Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

The purpose of this work was to further understand nutritional status, especially body weight and composition, during colorectal cancer progression. Population-based studies of colorectal cancer patients were conducted using administrative health data (primary and co-morbid diseases, demographics), and computed tomography (CT) imaging (body composition). In cohort 1, administrative health data was used to study comorbidities and nutritional status in 574 colorectal cancer patients referred for chemotherapy. Multivariate Cox regression revealed several comorbidities, performance status and weight loss 20% predicted survival. In cohort 2, a serial CT image analysis assessed longitudinal body composition changes during the last 12 months preceding death from colorectal cancer (n=34). Body composition changes were typified by exponential increases in liver metastases with concurrent accelerations of muscle and fat loss. These results have the potential to make a difference in how colorectal cancer patients are treated and researched by dietitians, oncologists, and health services researchers. / Nutrition and Metabolism

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-07-14T11:34:00Z No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-07-14T11:45:20Z (GMT) No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-07-14T11:45:20Z (GMT). No. of bitstreams: 2 Dissertação - Antonio Malan Cavalcanti Lima - 2011.pdf: 2459077 bytes, checksum: 66c327e4dee048354559d0f37ebf807e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2011-12-12 / Background: Chagas’s heart disease remains a major public health problem in Brazil. Sudden death is the leading cause of decease, because of that, the implantable cardioverter defibrillator (ICD) has become an important therapeutic option in this disease. Objective: To define the prevalence and predictors of electrical storm (ES) in patients with Chronic Chagas Heart Disease (CCh) with an ICD. Methods: We retrospectively studied 81 consecutive patients with CCh in whom an ICD was implanted between January 2004 to December 2007, with a mean follow up of 45,9 ± 15 months. Patients were classified into two groups according to the presence of ES episodes. We compared baseline and funcional characteristics. p values less than 0,05 were considered statistically significant. Results: Thirty five patients (43,2%) developed TE during follow up. By univariate analysis, QRS width ≥ 150 ms (p=0,001), previous pacemaker (p=0,001), ventricular tachycardia (VT) for indication of ICD (p=0,001) and cumulative percent ventricular pacing (C%VP) > 40%/80%) were all predictors of TE. However, by multivariate analysis only the indication of ICD for VT (odds ratio (OR) = 9.16, 95% CI: 1.98 to 42.78, p = 0.005) and C%VP > 40%/80% (OR = 6.30, 95% CI: 1.56 to 25.49, p = 0.010) were independent predictors of TE. Conclusion: 1- ES is very frequent in subjects with CCh and ICD; 2- Indication of ICD for VT and C%VP > 40%/80% were independent predictors of TE. / Fundamento: A Cardiopatia Chagásica ainda é um importante problema de saúde pública no Brasil. A morte súbita é a principal causa de óbito, por isto, o cardioversor desfibrilador implantável (CDI) tornou-se importante opção terapêutica nesta doença. Objetivos: Avaliar a prevalência e fatores preditores da tempestade arritmogênica ou elétrica (TA ou TE) em pacientes chagásicos portadores de CDI. Metodologia: Estudo retrospectivo de uma coorte de 81 pacientes chagásicos submetidos a implante de CDI entre Janeiro de 2004 a Dezembro de 2007, com seguimento médio de 45,9 ± 15 meses.Os pacientes foram classificados em dois grupos de acordo com a presença ou não de TE. Comparou-se as características basais e funcionais da amostra utilizando-se testes estastísticos (t student, qui-quadrado e, quando necessário, Fisher). Resultados: A idade foi de 57,0 ± 9,5 anos, sexo masculino 60 (74,1%), a fração de ejeção (FE) média foi de 43,8 ± 7,6. Dos 81 casos da amostra, 35 (43,2%) apresentaram pelo menos um episódio de TE. Estes tiveram um total de 378 TE com média de 10,8 ± 11,6. Em análise univariada, identificou-se que a indicação do CDI por taquicardia ventricular sustentada espontanea (TVSE) (p=0,001), duração do QRS (dQRS) ≥ 150ms (p= 0,001), ser portador de marcapasso (MP) (p=0,001) , percentagem de estímulo de ventrículo direito (PEVD) > 40%/80% (p= 0,001) e classe funcional (CF) final III/IV (p= 0,015), foram fatores preditores de TE nesta coorte. Porém, a análise multivariada demonstrou que apenas a indicação de CDI por TVSE ( odds ratio (OR)= 9,16; IC 95%: 1,98- 42,78; p= 0,005) e PEVD > 40%/80% ( OR=6,30; IC 95%: 1,56-25,49; p=0,010 ) foram fatores preditores independentes para TE. Conclusão: Nos pacientes chagásicos portadores de CDI, houve elevada prevalência de TE (43,3%). Os fatores preditores independentes para TE foram: TVS (TVSE) prévia e PEVD > 40%/80%.

O cardioversor-desfibrilador implantável (CDI) é um dispositivo eletrônico utilizado no tratamento de pacientes com episódios ou risco de parada cardíaca. Tem a capacidade do monitoramento contínuo do ritmo cardíaco para o reconhecimento de arritmias fatais e o consequente disparo de choques para revertê-las. Esses choques elétricos são classificados como apropriados quando o disparo ocorre em decorrência de arritmia potencialmente fatal, ou inapropriados quando o CDI dispara o choque em função de interpretação incorreta dos batimentos cardíacos. Em geral, ocorrem com o paciente consciente provocando desconforto inesperado, geralmente de forte intensidade. A maneira como o paciente vivencia tais acontecimentos, suas reações e sua capacidade de enfrentamento diante de situações inesperadas influenciam de forma relevante sua adaptação à doença e ao CDI. Além disso, o dispositivo é um objeto estranho alojado dentro do corpo, que remete a falha no funcionamento cardíaco, podendo despertar sentimentos ambivalentes e dificuldade de elaboração. Assim, o principal objetivo desse estudo foi descrever e compreender como os pacientes entrevistados vivenciaram e se adaptaram ao implante do CDI a partir das quatro variáveis possíveis relacionadas ao funcionamento do dispositivo: ausência de choques, presença de choques apropriados, presença de choques inapropriados e presença de choques mistos (apropriados e inapropriados). Para tanto, foi utilizado o método clínico-qualitativo. Foram realizadas entrevistas semi-estruturadas com 4 pacientes submetidos ao implante de CDI que representam cada uma das variáveis. Os critérios de inclusão foram pacientes do sexo masculino, com cardiopatia isquêmica prévia, implante do CDI como prevenção primária ou secundária de morte súbita cardíaca (MSC), idade entre 50 e 70 anos e dispositivo implantado há, pelo menos, dois anos. Todos os pacientes foram selecionados no ambulatório da Unidade Clínica de Estimulação Cardíaca Artificial do Instituto do Coração HC-FMUSP (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo). Os dados foram analisados a partir do referencial Piscossomático e Psicanalítico Freudiano e categorizados posteriormente pela Escala Diagnóstica Adaptativa Operacionalizada Revisada (EDAO-R). Os resultados demonstraram que a adaptação, segundo o conceito utilizado, ao impacto do CDI e do choque está diretamente ligada ao impacto do IAM e do adoecimento como um todo, e as reações dos pacientes diante dos diferentes episódios parecem análogas evidenciando que só é possível compreender as repercussões psíquicas relativas ao CDI a partir da compreensão das repercussões causadas pela doença que levou o paciente a ter o dispositivo implantado. Um paciente demonstrou estar adaptado ao adoecimento e ao CDI, embora não tenha vivenciado episódios de choque, e os outros três pacientes demonstraram estar em processo de adaptação, vivenciando conflitos psíquicos que influenciam sua capacidade adaptativa. Existem evidências de que, se intervenções psicológicas e informativas forem adotadas, esse processo ocorrerá de maneira mais eficaz / The implantable cardioverter - defibrillator (ICD) is an electronic device used to treat patients with episodes or risk of cardiac arrest. It is able to continuously monitor of the patients heart rate for the recognition of fatal arrhythmias and the consequent triggering of shocks to reverse them. These electric shocks are classified as appropriate when the triggering occurs due to potentially fatal arrhythmias or inappropriate when the ICD fires the shock due to incorrect interpretation of the heart beat. In general, the shocks occur while patients are conscious, thus causing unexpected discomfort of strong intensity. The way the patient experiences such events, their reactions and their ability to cope with unexpected situations substantially influence their adaptation to the disease and to ICD. Furthermore, the device is a foreign object lodged inside the body, which refers to a malfunction of the heart and may arouse ambivalent feelings and difficulty of adaptation. Thus, the main objective of this study was to describe and understand how surveyed patients experienced and adapted to ICD implantation from the four variables related to operation of the device: the absence of shocks, the presence of appropriate shocks, the presence of inappropriate shocks and presence of (appropriate and inappropriate) mixed shocks. In order to carry out the study, the clinical-qualitative method was used. Semi-structured interviews were conducted with 4 patients undergoing ICD implantation that represent each variable. Inclusion criteria were male patients with previous ischemic heart disease, ICD implantation as primary or secondary prevention procedure of sudden cardiac death (SCD ), aged between 50 and 70 years who had the implanted device for at least two years. All patients were selected from the outpatient clinic of the Clinical Unit of Cardiac Pacing of the Heart Institute - HC - USP (Hospital das Clinicas, Medical School, University of São Paulo). Data were analyzed having the Psychosomatic and Freudian Psychoanalytic referential and subsequently categorized by the Revised Operational Adaptive Diagnostic Scale (ROADS). The results have shown that adaptation (according to the concept used) to the impact of ICD and shock is directly linked to the impact of AMI and to the disease as a whole and that the reactions of patients on the different episodes seem analogous, showing that you can only understand psychic repercussions on the ICD from the understanding of the effects caused by the disease that led the patient to have the device implanted. One of the patients proved to be adapted to the illness and the ICD, although he has not experienced episodes of shock while the other three patients demonstrated to be somewhere along the adaptation process, having experienced psychic conflicts that influence their adaptive capacity. There is evidence that if psychological interventions are adopted, this adaptation process will occur much more effectively

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.

No description available.

In der vorliegenden randomisierten kontrollierten Studie wurde die Wirksamkeit der digitalen Gesundheitsanwendung (DiGA) Mawendo bei der Behandlung von Krankheiten der Patella untersucht und mit der Standardtherapie Physiotherapie der gesetzlichen Krankenversicherung (GKV-Physiotherapie) verglichen. In die Studie eingeschlossen wurden 259 Patienten mit einer ärztlich diagnostizierten Erkrankung der Patella gemäß ICD-10 Klassifikation M22. Nach randomisierter Zuteilung auf die Behandlungsarme absolvierten die Patienten über den 12-wöchigen Behandlungszeitraum entweder ein Eigentraining mit der DiGA Mawendo (Interventionsgruppe IG, 136 Patienten) oder wurden in einer physiotherapeutischen Einrichtung behandelt (Kontrollgruppe KG, 123 Patienten). Für den Nachweis des medizinischen Nutzens (mN) wurden zwei primäre Endpunkte untersucht: - Endpunkt 1: Verbesserung des Funktionszustandes (mNFunktion) - Endpunkt 2: Verbesserung der Morbidität durch Schmerzreduktion (mNSchmerz) Beide Endpunkte wurden mittels eines elektronischen Fragebogens erhoben. Der Endpunkt mNFunktion wurde mithilfe der deutschen Version des Patient Reported Outcome (PRO) KOOS (Knee Injury and Osteoarthritis Outcome Score) erfasst. Die Skala „Activities of Daily Living“ (KOOSADL) quantifizierte hier den mNFunktion (Wertebereich 0-100 Punkte (P), 100 P = bestmöglicher Funktionszustand). Der Endpunkt mNSchmerz wurde durch einen gesondert abgefragten Schmerzscore auf Basis einer Visuellen Analogskala (VAS, Wertebereich 0-100 Punkte, 100 P = stärkste vorstellbare Schmerzen) erhoben. Die Erhebungszeitpunkte wurden wie folgt definiert: Pre (t0): Vor Beginn der ersten Trainingseinheit mit der DiGA Mawendo bzw. vor dem ersten Behandlungstermin einer GKV-Physiotherapie. Post (t12): Nach der Behandlungsdauer von 12 Wochen. Als Nachweis des mN wurde die Überlegenheit (statistisch signifikant und klinisch relevant) der DiGA gegenüber der GKV-Physiotherapie in einem der beiden Endpunkte definiert. Mit der vorliegenden Studie konnte in beiden Endpunkten eine statistisch signifikante und klinisch relevante Überlegenheit der DiGA Mawendo gegenüber der Standardtherapie gezeigt werden. Im Endpunkt mNFunktion erzielte die IG eine mittlere Verbesserung von 15,7 P (95 % KI [13,7 P; 17,6 P]) gegenüber einer Verbesserung von 3,4 P (95 % KI [1,3 P; 5,5 P]) in der KG (Unterschied zwischen IG und KG statistisch signifikant mit p < 0,00001). Im zweiten Endpunkt mNSchmerz reduzierte sich der VAS-Schmerzscore in der IG im Mittel um -22,5 P (95 % KI [-25,2 P; -19,9 P]) gegenüber -6,3 Punkten (95 % KI [-8,7 P; -4,0 P]) in der KG (Unterschied zwischen IG und KG statistisch signifikant mit p < 0,00001). Darüber hinaus wurden in beiden Endpunkten die vorher festgelegten minimalen klinisch relevanten Differenzen (KOOSADL = 10 P, VAS = 10 P) deutlich übertroffen und sogar Verbesserungen im Bereich von „substantial clinical benefits“ erreicht. Medizinischer Nutzen und positiver Versorgunseffekt (pVe) der DiGA Mawendo sind somit evident. Neben dem mN zeigte sich bei Anwendung der DiGA Mawendo in dieser Studie ein weiterer positiver Aspekt. Die klinisch relevante Reduktion des Schmerzes in der IG äußerte sich in einem erheblich verringerten Anteil von Patienten, die zum Zeitpunkt der Post-Befragung Schmerzmittel einnahmen (IG: 28,0 % Pre -> 3,0 % Post vs. KG: 31,4 % Pre -> 29,8 % Post). Dadurch kann mit weniger Nebenwirkungen gerechnet und das Risiko für potenzielle Folgeschäden und -kosten verringert werden.

Comblant un fossé dans les études relatives à la diplomatie culturelle des pays émergents, cette thèse s’inscrit dans le cadre d’une analyse quantitative et qualitative de la diplomatie culturelle vietnamienne. Celle-ci est une partie intégrante de la politique étrangère en vue d’assurer une intégration internationale du pays et ce, au service du développement socio-économique. L’objectif primordial de cette stratégie, reconnue comme l’un des trois piliers de la diplomatie vietnamienne avec l’économie et le politique, est de présenter le Vietnam dans le monde entier afin d’attirer les investissements. Dans ce sens, elle constitue un outil de « marketing » pour le pays. L’histoire séculaire contre les invasions étrangères, une détermination de préservation de l’identité culturelle ainsi que la nature du régime politique sont à l’origine des particularités de cette stratégie qui articule diplomatie du parti communiste, du gouvernement et du peuple. L’élément étatique est indispensable dans la formulation de cette politique. L’observation des pratiques ainsi que le résultat de notre évaluation montre que cette diplomatie se concentre sur les activités évènementielles au détriment des projets structurels (éducation et information). Sa mise en œuvre constitue un défi pour le gouvernement, en raison d’une absence de véritable mécanisme de coordination d’une part, mais aussi d’une conception de la « culture » attachée à l’idéologie d’autre part. L’UNESCO est le partenaire principal du Vietnam car l’inscription au patrimoine mondial de sites ou de pratiques nationaux demeure l’un des sujets phare de cette diplomatie, contribuant à l’essor du tourisme. La Francophonie, elle, a des compétences spécifiques en particulier dans la diversité culturelle mais le Vietnam n’en a pas encore bénéficié. Si l’UNESCO est un forum où le Vietnam pourrait se présenter dans la communauté internationale, l’OIF, avec le dossier économique et la promotion du français, servirait de lieu pour promouvoir une recherche d’influence dans la région d’Asie du Sud-Est. / Filling a gap in studies on cultural diplomacy of the emerging countries, this thesis constitutes of a quantitative and qualitative analysis of the Vietnamese cultural diplomacy. This is an integral part of foreign policy in order to ensure international integration of the country and also for socio-economic development. The primary objective of this strategy, recognized as one of the three pillars of Vietnamese diplomacy with economy and politics, is to present Vietnam to the worldwide in order to attract investment. Thus, it is a “marketing” tool for the country. The secular history against foreign invasions, a determination to preserve the cultural identity and the nature of the political regime are the specific features of this strategy, articulating diplomacies of the Communist party, the government and the Vietnamese people. The element “state” is essential in the formulation of this policy. The observation of practices and the results of our evaluation show that this diplomacy focuses on event activities while seconding structural project (education and information). Its implementation is a challenge for the government, due to a lack of effective coordination on the one hand, but also a concept of “culture” attached to the ideology on the other. UNESCO is the main partner of Vietnam because inclusion in the World Heritage sites remains one of the major subjects of the Vietnamese cultural diplomacy, contributing to the development of tourism. La Francophonie has its specific expertise especially in cultural diversity but Vietnam has not benefited from that yet. If UNESCO is a forum where Vietnam could arise in the international community, OIF, with the economic issue and the promotion of French, would serve as a place to promote influence of Vietnam in the South-East Asia.

No description available.

Syfte: Syftet med studien är att lyfta maktperspektivet genom en kritisk diskursanalys av debatten kring konceptualiseringen av en diagnos för problematiskt digitalt spelande (PDS). Som professionella inom socialt arbete är PDS ett högaktuellt problem som nyligen har fått en ny officiell diagnos; Gaming Disorder, som ett nytt verktyg i praktiken. Teori: Studiens teoretiska förankring ligger i socialkonstruktionism, maktteori och diskursteori, som samtliga fokuserade på konceptualisering av diagnoser och diagnosens makt i samhället. Metod: Metoden för studien är främst kvalitativ genom en kritisk diskursanalys, men nyttjar även ett mer kvantitativt redskap genom korpuslingvistik. Korpuslingvistiken användes för att identifiera diskurser i debatten som sedan genomgick en tematiserad indelning inför den kritiska diskursanalysen. Resultat: Studiens resultat fokuserar främst på den diskursiva och sociala praktiken i en kritisk diskursanalys, detta då maktperspektivet uppfattades som starkast i dessa nivåer. Resultatet tyder på en fördelning mellan två oeniga fält av experter i debatten. där ena fältet har en stark koppling till WHO, vilket diskuteras i denna studie. / Aim: The aim with the study is to lift the power perspective through a critical discourse analysis of the debate about the conceptualization of a diagnosis for problematic digital gaming (PDS). For professionals in social work, PDS is a highly topical problem which recently gained a new official diagnosis, Gaming Disorder, as a new tool in social work. Theory: The study's theoretical grounding is in social constructionism, power theory and discourse theory, which all have been focused on the conceptualization of diagnoses and the power of diagnoses in society. Method: The method for the study is mainly qualitative through a critical discourse analysis but uses also a more quantitative tool through corpus linguistics. The corpus linguistics was used to identify discourses in the debate which later went through a thematization before the critical discourse analysis. Result: The study's result mainly focuses on discourse practice and social practice; due to that this was where the power perspective was perceived the strongest. The result indicates a division between two fields of discordant experts in the debate, where one field has a strong connection to WHO, which is discussed in this study.