos adversos graves, entretanto, a evidência não é definitiva. Estudos adicionais são necessários para responder esta questãoPurpose: To assess the effects of alveolar recruitment maneuvers on clinical outcomes in patients with acute respiratory distress syndrome (ARDS). Methods: We searched MEDLINE, EMBASE, LILACS, CINAHL, CENTRAL, Scopus, and Web of Science (from inception to July 2014) for randomized controlled trials evaluating the effects of alveolar recruitment maneuvers versus no recruitment maneuvers in adults with ARDS. We placed no language restriction on our search. Four teams of two reviewers independently assessed eligibility and risk of bias and extracted data from the included trials. We pooled data using random-effects models. We used trial sequential analysis to establish monitoring boundaries to limit global type I error due to repetitive testing for our primary outcome (in-hospital mortality). We rated the quality of evidence using the GRADE system. Results: We included 10 trials (1594 patients, 612 events). The meta-analysis assessing the effect of alveolar recruitment maneuvers on in-hospital mortality showed a risk ratio (RR) of 0.84 (95%CI 0.74-0.95; I2=0%). However, quality of evidence was considered low due to the risk of bias in the included trials and indirectness of evidence, that is, available evidence does not address our primary outcome directly as recruitment maneuvers were usually conducted along with other ventilatory interventions that may affect the outcome of interest. There were no differences in the rates of barotrauma (RR 1.11, 95%CI 0.78-1.57; I2=0%) or need for rescue therapies (RR 0.76, 95%CI 0.41-1.40; I2=56%). Most trials found no difference between groups regarding the duration of mechanical ventilation, length of stay in ICU and in hospital. The trial sequential analysis showed that the available evidence of the effect of recruitment maneuvers on in-hospital mortality is precise when considering a type I error of 5% but not when considering a type I error of 1%. Conclusions: Although recruitment maneuvers may decrease mortality of patients with ARDS without increasing the risk for major adverse events, the current evidence is not definitive. Additional trials addressing this question may better inform clinical practice
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Möller, Hans. "Isthmic spondylolisthesis in adults : a randomized controlled trial /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3834-2/.
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Santos, Monize Aydar Nogueira. "Efeito do ácido graxo ômega 3 no tratamento da esteatohepatite não alcoólica (EHNA): estudo randomizado placebo controlado." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5168/tde-20052015-083209/.
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Introdução: Existem poucas estratégias de intervenção medicamentosa que se mostraram eficazes na doença hepática gordurosa não alcoólica (DHGNA). Os ácidos graxos poliinsaturados (AGPI) Ômega-3 parecem ser eficazes no tratamento da esteatose hepática de modelos experimentais, mas poucos estudos randomizados em humanos foram realizados. O objetivo deste estudo foi avaliar prospectivamente a eficácia de AGPI Ômega-3 provenientes do óleo de linhaça e peixe na esteatohepatite não alcoólica (pacientes com EHNA). Métodos: Sessenta pacientes com biópsia confirmando EHNA foram incluídos no estudo duplo cego, randomizado, placebo controlado. Os pacientes foram randomizados em dois grupos. Grupo Ômega-3 (n = 32) recebeu três cápsulas contendo no total 945 mg de AGPI Ômega-3 (63% ácido alfa linolênico (ALA), 21% ácido eicosapentaenóico (EPA) e 16% do ácido docosahexaenóico (DHA)) e Grupo Placebo (n = 28) recebeu três cápsulas contendo óleo mineral. A intervenção foi realizada por seis meses, quando os pacientes foram novamente submetidos à biópsia hepática. O desfecho primário foi a mudança histológica hepática de acordo com o escore de atividade EHNA (NAS) no início (pré intervenção) e seis meses (após intervenção). Desfecho secundário compreendeu análise das aminotransferases séricas, perfil lipídico e glicemia em jejum, parâmetros antropométricos e nível sérico de IL6 em 0, 3 e 6 meses e dosagem de Ômega-3 plasmático, como prova de tratamento, em 0 e 6 meses. Resultados: Dos 60 pacientes avaliados, 10 não terminaram o estudo (5 no grupo Ômega-3, e 5 no grupo placebo). Analisando os resultados primários, a atividade NAS melhorou ou se manteve estável em 78,26% dos pacientes do grupo placebo e em 55,56% do grupo Ômega-3, sem diferença significativa entre os grupos (p = 0,978), a inflamação lobular reduziu ou se manteve estável em 91,3% no grupo de placebo e em 66,67% no grupo Ômega-3, também sem diferença entre os grupos (p = 0,994). Ômega-3 não reduziu a esteatose hepática, balonização hepatocelular e fibrose. Nos parâmetros bioquímicos houve redução do nível de triglicérides em três meses no grupo Ômega-3 (p = 0,011) quando comparado com o placebo. Por outro lado, aminotransferases séricas, colesterol total e frações, glicemia, parâmetros antropométricos e níveis séricos de IL-6 não foram alterados com o tratamento em seis meses quando comparado com placebo. Analisando o resultado do Ômega-3 plasmático no período seis meses, observou-se que no grupo Ômega-3 houve aumento do ALA (p = 0,014), EPA (p = 0,016), da relação Ômega-3/Ômega-6 (p = 0,018) e redução do ARA (p= 0,028), enquanto que no grupo placebo encontrou-se aumento do Ômega-3 nas formas de EPA (p = 0,03), DHA (p = 0,036) relação Ômega-3/Ômega-6 (p = 0,007), o que comprova que o grupo placebo de alguma forma ingeriu também Ômega-3. Avaliando o Ômega-3 plasmático entre grupos tratamento e placebo tem-se diferença entre os grupos em relação ao ARA (p = 0,03) que reduziu no grupo \"tratado com Ômega-3\". Devido ao consumo de Ômega-3 pelo grupo placebo, optou-se por desconsiderar o duplo cego e fazer nova análise estatística baseada no aumento de Ômega-3 plasmático e comparar com melhora histológica das variáveis NAS e encontrou-se que o aumento do DHA estava positivamente relacionado com a melhora ou estabilização da inflamação lobular em seis meses de estudo (p = 0,014). Conclusões: Os resultados dste estudo indicam que AGPI Ômega-3 a partir de uma mistura de óleos de linhaça e peixe não pode melhorar a histologia hepática, a maioria dos parâmetros bioquímicos e os níveis séricos de IL-6; no entanto, esta suplementação impacta significativamente o perfil lipídico dos pacientes com EHNA, aumentando os níveis de AGPI Ômega-3, diminuindo os níveis da ácido araquidônico (AA), potencialmente próinflamatória da família AGPI Ômega-6, e diminuição dos níveis de triglicérides séricos. Na análise post hoc houve correlação significativa entre o aumento dos níveis plasmáticos de DHA e melhora da inflamação lobular, independentemente do tratamento recebido. A limitação do estudo foi o grupo placebo ter ingerido ácidos graxos Ômega-3. Mais estudos são necessários para confirmar estes resultados (ID 01992809)Introduction: There is a limited number of effective drug treatments available for the treatment of nonalcoholic steatohepatitis (NASH). Polyunsaturaturated fatty acid (PUFAs) Omega 3 seems to be effective in treating hepatic steatosis in experimental animal models, however there is a limited number of humans randomized studies available in the literature. The purpose of the present study is to prospectively evaluate the treatment efficacy of the PUFAs Omega 3 from flaxseed and fish in patients with NASH disease. Methods: A total of sixty biopsy confirmed NASH patients were included in a double blind, randomized, placebo controlled study. They were randomized into two groups: Omega 3 group (n = 32) where patients received a total of 945mg of PUFAs Omega 3 and Placebo group (n = 28) where patients received only mineral oil. After a 6 month treatment all patients underwent a new liver biopsy. Primary goal was to evaluate and compare liver histologic changes, according to Nonalcoholic fatty liver disease (NAFLD) activity score (NAS), between pre and post treatment biopsies. Secondary goal was to evaluate serum transaminases, lipid profile and serum non fasting glucose, anthropometric parameters and serum IL6 at 0, 3 and 6 month treatment. A serum Omega 3 dosage was performed at 0 and 6 month as treatment proof. Results: A total of 50 patients finished the study, 25 from each original group. NAS score improved or was unaltered in 78.26% of the placebo group and in 55.56% of the Omega 3 group (p = 0,978). Lobular liver inflammation was reduced or unaltered in 91.3% and in 66.67% respectively of the placebo and Omega 3 groups (p = 0,994). Omega 3 alone was not able to reduce liver steatosis, hepatocelular balonization or fibrosis. Biochemical analysis revealed reduction on serum triglycerides after 3 month treatment for the Omega 3 group patients, when compared to placebo (p=0,011). Serum transaminases, total cholesterol and fractions, non fasting glucose and IL-6 were found to have no changes after 6 month treatment, when compared to placebo. After 6 month we found serum rise of Omega 3 on its forms as ALA (p= 0,014) and EPA (p = 0,016), and of the relation Omega 3/Omega 6 (p = 0,018), besides a reduction of the ARA (p= 0,028). The placebo group demonstrated to have an Omega 3 serum rise of its forms as EPA (p = 0,03) and DHA (p = 0,036) and of the relation Omega3/Omega6 (p = 0,007). These findings are proof that the placebo group also ingested some form of Omega 3. There is a difference between the groups regarding the serum Omega 3 on the ARA relation, which was reduced in the Omega 3 group. Due to the Omega 3 ingestion by the placebo group we decided to not consider the double blind and to perform a new statistic analysis based on the serum Omega 3 rise and compare with the improvement on NAS histologic variables. The analysis revealed that DHA rise was positively related with an improvement or unchanged of lobular inflammation after 6 months (p= 0,014). Conclusions: The present study was able to demonstrate that the AGPI Omega 3 from flaxseed and fish can not improve hepatic histology, most of the biochemical parameters and serum levels of IL-6. However this type of supplementation revealed a significant impact over lipid profile from NASH patients, providing an rise on AGPI Omega 3 levels and reducing the levels of Araquidonic Acid (AA) and triglycerides. The post hoc analysis demonstrated a significative correlation between the serum rise of DHA and the improvement of lobular inflammation, regardless of the received treatment. The fact that the placebo group ingested Omega 3 revealed to be a limitation of the present study. More studies are recommended to confirm our findings (ID 01992809)
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Griffith, Catherine A. "Frail older adults' experience of participating in clinical trials." Thesis, Boston College, 2015. http://hdl.handle.net/2345/bc-ir:104369.
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Thesis advisor: Callista L. RoyPurpose: The purpose of this research was to address the gap in the literature related to frail older adults' experience of participating in clinical trials. Background: Frail older adults are generally underrepresented in the population of research volunteers from which evidence-based guidelines are derived. To improve care for frail older adults, research must be expanded to specifically target this population. Most of the users of healthcare today are greater than 65 years old, use more health care services than any other age cohort and suffer from coexisting illnesses for which they take several prescribed medications. Since the number of elders is increasing within the general population, it is important to reach a more thorough understanding of frail older adults' experience. Acquiring a better understanding of their experience will give the investigator more insight into barriers of recruitment, retention, and factors affecting elders' decision to participate in research. Method: Using a qualitative descriptive approach involving semi-structured interviews, a cohort of participants age 65 and older was asked about their experience of participating in research studies. Data analysis used an interpretive paradigm involving the methods of Miles, Huberman, and Saldana (2014). Results: Participants identified the main factors influencing their decision to participate as the opinions and encouragement of family members with the strongest influence being a recommendation from their doctor. Participants were varied in the emotions evoked by their participation in the study procedures. The majority of participants stressed how important it was to them to receive feedback in the form of results of studies in which they had participated. The majority of participants stated that receiving feedback or research results was the exception. Conclusions: Data generated from this study related to the experience of frail elder participation in clinical trials will be useful in designing future clinical trials to be more inclusive of this patient population. Keywords: frail elders, research participation, clinical trials, chronic illness, qualitative, multmorbidity
Thesis (PhD) — Boston College, 2015
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Cruz, Sarai. "CONDUCTING A TRIAL-BASED FUNCTIONAL ANALYSIS WITH ADULTS IN A DAY PROGRAM SETTING." OpenSIUC, 2013. https://opensiuc.lib.siu.edu/theses/1190.
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AN ABSTRACT OF THE THESIS OF Sarai Cruz, for the Master's of Science degree in Behavior Analysis and Therapy, presented on June 21, 2013, at Southern Illinois University Carbondale. TITLE: CONDUCTING A TRIAL-BASED FUNCTIONAL ANALYSIS WITH ADULTS IN A DAY PROGRAM SETTING MAJOR PROFESSOR: Dr. Joel Ringdahl Functional analysis is an assessment that is used to identify the functional contingences in a variety of settings. The present study describes a trial-based functional analysis conducted in a day program setting, with two adult participants with intellectual disabilities that engaged in inappropriate touching. This study extended similar procedural methodology as outlined by Sigafoos and Saggers (1995) of conducting 1-min components (test and control) and 20 trials under three test conditions (demand, tangible, and attention). Results indicated a clear pattern of responding for both participants. For the male participant, the result suggest the problem behavior was maintained by multiple sources of reinforcement. For the female participants, the results suggest the problem behavior was maintained by access to attention. These results propose that a trial-based functional analysis is a viable options to determine maintaining contingences when conducted in a day program setting. Future research should be conducted to further establish trial-based functional analysis in applied natural settings to increase its use outside of contrived, clinical environments. Key words: Trial-based functional analysis, intellectual disabilities, day program
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Vogelberg, Christian. "Tiotropium in the add-on treatment of asthma in adults: clinical trial evidence and experience." Sage, 2016. https://tud.qucosa.de/id/qucosa%3A35545.
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Asthma is a chronic inflammatory airway disease, and its treatment is frequently challenging despite detailed national and international guidelines. While basic antiinflammatory therapy usually consists of inhaled corticosteroids in doses adapted to the asthma severity, add-on treatment with bronchodilators is essential in more severe asthma. Only recently, the long-acting anticholinergic tiotropium was introduced into the GINA guidelines. This review reports on the studies that have been performed with tiotropium in adult asthmatic patients. Following early proof-of-concept studies, several studies with tiotropium as an add-on therapy to inhaled corticosteroids (ICS), with or without a long-acting beta agonist (LABA), demonstrated convincing clinical benefit for patients. Important lung function parameters and quality of life scores significantly improved shortly after onset of the add-on therapy with tiotropium, and some studies even demonstrated non-inferiority against salmeterol. All studies reported an excellent safety profile of tiotropium. The still growing body of tiotropium studies, both in adults and children, will help to identify the position of tiotropium in future asthma guidelines and might also indicate which patients benefit most from an add-on therapy with tiotropium.
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Goldstein, Carly Michelle. "Randomized controlled trial of two telemedicine medication reminder systems for older adults with heart failure." Kent State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=kent1364946106.
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Hartescu, Iuliana. "Physical activity to the current recommended guidelines and sleep quality of adults with insomnia." Thesis, Loughborough University, 2014. https://dspace.lboro.ac.uk/2134/14905.
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Systematic reviews have consistently found that moderate intensity physical activity levels at or above a threshold value of 150 minutes per week reliably deliver cardiovascular, metabolic and musculo-skeletal health benefits. As a result, this threshold value has been widely adopted as an aspirational, public health goal throughout the world. However, while epidemiological and laboratory studies have established clear links between physical activity and sleep outcomes, the evidence base does not yet provide guidelines on minimum levels of exercise likely to reduce insomnia symptoms and improve sleep quality. Such a guideline, if evidence based, could greatly clarify advice, and accelerate the use of physical activity goals to improve sleep outcomes in behavioural sleep medicine and public health. This thesis examined the current public-health recommendation of 150 minutes of moderate intensity activity per week in relation to sleep outcomes. To commence, it established a population-level pattern of the relationship between levels of physical activity and sleep quality by reviewing relevant epidemiological evidence. Exploratory analyses were then conducted using data from an ongoing longitudinal study of physical activity and health outcomes among older people (aged 65 years and above) in which respondents were classified as walking at or above, or below the recommended threshold of 150 minutes per week. In regression models controlling for health and demographic factors, these analyses showed that higher levels of walking were significantly and independently associated with a lower likelihood of either reporting insomnia symptoms (OR = 0.67 (95% CI = 0.45 0.91) p=0.04), or experiencing poor sleep efficiency (OR = 0.70 (95% CI = 0.52 0.94 p=0.02). Using the same data, the predictive validity of this activity threshold was then confirmed in a 27-year survival analysis which showed a significantly decreased all-cause mortality risk associated with the higher level of walking (HR = 0.75 (95% CI = 0.65 - 0.86) p<0.01). These findings offered proof of concept that physical activity-sleep relationships operated on a continuum, with sleep benefits possible even at relatively low levels of activity. Experimental evidence on the acute and sustained effects of physical activity on sleep quality was then analysed and discussed. Outcomes from this review, together with the preliminary analyses described above, were then used to inform the design of a randomised controlled trial to investigate the effects on sleep quality of increasing physical activity to currently recommended levels among sedentary people with insomnia. A total of 41 sedentary adults meeting DSM-IV criteria for insomnia (30 female; mean age 59.8??9.5) were randomised to a physical activity group (???150 minutes moderate intensity activity/week) or a waiting list control group. The principal outcome was Insomnia Severity Index (ISI) change 6 months post baseline; secondary outcomes were anxiety (using the State Trait Anxiety Inventory) and depression (Beck Depression Inventory II). Physical activity was assessed using Actigraph GTX3+ accelerometers. Outcomes were assessed in univariate general linear models, adjusted for baseline confounders. Activity and sleep assessments did not differ at baseline. At 6 months post baseline the intervention group engaged in 213 min/week of moderate intensity PA, compared to the control group (82 min/week). Compared to the control group, the intervention group showed significant improvement in the ISI score at 6 months F(1,28) = 5.16, p=0.03), adjusted means difference = 3.37, with an adjusted Cohen's d =.78 (95% CI 0.10 1.45). There was a significant improvement in trait anxiety, and depression outcomes post-intervention, F(6,28)=4.41, p=0.05, and F(6,28)=5.61, p=0.02, respectively. The results showed that increasing activity in line with current guidelines could deliver clinically significant improvements in sleep quality and mood outcomes among inactive adults with insomnia. While the effect sizes are modest, the pattern of results reported here allow for two conclusions with clear implications for public health: 1) measures to increase levels of physical activity above the currently recommended threshold of 150 minutes per week could usefully be added to other approaches to insomnia management; and 2) the likelihood of improved sleep quality should be routinely added to those evidence-based cardiovascular and metabolic benefits most frequently associated with increased physical activity in behaviour change initiatives.
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Sowden, Emma R. "Recruitment to clinical trials in adult and child settings : qualitative case study in cystic fibrosis." Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3018481/.
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Loader, Kerrie Ann. "A compassionate mind approach to self-help for treatment seeking obese adults : a randomised controlled trial." Thesis, University of Leicester, 2013. http://hdl.handle.net/2381/28266.
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Obesity and overweight are global issues and the rate of obesity has more than doubled in the past 30 years. The financial and physical cost of obesity and overweight continues to rise. Obesity and overweight are characterised as relapsing conditions which can share psychopathology with eating disorders. This thesis intended to evaluate current psychological approaches to obesity and overweight which was under-researched. It explored a compassionate mind approach intervention for weight management which focused on psychosocial factors present in obesity and overweight. The systematic literature review evaluated psychological interventions for the treatment of obesity and overweight. Twelve articles were reviewed and assessed for methodological quality. The results demonstrated short-term treatment efficacy for behavioural therapy but the evidence for the most effective form of psychological intervention was inconclusive. There was no conclusive evidence that psychological interventions offered long-term weight-loss maintenance. A requirement for further research into psychological interventions for obesity and overweight using robust methodology was indicated. Methodological issues were considered which may have limited the conclusions of the review. The empirical study was a randomised control trial that lasted for six months. Thirty six participants received either compassionate mind approach guided self-help (GSH) or treatment as usual (TAU) in a dietetic clinic. Measures of shame, self-compassion, psychological wellbeing, disordered eating, physical activity and BMI were taken at pre and post-intervention. No statistically significant results were demonstrated for GSH or TAU in terms of these factors. Treatment effect sizes were observed for GSH regarding levels of external shame, self-compassion and preoccupation with shape and for TAU regarding levels of uncontrolled eating. The results suggested that eating psychopathology and psychosocial factors are relevant in treatment seeking obese populations and these should be explored when developing interventions. The study limitations, clinical implications and future research were discussed.
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Boxer, Rebecca S. "A Randomized Controlled Trial of Telemonitoring for Older Adults with Heart Failure Receiving Home Health Care." Case Western Reserve University School of Graduate Studies / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=case1323311318.
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Garver, Matthew J. "Improving Maintenance of Physical ACtivity Trial - Pilot (IMPACT-P)." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1312202558.
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Zimmerman, Marian Rose. "A Randomized Clinical trial of Cognitive-Behavioral Therapy for Insomnia in a College Student Population." Thesis, University of North Texas, 2011. https://digital.library.unt.edu/ark:/67531/metadc84307/.
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Nearly 10% of college students experience chronic insomnia. Cognitive-behavioral therapy for insomnia (CBTi) is an empirically validated multi-component treatment that has been demonstrated to produce reliable and durable benefits in the general adult population. However, there have been no studies examining the effectiveness of multi-component CBTi in a college student population, even though many studies have examined the efficacy of single treatment modalities. These young adults are different from the general adult population because they are in a unique transitional developmental phase as they are maturing from adolescence into adulthood, they are sleepier than adults, they tend to have irregular sleep schedules, and their living situations are often different from the general adult population. In this study college students with chronic insomnia were randomly assigned to either six sessions of CBTi or a wait list control (WLC) group. All participants completed sleep diaries, sleep measures, and psychosocial measures. The results indicated students who received CBTi showed improvements in sleep efficiency (SE), sleep onset latency (SOL), number of awakenings (NWAK), time awake after sleep onset (WASO), and sleep quality (SQ). They also had decreased insomnia severity (ISI), dysfunctional beliefs about sleep (DBAS), and general fatigue (MFI), as well as increases in global sleep quality (PSQI).
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Davidson, Jonathan R. T., Hans-Ulrich Wittchen, Pierre-Michel Llorca, Janelle Erickson, Michael Detke, Susan G. Ball, and James M. Russell. "Duloxetine treatment for relapse prevention in adults with generalized anxiety disorder: A double-blind placebo-controlled trial." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-110320.
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The objective was to examine duloxetine 60–120mg/day treatment for relapse prevention in adults with generalized anxiety disorder (GAD). Adult patients (N=887; mean age=43.3 years; 61.0% female) with DSM-IV-TR-defined GAD diagnosis were treated with duloxetine for 26 weeks. Patients who completed open-label phase and were treatment responders (≥50% reduction in Hamilton Anxiety Rating Scale total score to ≤11 and “much”/“very much improved” ratings for the last 2 visits of open-label phase) were randomly assigned to receive duloxetine or placebo for a 26-week double-blind continuation phase. Relapse was defined as ≥2-point increase in illness severity ratings or by discontinuation due to lack of efficacy. During the double-blind phase, placebo-treated patients (N=201) relapsed more frequently (41.8%) than duloxetine-treated patients (13.7%, N=204, P≤0.001) and worsened on each outcome measure (P≤0.001, all comparisons). Duloxetine 60–120 mg/day treatment was efficacious and reduced risk of relapse in patients with GAD.
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Davidson, Jonathan R. T., Hans-Ulrich Wittchen, Pierre-Michel Llorca, Janelle Erickson, Michael Detke, Susan G. Ball, and James M. Russell. "Duloxetine treatment for relapse prevention in adults with generalized anxiety disorder: A double-blind placebo-controlled trial." Technische Universität Dresden, 2008. https://tud.qucosa.de/id/qucosa%3A26830.
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The objective was to examine duloxetine 60–120mg/day treatment for relapse prevention in adults with generalized anxiety disorder (GAD). Adult patients (N=887; mean age=43.3 years; 61.0% female) with DSM-IV-TR-defined GAD diagnosis were treated with duloxetine for 26 weeks. Patients who completed open-label phase and were treatment responders (≥50% reduction in Hamilton Anxiety Rating Scale total score to ≤11 and “much”/“very much improved” ratings for the last 2 visits of open-label phase) were randomly assigned to receive duloxetine or placebo for a 26-week double-blind continuation phase. Relapse was defined as ≥2-point increase in illness severity ratings or by discontinuation due to lack of efficacy. During the double-blind phase, placebo-treated patients (N=201) relapsed more frequently (41.8%) than duloxetine-treated patients (13.7%, N=204, P≤0.001) and worsened on each outcome measure (P≤0.001, all comparisons). Duloxetine 60–120 mg/day treatment was efficacious and reduced risk of relapse in patients with GAD.
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Minagawa, Sakiko C. "Prevalence of Relative Energy Deficiency in Sport (RED-S) in Young Adult Female Distance Runners." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1554715996907624.
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Morrill, Kristin E., Benjamin Aceves, Luis A. Valdez, Cynthia A. Thomson, Iman A. Hakim, Melanie L. Bell, Jessica A. Martinez, and David O. Garcia. "Feasibility and acceptability of a beverage intervention for Hispanic adults: a protocol for a pilot randomized controlled trial." BIOMED CENTRAL LTD, 2018. http://hdl.handle.net/10150/627156.
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Background: In the U.S., Hispanics have among the highest rates of overweight and obesity when compared to other racial/ethnic groups placing them at a greater risk for obesity-related disease. Identifying intervention strategies to reduce caloric intake and/or improve cardiometabolic health in Hispanics is critical to reducing morbidity and mortality among this large and growing population. Evidence exists to support diet-specific behavioral interventions, including beverage modifications, in reducing obesity-related health risks. However, the acceptability and feasibility of a beverage intervention in obese Hispanic adults has not been robustly evaluated. Methods: The objective of this pilot study is to assess the feasibility and acceptability of a randomized, controlled beverage intervention in 50 obese Hispanic adults ages 18-64 over 8-weeks. Eligible participants were obese (30-50.0 kg/m(2)), between the ages 18-64, self-identified as Hispanic, and were able to speak, read, and write in either English and/or Spanish. Study recruitment was completed August 2017. Upon the completion of baseline assessments, participants will be randomized to either Mediterranean lemonade, Green Tea, or flavored water control. After completing a 2-week washout period, participants will be asked to consume 32 oz. per day of study beverage for 6-weeks while avoiding all other sources of tea, lemonade, citrus, juice, and other sweetened beverages; water is permissible. Primary outcomes will be recruitment, retention, and acceptability of the intervention strategies. Our study will also evaluate participant-reported tolerance and as an exploratory aim, assess safety/toxicity-related to renal and/or liver function. Fasting blood samples will be collected at baseline and 8-weeks to assess the primary efficacy outcomes: total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Secondary outcomes include fasting glucose, hemoglobin A1c (HbA1c), and high-sensitivity C-reactive protein (hs-CRP). Discussion: This pilot study will provide important feasibility, safety, and early efficacy data necessary to design a larger, adequately-powered randomized controlled trial.
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Ghahari, Setareh. "A randomised controlled trial of an online fatigue self-management group intervention for adults with chronic neurological conditions." Thesis, Curtin University, 2009. http://hdl.handle.net/20.500.11937/1988.
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Background: Fatigue is one of the most common symptoms of neurological conditions. Although the literature suggests different approaches to treatment of this pervasive symptom, there is not a single, agreed comprehensive and well-supported approach to manage fatigue. There is strong evidence (Mathiowetz, Finlayson, Matuska, Chen, & Luo, 2005; Mathiowetz, Matuska, Finlayson, Luo, & Chen, 2007) that the face-to-face fatigue self-management program designed by Packer et al (1995) is effective in improving fatigue in people with MS. However, in Australia and many other developed and developing countries this program is not available for those people who have difficulty accessing services due to geographical location, transportation problems, work commitments or who lack confidence to participate in face-to-face programs. Equity of access is an important issue not only for this particular program but also for any self-management program in Australia (and internationally) which has a large rural and remote population. Evidence highlights the need for self-management programs to be delivered in different formats to ensure equity of access. One of the suggested ways is delivering the programs online. There is sufficient evidence that people with a disability have access to the internet. Thus, this project was designed to refine and further develop a pre-designed online fatigue self-management (online FSM) program and to evaluate it in a sample of adults with chronic neurological condition through a randomised controlled trial (RCT). Further, the study intended to explore who and how people with fatigue improve in their health outcomes.Methodology and Results: The aims of the project were fulfilled through four studies: 1) a pilot study; 2) a randomised controlled trial of the online FSM program; 3) a comparison with the face-to-face FSM program; and 4) exploration of predictors of improvement.During the pilot study, three pilot tests were conducted for the purposes of formative evaluation and to make necessary changes to improve the program. During the third pilot test, the effectiveness of the online FSM was also tested using a pre-test post-test design on a sample of individuals with multiple sclerosis, Parkinson’s disease or post-polio syndrome. The pilot study resulted in a standardised 7-week online FSM program mimicking its face-to-face version. Participants were offered fatigue self-management skills through structured activities, sharing information and experiences, expressing their ideas or feelings and offering advice and support to one another. The participants in the third pilot study improved significantly on the Fatigue Impact Scale (p<.05) and showed a trend toward significance shown on the Personal Wellbeing Index (p=.08).The RCT, the second study, included 95 participants who were randomised into one of three groups: an online FSM, an information-only FSM (info FSM) and a control group. The groups were compared at three time points (pre-test, post-test and at 3-months follow-up) on Fatigue Impact Scale, Activity Card Sort and Personal Wellbeing Index (FIS, ACS and PWI). Sores on Generalized Self-efficacy (GSE), Duke Social Support Index (SSI) and Depression, Anxiety and Stress Scale (DASS) were also used as covariates. The results showed that although both the online and information-only FSM groups improved over time on the FIS and ACS (p < .05), they were not significantly different from the control group or from each other at any time point. The low power in all analyses when comparing the groups revealed that a larger sample size is required to detect possible differences between the online FSM and control groups. Results of the secondary analysis on a combined group (online FSM group plus info FSM groups) showed that the online FSM and info FSM group complemented each other. The combined group showed significant differences when compared to the control group. This further suggests that the need for a larger sample size.The literature suggests incorporating face-to-face interventions as one of the experimental conditions when testing the effectiveness of an online program. Therefore, in the third study, a face-to-face group was used as a non-randomized comparison group. As the online FSM program was designed to provide service for people who do not have access to the face-to-face program, randomisation of the participants to four groups (face-to-face FSM, online FSM, info FSM and control groups) was not feasible; restricting the inclusion criteria to participants who had access to both the face-to-face and online programs would have excluded the very people for whom the program was designed. Thus, this study compared a sample of 20 participants in a face-to-face FSM program with each of the three other groups (online FSM, info FSM and control groups) using a nonequivalent pre-test post-test study. The findings showed that after controlling for the baseline data these participants had better scores on the FIS than the control group at post-test while these results were not seen in comparison to the online and info FSM groups. The results of this study on the face-to-face FSM program in comparison with online FSM program suggest that the online and info FSM program were successfully mimicking its face-to-face version. Further, the differences in some outcome measures and some clinical and demographic characteristics clearly demonstrated that the participants with access to the face-to-face program were significantly different than those in the RCT study. The participants who volunteered for participation in the online FSM program had lower activity levels and higher fatigue levels than the participants who had access to the face-to-face program. It appears that the two versions of the program provide access to significantly different participants.The fourth study aimed to indicate predictors of improvement on the FIS, ACS and PWI. Regression analyses were performed to find whether baseline demographic, clinical characteristics and/or changes in clinical characteristics from pre-test to follow-up were predictors for positive health outcomes. In this study, 92 participants with complete data set (pre-test, post-test and follow-up) were included. In parallel to the results emerging in systematic reviews (Nolte, Elsworth, Sinclair, & Osborne, 2007; S. Taylor, 2005; Warsi, Wang, LaValley, Avorn, & Solomon, 2004), younger people with more severe baseline scores appear to be more likely to make clinically significant improvements in their health outcomes. Improvement in mood and selfefficacy of people with fatigue were found to be predictors of better results for fatigue. Another interesting finding of this study was that improvement in selfefficacy and stress helps people with neurological conditions to improve in their fatigue regardless of their activity level at baseline.Conclusion: While fatigue is a common problem for people with fatigue secondary to neurological conditions, this online FSM program is the first of its kind to be implemented. The primary purpose of the fatigue self-management program is to help the participants improve their everyday performance and quality of life by incorporating ‘energy conservation techniques’ and self-management principles into their own life. Through the application of the fatigue self-management program, occupational therapists and other health professionals expect that the participants will learn the self-management skills, make corresponding behaviour changes and experience a reduction in the effect of fatigue on their lives. New knowledge gained from this study can further support the idea of providing other self-management programs online. The results of this study also add to the growing body of evidence emerging regarding how information technology may assist with improving health outcomes related to chronic conditions. Further, some predictors of improvement in health outcomes in this group of people were determined. The findings provide some evidence of the potential benefits of online fatigue self-management program for people with chronic neurological conditions. Online interventions like the online FSM program represent an important strategy for bridging the gap in service for those who can not participate in face-to-face programs.
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Dennis, Sarah M. "Assessing asthma in adult clinical trials of inhaled B2-agonists : a search for a standard primary outcome measure." Thesis, Queen Mary, University of London, 2002. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1849.
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Since the late 1960s the safety of inhaled B2-agonists has been questioned and the longtenn regular use of these drugs has been linked to increasing morbidity and mortality. National and international guidelines recommend that short acting inhaled B2-agonists should only be used on an "as needed" basis and yet the evidence for these recommendations is still unclear, one reason being the lack of common definition for an outcome. The Regular Use of Salbutamol Trial (TRUST) was designed to assess the risks and benefits of regular versus as needed salbutamol in mild to moderate asthma. In order to establish whether a common primary outcome measure could improve the comparability and interpretation of different trials, a systematic rcyiew of randomised controlled trials of long and short acting inhaled B2-agonists in asthmatic subjects was undertaken to identify well designed trials in this field and primary outcome measures used. The systematic review identified five different primary outcome measures from 26 trials of long and short acting inhaled B2-agonists. The TRUST definition of exacerbation was compared with the five primary outcome measures identified using the TRUST diary card data. In addition, the diary card variables (changes in PEF, symptom scores and medication use) were examined to determine the extent to which they predicted exacerbations according to the different definitions. The use of additional corticosteroids and an increase in daytime symptoms of two or more above baseline were the strongest predictors of all four definitions of exacerbation. A fall in morning PEF of 100 lImin was strongly associated with all definitions of exacerbation but was not a sensitive measure. In conclusion, exacerbations of asthma could be identified by use of additional corticosteroids and an increase in two or more of daytime symptoms. The specificity could be improved by including morning PEF but this may reduce patient compliance with study protocol in asthma trials.
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Godskesen, Tove. "Patients in Clinical Cancer Trials : Understanding, Motivation and Hope." Doctoral thesis, Uppsala universitet, Centrum för forsknings- och bioetik, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-252542.
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The overall aim of this thesis was to study participants' understanding of clinical cancer trials, and their motivation for participation. Of particular interest was the question of whether the patients hoped for a cure resulting from the trial. The thesis was based on four studies and used three methods: interviews, a questionnaire, and empirical bioethics. The results of Study I indicated that the participants in phase 1 trials understood most of the information provided, but were unaware of both the very small potential for treatment benefit, and the risk of harm. Patients in phase 3 trials had a good understanding of the trial, except regarding side effects and their right to withdraw. Some found it hard to ask questions and felt they needed more information (Study III). The participants in phase 1 trials were strongly motivated by the generally unrealistic hope for therapeutic benefit (Study I). When the chances of a cure are minuscule, as for participants with end-stage cancer in phase 1 trials, hope can play an important, positive role and offer meaning to one’s remaining life. However, hope for an unrealistic outcome could also deprive patients of an opportunity to spend their remaining lives, as they would otherwise choose (Study II). The participants in phase 3 trials indicated that their motivation for participation was multifaceted; the most common motivations included hope of therapeutic benefit, altruism, access to extra clinical examinations or better care, and a wish to repay society for the help they had received (Study III). After stratifying and analysing the motivation data by gender, age, education and previous experience of trial participation, males and those aged ≥65 years were significantly more motivated to participate out of a desire to reciprocate the help they had received, either because of a sense of duty or because their families or friends considered that they should attend (Study IV). In conclusion, the informed consent process seems to work relatively well, with good results within most subgroups. However, patients with end-stage cancer who are participating in phase 1 trials are a vulnerable group as they have very little potential for treatment benefit coupled with a tangible risk of harm.
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Robert, Sarah. "Santé et recours aux soins des jeunes en insertion socio-professionnelle : une recherche interventionnelle multicentrique Santé et recours aux soins des jeunes en insertion âgés de 18 à 25 ans suivis en mission locale Effects of systematically offered social and preventive medicine consultation on training and health attitudes of young people not in employment, education or training (NEETs) : an interventional study in France." Thesis, Sorbonne université, 2020. http://www.theses.fr/2020SORUS038.
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En France, les Missions locales (ML) accueillent les jeunes en insertion socio-professionnelle – qui ne sont ni en emploi, ni en formation, ni en études – âgés de 16 à 25 ans, soit 10 à 15% des jeunes de cette tranche d’âge. L’objectif des ML est de permettre à ces jeunes de surmonter les difficultés qui font obstacle à leur insertion dans leur transition entre l’école et la vie active – les problématiques de formation, d’emploi, de logement, de santé étant interdépendantes. En France, les études sur la santé des jeunes en insertion restaient exceptionnelles avant la réalisation du projet Presaje conduite dans cinq ML en 2011. Les données de ce travail ont montré que, malgré une certaine hétérogénéité des parcours, ce public nombreux et vulnérable accumule des facteurs de risque vis-à-vis de la santé : peu ou pas diplômé, isolé socialement, ayant une couverture sociale insuffisante, et une faible confiance en soi et dans les institutions. Les jeunes en insertion sont, en effet, en moins bonne santé que les autres jeunes du même âge. Ils sont plus nombreux à présenter une maladie chronique, un mal-être psychique, une obésité ou un surpoids. Malgré des besoins en santé importants, ils ont moins souvent recours aux soins que les autres jeunes en population générale. Cette thèse a aussi permis de souligner l’importance des « points santé » au sein même des ML. La proposition systématique d’une consultation de médecine sociale et préventive auprès de ce public – en plus d’améliorer certains comportements et connaissances en santé – permet d’augmenter leur nombre d’entrées en mesure (participation à une formation ou à un atelier) et nous l’espérons in fine leur taux d’emploiIn France, ‘‘Missions locales’’ are public assistance sites for young people aged 16–25 years who are not in employment, in education or training (NEET). More than 1.4 million NEETs – i.e. ten to fifteen percent of the youth – participate in these sites each year. The main goal of ‘‘Missions locales’’ is to enhance both professional and social insertion – since education, employment, housing and health issues are inseperable. Several international studies have shown that NEETs have poor health status. In France, there were very few quantitative studies on this topic until the PRESAJE survey in 2011, which took place in five ‘’Missions locales’’. Based on data from this survey, we showed that the overall social profile of the NEET population was diverse, with more difficult living conditions than in the general population. Health-related vulnerability factors identified were: low education level; social isolation; insufficient health insurance; low self-esteem; and, low level of trust in institutions. Some of their health indicators were remarkably poor compared to other youth of the same age: more often, they had chronic disease, were overweight or obese, and their mental health status was poor. Despite their poor health, NEETs had less access to health care than the youth of the same age in the general population. This work also has highlighted the importance of having health sites inside ‘‘Missions locales’’. Social and preventive medicine consultations that are fully integrated into the social services for NEETs have an impact on their access to training (and we hope subsequently on their employment), and contribute to changing some of their health-related behaviours
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Peña, Valdovinos Abel. "Educational intervention in adults with type 1 diabetes : systematic review, pragmatic randomised trial, educational assessment and cost-effectiveness analysis." Thesis, University of York, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428475.
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Zusman, Enav Zipora. "Objective measurement of sedentary behaviour and physical activity in older adults after hip fracture : results from a randomised controlled trial." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/59554.
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Introduction: Hip fracture is a serious event with longstanding implications for older adults. These fractures frequently lead to reduced mobility, prolonged periods of sitting time, and consequently, a lack of physical activity. Objectives: I aimed to test how a comprehensive geriatric management clinic affects sedentary behaviour and physical activity patterns over a 12-month period, and to characterise the recovery patterns of sedentary behaviour and physical activity for older adults after hip fracture. Methods: This study collected prospective objective measurements (accelerometry) of sedentary behaviour and physical activity patterns from older adults with hip fracture. I described and tested sedentary behaviour and physical activity using accelerometry at baseline, 6 and 12 months from a parallel-group, 1:1 single-blinded randomised controlled trial for older adults 3-12 months after hip fracture. The usual care group received standard post-operative management; the intervention group received usual care plus a clinical management by health professionals. Results: The study enrolled 53 participants [mean age (SD) 79(8) years], 3-12 months post-fracture. Forty-five participants had valid data (intervention (n=22) or usual care (n=23) group). Participants had a mean (SD) age of 79.2 (7.4) years, ranged 65-98 years, with a median (p10, p90) of 203 (143, 335) days since fracture. Participants from both groups spent approximately 10 hours/day in sedentary behaviour. There were no statistically significant differences between groups for sedentary behaviour or physical activity variables at midpoint and final assessment. Men engaged in significantly more sedentary time (47 minutes; p=0.049), and spent less time in light physical activity (44 minutes; p=0.044) compared with women, across the study. Although men had more sedentary time at each time point, the difference was attenuated at final assessment and was no longer statistically significant. Conclusion: Older adults after hip fracture spend prolonged periods of waking hours sedentary and without much activity. Decreasing and breaking up sedentary time and increasing physical activity is an important target for rehabilitation. Differences between sexes should be acknowledged and addressed by health professionals. Further, strategies should be developed and tested to reduce time spent in sedentary behaviour and increase physical activity for older adults after hip fracture.Medicine, Faculty of
Graduate
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Parkes, Rosalind Margaret. "Morbidity, mortality and a trial of primary prophylaxis of invasive cryptococcal disease in a cohort of HIV positive Ugandan adults." Thesis, University of Liverpool, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.533957.
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Emmett, Christopher David. "Pragmatic randomised trial of low versus high volume initiated transanal irrigation therapy in adults with chronic constipation : a feasibility study." Thesis, Durham University, 2018. http://etheses.dur.ac.uk/12505/.
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Background Chronic Constipation (CC) is common in adults. The effect of symptoms on quality-of-life (QOL) is significant. Trans-anal irrigation therapy has become a widely-used treatment despite a lack of robust evidence. A randomised comparison of two different methods of irrigation (the CapaCiTY 02 study) will provide valuable evidence of superiority of one system over the other. This study aims to evaluate the feasibility of conducting CapaCiTY 02. Data presented are interim findings from a single study site nested within the large multi-centre CapaCiTY 02 study. Methods This study was a mixed methods study involving a) a systematic review and meta-analysis of current literature data for trans-anal irrigation in chronic constipation, b) a randomised controlled trial, and c) a qualitative study of the patient experience. Participants in the trial were randomised to either high volume (HV) or low volume (LV) irrigation and underwent standardised physiological investigations. Data from the first 10 months of data collection at the Durham site were used for the feasibility study. Data were collected according to a standardised outcomes framework. The primary outcome was reduction in PAC-QOL, measured at 3 months. Qualitative interviews using a phenomenological framework were undertaken to explore the nature of the participants’ lived experience of irrigation. Descriptive analysis of data enabled assessment of study feasibility. Results The meta-analysis of seven eligible studies reported a positive response to treatment rate of 50.4%. Trial recruitment nationally was slower than anticipated. However the recruitment rate at the Durham site met the target for individual sites. A total of 19 participants were recruited at Durham, of whom 11 reached the primary outcome visit (3 months). The overall reduction in mean PAC-QOL at three months was 0.39 (SD 0.44), with a difference between groups of 0.04. Some outcome data were incompletely recorded. Of the 19 participants, 5 (29%) discontinued treatment, after a mean time of 51 days (SD 35.2). Qualitative interviews (n=5 at 3 months, n=3 at 6 months) identified important themes regarding participants’ experiences of irrigation training and home use. Discussion Collaboration between participating sites, combined with protocol amendments, has allowed measures to be taken to improve recruitment and recording of outcomes. This study demonstrates that the proposed methodology is feasible and acceptable to a majority of patients. The qualitative study provided a broader context to the quantitative study findings.
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Harris, Leanne. "Examining the feasibility of a full-scale trial of the TAKE 5 weight management intervention for adults with intellectual disabilities." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/8197/.
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Background: Adults with intellectual disabilities experience equivalent or higher rates of obesity in comparison to the general population. This increases the risk for health conditions associated with adverse weight gain including cardiovascular disease and type II diabetes. Clinical guidelines on the management of obesity recommend multi-component interventions which include an energy deficit diet (EDD) of 600 kcal per day, support to increase physical activity and key behaviour change techniques including goal setting and self-monitoring to facilitate these healthy lifestyle changes. However, the current evidence base and provision of health services on the management of obesity in adults with intellectual disabilities is limited. A systematic review of multi-component weight management interventions was conducted and identified only seven randomised controlled trials of weight management interventions in adults with intellectual disabilities and obesity. The intervention components primarily focussed on a health education approach including diet, physical activity, and behaviour change techniques. However, no intervention adhered to clinical recommendations in terms of including an EDD, a weight maintenance intervention or investigating the long term efficacy of the intervention at 12 months. Meta-analyses revealed that post intervention (Weighted mean difference; WMD: -0.92kg; 95% CI -2.11kg, 0.28kg; p = 0.13) and at 12 months (WMD: -1.15 kg (95% CI -4.15 kg to 1.86 kg; p = 0.45), current multi-component weight management interventions are not more effective than no treatment. The results of this review illustrate that the current evidence base is insufficient to support multi-component weight management interventions focussed on a health education approach and therefore, future studies should investigate the efficacy of an alternative approach and the inclusion of an EDD to examine the efficacy of this approach to the management of obesity in adults with intellectual disabilities. Methods: The primary aim of this thesis was to add to the limited evidence base on multi-component weight management interventions in adults with intellectual disabilities by examining the feasibility of conducting a full-scale trial of a multi-component intervention, TAKE 5. TAKE 5 adheres to clinical recommendations on weight management and was specifically designed for adults with intellectual disabilities, and where applicable implemented with support from carers. The study design was a single blind cluster randomised controlled trial comparing two active interventions. The comparator intervention, WWToo, was based on a health education approach and consisted of multiple components focussed on diet, physical activity and behaviour change techniques. A multi-point recruitment strategy was piloted. Participants were recruited from multiple organisations, from specialist intellectual disabilities services, provider organisations and local day centres. Additional feasibility outcomes included retention rates and the fidelity and implementation of the intervention. The primary efficacy outcome was change in body weight at 12 months. Additional secondary outcomes included anthropometric outcomes (BMI, waist circumference, percentage body fat), objective measure of physical activity (time spent in light, moderate to vigorous intensity and total physical activity) and sedentary behaviour and health related quality of life. Results: The multi-point recruitment strategy was shown to be feasible and 50 participants were successfully recruited to the study. This study design was shown to be acceptable to adults with intellectual disabilities as retention to both interventions was high with 90% of participants completing the intervention. The TAKE 5 multi-component weight management intervention with support from carers led to significant reductions in weight, BMI, waist circumference and percentage body fat at six and 12 months. Furthermore, 50% of the participants in the TAKE 5 intervention achieved a clinically significant weight loss of 5% or greater of initial body weight in comparison to 21% of the participants in the WWToo intervention. Significant improvements in the above outcomes were not found in participants completing the WWToo intervention. A limitation of both interventions was the inability to engage participants in physical activity, reduce the sedentary lifestyle behaviours and improve health related quality of life of this population group. Both interventions were implemented as intended, and both interventions were shown to be feasible and accessible to all adults with varying levels in intellectual disabilities due to the social support provided by carers in implementing the interventions. Conclusion: This study is the first ever randomised controlled trial of a weight management intervention that adheres to clinical recommendations in adults with intellectual disabilities. This study provided evidence on the feasibility of this study design in adults with intellectual disabilities and demonstrated the acceptability of the EDD approach tailored to meet the needs of adults with intellectual disabilities. Furthermore, this study has provided preliminary evidence that an EDD may be an efficacious approach to weight management, and provided further evidence that current service provision based on health education approach is ineffective in the treatment of obesity in adults with intellectual disabilities. On the basis of these findings a future full-scale randomised controlled trial is necessary to confirm these findings and provide evidence on the optimum approach to weight management in this population group.
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Casper, Domonique Renee. "Predicting reasons for living among chronically ill and depressed middle aged and older adults enrolled in a randomized clinical trial." Diss., University of Iowa, 2015. https://ir.uiowa.edu/etd/1957.
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The American older adult population is rapidly growing and projected to double by 2030. There is high proportion of completed suicides in later life subsequent to several biopsychosocial variables. Medical populations, particularly Chronic Obstructive Pulmonary Disease (COPD) and Heart Failure (HF), have greater risk of depression, suicidality, and lower quality of life. Current geropsychology suicide research tends to focus on risk factors, a deficit approach. In contrast, the present study utilized a strength-based approach to study late life suicide by predicting life sustaining cognitions, reasons for living (RFL). This study explored the influence of physical health related quality of life (HRQOL) and depression on RFL in a sample of 75 depressed and chronically ill middle aged and older adults enrolled in a randomized clinical trial. The results indicate insignificant relationships between demographic variables (e.g. age, gender, and illness type) and reasons for living. Despite the statistically significant negative correlations between depression and physical and mental HRQOL at baseline and week five, only week five depression significantly predicted RFL (Β = -1.369, ΔR2 = .063, p= .034), after the effects of age and baseline depression were held constant. In conclusion, the present study supports integrative primary care modalities of treatment for late life depression and highlights the importance of incorporating protective factors in suicide risk assessments. Future research should consider utilizing population specific instruments and alternative medical and social variables.
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Milazi, Molly. "A bundled phosphate control intervention (4Ds) for adults with end stage kidney disease receiving haemodialysis: A cluster randomised controlled trial." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/198173/2/Molly_Milazi_Thesis.pdf.
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Hyperphosphataemia occurs in end-stage kidney disease and is managed by diet, drinks, drugs, and dialysis. Adherence to the 4Ds is challenging for patients. This thesis reports a pragmatic randomised controlled trial that evaluated the effectiveness of an innovative educational intervention "Taking control of your phosphate with the 4Ds" to improve adherence to phosphate control in adults receiving haemodialysis. The 4Ds, a bundled self-management intervention, was effective in improving patient's confidence about phosphate control methods. Importantly, the intervention was brief and feasible for nurses to deliver during haemodialysis treatment.
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Hayns, Alexandra Louise. "Mechanisms of mindfulness and the treatment of social anxiety: A randomized controlled trial of brief mindfulness training for socially anxious adults." Thesis, University of Auckland, 2011. http://hdl.handle.net/2292/8613.
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Carroll, Sarah. "A randomised controlled trial investigating the influences of food form and energy density on appetite, satiation and satiety in healthy adults." Thesis, Queen Margaret University, 2014. https://eresearch.qmu.ac.uk/handle/20.500.12289/7373.
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Background: Texture and energy density are two physical properties of foods known to impact on eating behaviour. For those with mastication and/or deglutition disorders; diets which have their texture altered are prescribed. Further these texture modified diets may be energy enriched in an effort to optimise the opportunity for individuals prescribed them to meet their required energy intakes. However there is insufficient evidence supporting this strategy. No well controlled studies have been conducted evaluating these alterations (made in line with clinical guidelines), which specifically investigates their impact on eating behaviour. As such despite their intention to facilitate food and energy intakes it is unknown if these diets are in fact fit for purpose. Objective: To investigate the effect of texture modification, and/or energy enrichment of a standard meal developed to meet current recommendations for meal provision in hospitals on appetite parameters and food and energy intakes at a single eating occasion, in healthy adults. Design: A single blind, randomised crossover within-subjects design, where on four occasions 33 healthy adults consumed a test meal at lunch until satiation (i.e. meal termination) was reached whilst rating their appetite parameters. The meal had its texture and/or energy density altered to compare the effects of food form and energy density on appetite and satiation. The quantity of meal consumed was calculated using a plate wastage method. Subsequent intakes were recorded in a food diary to determine the effect of the treatments on satiety and identify any evidence of energy compensation. Food (g) and energy intakes (kcal) consumed during the feeding session were analysed using repeated measures ANOVA. Results: Test meal energy intakes (kcal) were significantly higher with energy enrichment of both meals (standard texture (ST); 315 kcal and texture modified (TM); 303 kcal (p=0.001)). Area under the curve (AUC) did not differ between meals for hunger, fullness, or desire to eat however palatability was significantly reduced with texture modification. Regardless of the composition and quantity consumed at the test meal, post-meal energy and macronutrient intakes remained the same across all days. Evidence of partial energy compensation was revealed (15 % (ST) and 22% (TM)) thus energy intakes remained higher over the day for both (260 kcal and 225 kcal respectively) (p<0.05). Conclusions: Enriching a meal, suitable for provision in a hospital setting results in significantly greater energy content without impacting on rated palatability. In a well-controlled, healthy sample, this enriched meal was sufficient to increase energy intakes (kcal) at an individual eating occasion for both ST and TM meals without affecting absolute food intake (g) or appetite responses (between meals) at the testing session. Incomplete subsequent energy compensation resulted in daily energy intakes remaining significantly higher with consumption of the enriched meals. Thus energy enrichment at a single meal, appropriate for provision for patients requiring a “Texture C” diet appears to be a suitable method to optimise short term energy intakes, in a healthy sample not confounded by disease state. Further investigation into enrichment of these meals in a clinical setting is justified.
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Brizolla, Thiago Fernandes 1981. "Variabilidade genética de progênies de polinização aberta de Eucalyptus Grandis Hill ex Maiden e correlações entre caracteres juvenil-adulto /." Botucatu : [s.n.], 2009. http://hdl.handle.net/11449/99746.
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Resumo: A espécie Eucalyptus grandis Hill ex Maiden é a mais cultivada em estandes comerciais no Brasil e no mundo. A espécie é plantada como cultivar e também na forma de plantios clonais de seus híbridos interespecíficos. O trabalho é um estudo da variabilidade genética em progênies de polinização livre de Eucalyptus grandis de árvores selecionadas fenotipicamente em pomar de sementes por muda, cuja procedência é originária de Coff's Harbour - Austrália. Este pomar, de propriedade da empresa Duratex S.A. encontra-se na Fazenda Morro D'Ouro, no Município de Botucatu. Tem também como objetivo analisar as correlações entre os diferentes caracteres nas diferentes idades e estudar as correlações entre as idades juvenis e de final de rotação da cultura, visando subsidiar a seleção precoce em programas de melhoramento com espécie. Os ensaios foram instalados em três experimentos em cada um dos dois locais, Angatuba-SP e Lençóis Paulista-SP, em fevereiro de 1988. O delineamento experimental utilizado foi o blocos casualizados, com 10 repetições, 6 plantas por parcela, ao espaçamento de 3 x 2 metros e totalizando 75 progênies. Os caracteres avaliados foram o diâmetro a altura do peito (DAP); altura de planta e volume de madeira. As avaliações foram feitas em quatro anos consecutivos (02, 03, 04 e 05 anos) em Lençóis Paulista (local 2), sendo que em Angatuba (local 1) foram realizadas avaliações anuais do segundo ao sexto ano. Os resultados mostraram haver variabilidade genética suficiente para avançar as gerações de melhoramento com a espécie... (Resumo completo, clicar acesso eletrônico abaixo)Abstract: The species Eucalyptus grandis Hill ex Maiden is the most commonly cultivated in commercial stands in Brazil and throughout the world. The species is planted as a cultivar, by seed, e also by clonal plantings of its interspecific hybrids. The research is a study of genetic variability in open pollinated progenies of Eucalyptus grandis of phenotipically selected trees in Seedling Seed Orchard of Coff's Harbour - Australia provenance. The orchard is of Duratex S.A. company located in Morro D'Ouro Experimental Station, in Botucatu city, S.P., Brazil. The study also have as objective to analyze the correlations between different traits in different ages and to study the correlations between juvenile and final of culture rotation, aiming to get support for procedures of early selection in forest tree breeding programs of Eucalyptus grandis. The experiments were set up by three trails in each one of two localities, Angatuba and Lençois Paulista, both in São Paulo State, Brazil, in February of 1988. The experimental design was the randomized blocks, with 10 replications, 06 plants per plot, 3 x 2 spacing, and totalizing 75 progenies. The diameter of breast height (dbh), plant height, and wood volume were the studied traits. The evaluations were made through the consecutive years (02, 03, 04, and 05 years old) in Lençois Paulista (Locality 2), and in Angatuba (Locality 1) were made annual evaluations from de second to the sixth years old. The results have shown sufficient genetic variability to advance breeding generations of species... (Complete abstract click electronic access below)
Orientador: Edson Seizo Mori
Coorientador: Léo Zimback
Banca: Maurício Dutra Zanotto
Banca: Edwin Camacho Palomino
Mestre
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Wiberg, Bernice. "Risk factors for stroke in adult men a population-based study /." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-120542.
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Koech, Joyce. "Nutrition counseling in adults infected with the Human Immunodeficiency Virus : a systematic review of randomised controlled trials." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/9334.
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Includes bibliographical references (leaves 17-20).[Background] HIV-infected individuals may be at nutritional risk at any point in the course of their illness. Nutrition counselling has been found to be an important intervention for maintaining and improving nutritional status in HIV infection. The evidence for the magnitude of benefit has not previously been systematically reviewed. [Objectives] To assess the effectiveness of nutritional counselling in improving dietary intake and nutritional status in HIV-infected adults. [Methods] Eligible studies were identified from comprehensive searches of electronic databases and conference proceedings for all randomised controlled trials (RCTs) of nutrition counselling compared with either no nutrition counselling, oral supplements, or with nutrition counselling plus oral supplements. Two reviewers independently assessed the eligibility of the studies and their methodological quality, and extracted data on participants, interventions and outcomes. A meta-analysis of data on nutritional status and dietary intake was performed. Results Three studies with a total of 238 participants were included in the review. All three studies compared nutrition counselling with nutrition counselling plus oral supplements. Data were available from all three studies for changes from baseline in weight, lean body mass and body fat. ln one study the changes in both groups were significant, but the differences between groups did not reach statistical significance. Energy intake data were available from 2 studies, and both showed a significant increase from baseline in both groups.
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Plummer-D'Amato, Prudence, Anastasia Kyvelidou, Dagmar Sternad, Bijan Najafi, Raymond Villalobos, and David Zurakowski. "Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial." BioMed Central, 2012. http://hdl.handle.net/10150/610064.
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BACKGROUND:Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously. After stroke, individuals demonstrate a diminished ability to perform dual-tasks. Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke, which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors. The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke. Specifically, we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed (Aim 1), locomotor control during obstacle negotiation (Aim 2), and spontaneous physical activity (Aim 3).METHODS/DESIGN:This single-blind randomized controlled trial will involve 44 individuals within 12 months of stroke. Following baseline evaluation, participants will be randomly allocated to single- or dual-task gait training. Both groups will receive 12, 30-minute sessions provided one-on-one over 4-6 weeks in an outpatient therapy setting. Single-task gait training involves practice of gait activities incorporating motor relearning principles. Dual-task gait training involves an identical gait training protocolthe critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75% of the repetitions. Blinded assessors will measure outcomes at baseline, post-intervention, and 6 months after completion of the intervention. The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking. Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds, gait parameters during high and low obstacle crossing, spontaneous physical activity, executive function, lower extremity motor function, Timed Up and Go, balance self-efficacy, number of falls, and stroke-related disability. Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design.DISCUSSION:This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke.TRIAL REGISTRATION:ClinicalTrials.gov NCT01568957
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Biermann, Jeanette S. "Improving Cognition in Normally Aging Older Adults: A Randomized Controlled Trial of Mindfulness Meditation (Samatha) as a Treatment for Attentional Inhibitory Deficits." University of Akron / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=akron1310147941.
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Lovejoy, Travis I. "Telephone-Administered Motivational Interviewing Reduces Risky Sexual Behavior in HIV-Positive Late Middle-Age and Older Adults: A Pilot Randomized Controlled Trial." Ohio University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1312573034.
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