Thesis (Ph. D.)--University of Washington, 1988. / Vita. Bibliography: leaves [256]-279.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

To Wing Kee William. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 102-118). / Abstracts in English and Chinese ; questionnaires in Chinese. / Declaration --- p.3 / List of Abbreviations and definitions --- p.4 / List of Tables and Figures --- p.5 / Acknowledgement --- p.6 / Abstract of thesis --- p.7 / Chapter Chapter 1 --- "Menstrual dysfunction, physical exercises and bone mineral density - a review" --- p.12 / Chapter Chapter 2 --- Assessment of bone mineral density in young females - a review --- p.29 / Chapter Chapter 3 --- Objectives of the study --- p.33 / Chapter Chapter 4 --- A comparison of bone mineral density in adolescents with polycystic ovaries and normal ovaries --- p.42 / Chapter Chapter 5 --- The effects of oligomenorrhoea and amenorrhoea on bone mineral density in collegiate dance students --- p.57 / Chapter Chapter 6 --- Comparison of bone mineral density in young dancers and non-dancing young women --- p.70 / Chapter Chapter 7 --- Rate of interval changes in bone mineral density in exercising and non-exercising young women - an 18-month longitudinal assessment --- p.82 / Chapter Chapter 8 --- Summative discussion and conclusion --- p.95 / References --- p.102 / Appendix 1 Questionnaire for recruited dance students --- p.119 / Appendix 2 Information sheet and consent form for dance students --- p.124 / Appendix 3 Questionnaire for subjects recruited from Adolescent Clinic --- p.125 / Appendix 4 Proformer sheet for subjects recruited from Adolescent Clinic --- p.129 / Appendix 5 Consent form and information sheet for subjects from Adolescent Clinic --- p.130 / Abstracts presented in relation to thesis --- p.134 / Papers submitted in relation to thesis --- p.135

Orientadores: Ilza Maria Urbano Monteiro, Maria Yolanda Makuch / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-28T02:22:46Z (GMT). No. of bitstreams: 1 Montalti_CamilaStein_M.pdf: 1208610 bytes, checksum: f81cceda9a4fdf6f5d2f94dfa9b3583b (MD5) Previous issue date: 2015 / Resumo: INTRODUÇÃO: Sangramento menstrual abundante (SMA) é uma queixa comum entre as mulheres e pode comprometer a qualidade de vida (QV), além de levar à diminuição da concentração sérica de hemoglobina (Hb), causando anemia e fadiga. OBJETIVO: Verificar a prevalência de anemia, taxas baixas de ferro e ferritina entre as mulheres com e sem SMA, e comparar a QV e fadiga em mulheres anêmicas e não anêmicas com SMA confirmada. MÉTODOS: Foram realizados dois cortes transversais em mulheres com queixa de SMA, entre 18 e 55 anos, atendidas no Ambulatório de Hemorragia Uterina da UNICAMP. No primeiro estudo, foi realizada uma revisão de prontuários das mulheres atendidas entre 2011 e 2014 e extraídos os dados sobre os sintomas e hemograma. As mulheres foram divididas em três grupos: SMA (n=160), sem SMA (n=45), confirmados pelo Pictorial Blood Loss Assessment Chart (PBAC), e SMA subjetivo (n=160) sem confirmação do PBAC. No segundo estudo, entre 2013 e 2014, as mulheres com SMA confirmado pelo PBAC responderam a uma ficha de avaliação, ao questionário SF-36, à escala de fadiga FACIT-F e realizaram hemograma. Foram formados dois grupos: com anemia (GCA) apresentando níveis de Hb sérica menor que 12 g/dL (n=24) e sem anemia (GSA) com níveis de Hb sérica maior ou igual a 12 g/dL (n=51). RESULTADOS: No primeiro estudo os níveis médios de Hb e ferro séricos estiveram em torno do normal e semelhantes nos três grupos, enquanto os níveis de ferritina sérica foram mais baixos no grupo SMA. As frequências de anemia foram 33,1%, 28,9% e 40% nos grupos SMA, sem SMA e SMA subjetivo, respectivamente, sem diferenças significativas. Da mesma forma, não houve diferença significativa nos percentuais de mulheres com níveis de ferro e ferritina séricos baixos. No segundo estudo, as médias de Hb, ferro e ferritina séricos foram significativamente menores no GCA. Apesar do resultado médio de ferro e ferritina séricos nos dois grupos estarem dentro da normalidade, a frequência de mulheres com ferro e ferritina séricos baixos foi maior no GCA. No questionário SF-36 não houve diferença significativa entre os grupos, com variação de escore entre 20 e 63 nos oito domínios. O escore da escala de fadiga FACIT-F também não teve diferença significativa entre os grupos (26,3 no GCA e 30,6 no GSA), mas no GCA o escore foi abaixo de 30, ou seja, apresentou fadiga grave. CONCLUSÃO: Estes resultados reforçam a hipótese de que a queixa de SMA deve ser valorizada, independentemente da anemia, uma vez que apenas um terço das mulheres com SMA apresenta Hb abaixo do normal. Como o SMA torna-se uma condição crônica em muitas mulheres, a anemia não chega a comprometer a qualidade de vida e fadiga, uma vez que esta já estava afetada pelo próprio sangramento excessivo / Abstract: BACKGROUND: Heavy menstrual bleeding (HMB) is a common complaint among women and may compromise the quality of life (QoL). It can lead to decreased serum hemoglobin (Hb) level, resulting to anemia and fatigue. OBJECTIVE: To evaluate the prevalence of anemia and iron deficiency in women with and without confirmed HMB and to compare QoL and fatigue in anemic and non-anemic women with HMB. METHODS: Two cross-sectional studies were conducted with women with HMB complaint between 18 and 55 years old at the Department of Obstetrics and Gynecology, School of Medical Sciences, UNICAMP. In the first study, we reviewed medical charts between 2011 and 2014 and data on symptoms and blood counts were extracted. Women were separated into three groups: HMB (n=160), Non-HMB (n=45), both confirmed by the Pictorial Blood Loss Assessment Chart (PBAC), and subjective HMB (Subj-HMB) (n=160) without PBAC confirmation. In the second study, between 2013 and 2014, women with HMB confirmed by PBAC completed an evaluation form, the SF-36 health survey questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale and were evaluated by the blood count. They were divided into two groups: anemic (hemoglobin <12 g/dl; n=24) and non-anemic (hemoglobin ?12 g/dl; n=51). RESULTS: In the first study, mean serum hemoglobin and iron levels were similar in all three groups, while serum ferritin levels were lower in the HMB group. Frequencies of anemia were 33.1%, 28.9% and 40% in the HMB, non-HMB and subj-HMB groups, respectively, with no statistically significant differences. Likewise, there were no significant differences in the percentages of women with low serum iron levels or low serum ferritin levels. In the second study, mean serum hemoglobin, iron and ferritin levels were significantly lower in the anemic group. Although mean serum iron and ferritin levels were within the normal limits in both groups, there were more women with low serum iron and ferritin levels in the anemic group. The SF-36 questionnaire scores ranged from 20 to 63, with no significant difference between the groups. The FACIT-F score was also similar for both groups, 26.3 in the anemic group and 30.6 in the non-anemic group, however in the anemic group the score was below 30, ie, severe fatigue. CONCLUSION: These results give strength to the hypothesis that the complaint of HMB must be valorized irrespective of its association with anemia, since only 30% of women with HMB show low hemoglobin levels. HMB has become a chronic condition in many women, so anemia does not influence QoL and fatigue because the excess bleeding itself already affects these women¿s conditions / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Abstract Heavy menstrual bleeding causes significant health and social problems for up to 30% of women at some point of their lives. Medical treatment is not always sufficient or tolerated by women. Hysterectomy is a definitive solution, but it is a major operation associated with long disability and potential severe complications. Endometrial ablation techniques have been developed to avoid the risks related to hysterectomy. Further evolution of these techniques also offers a possibility of a quick and simple outpatient procedure. This study evaluated the long-term effects of endometrial ablation on heavy menstrual bleeding and later endometrial diagnostics. Another aim was to compare the costs when the procedure was performed in different settings. Finally, the effect of hyaluronic acid gel on intrauterine adhesion formation was assessed. Endometrial ablation had a good long-term effect on heavy menstrual bleeding in a retrospective study of 172 women, and up to 84% avoided hysterectomy during the follow-up time mean of 5 years. Seventy-six per cent of the patients were satisfied with the procedure. Due to the formation of intrauterine adhesions, prior endometrial ablation compromised later diagnostics of endometrium, and outpatient endometrial sampling failed in 23% of 57 women who had undergone endometrial ablation a mean of 6 years earlier, but that did not seem to have clinical importance. In a prospective, randomized and double-blind pilot study of 36 patients, hyaluronic acid gel did not prevent the formation of intrauterine adhesions. In a cost-minimisation analysis based on real resource use, performing endometrial ablation as an outpatient procedure under local anaesthetic instead of a day case procedure performed in the operating theatre under general anaesthetic reduced the costs significantly, from 1,865 to 1,065 euros. In conclusion, the results of this study suggest that endometrial ablation is a good alternative for the treatment of heavy menstrual bleeding, and remarkable cost savings can be achieved by taking the procedure out of the operating theatre. The formation of intrauterine adhesions is common and cannot be prevented with hyaluronic acid gel. / Tiivistelmä Runsaat kuukautiset aiheuttavat merkittävää terveydellistä ja sosiaalista haittaa jopa kolmasosalle naisista jossain elämänvaiheessa. Lääkehoito ei aina ole riittävä, eivätkä kaikki naiset voi tai halua käyttää sitä. Kohdunpoisto on lopullinen ratkaisu, mutta se on iso leikkaus, johon liittyy pitkä työkyvyttömyys ja vakavien komplikaatioiden riski. Näiden riskien välttämiseksi on kehitetty kohdun limakalvon tuhoavia tekniikoita, joista nykyisin eniten käytetty on limakalvon tuhoaminen lämpöhoidon avulla. Nykytekniikoilla toimenpide voidaan myös tehdä helposti ja nopeasti polikliinisesti. Tässä tutkimuksessa arvioitiin kohdun limakalvon lämpöhoidon pitkäaikaisvaikutuksia runsaiden kuukautisten hoidossa ja sen vaikutusta myöhemmin tapahtuvaan kohdun limakalvon diagnostiikkaan. Niin ikään verrattiin päiväkirurgisen ja polikliinisen toimenpiteen kustannuksia. Lopuksi tutkittiin pystytäänkö hyaluronihappogeelin avulla estämään kohdunsisäisten kiinnikkeiden muodostumista. Lämpöhoidolla oli hyvä pitkäaikaisvaikutus runsaisiin kuukautisiin 172 naista käsittäneessä retrospektiivisessä tutkimuksessa, ja kohdunpoistolta välttyi keskimäärin 5 vuoden seuranta-aikana 84&#160;% naisista. 76&#160;% naisista oli tyytyväisiä hoitoon. Lämpöhoidon aiheuttamat kohdunsisäiset kiinnikkeet vaikeuttivat myöhempää kohdun limakalvon diagnostiikkaa. Polikliininen imunäytteen otto ei onnistunut 23&#160;%:lla 57 potilaasta, joille oli tehty lämpöhoito keskimäärin 6 vuotta aikaisemmin. Tällä ei kuitenkaan näyttänyt olevan juurikaan kliinistä merkitystä. 36 potilasta käsittäneessä, prospektiivisessa, satunnaistetussa kaksoissokkotutkimuksessa hyaluronihappogeelin avulla ei pystytty estämään kohdunsisäisten kiinnikkeiden muodostumista. Todelliseen resurssien käyttöön perustuvassa kustannusten minimointianalyysissa todettiin, että tekemällä lämpöhoito polikliinisesti paikallispuudutuksessa leikkaussalissa nukutuksessa tehtävän toimenpiteen sijasta, kustannukset laskevat 1865 eurosta 1065 euroon. Tämän tutkimuksen perusteella kohdun limakalvon lämpöhoito tarjoaa hyvän vaihtoehdon runsaiden kuukautisten hoitoon, ja sen kustannuksia voidaan merkittävästi pienentää tekemällä toimenpide polikliinisesti. Kohdunsisäisten kiinnikkeiden muodostuminen on tavallista, eikä sitä pystytä estämään hyaluronihappogeelin avulla.

Diss. (sammanfattning) Stockholm : Karolinska institutet 2006. / Härtill 4 uppsatser.