Made available in DSpace on 2014-06-11T19:26:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-09Bitstream added on 2014-06-13T20:15:06Z : No. of bitstreams: 1 bruttos_dab_me_botfm.pdf: 462681 bytes, checksum: 038e3f95141da86625e1f48b217bffe6 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Avaliar o perfil da densidade mineral óssea (DMO) e os fatores de risco associados à osteoporose na pós-menopausa. Realizou-se estudo clínico-transversal com 431 mulheres. Idade entre 40-75 anos, atendidas ambulatorialmente em Hospital Universitário. Incluíram-se mulheres com: amenorréia>12 meses e idade ≥45 anos ou, ooforectomia ≥40 anos, com valores de DMO (coluna lombar e colo de fêmur) pelo DEXA dos últimos 12 meses. Fatores de risco avaliados: idade, idade e tempo de menopausa, tabagismo, atividade física (30min/5x/sem), artrite reumatóide (AR), uso de corticoterapia e de terapia hormonal (TH), fratura prévia, fratura materna de quadril e índice de massa corpórea (IMC=peso/altura2). Valores séricos de cálcio, fosfatase alcalina (FA) e calciúria-24h foram analisados. Empregou-se teste do Qui-quadrado (variáveis categóricas) e método de regressão logística no risco (odds ratio-OR) para osteoporose. A média de idade foi 54,1 ± 6,9 anos, tempo de menopausa 7,5 ± 5,8 anos, IMC 28,2 ± 5,3kg/m2. Encontrou-se: usuárias de TH 35,9%, exercício regular 27,3%, tabagistas 23,8%, menopausa <40anos 18,1%, fratura prévia 11,8%, fratura materna de quadril 10,7%, corticoterapia 4,8%, AR 4,0%. Pelos critérios da OMS, 106 (24,6%) mulheres apresentavam osteoporose (T-escore≤-2,5DP), 188 (43,6%) osteopenia (-1,0/-2,4DP) e 137 (31,8%) eram normais (≥-1,0DP). Detectou-se osteoporose em 12% das mulheres com idade entre 40-49anos, 21,8% 50-59 anos e 45,7% >60 anos (p<0,001). Osteoporose ocorreu em 11,8% com tempo de menopausa <5anos, 29,4% de 6-10anos, e 41% >10anos (p<0,001). Naquelas com menopausa precoce, 80% apresentaram osteopenia/osteoporose (p=0,032) e com IMC<20kg/m2, 50% osteoporóticas (p<0,001). Nenhuma associação foi observada entre DMO e valores de cálcio (p=0,174), FA (p=0,901) e calciúria (p=0,759). O risco de detectar osteoporose aumentou com idade... / To evaluate bone mineral density (BMD) profiles and their risk factors associated with postmenopausal osteoporosis. A cross-sectional clinical study was performed on 431 women aged 40-75 years and cared for at the outpatient clinic of a University Hospital. Women showing the following characteristics were included: amenorrhea >12 months and age ≥ 45 years or, ooforectomy ≥ 40 years with BMD values (lumbar spine and femur neck) by DXA of the last 12 months. Risk factors evaluated: age, age and time of menopause, smoking, physical activity (30min/5x/week), rheumatoid arthritis (RA), use of corticotherapy and hormone therapy (HT), previous fracture, maternal hip fracture and body mass index (BMI=weight/height2). Serum values of calcium, alkaline phosphatase (AP) and 24-h urinary calcium were analyzed. The Chi-square test was used for categorical variables, and the logistic regression method (odds ratio-OR) was utilized for osteoporosis risk. Mean age was 54.1±6.9 years, menopausal period 7.5±5.8 years, BMI 28.2±5.3 kg/m2. The following were found: HT users 35.9%; regular exercise 27.3%; smokers 23.8%; menopause < 40 years 18.1%; low calcium intake (<400mg/day) 55.3%; previous fracture 11.8%; maternal fracture 10.7%, corticotherapy 4.8%, RA 4.0%. According to WHO criteria, 106 (24.6%) women showed osteoporosis (T- score ≤ -2.5 DP), 188 (43.6%) osteopenia (-1.0/-2.4 DP), and 137 (31.8%) were normal (≥ -1.0 DP). Osteoporosis was detected in 12% of the women aged 40-49 years, 21.8% 50-59 years and 45.7% > 60 years (p<0.001). Osteoporosis occurred to 11.8% with a menopause period < 5 years, 29.4% from 6 to 10 years, and 41% > 10 years (p<0.001). Of the women with early menopause, 80% showed osteopenia/osteoporosis (p=0.032), and of those with BMI < 20kg/m2, 50% were osteoporotic (p<0.001). No association was observed between BMD and calcium values (p=0.174), AP (p=0.901)... (Complete abstract click electronic access below)

Thesis (M. D. S.)--University of Hong Kong, 2004. / Title proper from title frame. Also available in printed format.

No description available.

Resumo: Avaliar o perfil da densidade mineral óssea (DMO) e os fatores de risco associados à osteoporose na pós-menopausa. Realizou-se estudo clínico-transversal com 431 mulheres. Idade entre 40-75 anos, atendidas ambulatorialmente em Hospital Universitário. Incluíram-se mulheres com: amenorréia>12 meses e idade ≥45 anos ou, ooforectomia ≥40 anos, com valores de DMO (coluna lombar e colo de fêmur) pelo DEXA dos últimos 12 meses. Fatores de risco avaliados: idade, idade e tempo de menopausa, tabagismo, atividade física (30min/5x/sem), artrite reumatóide (AR), uso de corticoterapia e de terapia hormonal (TH), fratura prévia, fratura materna de quadril e índice de massa corpórea (IMC=peso/altura2). Valores séricos de cálcio, fosfatase alcalina (FA) e calciúria-24h foram analisados. Empregou-se teste do Qui-quadrado (variáveis categóricas) e método de regressão logística no risco (odds ratio-OR) para osteoporose. A média de idade foi 54,1 ± 6,9 anos, tempo de menopausa 7,5 ± 5,8 anos, IMC 28,2 ± 5,3kg/m2. Encontrou-se: usuárias de TH 35,9%, exercício regular 27,3%, tabagistas 23,8%, menopausa <40anos 18,1%, fratura prévia 11,8%, fratura materna de quadril 10,7%, corticoterapia 4,8%, AR 4,0%. Pelos critérios da OMS, 106 (24,6%) mulheres apresentavam osteoporose (T-escore≤-2,5DP), 188 (43,6%) osteopenia (-1,0/-2,4DP) e 137 (31,8%) eram normais (≥-1,0DP). Detectou-se osteoporose em 12% das mulheres com idade entre 40-49anos, 21,8% 50-59 anos e 45,7% >60 anos (p<0,001). Osteoporose ocorreu em 11,8% com tempo de menopausa <5anos, 29,4% de 6-10anos, e 41% >10anos (p<0,001). Naquelas com menopausa precoce, 80% apresentaram osteopenia/osteoporose (p=0,032) e com IMC<20kg/m2, 50% osteoporóticas (p<0,001). Nenhuma associação foi observada entre DMO e valores de cálcio (p=0,174), FA (p=0,901) e calciúria (p=0,759). O risco de detectar osteoporose aumentou com idade... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To evaluate bone mineral density (BMD) profiles and their risk factors associated with postmenopausal osteoporosis. A cross-sectional clinical study was performed on 431 women aged 40-75 years and cared for at the outpatient clinic of a University Hospital. Women showing the following characteristics were included: amenorrhea >12 months and age ≥ 45 years or, ooforectomy ≥ 40 years with BMD values (lumbar spine and femur neck) by DXA of the last 12 months. Risk factors evaluated: age, age and time of menopause, smoking, physical activity (30min/5x/week), rheumatoid arthritis (RA), use of corticotherapy and hormone therapy (HT), previous fracture, maternal hip fracture and body mass index (BMI=weight/height2). Serum values of calcium, alkaline phosphatase (AP) and 24-h urinary calcium were analyzed. The Chi-square test was used for categorical variables, and the logistic regression method (odds ratio-OR) was utilized for osteoporosis risk. Mean age was 54.1±6.9 years, menopausal period 7.5±5.8 years, BMI 28.2±5.3 kg/m2. The following were found: HT users 35.9%; regular exercise 27.3%; smokers 23.8%; menopause < 40 years 18.1%; low calcium intake (<400mg/day) 55.3%; previous fracture 11.8%; maternal fracture 10.7%, corticotherapy 4.8%, RA 4.0%. According to WHO criteria, 106 (24.6%) women showed osteoporosis (T- score ≤ -2.5 DP), 188 (43.6%) osteopenia (-1.0/-2.4 DP), and 137 (31.8%) were normal (≥ -1.0 DP). Osteoporosis was detected in 12% of the women aged 40-49 years, 21.8% 50-59 years and 45.7% > 60 years (p<0.001). Osteoporosis occurred to 11.8% with a menopause period < 5 years, 29.4% from 6 to 10 years, and 41% > 10 years (p<0.001). Of the women with early menopause, 80% showed osteopenia/osteoporosis (p=0.032), and of those with BMI < 20kg/m2, 50% were osteoporotic (p<0.001). No association was observed between BMD and calcium values (p=0.174), AP (p=0.901)... (Complete abstract click electronic access below) / Orientador: Jorge Nahás Neto / Coorientador: Eliana Aguiar Petri Nahás / Banca: Rogério Bonassi Machado / Banca: Adriana O. Pedro / Mestre

Call number: LD2668 .T4 1966 M22 / Master of Science

published_or_final_version / abstract / Dentistry / Master / Master of Dental Surgery

Heart transplantation has enjoyed a spectacular success over the past 25 years. Prior to 1980 less than 350 operations were carried out with an overall one year survival of less than 60%. In 1995 more than 3,000 transplants were performed with a one year survival of 83%. However, growth and improved survival have both plateaued over the last few years; the former because of the falling donor supply and the latter, in part, because of the use of less suitable donors in an effort to offset the problem of supply. Much attention has been focused on the drama of the surgery and the intricacies of immunological manipulation whilst little effort has been devoted to the area of donor management, despite the fact that primary graft failure is responsible for as many post transplant deaths as either infection or rejection. Optimum preservation of the donor heart has also provided a difficult challenge, such that, despite a considerable scientific effort little advance has been achieved to extend the 4 hour safe storage limit which has remained in place over the past 20 years. In this dissertation the problem has been approached by combining laboratory based preservation models with an objective regime of donor management. A sensitive isolated small animal working heart model was developed and used to characterise cardioplegic induction. Subsequently, the model was used to examine the interaction of oxygen content with the mode of delivery, during preservation. Finally, a number of representative solutions were combined with the most promising oxygen delivery method. These studies served to illustrate the utility of controlled laboratory studies and offer the prospect of more than doubling post storage function. The development of a rigorous donor management regime was also shown to be capable of reducing the variance in haemodynamic parameters by up to 44% whilst safely increasing the donor pool by approximately 30%. It is the contention of this thesis that the only prospect of improving the current impasse with the supply of donor hearts in sufficient quantity and of acceptable quality, is by the combination of appropriate laboratory models with controlled clinical trials.

As the population of transgender individuals continues to grow and the utilization of hormone therapy becomes more common, it is becoming more important to completely understand the effects it has on the body. The current recommendations regarding administration of testosterone therapy stem from small studies with young cohorts that found little evidence of increased cardiovascular disease (CVD) in the transgender male population. This is expected as CVD in populations younger than 50 are a relatively rare occurrence. Recent cross-sectional studies that include the whole transgender population have shown an association between being a transgender male and having a myocardial infarction (MI). Numerous studies have shown that testosterone therapy increases a multitude of risk factors for CVD, including increased hematocrit, cholesterol, blood pressure, and diminished endothelial function. Other risk factors are usually clustered in transgender populations including increased social stressors, substance abuse, poor socioeconomic status, and increased health disparities. This study will find the rate of CVD in an older population of transgender males, using transgender males who do not take testosterone therapy as a control, in order to find the true effect that testosterone therapy has on cardiovascular disease.

INTRODUCTION: Transgender individuals experience distress due to the persistent feeling that their gender identity is incongruent with their assigned sex. This distress is associated with depression, a high suicide rate, and increased mortality. The best solution for transgender patients is cross-sex hormone therapy, a treatment that changes the physical sex of the patient to be more congruent with their gender identity. This treatment has been proven to reduce depression and suicide rates, as well as increase overall quality of life. Unfortunately transgender patients face unacceptable barriers to accessing this treatment, due in most part to the lack of willing and knowledgeable transgender care providers. Many physicians share the misconceptions that gender identity is malleable, making transgender identity a psychiatric problem, and that cross-sex hormone therapy may not be effective and carries too great a risk. However, the literature supports the notion that gender identity is a rigid biological phenomenon and that cross-sex hormone therapy is safe and effective. Studies reporting failed attempts to assign female sex to XY patients with disorders of sexual development provide evidence that gender identity is not malleable. Other studies reporting elevated gender identity disorder rates in XX individuals with excess prenatal androgen suggest that gender identity is a biological phenomenon influenced by hormones during prenatal development. Neuroanatomical studies of transgender cadavers report that some sexually dimorphic areas of the transgender brain are more similar to the opposite sex than the natal sex, suggesting that gender identity is a rigid biological phenomenon originating in the structure of the brain. A review of the side effects and risks associated with cross-sex hormone therapy concluded that treatment is safe provided the physician is familiar with the recommended treatment and monitoring regimens. The lack of transgender care providers is perpetuated by the fact that transgender medicine is not a standard part of the medical school curriculum. Few physicians, therefore, have experience or training in transgender medicine, which is why, to combat this problem, this study has focused on the medical school education system. Previous studies have demonstrated that the addition of transgender medicine to the medical school curriculum increases student comfort and willingness to provide transgender care. Building upon these findings the present study aims to demonstrate that the addition of transgender medicine to the medical school curriculum is an effective means to increase knowledge and change attitudes towards transgender medicine. METHODS: A single lecture on gender identity and transgender medicine was added to the mandatory first-year biochemistry course and the mandatory second-year pathophysiology course at Boston University School of Medicine. An audience response survey was conducted immediately before and after the first- year lecture to assess the change in students opinions regarding of the etiology of gender identity. An elective online survey consisting of two exam style questions was also sent to the first-year students prior to exposure to the curricular content. The same questions were also added to the first-year biochemistry and second-year pathophysiology exams following exposure to the content. The exam-style questions were designed to assess student knowledge of the rigidity of gender identity and transgender medicine. Results: Following exposure to the curricular content there was an increase in the number of students who believe that the origin of gender identity is in the neuroanatomical structure of the brain (p<0.001). The relative number of correct responses to the exam-style questions significantly improved between the online survey and the first-year exam (p<0.001). On one of the exam questions there was no significant difference between the relative number of correct responses given first-year students the second-year students. On the other exam question the second-year students performed significantly worse (p<0.001). CONCLUSION: Here we demonstrate that the addition of transgender medicine to a medical school curriculum can increase students' knowledge and change their attitudes towards transgender medicine. Following the curricular content students were convinced that gender identity is a rigid biological phenomenon and that cross-sex hormone therapy is a medically justified treatment. These findings suggest that a simple curricular content change is an effective means of training knowledgeable physicians who are willing to provide transgender care.

Graduation date: 2000