This thesis explores chronicity amongst a small group of migrants living with HIV and other illnesses in London. It elucidates their engagements and experiences with self-care, particularly in light of tenuous citizenship. Drawing on field work in London from 2010-2011 with support groups for persons with HIV, largely made up of refugees and asylum seekers, I look at how social vulnerability and frustrations of claims to citizenship are crucial factors in creating conditions for doubt – reservations that centre less on living normally with chronic illness, than living and pursuing a life. I suggest chronicity encompasses varying and contested temporalities that place pressure on what the body is expected to achieve and endure. The thesis argues the task is not only to identify sources of injury and suffering, but to consider different manifestations of how people carry on living, and the ordinary ethical orientations emerging therein. It makes a number of interdisciplinary contributions to studies of chronic illness, chronicity, HIV, ordinary ethics, and migration. It brings together subjects of migration and HIV in novel ways. In drawing attention to the accidental converging of HIV, pharmaceuticals and migration, it highlights the unpredictable forms in which citizenship claims take shape, and go adrift. The thesis thus highlights how the basis for social entry, as well as exclusion, is deeply troubled. Being sick with HIV initiates one into systems of care offered by hospitals and charities, and further services for some, without resolving the legal and political-economic barriers to employment and self-sufficiency. For scholars and practitioners working within areas of community and public health, this study adds to research on both the continued importance and limitations of support groups for HIV and chronic illness management. This thesis illustrates how multifaceted support groups are, in the activities and conversation that unfold, and how this diversity is also a matter of recognising the diversity of individuals and collectives within them. It contributes to ethnographies of HIV in terms of chronic illness and chronicity by focusing less on the integration and presence of HIV into everyday routine, than its lapsing into a wider ethos of wellness and optimism, common hardships and distractions. In considering not only how individuals suffer but also how they endure, this work contributes to the emerging body of scholarship on ordinary ethics, and the extent to which the pursuit of good is stitched into both everyday and extraordinary events and negotiations.

This dissertation explores how language has evolved as metastatic breast cancer (MBC) has shifted from an imminent death sentence to a potentially chronic disease. War rhetoric, of which the survivor trope is a part, has been the primary mechanism by which healthcare defines the cancer experience. Using Celeste Condit's framework of rhetorical formations, I question if a new rhetoric of breast cancer is indeed emerging as new developments in medicine allow women with terminal disease to live longer. My data reveals that this new rhetorical formation, of which metavivor rhetoric is the anchor point, contains its own key metaphors and rhetorical appeals. In metavivor rhetoric, the focus becomes living with cancer, in which simply existing through a sense of homeostasis develops as the central part of the rhetoric. In this homeostasis as the key part of metavivor rhetoric, a cure is not the focus, as it is in survivor rhetoric. I explore how this emerging rhetoric supersedes the war rhetoric that is deeply entrenched in medical discourse--especially breast cancer--for decades, and how metavivor rhetoric builds upon and repudiates the war rhetoric. Through my qualitative rhetorical analysis of a popular breast cancer message board for patients with metastatic disease, I coded 589 posts to see how women use language to discuss living with MBC, and Condit's concept of rhetorical formations allows me to argue more specifically for the changes I see in patient discourse. My analysis revealed that women living with MBC argue against war/survivor rhetoric and prefer metavivor rhetoric and its ancillary terms, allowing them to transition to an acceptance of their own mortality. I conclude that a new rhetorical formation has taken shape within MBC patient discourse, with implications for women's mortality as they live with a chronic disease, and as I look to the future of this research, my goal is to promote rhetorical changes that will help to enfranchise women with MBC into the broader breast cancer discourse in the United States. / Doctor of Philosophy / Metastatic breast cancer has become a disease that some women can live with for many years, as treatments have advanced for this specific type of cancer. As this disease has become a chronic condition for many women, the language that women use to discuss living with chronic cancer has also shifted. Using the framework of Celeste Condit's rhetorical formations, which encompasses uses of metaphors, topics, and values, among other rhetorical features, I examine how language has shifted from one of war and survivor rhetoric to that of metavivor rhetoric. In metavivor rhetoric, the focus becomes living with cancer, through a sense of homeostasis and of simply existing with cancer. Within homeostasis as the key part of metavivor rhetoric, a cure is not the focus, as it is in survivor rhetoric. By examining how women talk about living with cancer on a popular online breast cancer support group, I analyze the shifts that take place in their language and argue that women have moved from the dominant war and survivor rhetorical formation to one that is grounded in metavivor rhetoric and the idea of homeostasis. Within this evolution comes a transition to their own mortality as they come to better understand what it means to live with a chronic, yet ultimately, terminal, illness and an acknowledgment of the impact that their lives' perceived time has on these language choices.

A Febre de Chikungunya é uma doença sistêmica causada por arbovírus e estima-se que afete cerca de 1 milhão de pessoas anualmente. Os principais sintomas associados com esta doença são febre e poliartralgia, podendo esta última assumir um caráter crônico em cerca de metade dos casos. Devido aos inúmeros surtos que ocorreram nos últimos 50 anos, diversos estudos tiveram como objetivo determinar os mecanismos de replicação do vírus e da resposta imune. Mesmo assim, pouco se sabe sobre quais moléculas possibilitam o processo de infecção. Já foi demonstrada a importância de interferons, principalmente de tipo I, citocinas e quimiocinas na diminuição da replicação viral. Além disso, há uma preferência do vírus por tipos celulares específicos como células endoteliais e epiteliais. Porém, estudos mostram informações contraditórias referentes ao papel de células mononucleares do sangue periférico (PBMC), principalmente com relação a monócitos e células B e T. Diante deste contexto, o tratamento utilizado atualmente é direcionado apenas ao alívio de sintomas uma vez que não existem drogas ou vacinas licenciadas específicas para esta doença. Logo, o objetivo deste trabalho é estudar as modificações transcricionais que ocorrem em amostras humanas durante o processo de infecção pelo vírus de Chikungunya de modo a esclarecer os mecanismos utilizados pelo sistema imune em resposta a infecção. Além disso, este estudo tem como finalidade apontar possíveis diferenças transcricionais entre amostras crônicas e não-crônicas. / The Chikungunya Fever is a systemic disease transmitted by arboviruses and is estimated to affect 1 million people annually. The main symptoms associated with this disease are fever and polyarthralgia, which can develop to chronic features in about half of the cases. Due to outbreaks that occurred in the last 50 years, many studies had the goal of determining the mechanisms of virus replication and immune response. Nevertheless, it is still poorly understood which molecules enable the ocurrence of the infection process. It has already been shown the importance of interferons, mainly type I, cytokines and chemokines in restricting the viral replication. In addition, the Chikungunya virus shows a preference for specific cell types such as endothelial and epithelial cells. However, studies display contradictory information regarding the role of peripheral blood mononuclear cells (PBMC), mainly in relation to monocytes and B and T cells. Given this context, the treatment currently used is directed only to alleviate the symptoms since there are no specific licensed drugs or vaccines for this disease. Therefore, the objective of this work was to study the transcriptional modifications that occur in humans during the process of Chikungunya virus infection in order to clarify the mechanisms used by the immune system. In addition, it aims to point out possible transcriptional differences between sample from the Chronic and Non-Chronic acute phase of the infection.

Background: There is need for judicious use of immunosuppression in patients with active lupus nephritis (LN), however this is guided by renal biopsy which is invasive and not freely available in most centres. Novel urinary biomarkers such as monocyte chemoattractant protein-1 (MCP-1) and tumour necrosis factor-like weak inducer of apoptosis (TWEAK) are secreted in the kidney and may be useful for predicting histological class, monitoring flares and assessing response to therapy. We assessed the utility of urinary MCP-1 (uMCP-1) and TWEAK (uTWEAK) in predicting renal histological findings, disease flares and treatment response 6 months following initiation of treatment for LN in newly biopsied patients. Methods: We recruited consenting patients with active LN confirmed on kidney biopsy. Relevant baseline demographic, biochemical and histological information was collected from the patients. ELISA methods were used to assess uMCP-1 and uTWEAK at baseline and at 6 months after completion of induction therapy. Results: There were 14 females and 6 male patients with a mean age of 29.8 ± 10.7 years, 60% were of mixed ancestry, 70% had proliferative LN. There was no association between uMCP-1 and uTWEAK and histological features (LN class, activity index, chronicity index and interstitial fibrosis). At 6 months, 6 patients were lost to follow-up and of the remaining 14, 12 (85%) attained remission (partial remission (n = 7) or complete remission (n = 5)). Both biomarkers were elevated in patients with active disease and significantly declined amongst those attaining remission, p = 0.018 and p = 0.015 respectively. However, for those not attaining remission, no association was found for both biomarkers (p >0.05). Conclusion: Our study did not show correlation between uMCP-1 and uTWEAK with histological features of LN. However, both biomarkers were elevated in patients with active disease and correlated with the remission status at the end of induction phase of treatment.

The diploma thesis deals with anorexia nervosa as one of the basic forms of eating disorders, with emphasis on the very common chronic progression of this serious psychiatric illness. This thesis is based on the scientific fact, that conspicuous eating habits, constant control of thinking and behavior, as well as self-perception disorders, are observed in most cases, even in already cured patients. Long-term stress in common with a prone personality, can result in the acute phase of anorexia nervosa. The diploma thesis is qualitatively focused. The chosen methods of data collection are a questionnaire survey and a following semi-structured interview. The condition for participation in the research is the past experience with anorexia nervosa, without the current presence of the acute phase of this disease. The main goal of the diploma thesis is to map the burning issues of individuals who have gone through the acute phase of anorexia nervosa in the past, their current feelings and needs. The output of the diploma thesis are the specific recommendations, coming from the results of research survey, which would help to reduce the probability of relapse of the acute phase of mental anorexia in stressful situations. KEYWORDS Anorexia nervosa, eating disorders, chronicity, relapse prevention, addictive...

Low back pain (LBP) is regarded as a major health and economic problem in western industrialised countries even at this time in the twenty-first century. Researchers estimate that it has increased to affect about 45% of the population in 2011. This increase creates a major burden on the health care services, social structures and the economy in terms of absenteeism from work. CNSLBP is still poorly understood. Main reasons for the poor understanding of CNSLBP discussed in this study are the limited understanding of the effect of the spine as kinetic chain which includes the head and pelvic girdle and with its attachments to the scapulae . The process of development of ISMS dysfunction are discussed as a combination of abnormal spinal loading, soft and neural tissue plasticity that result in biomechanical malalignment, adaptive and maladaptive movement patterns, pain processing integrated with psychosocial factors that influence the biomechanical, pain processing and psychological responses are discussed as possible mechanisms in the development of CNSLBP. The researcher developed a multidimensional manual therapy model to manage patients with CNSLBP based on metacognitive reflection on her clinical reasoning over a period of 40 years as the research methodology. The metacognitive reflection has been performed within the interpretive paradigm The model that resulted from the metacognitive reflection is dialectic in nature because it entails the understanding of the patient‘s problem from an interpretive as well as from an empirico-analytical perspective. The model is conceptualised in three stages: Firstly the conceptualisation of the integrated spinal movement system (ISMS), to indicate that the spine, head, shoulder and pelvic girdles function as a closed kinematic chain. Secondly the process of the development of ISMS dysfunction as a major concept in the clinical picture of patients with CNSLBP is based on functional anatomy of the ISMS and the researcher‘s clinical observation in clinical practice. The researcher indicates how the development of ISMS dysfunction and characteristic adaptive behaviour are integrated components of the patient‘s complex heterogenic clinical picture. The underlying process for the development of ISMS dysfunction as a possible mechanism for CNSLBP is described as plasticity of soft and neural tissues (including the brain) which result in chronicity over time. Thirdly a multidimensional manual therapy model to manage patients with CNSLBP‘s heterogenic condition is discussed. The model indicates how the mechanisms underlying the development of ISMS dysfunction is addressed in a multidimensional approach to patient management. Finally the multidimensional manual therapy model is discussed in relation to other relevant intervention approaches. The model finally serves as a point of departure for planning and conducting appropriate research in basic and clinical sciences. The multidimensional manual therapy model for the management of patients with CNSLBP has been developed in clinical practice and is presented as a practicetheory in the form of a model. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Physiotherapy / Unrestricted

La négligence spatiale unilatérale (NSU) est une affection neurologique fréquemment observée après une lésion de l'hémisphère cérébral droit. Les patients ne vont plus être en mesure de prendre en compte les stimuli présentés dans l'hémi-espace gauche. La NSU participe à l'aggravation du handicap des patients, par la réduction des possibilités en rééducation motrice et cognitive à la phase aigue d'un accident vasculaire comme sur le long terme. L'identification des facteurs prédictifs de sa chronicité pourrait permettre une meilleure prise en charge clinique de ces patients. Nous avons étudié les altérations des connexions anatomiques observées en IRM de diffusion sous-tendant la persistance de la NSU. Nos résultats démontrent qu'en plus d'un dysfonctionnement fronto-pariétal hémisphérique droit, la persistance de ce syndrome serait associée à une déconnexion interhémisphérique. L'hémisphère gauche isolé ne serait pas en mesure de compenser les déficits des patients. La récupération devrait s'effectuer par une amélioration dans les capacités d'échange des informations entre les deux hémisphères, notamment dans les régions postérieures pariétales et occipitales. Nous nous sommes intéressés à tester cette hypothèse par le biais d'une méthode de rééducation, l'adaptation prismatique (AP). Il s'agit d'une thérapie dont les effets sur la sémiologie des patients sont remarquables. Nos résultats suggèrent que l'amélioration de la NSU pourrait s'observer par le recrutement du réseau fronto-ponto-cérébelleux. Les régions frontales gauches seraient un relais anatomique entre le cervelet droit et le réseau fronto-pariétal gauche / Unilateral spatial neglect is a frequent neurological condition after right hemisphere damage. Patients behave as if objects on their left did not exist anymore. The presence of neglect has negative prognostic value for functional recovery in the acute and chronic phases after a stroke. Finding predictors of persistent neglect would permit to adapt rehabilitation procedures. We used diffusion MRI to define the state of anatomical connections in neglect and their predictor value for neglect persistence. Our results revealed that, together with right intra-hemispheric fronto-parietal disconnections, persistence of neglect is associated with inter-hemispheric disconnection. We concluded that an isolated left hemisphere may fail to compensate neglect because it cannot take into account left-sided objects. Recovery of neglect would instead occur thanks to the sharing of visual information between the two hemispheres, notably in posterior parietal and occipital cortices. We tested this hypothesis by using prism adaptation (PA) therapy. PA is a non-invasive and convenient technique to rehabilitate neglect. We showed that patients with damaged fronto-ponto-cerebellar pathways did not benefit from PA. This finding strongly suggests that PA can ameliorate signs of neglect by improving inter-hemispheric communication through enhanced activity of these connections. Left frontal areas may constitute the anatomical link between the right cerebellum and the left fronto-parietal network. Thus, connectional anatomy can help predict both neglect recovery and the quality of its response to rehabilitation therapies

No description available.

In order to obtain a closer look into the psychosocial impact of chronic conditions, symptom severity, loss of resources, and demoralization were investigated through a mediation analysis. The function and implication of social support was also explored within the circumstances of chronic conditions. Lastly, symptom chronicity was probed as an influential element in the understanding of the consequences of being chronically ill. Participants were 200 men and women, with a mean age of 46 years, and the dataset came from the VOICE (Verification of Illness and Coping Experience) survey. The concepts of Conservation of Resources (COR) theory and Demoralization Syndrome were utilized to portray the underlying processes experienced by individuals with chronic condition. Analyses between symptom severity and demoralization via loss of resources as the mediator were statistically significant. Symptom chronicity did not interact with symptom severity on predicting loss of resources, but analyses showed that individuals with less symptom chronicity reported both larger loss of resources and demoralization. Social support was confirmed as a moderator, buffering the effects of symptom severity on loss of resources. Exploratory analyses with the inclusion of both symptom severity and chronicity as the predictor variable and the use of age as a moderating factor at the prediction of loss of resources was statistically significant, showing that when symptoms were more severe and chronic, younger participants experienced more losses than older participants. Additionally, when age was included as a moderator of the effect of symptom chronicity and severity on the prediction of social support, it was indicated that when symptoms were less chronic and severe, the average perception of social support was higher among younger participants, but, on the other hand, when symptoms were more chronic and severe, younger participants suffered an abysmal drop in their social support perception. In light of the aforementioned results, risk, protective, and developmental aspects are discussed, along with implications for health care providers.

Made available in DSpace on 2014-12-17T15:38:49Z (GMT). No. of bitstreams: 1 CintiaGB_DISSERT.pdf: 782539 bytes, checksum: 1cd1039b2eef4544b15926fdef7c22d3 (MD5) Previous issue date: 2010-10-07 / The existence of chronic inhabitants in the psychiatric hospitals imposes a challenge to the Psychiatric Reform, that proposes things such as the gradual and progressive way to extinct mental institutions, once the permanence of the hospital in the system is only necessary because there is not a net of well structured substitute services capable of receiving that demand. This work considered relevant to deepen the knowledge about those people who passes their lives jailed by the walls of psychiatric hospitals and compose significant part of the world population. It also aimed to investigate the problem relative to the condition of being an inhabitant of a psychiatric hospital the Dr. Jo?o Machado Hospital (HJM), in the city of Natal/RN. The paper used different points of view (patients , families and professionals ) to define the profile of the inhabitants, to identify the possibility of insertion in substituting social equipment, to know the expectations of the inhabitants and their relatives regarding to the exit of the life shelter, to investigate the demands related to the net of cares social support for making feasible the discharge and to identify the difficulties that are involved in the exit of the chronic inhabitant of the hospital. There were defined three methodological phases: delineation of the identification, socio-economic and clinical profile of the inhabitants of the HJM; semi-structured interviews with professionals; and open interviews with inhabitants and family. It concluded that the psychiatric institutionalization contributes to the generation of chronic inhabitants in the psychiatric hospitals. Among the professionals, it was detached the defense of desospitalization, but an existence of devices of the asylum model. The relatives showed a resistance to participate in the care and the inhabitants exposed their desire to leave the hospital, as well like the wish of permanence. It was considered important: the construction of an extra-hospital net that enables to desinstitutionalization; the qualification of the technical; orientation to the family, stimulating its participation in the process of caring; give freedom to the individuals in mental suffering, enabling them to be ahead of their lives and express their desires and opinions; the implementation of an extended clinic that is capable of building new possibilities; and a subjectivity guided by the social enclosure / A exist?ncia de moradores cr?nicos nos hospitais psiqui?tricos imp?e um desafio ? desinstitucionaliza??o proposta pela Reforma Psiqui?trica, na medida em que o hospital se coloca como ?nica alternativa assistencial, enquanto n?o h? uma rede de servi?os substitutivos suficiente para acolher essa demanda. Considerou-se relevante aprofundar o conhecimento acerca desses sujeitos que passam suas vidas isoladas pelos muros de hospitais psiqui?tricos e comp?em parcela significativa da popula??o mundial. Objetivou-se investigar a problem?tica relativa ? condi??o de ser morador de um hospital psiqui?trico Hospital Dr. Jo?o Machado (HJM), na cidade de Natal/RN por parte dos t?cnicos, dos familiares e dos moradores, com vistas a: definir o perfil destes; identificar a possibilidade de inser??o em equipamentos sociais substitutivos; conhecer as expectativas dos moradores e familiares em rela??o ? desinstitucionaliza??o; investigar as demandas de cuidados e suporte social para viabiliz?-la e identificar as dificuldades envolvidas nesse processo. Realizaram-se tr?s etapas metodol?gicas: delineamento do perfil identificat?rio, s?cio-econ?mico e cl?nico dos moradores do HJM; entrevistas semi-estruturadas com t?cnicos do HJM e entrevistas abertas com moradores e familiares. Constatou-se que a institucionaliza??o psiqui?trica contribui para a gera??o de moradores cr?nicos nos hospitais psiqui?tricos. Entre os t?cnicos, destacou-se a defesa pela desospitaliza??o, mas tamb?m a exist?ncia de discursos institucionalizantes. Os familiares expuseram uma recusa ? participa??o no cuidado e os moradores evidenciaram a vontade de sair do hospital, bem como o desejo de perman?ncia. Verificou-se a import?ncia: da constru??o de uma rede extra-hospitalar que possibilite a desinstitucionaliza??o; da capacita??o da equipe t?cnica em rela??o ao exerc?cio de pr?ticas desinstitucionalizantes; da orienta??o ? fam?lia, estimulando a participa??o desta no cuidado; de possibilitar a apropria??o de suas vidas pelos sujeitos em sofrimento mental e a express?o de seus desejos e opini?es e da efetiva??o de uma cl?nica ampliada instauradora de uma subjetividade pautada na inclus?o social