Made available in DSpace on 2014-06-11T19:35:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-08-29Bitstream added on 2014-06-13T20:46:16Z : No. of bitstreams: 1 assuncao_rc_dr_botfm.pdf: 801118 bytes, checksum: 0dac6a31b42d3f86f256f01c95f90a10 (MD5) / Trata-se de pesquisa na abordagem qualitativa realizada na cidade de Londrina, Paraná, Brasil, e teve como objetivos compreender a experiência interacional homem-processo saúde-doença de usuários de serviços de urgência e emergência atendidos com crise hipertensiva e propor um modelo teórico representativo dessa experiência. A saturação teórica se configurou mediante a análise da vigésima primeira entrevista do tipo não diretiva, tendo como pergunta de partida: “Conte-me sobre a sua experiência em relação aos cuidados com a sua saúde.”. As entrevistas foram audiogravadas, transcritas na íntegra e analisadas segundo os passos da Teoria Fundamentada nos Dados, de junho de 2011 a junho de 2012. Da análise das experiências emergiram três subprocessos: concebendo o cuidado à saúde inerente ao feminino: uma fantasia do masculino; aprisionando-se ao papel de homem com superpoderes sobre sua saúde; vivenciando a materialidade da doença nas comorbidades. Do realinhamento dos componentes desses subprocessos originou a categoria central e modelo teórico, denominado “movendo-se entre o fortalecimento e a fragilização do poder como homem de saúde inabalável: o medo do diagnóstico médico imaginado como componente interveniente para a materialidade da doença.”. Analisando-o à luz do interacionismo Simbólico, verificou-se a necessidade de o indivíduo reconfigurar o seu self, dando a si mesmo a oportunidade de romper com a concepção de homem com superpoderes sobre a sua saúde para poder (re)alinhar-se a comportamentos saudáveis e abandonar o autocontrole de sua saúde sem auxílio de serviços de saúde. A pesquisa corrobora resultados de estudos anteriores, porém o modelo teórico descoberto configura-se em grande contribuição se considerado protótipo tecnológico para profissionais da saúde ajudarem homens a refletirem e se auto-avaliarem, ao interagirem com ele durante ações educativas / This is a qualitative study conducted in the city of Londrina, Paraná, Brazil, and it aimed at understanding the interactional experience man-health-disease process of users of urgency and emergency services attended to when facing a hypertensive crisis and at proposing a theoretical model of such experience. Theoretical saturation was configured by analyzing the twenty one non-directive interview with the starting request: Tell me about your experience in relation to your health care. The interviews were audiotaped, fully transcribed and analyzed according to the steps of the Grounded Theory from June 2011 to June 2012.Three sub-processes emerged from the analysis of the experiences: conceiving health care as inherent to females: a male‟s fantasy; being trapped to the role of a man with superpowers over his health; experiencing the materiality of disease comorbidities. The realignment of these sub-components gave origin to the theoretical model and the core category denominated moving between the strengthening and weakening of power as a man of unfailing health: the fear of medical diagnosis imagined as intervenient component for materiality of disease. When examined in light of Symbolic Interactionism, there was the need for the individual to reconfigure his self, giving himself the opportunity to break with the conception of a man with superpowers over his health in order to (re)align with healthy behaviors and abandon the self-control of his disease without help from health care services. The study confirms results from previous investigations, but the theoretical model discovered is configured as great contribution if considered as a technological prototype for health professionals to help men reflect and evaluate themselves when interacting with them during educational activities

This dissertation is divided into five Chapters. The first chapter provides the background and thereafter justifies the need for this research. It also includes the research questions, the methodology employed in undertaking this research, the literature review, and the limitations of the study. Chapter Two is the theoretical framework of this dissertation. It provides the theories which underpin and explain the interplay between JW guardians’ authority which form the basis of their children’s healthcare decisions on one hand, and children’s RTH on the other hand. Chapter Three examines the legal frameworks for the protection of children’s RTH in the United Kingdom and South Africa and further provides an analysis of the norms and operation of both legal frameworks. This is in order to highlight learning points for possible law reform in Zambia for attaining an effective framework for the protection of children’s RTH. Subsequently, Chapter Four delves into Zambia’s legal framework for the protection of children’s RTH. In view of the comparative study in the preceding Chapter, this Chapter identifies the weaknesses and gaps in Zambia’s children RTH framework by drawing lessons from the foreign laws examined. Subsequently, Chapter Five concludes the study. It summarises the findings and provides the appropriate recommendations for the implementation of effective and adequate children’s RTH framework in Zambia. / Mini Dissertation (LLM)--University of Pretoria, 2021. / Centre for Human Rights / LLM / Unrestricted

Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion: In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support.

Our aim was to determine the characteristics, treatments and outcomes of patients with primary spinal glioblastomas (GB) or gliosarcomas (GS) reported in literature until March 2015. PubMed and Web of Science were searched for peer-reviewed articles pertaining to cases of glioblastomas / gliosarcomas with primary spinal origin, using predefined search terms. Furthermore we performed hand searches tracking the references from the selected papers. Eighty-two articles published between 1938 and March 2015 were eligible. They reported on 157 patients. Median age at diagnosis was 22 years. The proportion of patients who received adjuvant chemo- or radiotherapy clearly increased from the time before 1980 until present. Median overall survival from diagnosis was 8.0 ± 0.9 months. On univariate analysis age influenced overall survival, whereas tumor location, gender and the extent of initial resection did not. Outcomes did not differ between children (< 18 years) and adults. However, the patients who were treated after 1980 achieved longer survival times than the patients treated before. On multivariable analysis only age (< 60 years) and the time period of treatment (>1980) were confirmed as positive independent prognostic factors. In conclusion, primary spinal GB / GS mainly affect younger patients and are associated with a dismal prognosis. However, most likely due to the increasing use of adjuvant treatment, modest therapeutic progress has been achieved over recent decades. The characteristics and treatments of primary spinal glioblastomas should be entered into a central registry in order to gain more information about the ideal treatment approach in the future.

Inledning: Nålar beskrivs av barn som det mest skrämmande vid sjukhusbesök. Vårdpersonalen spelar en viktig roll för upplevelsen av undersökningen. Kunskap och förståelse för såväl patienten som den medicinska utrustningen kan vara avgörande för patientens upplevelse. Röntgensjuksköterskan har begränsade kunskaper och erfarenheter av barns upplevelser på röntgenavdelningen. Syftet: Syftet med denna integrativa litteraturöversikt var att granska och sammanställa metoder för att kunna möta barn med stickrädsla som undersöks på röntgenavdelningen. Metod: En integrativ litteraturöversikt har utförts där 12 vetenskapliga artiklar har kvalitetsgranskats, analyserats, kategoriserats samt sammanställts till ett resultat. Resultat: Fem kategorier identifierades och utformade resultatkategorier. Vår litteraturstudie visar att röntgensjuksköterskor kan använda många olika metoder och tekniker för att hjälpa stickrädda barn till minskad oro, ångest samt smärta. Konklusion: Slutsatserna i litteraturstudien visar att röntgensjuksköterskan har en stor och viktig roll i vård mötet med barn. Barns oro, rädsla och smärta kan lindras med hjälp av individuellt anpassat bemötande. / Needles are described by children as the most frightening part during the hospital visit. Caregivers play an important role in the experience of the examination. Knowledge and understanding of both the patient and the medical equipment can be crucial to the patient's experience. The radiographer has limited knowledge of children´s experiences in the radiology department. Purpose: The aim of this paper was to compile different methods how to meet children with fear of needles at the radiology department. Methods: An integrative literature review has been conducted, which includes 12 scientific articles who have been quality reviewed, analyzed, categorized and finally the result has been compiled in form of a synthesis. Results: Five categories were identified and formed as result categories. Our literature review shows that the radiographers can use many different methods and techniques to help children who fear needles to reduced anxiety and pain. Conclusion: The findings of the literature shows that the radiographer has a large and important role in the care meeting with children. Children's anxiety, fear and pain can be reduced with the help of individually tailored treatment.

Bakgrund Många barn upplever oro i samband med vistelse inom hälso- och sjukvården. Oron kan försämra barnets förmåga att hantera medicinska procedurer och forma negativa sjukvårdsupplevelser som kan komplicera kommande kontakter med sjukvården. Det finns också ett samband mellan oro och smärta. Lek är ett viktigt sätt för barn att uttrycka sig och olika typer av lek kan i strukturerad form användas i sjukvården för att informera och förbereda barn inför olika medicinska procedurer. Barnkompetens och kunskap kring barns svar på olika förberedande interventioner är av stor vikt för ett professionellt arbete med barn. Syfte Syftet var att undersöka effekter av förberedande lekterapeutiska interventioner på barns oro och smärta i samband med olika medicinska procedurer. Metod En litteraturöversikt av allmän karaktär genomfördes där 17 vetenskapliga artiklar av kvantitativ design utgjorde grunden för resultatet. De vetenskapliga artiklarna inhämtades från databaserna PubMed och CINAHL, och kvalitetsgranskades utifrån Sophiahemmet Högskolas bedömningsunderlag för klassificering och kvalitetsgranskning. En integrerad dataanalys genomfördes och resultatet sorterades in i kategorier och subkategorier.  Resultat Resultatet redovisas genom två huvudkategorier och fem subkategorier. De identifierade huvudkategorierna var: direkta effekter på barns periprocedurala oro och smärta och indirekta effekter på barns periprocedurala oro och smärta. Subkategorierna som identifierades var i sin tur: minskad oro, minskad smärta, ökad följsamhet, minskademaladaptiva beteenden samt minskade fysiologiska stressreaktioner.  Slutsats Resultatet visade positiva effekter av lekterapeutiska förberedelseinterventioner på barns periprocedurala oro och smärta, genom minskade oros- och smärtnivåer. Vidare kunde även indirekta effekter ses på barns periprocedurala oro och smärta genom ökad följsamhet, minskade maladaptiva beteenden och minskade fysiologiska stressreaktioner. Fler studier behövs dock för att bekräfta de indirekta effekterna. / Background Medical procedures and hospitalization can be a cause of anxiety for children. Anxiety canimpede children's ability to cope with medical treatment and complicate further treatment or contact with the healthcare system. There is also a correlation between anxiety and pain. Play is an important way for children to express themselves and different types of play can, in a structured form, be used to inform and prepare children for medical procedures. Pediatric expertise and knowledge about children's responses to various preparatory interventions is important in the professional work with children. Aim The aim of this study was to evaluate the effects of preparatory play interventions on children's anxiety and pain when undergoing medical procedures. Method A literature review was conducted, and the result was based on 17 included scientific articles of quantitative design. The scientific articles were obtained from the two databases PubMed and CINAHL, and their quality was reviewed on the basis of SophiahemmetUniversity's assessment matrix for classification and quality review. An integrated data analysis was performed, and the results were sorted into categories and subcategories. Results Two main categories and five subcategories were identified. The two main categories were: direct effects on children's periprocedural anxiety and pain and indirect effects on children's periprocedural anxiety and pain. In addition, the five subcategories were: reduced anxiety, reduced pain, increased compliance, less maladaptive behaviors and less physiological stress responses.  Conclusions The results showed positive effects of preparatory play interventions on children's periprocedural anxiety and pain. In addition, the results showed increased compliance, lessmaladaptive behaviors and less physiological stress responses, though more studies are necessary to confirm these effects.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / This paper proposes a technological solution using a predictive analysis model to identify and reduce the level of risk for type 2 diabetes mellitus (T2DM) through a wearable device. Our proposal is based on previous models that use the auto-classification algorithm together with the addition of new risk factors, which provide a greater contribution to the results of the presumptive diagnosis of the user who wants to check his level of risk. The purpose is the primary prevention of type 2 diabetes mellitus by a non-invasive method composed of the phases: (1) Capture and storage of risk factors; (2) Predictive analysis model; (3) Presumptive results and recommendations; and (4) Preventive treatment. The main contribution is in the development of the proposed application. / Revisión por pares

Background: Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation. Materials and methods: Branching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections. Results: Cervical vagus nerve branching was observed in 29%of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79mm vs. 3.78mm) and cross-sections (7.24 mm2 vs. 5.28mm2). Discussion: Cervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation.

Our aim was to determine the characteristics, treatments and outcomes of patients with primary spinal glioblastomas (GB) or gliosarcomas (GS) reported in literature until March 2015. PubMed and Web of Science were searched for peer-reviewed articles pertaining to cases of glioblastomas / gliosarcomas with primary spinal origin, using predefined search terms. Furthermore we performed hand searches tracking the references from the selected papers. Eighty-two articles published between 1938 and March 2015 were eligible. They reported on 157 patients. Median age at diagnosis was 22 years. The proportion of patients who received adjuvant chemo- or radiotherapy clearly increased from the time before 1980 until present. Median overall survival from diagnosis was 8.0 ± 0.9 months. On univariate analysis age influenced overall survival, whereas tumor location, gender and the extent of initial resection did not. Outcomes did not differ between children (< 18 years) and adults. However, the patients who were treated after 1980 achieved longer survival times than the patients treated before. On multivariable analysis only age (< 60 years) and the time period of treatment (>1980) were confirmed as positive independent prognostic factors. In conclusion, primary spinal GB / GS mainly affect younger patients and are associated with a dismal prognosis. However, most likely due to the increasing use of adjuvant treatment, modest therapeutic progress has been achieved over recent decades. The characteristics and treatments of primary spinal glioblastomas should be entered into a central registry in order to gain more information about the ideal treatment approach in the future.

Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion: In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support.