Thesis (PhD)--Stellenbosch University, 2012. / Includes bibliography / ENGLISH ABSTRACT: Introduction: The increased prevalence of adolescent upper quadrant musculoskeletal pain (UQMP) is becoming a great concern to health professionals. The risk factors associated with adolescent UQMP are complex and multifactorial, including, among others sitting as a physical risk factor. However, no evidence exists to support sitting postural angles as a potential predictive factor for adolescent UQMP in computing high school students. Thus, the current project aimed to describe the three-dimensional (3D) sitting postural angles of computing South African high school students in a real-life setting, using a well-tested and documented posture measurement instrument. Methodology: This research project is comprised of seven related studies. Part I of the dissertation presents a systematic review describing the reliability and validity testing of posture measurement instruments. This is followed by three primary correlation and repeated measures observational studies aimed at ascertaining the reliability and validity of a newly developed 3D Posture Analysis Tool (3D-PAT) in the measurement of nine sitting postural angles of computing high school students. Part II of the dissertation presents a systematic review, that evaluates the latest published research evidence of whether sitting is related to UQMP, and, if so, to identify the elements of sitting that significantly contribute to UQMP. This review is followed by a description of a cohort study, with a prospective period of one year. The 3D-PAT was implemented in a clinical research setting in order to measure the 3D sitting posture of a cohort of asymptomatic computing high school students and in order to assess the outcome, seated-related UQMP, prospectively. The prospective study design enabled the research project to contribute to an understanding of any causative relationship between the exposure (sitting postural angles) and the outcome (seated-related UQMP) in a subgroup of adolescents (computer users). Results: After the first phase of psychometric testing of the 3D-PAT using high school students, the findings indicated that the instrument required modifications prior to further psychometric testing. The second phase of testing revealed that the 3D-PAT compared very well with the reference standard for measurement of the X-, Y- and Z-coordinates of the reflective markers on a mannequin. The findings from the phase three study, again using high school students, indicated that the 3D-PAT compared very well with the reference standard and justified its use for the measurement of six sitting postural angles of the upper quadrant in computing high school students. For the cohort study, a 60% response rate for participation was achieved at baseline, with 98% of the students participating at six-month and 80% at one-year follow up. Of the students, 33.5% complained of seated-related UQMP during the follow-up period. Exposure to increased head flexion (>80°) (ρ=0.0001) and the combination of increased head flexion and decreased cranio-cervical angles (ρ=0.007) were significant predictors of seated-related UQMP for those computing high school students complaining of pain greater than the 90th percentile for such. Conclusion: The project described in the current dissertation is the first research project to assess sitting postural angles in asymptomatic high school students, while they worked on desktop computers in a school computer classroom and to assess UQMP prospectively. The research project reports a causal relationship between increased head flexion and seated-related UQMP as increased head flexion was found to be a predictor of seated-related UQMP developing within six to 12 months for computing high school students with a pain score equal or greater than the 90th percentile for pain. The research project emphasises that further research is warranted to investigate the causal pathway between sitting posture and adolescents’ UQMP. / AFRIKAANSE OPSOMMING: Inleiding: Die stygende voorkoms van boonste-kwadrant muskuloskeletale-pyn (BKMP) onder adolessente is besig om ’n groot bron van kommer vir professionele gesondheidswerkers te word. Die risiko-faktore waarmee adolessente BKMP gepaard gaan, is kompleks en multifaktories. Dit sluit onder andere sit as ’n fisiese risiko-faktor in. Daar is egter nog geen bewyse om sittende posturale hoeke as potensiële voorspeller van adolessente BKMP te ondersteun nie. Dus beoog hierdie projek om die drie-dimensionele (3D) sittende posturale hoeke van Suid-Afrikaanse hoërskoolleerders wat ook rekenaargebruikers is, in ’n werklike omgewing te beskryf, deur gebruik te maak van ’n instrument wat postuur meet en wat goed getoets en gedokumenteerd is. Metodiek: Hierdie navorsingsprojek is saamgestel uit sewe studies. Gedeelte I van die proefskrif bied ’n sistematiese oorsig van betroubaarheids- en geldigheidstoetsing van instrumente wat postuur meet. Dit word gevolg deur drie primêre korrelasie studies en studies vir die waarneming van herhaalde meting wat die betroubaarheid en geldigheid van n nuut-ontwikkelde 3D instrument vir posturale analise (3D-PAT) bepaal, wanneer nege sittende posturale hoeke van hoërskoolleerders wat rekenaars gebruik, gemeet word. Gedeelte II van die proefskrif bied ’n sistematiese oorsig van die jongste gepubliseerde navorsing om te evalueer of daar bewyse is dat sit verband hou met BKMP, en, indien wel, om die elemente van sit wat betekenisvol bydra tot BKMP, te identifiseer. Die sistematiese oorsig word deur ’n beskrywing van ‘n jaarlange kohortstudie gevolg. Die 3D-PAT is gebruik in ’n kliniese-navorsingsraamwerk om die 3D-sitpostuur van ’n kohort simptoomvrye hoërskoolleerders wat rekenaargebruikers is, te meet en sitverwante BKMP as uitkoms in die vooruitsig te stel. Die studie ontwerp het dit vir die navorsingsprojek moontlik gemaak om ’n insiggewende bydrae te lewer tot begrip vir enige oorsaaklikheidsverwantskap tussen die blootstelling (sittende posturale hoeke) en die uitkoms (sitverwante BKMP) in ’n subgroup van adolessente (rekenaargebruikers). Resultate: Na afloop van die eerste psigometriese toesting van die 3D-PAT, waarin hoërskoolleerders gebruik is, het bevindings daarop gedui dat die instrument verander moet word voordat toetsing kan voortgaan. Die tweede fase van toetsing het getoon dat die 3D-PAT baie goed vergelyk met die verwysingstandaard vir die meet van die X-, Y- en Z-koördinate van die reflektiewe merkers op ’n mannekyn. Die bevindings van die derde fase van die studie, waartydens hoërskoolleerders weer gebruik is, het aangedui dat die 3D-PAT baie goed vergelyk met die verwysingstandaard. Dit het die gebruik van die instrument om ses sittende posturale hoeke van die boonste kwadrant van hoërskoolleerders wat rekenaars gebruik te meet, bevestig. Die kohortstudie het ’n 60%-reaksiesyfer vir deelname behaal tydens die basislynmetings, waarvan 98% leerders deelgeneem het aan die sesmaande-opvolgmetings en 80% aan die eenjaaropvolgmetings. ’n Totaal van 33.5% van die leerders het gekla van sitverwante BKMP gedurende die eenjaar opvolgperiode. Blootstelling aan ’n vergrootte kopfleksie-hoek (>80°) (ρ = 0.0001) en die kombinasie van ’n vergrootte kopfleksie- en verminderde kranio-servikale hoek (ρ = 0.007) was betekenisvolle voorspellers van sitverwante BKMP vir die hoërskoolleerders wat rekenaars gebruik en kla van groter pyn as die 90ste persentiel daarvan. Gevolgtrekking: Hierdie projek is die eerste navorsing wat sittende posturale hoeke van simptoomvrye hoërskoolleerders wat op tafelrekenaars in die skool se rekenaarklaskamer werk, meet en BKMP voorspel. Die navorsingsprojek rapporteer ‘n oorsaaklikheidsverwantskap tussen ‘n vergrootte kopfleksie-hoek en sitverwante BKMP omdat vergrootte kopfleksie ‘n voorspeller is van sitverwante BKMP wat binne ses tot 12 maande by hoërskoolleerders wat rekenaars gebruik, met ‘n pyntelling gelyk of groter as die 90ste persentiel van pyn, ontwikkel. Die navorsingsprojek beklemtoon dat verdere navorsing om die oorsaaklikheidsroete tussen sitpostuur en adolessente BKMP te ondersoek, geregverdig is. / Medical Research Council of South Africa / National Research Fund / Division of Research Development and Support of Stellenbosch University

This thesis concisely describes transformation of medical way of thinking in Eu- rope from hippocrato-galenic tradition to anatomo-pathological understanding of human body. It aims to trace conditions, that allowed rise of organic and later tissual pathology. Thesis also shows ideological shift in medical thinking concer- ning localization faculties of soul (shift from so called ventricular paradigm to localization faculties of soul into solid parts of brain). These ideas also affected reception of causes of mental illness. 1

O estudo investiga o efeito simbólico da criação da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP-USP), na imprensa escrita (1951), através da análise e discussão das matérias jornalísticas publicadas em três jornais da cidade, à época: A Cidade, Diário da Manha e a Tarde. Estudo de perspectiva histórica que se aproxima da abordagem da micro-história. O marco temporal desse trabalho refere-se à aprovação da organização e finalidade da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), que criou, anexa à mesma, a EERP/USP, através da Lei Estadual nº. 1467, de 26 de dezembro de 1951. O corpus documental constituiu-se das matérias jornalísticas relativas à criação da EERP-USP e/ou Enfermagem/enfermeiro(a) publicadas pelos jornais disponíveis para a pesquisa no Arquivo Público e Histórico da cidade. A coleta compreendeu os meses de dezembro de 1951 e janeiro de 1952. O marco teórico de referência para análise do texto jornalístico trata-se da teoria de mundo social, com utilização da noção de campo jornalístico, do sociólogo Pierre Bourdieu. Os resultados obtidos apontaram para um total de 47 matérias jornalísticas. Entretanto, 34 possuem a FMRP-USP como tema centrale seis (6) matérias se referem diretamente a EERP/USP, Enfermagem ou enfermeira(o). Observa-se que o discurso jornalístico sobre a instalação da FMRP-USP reconfigura o campo científico na cidade. Verificou-se que a EERP-USP, mesmo antes de sua instalação, apropriou-se de certo capital cultural, efeito da visibilidade da FMRP-USP. Nas seis matérias analisadas destaca-se um discurso ambivalente quanto à posição da Enfermagem e/ou EERP-USP em relação à FMRP-USP/Medicina, ora àquela que agrega capital simbólico de força equivalente às demais profissões, ora aquela que é referida como integrante, de um conjunto maior, que seria de domínio médico. Entretanto, destaca-se que este fenômeno ocorreu em virtude da inexistência de agentes sociais no campo simbólico que pudessem exercer forças a favor da EERP-USP, uma vez que, a Profa. Glete de Alcântara, sua principal agente social, iniciou suas atividades em Ribeirão Preto quatro meses após o período de analise do presente estudo. / The study investigates the symbolic effect of University of São Paulo at RibeirãoPreto College of Nursing\'screationin press (1951), through analysis and discussion of newspaper articles published in three newspapers of the city, at the time: THE CITY (A CIDADE), THE DAILY MORNING (DIÁRIO DA MANHÃ) and THE EVENING (A TARDE).Historical perspective Study that approximates of the micro historyapproach of. The timeframe refers to the approval of the organization and purpose of the University of São Paulo Faculty of Medicine of Ribeirao Preto (FMRP-USP), which created, attached to it, the University of São Paulo at RibeirãoPreto College of Nursing (EERP-USP) by State Law. 1467 of December 26 of 1951. The corpus of documents consisted of newspaper articles about the creation of EERP-USP and/or nursing/nurse published in the newspapers available for research in the Historical Public Archives of the city. The data were collected to the months of December 1951 and January 1952. The theoretical framework of reference for analysis of newspaper text is the social world theory, using the notion of journalistic field, by the sociologist Pierre Bourdieu. The results pointed to a total of 47 newspaper articles. However, 34 have the FMRP-USP as a central theme, and six (6) refers directly to EERP / USP, nursing or nurse. It is observed that media discourse about the installation of the FMRP-USP reconfigures the scientific field in the city. It was found that the EERP-USP, even before its installation, appropriated certain cultural capital, with is effect of the visibility of FMRP-USP. In the six articles analyzed stands anambivalent speech about the position of Nursing and/or EERP-USP regarding FMRP-USP/Medicine, once adds to that symbolic capital strength equivalent to other professions, once that is sometimes referred to as an integrant of a larger field dominated by the medical field. However, it is emphasized that this phenomenon occurred because of a lack of social agents in the symbolic field that could apply forces for EERP-USP, since the Professor. Glete de Alcântara, that is themost important social agent of EERP-USP, started its activities, in RibeirãoPreto, four months after the period analyzed in this study.

O estudo investiga o efeito simbólico da criação da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP-USP), na imprensa escrita (1951), através da análise e discussão das matérias jornalísticas publicadas em três jornais da cidade, à época: A Cidade, Diário da Manha e a Tarde. Estudo de perspectiva histórica que se aproxima da abordagem da micro-história. O marco temporal desse trabalho refere-se à aprovação da organização e finalidade da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), que criou, anexa à mesma, a EERP/USP, através da Lei Estadual nº. 1467, de 26 de dezembro de 1951. O corpus documental constituiu-se das matérias jornalísticas relativas à criação da EERP-USP e/ou Enfermagem/enfermeiro(a) publicadas pelos jornais disponíveis para a pesquisa no Arquivo Público e Histórico da cidade. A coleta compreendeu os meses de dezembro de 1951 e janeiro de 1952. O marco teórico de referência para análise do texto jornalístico trata-se da teoria de mundo social, com utilização da noção de campo jornalístico, do sociólogo Pierre Bourdieu. Os resultados obtidos apontaram para um total de 47 matérias jornalísticas. Entretanto, 34 possuem a FMRP-USP como tema centrale seis (6) matérias se referem diretamente a EERP/USP, Enfermagem ou enfermeira(o). Observa-se que o discurso jornalístico sobre a instalação da FMRP-USP reconfigura o campo científico na cidade. Verificou-se que a EERP-USP, mesmo antes de sua instalação, apropriou-se de certo capital cultural, efeito da visibilidade da FMRP-USP. Nas seis matérias analisadas destaca-se um discurso ambivalente quanto à posição da Enfermagem e/ou EERP-USP em relação à FMRP-USP/Medicina, ora àquela que agrega capital simbólico de força equivalente às demais profissões, ora aquela que é referida como integrante, de um conjunto maior, que seria de domínio médico. Entretanto, destaca-se que este fenômeno ocorreu em virtude da inexistência de agentes sociais no campo simbólico que pudessem exercer forças a favor da EERP-USP, uma vez que, a Profa. Glete de Alcântara, sua principal agente social, iniciou suas atividades em Ribeirão Preto quatro meses após o período de analise do presente estudo. / The study investigates the symbolic effect of University of São Paulo at RibeirãoPreto College of Nursing\'screationin press (1951), through analysis and discussion of newspaper articles published in three newspapers of the city, at the time: THE CITY (A CIDADE), THE DAILY MORNING (DIÁRIO DA MANHÃ) and THE EVENING (A TARDE).Historical perspective Study that approximates of the micro historyapproach of. The timeframe refers to the approval of the organization and purpose of the University of São Paulo Faculty of Medicine of Ribeirao Preto (FMRP-USP), which created, attached to it, the University of São Paulo at RibeirãoPreto College of Nursing (EERP-USP) by State Law. 1467 of December 26 of 1951. The corpus of documents consisted of newspaper articles about the creation of EERP-USP and/or nursing/nurse published in the newspapers available for research in the Historical Public Archives of the city. The data were collected to the months of December 1951 and January 1952. The theoretical framework of reference for analysis of newspaper text is the social world theory, using the notion of journalistic field, by the sociologist Pierre Bourdieu. The results pointed to a total of 47 newspaper articles. However, 34 have the FMRP-USP as a central theme, and six (6) refers directly to EERP / USP, nursing or nurse. It is observed that media discourse about the installation of the FMRP-USP reconfigures the scientific field in the city. It was found that the EERP-USP, even before its installation, appropriated certain cultural capital, with is effect of the visibility of FMRP-USP. In the six articles analyzed stands anambivalent speech about the position of Nursing and/or EERP-USP regarding FMRP-USP/Medicine, once adds to that symbolic capital strength equivalent to other professions, once that is sometimes referred to as an integrant of a larger field dominated by the medical field. However, it is emphasized that this phenomenon occurred because of a lack of social agents in the symbolic field that could apply forces for EERP-USP, since the Professor. Glete de Alcântara, that is themost important social agent of EERP-USP, started its activities, in RibeirãoPreto, four months after the period analyzed in this study.

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Pražské nemocnice v letech 1948-1968 Ing. Mgr. Kateřina Murtingerová Summary: This work presents a development of Prague hospitals during 1948 and 1968. The first part of my thesis describes theoretical and historical background of health care provision in the first half of the 20st century and it is focused on development of Czech healthcare system. This part of thesis also includes reform plans and concepts proposed during the first republic and the Second World War, with special attention to Albert and Nedvěd's plans playing a key role in setting of healthcare provision after the year 1948. The second part of this thesis is based on legislative and institutional analysis after the Second World War that was developing hand in hand with social, political, and economic changes in Czechoslovakia. Important part of this capture is also an assessment of the results of health care provision during 1948-1968 from the perspective of the whole country, including structure and availability of hospital care, demographic trends and population health trends, expenditure of health care provision and preventive measures etc. Thesis also includes historical overview of academic environment. The issue of Prague hospitals and hospital care is framed in the context of institutional and legal framework of health care system...