Syfte: Syftet var att beskriva hur män upplever att de påverkats av miktionsproblem och erektil dysfunktion efter radikal prostatektomi. Metod: Examensarbetet utfördes som en litteraturöversikt med tio vetenskapliga studier. Resultat: Upplevelsen av förlorad kontroll vid miktionsproblem var det som främst påverkade männen samt medförde att det sociala livet blev lidande. Männen beskrev hur de var tvungna att planera inför olika sociala tillställningar, vilket upplevdes som stressande och ångestfyllt. Det framkom också att männen oroade sig för urinläckage, stark odör och upplevde möten med oförstående människor som frustrerande. Erektil dysfunktion var den vanligaste komplikationen efter behandling, men miktionsproblem var det som orsakade mest besvär. Det upplevdes som att männen förlorat sin självständighet. Det framkom även att erektil dysfunktion upplevdes av vissa män som den komplikation som gav störst besvär. Erektil dysfunktion påverkade männen och var mycket svårt att hantera. Det var svårt att finna en acceptans för att den erektila dysfunktion kunde vara bestående. Många av männen beskrev att en viktig del i deras liv förlorats, en del av deras maskulinitet. De kände sig ofullständiga och det fanns en rädsla för att förlora sin partner. Slutsats: Studier visar att erektil dysfunktion och miktionsproblem i samband med radikal prostatektomi ger upphov till stress, oro, ångest samt en känsla av ofullständighet.

Ammonia is a nuisance gas in many swine barns. The overall objective of this research project was to model ammonia formation and transmission processes in a grower-finisher swine barn, by first modelling the ammonia production and emission from urine puddles on the floor surface and the ammonia emission from the slurry pit, and then incorporating these emission rates in a dynamic model that separates the room and slurry pit headspace as two separate, but linked, control volumes. A series of studies were conducted to gather more information about the processes affecting the ammonia emission rate from the floor surface and the slurry that were later included in the overall room model developed. The model was then used to investigate ammonia reducing techniques and technologies based on the understanding of ammonia production and transmission incorporated in the model. The first step in modelling the ammonia emission rate from the floor surface was to determine the frequency of urinations by grower-finisher pigs. Male and female pigs were observed three times during their finishing phase to determine their urination frequency over the course of a day. The average measured urination frequency was 0.62 ± 0.11 urinations pig-1 h-1. A sinusoidal dromedary model was developed to describe the daily variation in urination frequency for male and female pigs between 51 and 78 kg.<p>In order for the deposited urinations on the floor surface to emit ammonia, the urea in the urine must first be converted to ammonia and the urease enzyme catalyzes this reaction. Two methods, a fixed-time-point method using the indophenol assay for ammonium-nitrogen analysis and a continuous method using the coupled enzyme assay, were used to measure enzyme activity at the floor surface of a swine barn and were compared to reported urease activity levels in the literature. Using both methods, there appeared to be an ammonia-producing site on the floor surface or within the collected samples that made accurate measurements of urease activity impossible. A review of urease activity levels in the literature from dairy-cow houses suggest that urease activity will be lowest following floor-cleaning and increase quickly following fouling of the floor surface. Based on the literature review, a urease activity value of 5 g NH¬3 m-2 h-1 was suggested for use in ammonia emission modelling of fouled floor surfaces in swine barns until better measurements become available. <p>The ammonia emissions from 36 simulated urine puddles under a variety of temperature, air velocity and initial urea concentration conditions were measured in a bench-scale experimental set-up. The measurements were used to calibrate and validate a dynamic, mechanistic, urine puddle emission model that considered the processes of evaporation, urea conversion, change in liquid concentration and puddle pH in order to simulate the amount of ammonia emitted from a puddle. Based on the correlation coefficients (R) between measured and simulated values for water volume (R=0.99), total ammoniacal nitrogen concentration (R=0.90), and total emission (R=1.00), along with five other statistical tests for each simulated variable, the model was deemed accurate. The measurements and simulations in this experiment showed the impact of puddle pH, urease activity and changing environmental conditions on the average puddle emission rate. Puddle emission continued to occur as long as there was still water.<p> The impact of different slurry compositions on the ammonia emission rate from slurry pits was tested in another bench-scale experimental set-up with emission chambers. The emission chamber concentration data collected was used to calibrate and validate a developed slurry emission model. The collected slurry samples were concentrated mixtures of urine and feces from individually-housed animals fed different diets. An empirical equation was developed to express the amount of total ammoniacal nitrogen in the slurry that was in the form of ammonia (f) and thus volatile to the surroundings. Based on the empirical equation, the simulated value of f was between 0.03 and 0.08 and did not show the sensitivity to slurry pH that has been reported by other authors. The slurry emission model with the empirical equation for f was validated with ammonia emission measurements from eight different slurry samples and simulated hourly concentration measurements within 17% and five-day average concentration measurements within 3%. Further testing was recommended to ensure the model developed for concentrated manure in this study was applicable to the more dilute slurry found in swine barns. <p>Using the information gained in the previous experiments, a mechanistic model describing the dynamic ammonia concentration in the room and in the slurry channel headspace of grower-finisher swine barns, as well as the ammonia emitted to the surrounding environment was developed. Data was collected from two grower-finisher rooms to use as input data to the model and for calibration and validation purposes. The model calibration procedure determined that the amount of emissions originating from the slurry for the simulated room conditions was generally less than 5% of the total room emissions, the air exchange rate through the slatted floor was approximately 4% of the room ventilation rate, and that in the first two weeks of animal activity in a room the urease activity at the floor surface will increase. The model was validated using separate data from that used in the calibration process. The model simulated hourly room concentration levels within 2.2 ppm and 3-day average concentration levels within 1.6 ppm. The model simulations were more accurate for one room that was fed a typical grower-finisher diet compared to another room fed an experimental diet with lower protein content and sugar-beet pulp inclusion. <p>The dynamic model was tested for its sensitivity to various input factors in terms of the floor emission rate, slurry emission rate and total emission rate. An interesting aspect of the simulations was that increases in either floor or surface emission rate were compensated to a small extent by decreases in the other emission rate as a result of a reduced concentration gradient for mass transfer. The ammonia emission rate from the floor was most sensitive to changes in urease activity, fouled floor area and puddle area. The ammonia emission rate from slurry was most sensitive to changes in slurry pH. The impact of input variables on the total emission rate was dependant on the simulated proportion of the total ammonia emission coming from either the floor surface or slurry channel. Three ammonia reduction techniques were tested and evaluated on their impact to the total ammonia emission rate from a room compared to a given set of control conditions.<p>The work in this thesis highlighted the importance of ammonia emission from the floor surface. The proportion of ammonia originating from the slurry and from the floor surface respectively will vary on the specific conditions within the barn, and will impact the effect of any ammonia mitigation technique that is investigated or used.

Orientador: Elizabeth Maria Aparecida Barasnevicius Quagliato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T20:16:26Z (GMT). No. of bitstreams: 1 Sousa_RaimundoNonatoCampos_D.pdf: 2351873 bytes, checksum: aa05f2a60629deedfa05db1c8ace9d8b (MD5) Previous issue date: 2013 / Resumo: Objetivos: Avaliar em mulheres com doença de Parkinson e disfunções urinárias as correlações dos sintomas urinários com os sintomas motores e disfunções mentais. Verificar a prevalência de hiper-reflexia detrusora (HD), bem como analisar em longo prazo a gravidade do desempenho motor, estadiamento de Hoenh-Yahr, habilidades funcionais, funções neuropsicológicas e a magnitude da progressão desses aspectos clínicos e do declínio cognitivo em pacientes com HD. Sujeitos e Métodos: Estudamos uma coorte ambulatorial de sessenta e três (63) pacientes com DP cujos aspectos neurológicos foram avaliados com a utilização das escalas Unified Parkinson's Disease Rating Scale (UPDRS) e a escala de Hoehn-Yahr. As habilidades funcionais foram avaliadas pela escala Schwab & England e a função urológica foi quantificada pela International Prostatic Symptom Scale (IPSS) e qualificada pelo estudo urodinâmico. Foram então categorizados dois grupos: pacientes com e sem HD. Após sete anos os mesmos parâmetros foram reavaliados e a escala Montreal Cognitive Assessment (MoCA)-versão brasileira foi utilizada para o rastreamento neuropsicológico. Resultados: Na avaliação inicial foi constatada correlação positiva entre os sintomas urinários e a gravidade da doença, porém não havia correlação entre a sintomatologia urinária e os sintomas mentais. Sintomas motores, estágio de gravidade da doença e habilidades funcionais eram mais graves em pacientes com HD. Na reavaliação, os grupos não apresentavam diferença quanto à magnitude da progressão dos sintomas motores, do estadiamento da doença e das inabilidades funcionais. Foi observado no grupo com HD maior declínio cognitivo e uma nítida progressão dos escores mentais com risco aumentado para demência. Conclusão: Hiper-reflexia detrusora é um achado urodinâmico frequente em mulheres com DP e embora esteja associada à pior desempenho motor, estágios de maior gravidade da doença e inabilidades funcionais, não é um fator de maior progressão desses aspectos clínicos. Por outro lado as pacientes com HD tiveram, em longa duração, significante progressão da sintomatologia neuropsicológica.O perfil do declínio cognitivo e o risco para demência necessitam ser confirmados em estudos posteriores / Abstract: Objectives: This long-term study in women with Parkinson's disease (PD) and lower urinary tract dysfunctions aimed to verify the correlation of urinary symptoms with the severity of the disease and mental functions. Verify the prevalence of detrusor hiper-reflexia (DH) and analyze the severity of motor symptoms, Hoehn and Yahr stage, functional abilities and neuropsychological functions, as well as analyze the progression of these clinical aspects and cognitive decline in patients with DH. Subjects and Methods: We studied a cohort of sixty-three (63) PD patients whose neurological aspects were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr scale. Functional abilities were evaluated by Schwab and England scale and the urological function was quantified by International Prostatic Symptom Scale (IPSS) and qualified by urodynamic study. Two groups were then categorized: patients with and without HD. After seven years the same parameters were re-evaluated and the cognitive functions were assessed with the Montreal Cognitive Assessment (MoCA). Results: At baseline a correlation between urinary symptoms and motor dysfunction was verified but no correlation between urinary symptoms and mental symptoms was observed. The severity of motor symptoms, stage of the disease and functional disabilities were significant in patients with DH. In the follow up, the groups were similar in regards to progression of motor symptoms, Hoehn and Yahr stage and functional disabilities. On the other hand, decline in cognitive function and clear progression of mental scores and risk for dementia was observed in the group with DH. Conclusion: Urinary symptoms are correlated with the severity of the Parkinson's disease. Detrusor hyper-reflexia is a frequent urodynamic finding in women with DP and although it is associated with worse motor performance, stage of the disease and functional disabilities, it is not a factor of greater progression of these clinical aspects of the disease. On the other hand, patients with DH had a significant progression of the neuropsychological symptoms and risk of dementia. The profile of cognitive decline and dementia risk need to be confirmed in subsequent prospective studies / Doutorado / Neurologia / Doutor em Ciências Médicas

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24191号 / 医博第4885号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 松村 由美, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The research has shown that the need to empty urine with the wetting problem, the need for certainty and security with the feeling of shame not only among enuretic children but also their parents, the need for liquid intake with the problem of not meeting the sufficient intake during morning and early afternoon hours and subsequent feeling of thirst are the most frequently unmet needs of enuretic children. According to nurses their role is based on education of parents and their enuretic children in the field of liquid intake regime and emptying the urine, and basic urine examination. The nursing care provided by nurses in surgeries of paediatric practitioners to enuretic children is sufficient; nurses are aware of the problems with the needs of enuretic children and try to solve them. However they educate enuretic children and their parents badly in the treatment regime principles, they do not require a feedback and are not interested in adherence on the rules they recommend. The nurses? knowledge is particularly poor in terms of the correct drinking regime rules the principles of the correct hygienic regime and application of hygienic aids to older children, the rules of waking children up for urination by their parents and particularly the knowledge of physiologic development of a child in urination regulation and its upbringing in 7 steps. Knowledge of the treatment regime is quite sufficient among parents. They probably gain correct information from practitioners, nephrologists and further sources, like the Internet. However the knowledge in the field of enuresis problems (the term, causes, age limit of wetting pathology) and of the child development in urination regulation and its upbringing in 7 steps is insufficient. Parents sit their children on the potty early, mostly before 1 year of age which contributes to the occurrence of enuresis. The parents unfortunately consider their knowledge insufficient.

Orientador: Carlos Arturo Levi D'Ancona / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T19:52:10Z (GMT). No. of bitstreams: 1 Campos_RenataMartins_M.pdf: 1119575 bytes, checksum: 397148d4be81905b2e9d46e70227d07b (MD5) Previous issue date: 2008 / Resumo: Introdução: A enurese polissintomática é uma alteração funcional caracterizada por perdas involuntárias de urina durante o dia e a noite, que acometem indivíduos de uma faixa etária na qual o controle miccional deveria estar estabelecido. Está estimado que 5 % a 10% das crianças na idade escolar experimentam esse sintoma. A enurese polissintomática está freqüentemente associada com infecções recorrentes no trato urinário inferior e constipação intestinal. Objetivos: Verificar os resultados do tratamento fisioterapêutico associado à reeducação comportamental nas crianças enuréticas; analisar os efeitos do tratamento medicamentoso associado à reeducação comportamental; e comparar os resultados do tratamento fisioterapêutico com o farmacológico. Material e Métodos: O desenho do estudo foi um ensaio clínico controlado. O grupo I, com 21 crianças, fez uso de oxibutinina, orientações higiênico-dietético, postura miccional e diário miccional lúdico. O grupo II, com 26 crianças, realizou fisioterapia, por meio do treinamento dos músculos do assoalho pélvico e acessório, orientações higiênico-dietético, postura miccional e diário miccional lúdico, durante três meses de tratamento. O diário miccional lúdico foi realizado pela criança por meio de desenhos coloridos sobre o sol e a chuva, registrando as perdas urinárias noturnas. Além disso, a criança era instruída a realizar somente um dos exercícios em casa por duas vezes semanais, com acompanhamento de um dos pais, previamente também orientados, a fim de motivá-los em todas as etapas. Resultados: A variável do diário miccional, ou seja, o número de dias com sol ou de noites secas, foi comparado a cada mês entre os grupos I e II, farmacológico e fisioterapêutico, respectivamente, por meio da análise de variância para medidas repetidas (ANOVA). No primeiro mês de tratamento as crianças do grupo I apresentaram 12±7 noites secas, no segundo mês 13±6 noites secas, chegando ao final do terceiro mês com 16±7 noites secas. Diferentemente, no grupo II, houve diferença significativa na evolução (p<0,001), ou seja, no primeiro mês de tratamento 15±8 noites secas, no segundo mês 21±6 noites secas, e finalmente no terceiro mês 24±5 noites secas. Conclusão: O tratamento fisioterapêutico associado às mudanças comportamentais, grupo II, comprovou sua eficácia nesses casos, sendo significativamente superiores ao tratamento farmacológico associado à mudança comportamental, o grupo I / Abstract: Introduction: Polysymptomatic enuresis is a functional alteration characterized by involuntary urine loss during the day and night that affects individuals of an age group in which the miction control should be established. It is estimated that 5%-10% of school age children experience this symptom. Polysymptomatic enuresis is frequently associated with recurrent infections of the low urinary tract and intestinal constipation Objectives: Verify the physiotherapeutic treatment results associated with behavioral reeducation in enuretic children, analyze the effects of medicines associated with behavioral reeducation, and compare the physiotherapeutic and pharmacological treatment results. Material and Methods: Twenty-one children in group I took oxybutynin, and received orientations concerning diet and hygiene, posture on the toilet, and miction schedule. Twenty-six children in group II underwent pelvic floor physiotherapy, received orientations about diet and hygiene, posture on the toilet, and miction schedule. Both groups were submitted to a three-month treatment period. The miction schedule was performed by the child through sun and rain pictures, registering urinary losses. In addition, the child was oriented to do only one of the exercises at home two times a week, being followed by one of their parents, who were also previously oriented to motivate them during all phases. Results: The ANOVA test was used to compare the variables of the miction schedule between the group I - pharmacological -, and the group II - physiotherapeutic -, according to the number of sun pictures. During the first treatment month, the children of the group I presented 12±7 dry nights, while during the second month, they presented 13±6 dry nights, arriving at the end of the third month with approximately 16±7 dry nights. On the other hand, the group II showed a significant difference (p<0,001), presenting15±8 dry nights during the first treatment month, 21±6 dry nights during the second month and, finally, 24±5 dry nights during the third month. Conclusion: Pelvic floor physiotherapy and orientations detailed before present better results than pharmacological treatment. Pelvic floor physiotherapy is a new treatment and could become an option for polysymptomatic enuresis / Mestrado / Cirurgia / Mestre em Cirurgia

Compared to males in almost any social group in all affluent nations, Australia's Aboriginal and Torres Strait Islander men suffer from substantially more serious illnesses and early death. To date, research done by or in collaboration with Indigenous communities has revealed the extent of the problems that arise from diabetes, heart disease, hypertension, cancers, respiratory diseases, psychological disorders, accidental injuries, violence and other causes. Reproductive health, however, rarely has been studied among Indigenous men. To date, research in this field has been limited mainly to studies of sexually transmitted infections. No data has been published on Aboriginal men's symptoms of prostate disease or erectile dysfunction, nor has the clinical screening and treatment of these disorders among these men been assessed. In-depth search of the worldwide web demonstrated that little information on these issues was available from other Indigenous populations. It does appear that Indigenous men in Australia, New Zealand and North America are less likely than European-ancestry men to die from prostate cancer, or for living cases to be recorded on cancer registries. This may arise because Indigenous men genuinely have a lower risk, or because they are not captured by official statistics, or because they do not live long enough to develop severe prostate disease. We also know very little about other reproductive health problems such as sexual dysfunction and specifically erectile difficulties. One reason for our scant knowledge is that research mainly relies on self-report of sensitive information. The aim of the research study was to improve the understanding of sexual and reproductive health problems experienced by Indigenous men. This is best gathered by Aboriginal males who are inside the culture of middleaged and older Indigenous men, but until now this has not been attempted. In this study we adopted the World Health Organization (WHO) definitions for Reproductive and Sexual Health (WHO, 2001). Thus, we consider reproductive system disorders (prostate disease, erectile dysfunction) and related health care-seeking, and also men's perceptions about a "satisfying and safe sexual life". The methodology was framed within an Aboriginal and Torres Strait Islander research protocol that advocates respect for cultural, social and community customs. A mixed method design combined qualitative inquiry (4 focus groups and 18 in-depth interviews) and quantitative survey (n=301) involving men living in remote, rural and urban communities (Tiwi Islands, Darwin and north and south-east Queensland). Survey data were compared to recently published self-reports from 5990 randomly selected men aged over 40 years in Australia (Holden et al., 2005, The Lancet, 366, 218-224. The qualitative interviews revealed that most men were silent about reproductive health. They were unwilling to reveal their inner feelings to wives or partners, and they were unwilling to discuss such issues with doctors and other health care workers. Men's reaction to sexual difficulties included shame, denial, substance abuse and occasionally violence. On a positive note many men said they want to learn about it, so they understand how to cope with such problems. The Indigenous men reported symptoms of erectile dysfunction at least as much as non-Indigenous men in other Australian studies. Bivariate analysis showed that erectile dysfunction was correlated with many health and lifestyle variable. However multivariate analysis revealed that only three factors significantly predicted ED: presence of chronic disease, presence of pain when working, and living in a remote geographic location The quantitative survey data indicate that Indigenous men have more symptoms of prostate disease than non-Indigenous men. The syndrome appears to be poorly managed in clinical practice (e.g. rates of PSA testing and digital-rectal examination are only one-third the rate reported by non-Aboriginal men, despite equivalent likelihood of GP visits). The research study adds to the literature by providing better insight and depth into the issues impacting on Aboriginal and Torres Strait Islander males experiencing reproductive and sexual health difficulties. It also provides a platform to undertake comprehensive research with Aboriginal and Torres Strait Islander men to explore a wider spectrum of questions in this important but neglected area. Implications for education of primary healthcare workers and community-based awareness campaigns for Indigenous males are discussed. Most of all, this study revealed "layers" of silence around sexual and reproductive health of Indigenous men. This includes silence in the scientific establishments in health services, and in the community. It is hoped that this study puts the voices of the men forward to help to break down this silence.