No description available.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23469号 / 医博第4776号 / 新制||医||1053(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 溝脇 尚志, 教授 武藤 学, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

There is documented evidence of high genetic diversity amongst African populations, but there is limited data on human leukocyte antigen (HLA) diversity in these populations. HLA genes are highly polymorphic, and encode for proteins that are part of the host defence mechanism mediated through antigen presentation to immune system effector cells. The highly polymorphic nature of HLA genes facilitates the presentation of a wide range of antigenic peptides to the immune system leading to an immune response. With the high disease burden in Africa, it is important to fully understand HLA diversity in these populations, to establish HLA-disease associations, and potentially use this data for the informed design of population-specific vaccines against the many diseases, and to improve on donor-recipient matching. The aim of this thesis is to understand HLA diversity in South African populations to support transplantation programs, add knowledge on human diversity and build a potential future resource for disease association and population studies. There is generally limited HLA data from southern African populations (Chapter 2) to support disease association studies, provide guidance in vaccine design and donor recruitment for transplantation programs. Despite being the only active bone marrow donor registry in Africa supporting transplantation programs, HLA diversity in volunteer bone marrow donors registered at the South African Bone Marrow Registry (SABMR) is largely undocumented. This study documents HLA -A, -B, -C, -DRB1 and -DQB1 allele and haplotype frequencies from a subset of 237 SABMR registered donors with the objective of highlighting HLA diversity in South Africans (Chapter 3). Additionally, mixed resolution HLA data from the National Health Laboratory Services (NHLS) and the South African National Blood Transfusion Service (SANBS) are reported (Chapter 4). A comparison of South African HLA data (NHLS and SANBS) with other global populations including sub Saharan Africans confirm the genetic diversity of South Africans. To counter the paucity of HLA data, in silico HLA imputation tools may be used to determine HLA alleles from existing whole genome sequencing (WGS) data. HLA imputation is an economically feasible typing option for resource limited settings. To support the feasibility of HLA imputation, this study describes high resolution (up to 8 digit typing) HLA alleles determined by in silico HLA imputation tools from 24 WGS of South African individuals (chapter 5). Generally, HLA diversity of South African populations is described in detail through literature meta-analysis, documentation of previously typed individuals (SANBS, NHLS and SABMR) and HLA imputation from existing next generation sequencing (NGS) data. Although results reported here are from a small subset of 237 SABMR registered donors (chapter 3), 24 WGS (chapter 5) and mixed resolution typing NHLS and SANBS data (chapter 4), allele and haplotype frequencies generated could be a useful resource for future anthropological and population genetics studies. Furthermore, these findings may better inform donor recruitment strategies for the SABMR, and disease association studies. Future study recommendations include development of an HLA diversity resource for African populations, a comparison of large SABMR dataset with other global registries, and using more robust assembly based computational tools to fully understand the HLA diversity in South Africans. / Thesis (PhD)--University of Pretoria, 2018. / South African Medical Research Council (SAMRC) in terms of the MRC’s Flagships Awards Project (SAMRC-RFA-UFSP-01-2013/STEM CELLS), the SAMRC Extramural Unit for stem cell Research and Therapy, the Institute for Cellular and Molecular Medicine of the University of Pretoria, and the National Research Foundation of South Africa. / Immunology / PhD Medical Immunology / Unrestricted

This diploma thesis deals with the analysis and description of high power laboratory CVVOZE. In the text we can find a description of the individual elements high power laboratory stating their parameters and their analysis from the perspective of impedance. The practical concern of this work is the creation of program for calculating the adjustment burdens and creating utilities helpful for operation and interpretation of laboratory function laity and technical employees.

Purpose: The aim of the first part of this work was to evaluate the trend of the number of head CT examinations in patients with minor head injury in emergency service and to find out whether it has objective causes. The aim of the second part was to assess patients' knowledge regarding the CT examination, its risks, the source of their information and to evaluate the effect of providing information about the CT examination in a printed form. Method: In the first part of the work, we extracted data from the radiological module of the hospital information system. We searched for head CT scans in patients with minor head injury and their input characteristics and findings on CT. Further data were obtained from the hospital, the Institute of Health Information and Statistics and the Czech Statistical Office. Trends of regression curves were compared by F-test, correlation of trends was expressed using Spearman's coefficient. The second part of the work was based on a questionnaire for patients scheduled for CT scan of the body. The questionnaire included demographic data as well as items assessing patients' awareness of the risks of radiation exposure, intravenous contrast media, their sources of information and their fear of the examination. On the second page, Zung's Anxiety Scale was printed. On...

Background & aims: Several systematic reviews have demonstrated that caring for a child with functional limitations leads to poor caregiver mental health outcomes. For instance, depression, anxiety and caregiver burden are endemic in informal (unpaid) caregivers of children with cerebral palsy (CP), a common paediatric disability. However, caregivers who receive an adequate amount of social support are likely to better adjust to the caregiving role. Given the increasing move towards family-centred care and evidence-based care, there is a need to evaluate caregivers’ mental health and to develop and implement context-specific caregiver well-being programs. The valid measurement of the impact of these programs is dependent on the availability of psychometrically robust patient-reported outcomes (PROMs). Unfortunately, most available PROMs have been developed in high-income settings, and their applicability in low-resource settings such as Zimbabwe may be questionable. The present study thus aimed to develop a context-specific caregiver strain outcome, to adapt, translate, and validate a social support outcome measure and finally to profile the mental health of caregivers of children with CP residing in Zimbabwe. Methods: The Zimbabwean Caregiver Challenges Scale (ZCCS) was developed through the amalgamation of findings from a systematic review, caregivers’ interviews and two rounds of content validation by a panel of experts. A systematic review was then undertaken to appraise the psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS was then adapted, translated into Shona, a Zimbabwean native language, and validated. In the final phase, further validation of the ZCCS and the MSPSS was done, and structural equation modelling was used to profile the mental health profile of caregivers. Results: The ZCCS yielded four factors which were ; physical & economic burden, concerns for the child, family relations and community participation. The ZCCS was found to be a reliable tool as it yielded excellent Internal Consistency (IC) ratings at both sub-scale [α range: 0.765- 0.841] and scale level [α=0.925]. The Interclass Correlation (ICC) (95% CI) for ZCCS scores at baseline and after four weeks was 0.880 (0.793: 0.930), demonstrating the stability of the ZCCS. We replicated the original 3-factor structure of the MSPSS through factor analysis. Further, dichotomisation of scoring options and the deletion of one item resulted in a parsimonious solution as the 11-items solution met Rasch modelling requirements. The MSPSS-Shona version is reliable; it yielded excellent IC ratings at both sub-scale [α range: 0.833-0.892] and scale levels[α=0.8685]. The ICC rating (95% CI) for MSPSS scores at baseline and after four weeks was 0.980 (0.959: 0.990) demonstrating the stability of the MSPSS, and the person separation index (PSI) was 0.731. Both the ZCCS and MSPSS displayed construct validity; higher caregiver burden was associated with greater psychiatric morbidity and lower health related quality of life. Caregivers who received a higher amount of social support had the best mental health outcomes. Further, structural equation modelling provided evidence of the multidimensionality of the caregiver burden. Contextual factors, such as increased child age, increased caregiving duration, lower child functional capacity/more severe CP, and lower socioeconomic status were associated with poor mental health functioning. Conclusion: The thesis contributes to the body of knowledge by documenting the validation of caregivers' mental health outcomes and determination of mental health functioning of caregivers residing in low-resource settings. The ZCSS and MSPSS were both found to be valid and reliable measures within the context of Shona speaking rural and urban Zimbabweans. It is therefore suggested that both measures can be used with confidence in these contexts. Efforts should be made to integrate patient-reported outcome measures (PROMs) in routine clinical care and research and in developing and implementation of tailor-made caregiver wellness programs, within the validation contexts.

Bakgrund: Den psykiska ohälsan ökar bland befolkningen. När en person drabbas av psykisk ohälsa kan det komma att påverka hela familjen. Sjuksköterskor behöver få en ökad kunskap i närståendes upplevelser av att leva nära en person med psykisk ohälsa för att kunna möta den närståendes behov. Syfte: Belysa närståendes upplevelser av att leva nära en person med psykisk ohälsa. Metod: En litteraturöversikt med tio kvalitativa artiklar. Resultat: Av analysen framträdde fyra kategorier, att hamna utanför samhället, att inte få sätta sig själv i första rummet, att vilja ses som en resurs inom sjukvården och en känsla av tillhörighet. Konklusion: Examensarbetet belyser att det är många närstående till personer med psykisk ohälsa som upplever stigmatisering. Som sjuksköterska ska man bemöta varje patient och närstående med respekt och ett öppet sinne. Sjuksköterskor kan genom detta arbete få en ökad förståelse för hur närstående upplever hur det är att leva nära en person med psykisk ohälsa och därigenom ge ett bättre stöd till den närstående. / Background: Mental illness is increasing among the population. When a person suffers from mental illness, it can affect the whole family. Nurses need to gain an increased knowledge of relatives‘ experiences of living close to a person with mental illness to meet the needs of the relatives. Aim: Illuminate relatives‘ experiences of living close to a person with mental illness. Method: A literature overview with ten qualitative articles. Result: Of the analysis, four categories emerged, to end up outside society, not put oneself first, to want to be a resource in healthcare and to want to feel a sense of belonging. Conclusion: The study highlights that there are many relatives of people with mental illness who experience stigma. As a nurse, you must treat every patient and relative with respect and an open mind. Through this work, nurses can gain an increased understanding of how close relatives experience what it is like to live close to a person with mental illness and thereby provide better support to the close relative.

This diploma thesis analyzes the phenomenon of NATO burden-sharing. Due to late security crises in Europe, such as Crimea crisis, the never-ending alliance issue has been encased in new dynamics. This new dynamics supposedly threatens the long preserved status quo and can even lead to the breakup of the alliance. The thesis uses methodological framework prescribed by Lene Hansen. This framework draws heavily on work from David Campbell and his Writing Security. For the successful analysis, we first designate our inter-textual governmental field in which we then try to observe the repeating ideational/argumentative norms of the respective discursive actors in the alliance. We also divide our research field into two time units: the 1990s era and events after 9/11. Interpretation of the behaviour of certain members shows establishment of a several interconnected centres of argumentation, which somehow coincides with the three largest European members of NATO. The thesis also shows, that these argumentative actors tend to transform their argumentative structures along with the changing environment and context. For better understanding, the work encompasses the short-term, intensive burden-sharing situations, like NATO interventions, but also debates on long-term institutional solutions, which are mostly seen...

Caregiving, specifically caregiver burden, is commonly related to decreased psychological well-being. Conversely, marital quality is positively related to psychological well-being, though existing literature presents mixed findings as to whether or not a gender difference exists in this relationship. The current study examined the relationship between objective and subjective spousal caregiver burden and psychological distress with marital quality as a moderator. Gender differences in this relationship were also explored. 1,066 spousal caregivers from the National Study of Caregiving (NSOC) were used to estimate cross-sectional moderation models and plot significant interactions in Mplus. Results indicated a significant positive relationship between subjective caregiver burden and psychological distress, and higher marital quality protected against psychological distress in this relationship. The connection between objective caregiver burden and psychological distress was not significant, and no gender differences were found in the moderation of marital quality. These findings suggest that perceptions of caregiver burden are important for the psychological health of spousal caregivers, and higher marital quality may be an effective buffer of this relationship regardless of gender. Spousal caregivers who perceive caregiving to be highly burdensome may benefit from improving their marital quality to protect against negative psychological health outcomes.