Este estudo teve como objetivos realizar a adaptação cultural do Family Management Measure (FaMM) para a língua portuguesa do Brasil; avaliar a confiabilidade da versão adaptada do Family Management Measure (FaMM) verificando a consistência interna de seus itens em amostra de família de crianças e adolescentes com doença crônica. Na realidade brasileira, não se localizou qualquer outro instrumento que tivesse objetivos iguais, nem semelhantes aos propostos pelo FaMM, além de haver uma lacuna no que diz respeito à maneira como a família maneja a situação de doença crônica da criança. Consiste de um estudo metodológico com abordagem quantitativa a fim de alcançar os objetivos propostos, seguindo as seguintes etapas: tradução, adaptação transcultural do Family Management Measure para o português e validação das propriedades de medida do instrumento adaptado. Para tanto, utilizou-se a metodologia proposta por Guillemin para tradução e adaptação transcultural de instrumentos (Guillemin 1993, 2002), composta pelo seguinte processo: permissão dos autores para a adaptação transcultural e validação do Family Management Measure (FaMM); tradução para língua portuguesa do Family Management Measure; obtenção do primeiro consenso das versões traduzidas; avaliação pelo Comitê de Especialistas; retrotradução - (Back translation); pré-teste; tratamentos dos dados. A população da pesquisa foi composta por 72 famílias de crianças e adolescentes com doenças crônicas em atendimento em um ambulatório de especialidades de hospital-escola público no município de Londrina. A confiabilidade interna medida através do Alfa de Cronbach foi de 0,8660 para o instrumento todo e variou de 0,4430 a 0,7908 entre as dimensões do instrumento. Houve a eliminação do item 35 da dimensão Esforço de manejo. Concluiu-se que o Family Management Measure (FaMM) apresenta-se adaptado para a língua portuguesa do Brasil e recomenda-se a realização de outros estudos junto a outros familiares de crianças. / This study aimed to realize the cultural adaptation of the Family Management Measure (FaMM) for the Portuguese language of Brazil, to evaluate the reliability of the adapted version of the Family Management Measure (FaMM) by verifying the internal consistency of the items from a family sample of children and adolescents with a chronic disease. In Brazil, no other instrument having the same goals was located, nor were any similar to those proposed by FaMM, moreover there is a gap regarding how the family handles the child\'s chronic illness. This was a methodological study with a quantitative approach attempting to achieve the proposed objectives, following these steps: translation and cultural adaptation of the Family Management Measure to Portuguese; validation of the measurement properties of the adapted instrument. For this purpose, the methodology proposed by Guillemin was used for the translation and the cultural adaptation of instruments (Guillemin 1993, 2002) consisting of the following process: Permission of the authors for the cultural adaptation and validation of the Family Management Measure (FaMM) Translation into Portuguese the Family Management Measure; Obtaining the consent of the first translated versions; Evaluation Committee of Experts; Retro-translation - (Back translation); Pre-test; Treatment of the data. The study population consisted of 72 families with children and adolescents who have chronic diseases being attended in specialty outpatient clinic in a public teaching hospital in Londrina. The internal reliability measured with Cronbach\'s alpha was 0.8660 for the entire instrument and varied from 0.4430 to 0.7908 between the dimensions of the instrument. There was an elimination of item 35 in the dimension \"Stress management. It can be concluded that the Family Management Measure (FaMM) appears to adapt well to the Portuguese language in Brazil and it is recommended that further studies be performed with other families with children.

Moçambique é um pais que vem passando por profundas mudanças políticas e sociais nos últimos 50 anos. Dentro deste contexto, em 1996, uma Unidade de Dor foi criada no Hospital Central de Maputo. O objetivo do presente estudo foi descrever e analisar os aspectos epidemiológicos, clínicos e emocionais de pacientes com dor crónica atendidos na Unidade de Dor. Um total de 118 pacientes foram entrevistados por um período de 2 meses. Destes, 79 (66,9%) eram mulheres e 39 (33,1%) eram homens. A média de idade foi de 52,4 anos, com um desvio padrão de 13,7. Cento e sete (90,7%) eram negros. Quarenta pacientes (33,9%) tiveram o diagnóstico da dor neuropática, 40 (33,9%) apresentaram dor osteomuscular, 8 (6,8%) tiveram dor relacionada com a SIDA, 17 (14,4%) tiveram dor oncológica. A média da escala numérica de dor foi 8,37 e a media de duração da dor crónica foi 41,75 meses. Entre os medicamentos abortivos para a dor, o paracetamol foi o mais utilizado e amitriptilina profilático foi o mais amplamente utilizado. Independentemente do seu tratamento na unidade de dor, cinquenta e oito pacientes (49,2%) também receberam algum tratamento de curandeiros locais. Quanto aos aspectos emocionais, foram encontrados 39 (33,1%) pacientes que preenchiam os critérios do DSM-IV de transtorno depressivo maior. Estes resultados são discutidos com base nos aspectos culturais envolvidos / Mozambique is a country that has been experiencing profound political and social changes over the last 50 years. Within this context, in 1996 a Pain Unit was set up in the Central Hospital of Maputo. The objective of the present study was to describe and analyze the epidemiological, clinical and emotional aspects of patients with chronic pain attended at the Pain Unit. A total of 118 patients were interviewed over a period of 2 months. Of these, 79 (66.9%) were women and 39 (33.1%) were men. Mean patient age was 52.4 years, with a standard deviation of 13.7. Hundred seven (90.7%) were black. Forty patients (33.9%) had a diagnosis of neuropathic pain, 40 (33,9%) had ostheomuscular pain, 8 (6.8%) had pain related to AIDS, 17 (14.4%) had oncologic pain. Mean of visual analogic scale for pain was 8,37 and chronic pain duration was 41.75 months . Between the abortive medications for pain, paracetamol was the most used and prophylactic amitriptyline was the most widely used. Regardless of their treatment at the Pain Unit, fifty eight patients (49.2%) also received some treatment from local healers. When emotional aspects were considered, 39 (33.1%) patients were found to have depressive symptoms that fulfilled DSM IV criteria of depressive disorder. These results are discussed based on the cultural aspects involved

Stroke is a neurovascular disease that frequently results in decreased motor and cognitive functioning. Obesity is a major risk factor associated with ischemic stroke and is thought to worsen the functional deficits observed after stroke. Previous findings from our laboratory suggest that worse motor deficits in obese animals may be a result from an exacerbated neuroinflammatory response. Most animal studies demonstrate an association between obesity and worse cognitive functioning after stroke. However, the mechanisms are not well studied. This study examines the neuroinflammatory response, ischemic brain tissue damage, and cognitive functioning in diet-induced obese mouse models during the chronic phase after ischemic stroke, defined as weeks after stroke. Our study found an earlier onset of cognitive deficits in obese mice after stroke compared to normal weight mice. We found no differences in the degree of brain damage in obese animals and normal weight animals 11 weeks after stroke, but observed higher levels of microgliosis in obese animals compared to normal weight animals. Due to the limitations of our study, additional studies should be done to assess the severity of cognitive deficits in obese animals compared to normal weight animals in the chronic phase after stroke. Further studies also need to be done to confirm our findings regarding the microglial response and degree of ischemic brain damage during the chronic phase.

The internalizing and externalizing dimensions of psychopathology have been shown to effectively identify groups that are at higher risk for experiencing certain forms of psychopathology. Many studies have shown that chronic physical health conditions are a risk factor for psychological distress, yet there has been very little research examining the association between chronic physical health conditions and dimensional models of psychopathology to date. In the present study we examined the factor structure of internalizing and externalizing symptoms in a sample of adults with postural orthostatic tachycardia syndrome (POTS; n =172) and in a sample of adults without any chronic illness diagnoses (n = 199). Confirmatory factor analyses suggested that psychological distress in individuals with POTS can be effectively characterized by an internalizing dimension composed of distress and fear subcomponents as well as an externalizing dimension. Tests of measurement invariance allowed for the examination of latent means, which showed that individuals with POTS tend to have higher scores on the internalizing dimension and lower scores on the externalizing dimension than healthy controls. Regression analyses suggested that within the sample of people with POTS, those who were more accepting of their illness and had higher health related quality of life tended to have lower scores on the internalizing dimension. Findings suggest that individuals with POTS are at heightened risk for experiencing internalizing symptoms of psychopathology. A dimensional conceptualization of psychopathology seems like an effective way to identify symptoms of psychopathology that are separate from symptoms of autonomic nervous system dysfunction.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Consumer Science: Food and Nutrition in the Faculty of Applied Sciences at the Cape Peninsula University of Technology 2014 / The prevalence of nutrition-related chronic diseases of lifestyle (CDL) is escalating in South Africa (SA). Studies suggest that poor nutrition plays a major role in the aetiology of these diseases. Phytochemicals present in plant foods, namely fruit, vegetables, whole grains and tea, may prevent the onset of CDL. Most South African diets appear to be deficient of these plant foods. Achieving enhanced phytochemical intake amongst South Africans may therefore have to be supported in other ways. The objectives of this research were to determine whether consumers in the professional sector in the City of Cape Town would be (i) likely to consume proficient home-cooked category prepared dishes and (ii) purchase and consume commercially manufactured category prepared dishes for enhanced phytochemical intake and, if so, (iii) which dietary source adjustment category/categories and (iv) food vehicle category/categories they would be likely to consume, and (v) who would be likely to consume them. After obtaining ethical approval, a survey was conducted amongst 184 white collar workers (87% response rate) representing the professional sector (professional, technician and associate professional) occupational groups. The respondents were approached for voluntary participation based on their occupation and age, representing adulthood to the elderly life stage as a risk factor for the development of lifestyle diseases. A pilot-tested questionnaire was used to obtain information regarding the respondents awareness of phytochemicals, whether or not they were involved in the preparation of food at home, their degree of ‘likelihood’ to consume proficient home-cooked and commercially manufactured category prepared dishes for enhanced phytochemical intake, their current daily intake of fruit, vegetables, whole grains and tea, and demographic, health and lifestyle information. The frequencies of the respondents’ consumption of phytochemical-rich dietary sources pertaining to the stages of change model were assessed using Pearson’s chi-squared analysis to determine significant associations/differences (p < 0.05) between the data sets. The repeated measure analysis of variance (ANOVA) on Bonferroni correction was used to assess the ‘likeliness’ scale (from ‘extremely unlikely’ as ‘1’ to ‘extremely likely’ as ‘5’) for the household and commercial dietary source adjustment and food vehicle categories. The respondents were mostly female (58.7%), 31 to 44 years of age (67.9%) and of White ethnicity (72.3%). The majority (61.5%) had obtained grade 12 and a diploma (29.4%) or a degree (32.1%). Almost half were married or living together with children (48.9%) and were English (48.9%) or Afrikaans (47.3%) speaking. The majority of respondents were non-smokers (69%), and approximately half (54.4%) consumed alcohol less than three times per week (54.4%). About fifty percent used dietary supplements (50.5%) and exercised (59.2%) regularly. A small percentage of the respondents were obese (7.6%), had diabetes mellitus (4.4%) or cardiovascular disease (CVD) and cancer (2.2% or four respondents each). Cancer was most prevalent (36.4%) within the respondents’ family, followed by diabetes mellitus (29.9%), CVD (26.6%) and obesity (7.6%). The majority (77.7%) were not aware of phytochemicals and about half (55.4%) could not indicate the role these compounds play in the human diet. Half of the respondents consumed the recommended two to four servings of fruit daily, very few (10.9%) consumed the recommended three to five servings of vegetables daily, only about 10% (9.2% or 17 respondents) consumed the recommended three servings of whole grains daily, and about a third (36.4%) consumed two to three cups of tea daily. The respondents who considered phytochemicals to be very necessary to support health were more likely to consume rooibos herbal tea added to category prepared dishes than those who considered phytochemicals to be necessary to support health (p < 0.05) and those who did not know the role phytochemicals played in the diet (p < 0.05). The likelihood to consume category prepared dishes with added vegetables and added fruit respectively was lower (p < 0.05) amongst those respondents who consumed none to one serving of vegetables daily than amongst those who consumed two to four servings of vegetables daily. The respondents who did not consume tea were less likely to consume category prepared dishes with added rooibos herbal tea than those who consumed one cup (p < 0.05) or two to three cups (p < 0.001) daily. Furthermore, the respondents who did not consume tea were also less likely to consume category prepared dishes with added herbs than those who consumed one cup (p < 0.05), two to three cups (p < 0.001) or four to six cups (p < 0.05) daily. The likelihood to consume category prepared dishes with fruit additions was lower amongst those respondents who did not consume tea than amongst those who consumed two to three cups (p < 0.05) or four to six cups (p < 0.05) daily. The respondents were more likely (p < 0.05) to consume herb, vegetable and fruit additions respectively than rooibos herbal tea addition, and more likely to consume vegetable additions than herb (p < 0.05) or fruit (p < 0.001) additions as dietary source adjustment options. Furthermore, vegetable additions to category prepared dishes were more likely to be consumed by the respondents than fruit additions (p < 0.001), and starch-based dishes more likely to be consumed than vegetable-based dishes (p < 0.001) or fruit-based dishes (p < 0.05) for the addition of rooibos herbal tea. The respondents were likely to consume the food vehicle categories egg and chicken for added herbs in comparison to other starch (p < 0.05) and vegetables (p < 0.001) respectively. Chicken was a likely option over pasta for added broccoli (p < 0.05). Crêpe was a likely option over compote for added mixed berries (p < 0.001). Potato was a likely option over vegetables (p < 0.05) as well as other starch over vegetables (p < 0.05) for added herbs. Carrot salad with raisins was a likely option above carrot salad with raisins and parsley (p < 0.05). Poached pear in red grape juice was a likely option over poached pear in rooibos herbal tea (p < 0.001). Tomato (p < 0.001) and broccoli (p < 0.05) were more likely to be consumed than spinach, while spinach (p < 0.05) and roasted butternut (p < 0.05) respectively were likely options over onion as vegetables added to a quiche. Onion was a less likely option over broccoli (p < 0.001), tomato (p < 0.001) and roasted butternut (p < 0.001) as respective vegetables in a soup. Tomato soup was a likely option over tomato soup with rooibos herbal tea (p < 0.001). Roasted butternut soup was a likely option over butternut and orange soup (p < 0.001) and butternut and rosemary soup (p < 0.001). Berries as fruit addition were a likely option over pome fruit as pear (p < 0.05) and citrus fruit (p < 0.001), and furthermore citrus fruit over pome fruit as pear (p < 0.05). Raw apple with its skin on was a more likely option over chicken breast salad with apple pieces (p < 0.001), and chicken breast salad with apple a likely option over chicken and apple casserole (p < 0.001). Parsley was a likely option over basil (p < 0.001), and mixed herbs (p < 0.001) and rosemary (p < 0.001) respectively were likely options over basil as herb addition. Commercially manufactured category prepared dishes likely to be purchased and consumed by the respondents included category prepared dishes with added fibre more than added herbs (p < 0.05), fruit (p < 0.001), vegetables (p < 0.001) or tea (p < 0.001), and added herbs than added vegetables (p < 0.05) or tea (p < 0.05). Pizza/pasta was a likely option over beverages (p < 0.05), grains/bake (p < 0.001) and dairy (p < 0.001) respectively, and baked goods than grains/bake (p < 0.001), dairy (p < 0.001) and beverages (p < 0.05) respectively as food vehicles. A baked dish with added fibre was more likely to be consumed than with added fruit (p < 0.001), tea (p < 0.001) or vegetables (p < 0.001), and added fruit more likely to be consumed than added vegetables (p < 0.05). Pasta incorporating vegetables was a more likely option than pasta incorporating fruit (p < 0.001). Shortbread with added fruit was a likely option over added herbs (p < 0.05), and a muffin with bran (p < 0.001) or blueberries (p < 0.001) a likely option over a muffin with spinach. Fruit juice incorporating rooibos herbal tea (p < 0.001) or herbs (p < 0.001) were likely options over fibre incorporation. The female respondents were more likely to consume category prepared dishes with added fruit than the male respondents (p < 0.05), while the older respondents (55 to 64 years) were more likely to consume category prepared dishes with added herbs than the younger respondents (31 to 44 years) (p < 0.05). The older respondents were also more likely to consume category prepared dishes with fruit additions than the younger respondents aged 31 to 44 (p < 0.05) and 45 to 54 (p < 0.05) respectively. The respondents involved in the preparation of food at home were more likely to consume category prepared dishes with the addition of rooibos herbal tea (p < 0.05), herbs (p < 0.05) and fruit (p < 0.05) respectively than those who were not involved in preparing food at home.

Background: Chronic pain conditions particularly fibromyalgia (FM) are an important issue considering the demand that they place on health services and the negative impact on an individual’s well-being. Research regarding what impact FM may have on the various domains of health related quality of life is sparse. In addition, research identifying predictors relating to a person’s self-concept on pain outcomes such as quality of life and disability is scarce in a chronic pain population. Self-esteem has been linked to psychological adjustment in various chronic diseases (Chong et al, 2009) and is suspected to be a vulnerability factor in FM (Johnson et al., 1997; Michielsen et al., 2006). Research on self-compassion found that it is a significant predictor of increased psychological adjustment in people with chronic medical conditions (Wren, Somers, & Wright, 2011). The majority of research on self-compassion has been conducted in non-clinical samples. Identifying the predictive values of self-esteem and the self-compassion subscales (self-warmth and self-coldness) in relation to pain outcomes are useful provided they can be enhanced and utilised to inform intervention. Aims: This research portfolio had two aims, to systematically review and carry out a meta-analysis with the literature investigating the impact of FM on health related quality of life using the Short Form-36 version one and to investigate whether self-warmth, self-coldness and self-esteem act as predictors of quality of life and disability for individuals with chronic pain. Method: A systematic review and meta-analysis of studies which assessed the impact of FM on health related quality of life was undertaken. Sensitivity and subgroup analyses were conducted to address the level of heterogeneity in the studies. The empirical study comprised of a cross-sectional design in which 60 individuals with chronic pain were recruited from three NHS sites based in Fife and Lothian and a pain self-management group in Fife to complete six validated psychometric questionnaires: Self Compassion Scale (Neff, 2003), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Brief Pain Inventory- Short Form (Cleeland, 1991), Pain Disability Questionnaire (Anagnostis, Gatchel, & Mayer, 2004), Hospital Anxiety and Depression Scale (Zigmond and Snaith, 1983) and Quality of Life Scale (Burckhardt, Woods, Schultz, & Ziebarth, 2003). Systematic Review Results: In total, 18 studies met the inclusion criteria of the systematic review and demonstrated that the health related quality of life of individuals with FM was lower compared to healthy controls on all eight subdomains of the SF-36 particularly Physical Role. It was found that Social Functioning was the subdomain least affected when comparing participants with FM to healthy controls. Empirical Project Results: Quality of life was lower than previous research with females reporting a higher level of quality of life than males. It was found that after controlling for demographic and clinical variables, self-warmth was the only significant predictor for quality of life but not on levels of disability. Neither self-coldness nor self-esteem were significant predictors on scores of quality of life or disability. Conclusion: The above studies expand literature on the nature of chronic pain and its outcomes such as health related quality of life. The meta-analysis evidenced that HRQoL was lower in individuals with FM than in healthy controls. The association between symptom severity and quality of life requires further investigation in FM. Psychological interventions targeting the development of self-warmth attributes and skills may have a beneficial effect in improving quality of life for people with chronic pain. While the systematic review highlighted that FM has a more significant impact physically rather than mentally in relation to quality of life, both studies highlighted the need for interventions to target the psychological adjustment of people with chronic pain conditions.

A insuficiência renal crônica (IRC) pode ocasionar uma série de alterações metabólicas no organismo, das quais o comprometimento do metabolismo do cálcio pode acarretar em desmineralização óssea e mineralização de tecidos moles, inclusive renal, favorecendo a perda ainda maior de néfrons. Na rotina, a avaliação do cálcio é geralmente realizada pela mensuração do cálcio sérico total, entretanto, a única fração biologicamente ativa deste mineral é representada pelo cálcio ionizado. Assim, o presente estudo teve como objetivo avaliar o cálcio ionizado em gatos sadios e em gatos com IRC, com o intuito de se obter subsídios para o melhor entendimento da homeostase do cálcio. Foram analisados 25 gatos sadios (grupo controle) e 19 gatos com IRC (grupo de estudo) em que foram determinadas as concentrações séricas de cálcio ionizado, cálcio total, sódio, potássio, cloreto, fósforo inorgânico, albumina, como também do pH sangüíneo e das variáveis da hemogasometria. Não foram observadas diferenças significantes entre os grupos controle e estudo no que se relaciona aos valores de cálcio total (controle = 9,52 ± 0,96; IRC = 9,48 ± 0,96) e cálcio ionizado (controle = 5,24 ± 0,18; IRC = 5,29 ± 0,53). Em ambos os grupos observou-se que o valor da fração de cálcio ionizado foi superior a 50% do valor do cálcio total, dado este que difere da literatura, principalmente quando se compara com a espécie canina. Quando da avaliação individual dos dados, foi constatado nos gatos com IRC que o valor de cálcio sérico ionizado encontrava-se aumentado em 31,6% dos animais e diminuído em 15,8%; entretanto, quando foi considerado o cálcio sérico total, a hipercalcemia não foi detectada em nenhum dos animais e a hipocalcemia observada em 5,3%. Ainda, nos gatos com IRC que apresentaram normocalcemia relacionada ao cálcio ionizado, quando da mensuração do cálcio sérico total, a normocalcemia só foi constatada em 50% daqueles animais. Diferença significante também foi observada entre os dois grupos no que se refere aos valores de fósforo inorgânico e algumas variáveis da hemogasometria, caracterizando discreta hiperfosfatemia e acidose metabólica nos gatos com IRC. Apesar da presença de acidose, que poderia resultar na diminuição do cálcio ligado à albumina e assim justificar o desenvolvimento de hipercalcemia relacionada ao cálcio ionizado nos gatos com IRC, a normocalcemia e a hipocalcemia também foram detectadas, demonstrando-se, assim, a importância de se mensurar o cálcio ionizado, pois somente a mensuração do cálcio sérico total não refletiu a real condição do cálcio biologicamente ativo e, ainda, que devem ser investigados outros mecanismos que possam influenciar a fração de cálcio ionizado. / Chronic renal failure (CRF) can cause many metabolic abnormalities in the body, and one of these is represented by alteration in calcium metabolism, and the animal can develop demineralization and calcification of soft tissues, including renal parenchyma, which can facilitate the progression of renal damage. In routine, calcium is usually evaluated by measurement of total serum calcium, however, the biologically active fraction is represented by ionized calcium. Thus, the aim of the present study was to evaluate serum ionized calcium in healthy cats and in cats with chronic renal failure. Twenty-five clinically normal cats (control group) and nineteen cats with CRF were evaluated, and serum ionized calcium, total calcium, sodium, potassium, chloride, phosphorus, albumin, as well as blood pH and blood gases parameters were measured. No difference between normal cats and cats with CRF concerning total calcium (control = 9.52 ± 0.96; CRF = 9.48 ± 0.96) and ionized calcium (control = 5.24 ± 0.18; CRF = 5.29 ± 0.53) were observed. In both groups, the fraction of ionized calcium represented more than 50% of total calcium value, and the data were different from those reported in the literature, mainly concerning dogs. In cats with CRF, when the data were evaluated individually, serum ionized calcium was increased in 31.6% of the animals and decreased in 15.8%; however considering serum total calcium, hypercalcemia was not detected in any of those cats and hypocalcemia was observed in 5.3%. In addition, from the cats with CRF that presented normocalcemia related to ionized calcium, only 50% of those animals showed normocalcemia when total calcium was determined. Difference between control group and the group of cats with CRF concerning phosphorus and some parameters of blood gases were detected, observing slight phosphatemia and metabolic acidosis. The presence of acidosis can possible result in decrease of albumin bound to calcium and in consequence justify the hypercalcemia related to ionized calcium observed in cats with CRF, but normocalcemia and hypocalcemia were also observed, showing the importance of the measurement of ionized calcium, because total serum calcium did not reflect the real status of calcium that is considered the biologically active form; in addition, other mechanisms that can compromise the ionized calcium fraction should be investigated.

by Leung Cheuk Wa. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 97-106). / ACKNOWLEDGEMENTS --- p.i / LIST OF FIGURES --- p.v / LIST OF TABLES --- p.vi / SUMMARY --- p.1 / Chapter 1. --- INTRODUCTION --- p.3 / Chapter 2. --- BASIC ASPECTS OF CARNITINE / Chapter 2.1 --- BIOSYNTHESIS OF CARNITINE --- p.5 / Chapter 2.2 --- CARNITINE TRANSPORT --- p.8 / Chapter 2.3 --- THE ROLE OF CARNITINE IN INTRACELLULAR METABOLISM --- p.10 / Chapter 2.4 --- THE ROLE OF KIDNEY IN CARNITINE METABOLISM --- p.16 / Chapter 3. --- CARNITINE DEFICIENCY --- p.18 / Chapter 3.1 --- PRIMARY CARNITINE DEFICIENCY --- p.20 / Chapter 3.1.1 --- MYOPATHIC CARNITINE DEFICIENCY --- p.21 / Chapter 3.1.2 --- SYSTEMIC CARNITINE DEFICIENCY --- p.21 / Chapter 3.2 --- SECONDARY CARNITINE DEFICIENCY --- p.22 / Chapter 4. --- CARNITINE METABOLISM IN SELECTED DISEASES / Chapter 4.1 --- CARDIOMYOPATHY --- p.23 / Chapter 4.2 --- ORGANIC ACIDURIAS --- p.24 / Chapter 4.3 --- VALPROIC ACID THERAPY --- p.26 / Chapter 4.4 --- RENAL DIALYSIS ANDTRANSPLANTATION --- p.28 / Chapter 5. --- ANALYTICAL METHODS FOR CARNITINE ASSAYS --- p.30 / Chapter 6. --- DETERMINATION OF TOTAL AND FREE CARNITINE / Chapter 6.1 --- PRINCIPLE OF THE ASSAYS --- p.32 / Chapter 6.1.1 --- FREE CARNITINE DETERMINATION --- p.32 / Chapter 6.1.2 --- TOTAL CARNITINE DETERMINATION --- p.33 / Chapter 6.2 --- INSTRUMENTATION --- p.34 / Chapter 6.3 --- PREPARATION OF REAGENTS AND STANDARDS --- p.36 / Chapter 6.4 --- SPECIMEN COLLECTION --- p.42 / Chapter 6.5 --- SAMPLE PREPARATION --- p.43 / Chapter 6.6 --- ASSAY PROTOCOL FOR FREE CARNITINE --- p.44 / Chapter 6.7 --- ASSAY PROTOCOL FOR TOTAL CARNITINE --- p.46 / Chapter 6.8 --- FACTORS AFFECTING THE PERFORMANCE OF ASSAYS --- p.48 / Chapter 6.9 --- EVALUATION OF FREE AND TOTAL CARNITINE ASSAYS --- p.50 / Chapter 7. --- RESULTS OF EVALUATION OF TOTAL AND FREE CARNITINE ASSAYS / Chapter 7.1 --- CALIBRATION --- p.52 / Chapter 7.2 --- PRECISION --- p.55 / Chapter 7.3 --- LINEARITY RANGE --- p.56 / Chapter 7.4 --- RECOVERY --- p.58 / Chapter 7.5 --- INTERFERENCE OF ACETYLCARNITINE ON FREE CARNITINE ASSAY --- p.59 / Chapter 7.6 --- DISCUSSION --- p.59 / Chapter 8. --- STUDY IN NORMAL SUBJECTS / Chapter 8.1 --- SUBJECTS --- p.61 / Chapter 8.2 --- RESULTS OF THE NORMAL SUBJECTS --- p.61 / Chapter 8.3 --- DISCUSSION --- p.63 / Chapter 9. --- PATIENTS STUDY / Chapter 9.1 --- PATIENTS WITH CARDIOMYOPATHY / Chapter 9.1.1 --- SUBJECTS --- p.66 / Chapter 9.1.2 --- RESULTS OF THE STUDY --- p.66 / Chapter 9.1.3 --- DISCUSSION --- p.69 / Chapter 9.2 --- PATIENTS WITH METABOLIC DISEASES / Chapter 9.2.1 --- SUBJECTS --- p.71 / Chapter 9.2.2 --- RESULTS OF THE STUDY --- p.71 / Chapter 9.2.3 --- DISCUSSION --- p.74 / Chapter 9.3 --- PATIENTS ON VALPROIC ACID THERAPY / Chapter 9.3.1 --- SUBJECTS --- p.75 / Chapter 9.3.2 --- RESULTS OF THE STUDY --- p.75 / Chapter 9.3.3 --- DISCUSSION --- p.77 / Chapter 9.4 --- PATIENTS ON RENAL DIALYSIS AND AFTER TRANSPLANTATION / Chapter 9.4.1 --- SUBJECTS --- p.79 / Chapter 9.4.2 --- RESULTS OF THE STUDY --- p.79 / Chapter 9.4.3 --- DISCUSSION --- p.81 / Chapter 10. --- GENERAL DISCUSSION --- p.84 / Chapter 11. --- REFERENCES --- p.97

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The aim of this thesis is to investigate the prevalence and management of bladder pain syndrome (BPS) amongst women with chronic pelvic pain (CPP) through a series of systematic reviews, a structured survey and primary study. It has been acknowledged that the diagnosis and management of BPS is a contentious subject. The mean prevalence of BPS in women with CPP is 61%. I initially carried out a patient and clinician survey to understand how BPS was being managed in the UK. I found wide variation in diagnostic methods and treatments of BPS used by clinicians and experienced by patients with no obvious consensus. Since we know the predominant complaint in these patients is pain (bladder or pelvic) I used patients with pelvic pain as my cohort. Cystoscopy is no longer used as a diagnostic test for BPS. It is possible to diagnose BPS through a consensus expert panel using symptom-based criteria. This method of deriving a reference standard is demonstrated in the primary study, since no gold standard diagnostic test exists for BPS. A case-control feasibility study was undertaken to investigate the accuracy of a group of urinary symptoms to diagnose BPS. While, neither index test of bladder filling pain or bladder wall tenderness can sensitively diagnose BPS alone, the symptoms of bladder filling pain, urinary frequency, pain on urination and pain on full bladder are a good predictor of the condition. A systematic review assessing the reporting outcomes identified five measures that should be included in studies; pain, urinary symptoms, general 8 wellbeing, quality of life and bladder capacity. Of the 19 treatments used for BPS, the level and strength of evidence ratings overestimated quality compared to the GRADE ratings. BPS can be diagnosed symptomatically but there is variable reporting of outcome measures and poor evidence for treatment effectiveness.