Eine Dysbalance zwischen Sauerstoffradikalen und der plasmatischen antioxidativen Kapazität sowie eine gesteigerte Aktivität der neutrophilen Granulozyten werden als mögliche pathophysiologische Faktoren der Schwangerschaftserkrankungen Präeklampsie (PE) und intrauterine Wachstumsretardierung (IUGR) diskutiert. Das Ziel der Studie war, zu prüfen, ob der plasmatische antioxidative Status und die Plasmaspiegel der neutrophilen Granulozyten Myeloperoxidase und PMN Elastase bei Schwangerschaften mit uteriner Perfusionsstörung, die ein Hochrisikokollektiv für die oben genannten Schwangerschaftskomplikationen darstellen, verändert sind. Die Messungen mit dem immundiagnostischen ELISA zur Bestimmung der antioxidativen Kapazität (ImAnOx) ergaben, dass eine signifikante Erniedrigung der Totalen Antioxidativen Kapazität im Hochrisikokollektiv vorlag. Eine Verbesserung der Risikobeurteilung war durch den ImAnOx-Test nicht möglich. Die Berechnung des Antioxidativen Quotienten durch die zusätzliche Bestimmung des Harnsäurespiegels konnte die Voraussage nicht verbessern. Zur inflammatorischen Komponente mit Hilfe der Enzymspiegelmessungen zeigten die Ergebnisse weder einen Zusammenhang mit der uterinen Perfusionsstörung noch verbesserten sie die Einschätzung des Risikos. Anhand der Ergebnisse wird deutlich, dass mit der uterinen Dopplersonographie insbesondere für das fetale Geburtsgewicht eine Kalkulation möglich ist.

Die in der Bundesrepublik Deutschland übliche Therapie für das Zervixkarzinom der FIGO-Stadien IB-IIB ist die Wertheim-Meigs-Operation. Bei bestimmten Risikofaktoren wird häufig eine adjuvante Bestrahlung, gegebenenfalls eine postoperative Radioche-motherapie angeschlossen. Die Folge können zahlreiche Einschränkungen der gesund-heitsbezogenen Lebensqualität sein. Zur Verbesserung der postoperativen gesund-heitsbezogenen Lebensqualität wurde eine neue nervenschonende Operationsmetho-de, die totale mesometriale Resektion (TMMR), von Höckel und Kollegen der Universi-tätsfrauenklinik Leipzig entwickelt. Die vorliegende retrospektive Querschnittsstudie untersucht erstmals die Auswirkungen der TMMR im Vergleich zur Wertheim-Meigs-Operation in Bezug auf die postoperative gesundheitsbezogene Lebensqualität. Dazu wurden 110 Zervixkarzinompatientinnen mit der Hilfe der Fragebögen EORTC-QLQ-C30 und EORTC-QLQ-CX24 befragt. Die Ergebnisse dieser Pilotstudie deuten daraufhin, dass Patientinnen nach einer TMMR-Operation im Vergleich zu Frauen nach einer Wert-heim-Meigs-Operation in einigen Teilaspekten eine bessere Lebensqualität haben. So fanden sich bezüglich der postoperativen körperlichen Funktionsfähigkeit und der Rol-lenfunktion sowie der postoperative Ausprägung der Symptome Fatigue, Schmerzen, Diarrhö, Appetitlosigkeit und Dyspnoe in der vorliegenden Untersuchung signifikant bessere Werte in der Gruppe der mittels TMMR operierten Frauen im Vergleich zur Wertheim-Meigs-Gruppe. Dies kann zum Anlass genommen werden große multizentri-sche prospektive Studien durchzuführen.:BIBLIOGRAPHISCHE BESCHREIBUNG - 5 - ABKÜRZUNGSVERZEICHNIS - 6 - 1 EINLEITUNG - 7 - 2 KLINISCHE UND MEDIZINPSYCHOLOGISCHE GRUNDLAGEN - 9 - 2.1 DAS ZERVIXKARZINOM - 9 - 2.2 DIE WERTHEIM-MEIGS-OPERATION - 12 - 2.3 NERVENSCHONENDE OPERATIONSMETHODEN - 13 - 2.4 EINE NEUE OPERATIONSTECHNIK: DIE TOTALE MESOMETRIALE RESEKTION (TMMR) - 14 - 2.5 MORBIDITÄT UND LEBENSQUALITÄT - 16 - 2.5.1 MORBIDITÄT UND PATHOPHYSIOLOGIE DER ZERVIXKARZINOMTHERAPIE - 16 - 2.5.2 DER EINFLUSS DER THERAPIE AUF DIE LEBENSQUALITÄT BEI ZERVIXKARZINOMPATIENTINNEN - 18 - 2.5.3 WEITERE EINFLUSSFAKTOREN SOWIE INTERAKTIONEN DER LEBENSQUALITÄT - 26 - 2.6 FAZIT - 28 - 3 FRAGESTELLUNG - 30 - 4 METHODIK - 31 - 4.1 STUDIENBESCHREIBUNG - 31 - 4.2 PATIENTINNENKOLLEKTIV - 32 - 4.3 ERHEBUNGSINSTRUMENTE - 34 - 4.4 STATISTISCHE ANALYSE - 36 - 5 ERGEBNISSE - 37 - 5.1 STICHPROBENCHARAKTERISTIKA - 37 - 5.2 GESUNDHEITSBEZOGENE LEBENSQUALITÄT - 41 - 5.2.1 ERGEBNISSE DES GRUPPENVERGLEICHS IM ÜBERBLICK - 41 - 5.2.2 ERGEBNISSE DES GRUPPENVERGLEICHES IM DETAIL - 44 - 6 DISKUSSION - 52 - 6.1 ALLGEMEINE DISKUSSION - 52 - 6.2 DISKUSSION DER EINZELNEN LEBENSQUALITÄTSEBENEN - 53 - 6.3 METHODENKRITISCHE DISKUSSION - 65 - 6.4 FAZIT UND AUSBLICK - 67 - 7 ZUSAMMENFASSUNG - 69 - LITERATURVERZEICHNIS - 72 - TABELLEN- UND ABBILDUNGSVERZEICHNIS - 78 - ANLAGEN - 79 - SELBSTSTÄNDIGKEITSERKLÄRUNG - 86 - WISSENSCHAFTLICHE VERÖFFENTLICHUNG - 88 - DANKSAGUNG - 89 -

This research project explores the contribution of prenatal stress to the pathogenesis of autism as a neurobiological developmental disorder. The neurobiological impact of stress prior to the 28th week of gestation might produce structural neural changes, specifically regarding the cerebellum, the brain stem and limbic pathways, including the hippocampal area, which concept relates closely to the pathogenesis of autism. In this research project a significant focus is placed on prenatal hipothalamic-pituary-adrenal (HPA) activity due to the HPA axis’ interactivity with cortisol, digoxin and serotonin, as these biochemicals are significantly implicated in programmed foetal development, postnatal cortical behaviour, postnatal learning, as well as in functional impairment of socialization, communication and imagery associated with autism. Based upon the rationale of this research project and the conceptualisation of the topic of interest, the research problem was formulated as follows: In what unique ways does prenatal stress contribute to the pathogenesis of autism as a neurobiological developmental disorder? Sub questions included: Did the mother of the dizygotic twins experience significant stress during the period of gestation? What structural brain differences can be observed among the dizygotic twins at hand of MR-imaging? To which periods of prenatal development can these structural differences be related? How do these differences account for sensory, motor, cognitive, and affective behavioural differences among the dizygotic twins? What plasma differences can be observed among the dizygotic twins at hand of blood sampling? How does elevation of pre- and postnatal glucocorticoids relate to plasma difference among the dizygotic twins? How do these plasma differences account for sensory, motor, cognitive, and affective behavioural differences among the dizygotic twins? This research project represents quantitative research. The mode of inquiry is non-experimental at hand of a single dizygotic twin study. The following data generating strategies were employed: clinical intake interviews, administration of a diagnostic stress inventory and the 16-PF Questionnaire, MR-imaging, and the collection of blood plasma pathology results. / Dissertation (M.Ed)--University of Pretoria, 2006. / Educational Psychology / unrestricted

No description available.

Este trabajo de investigación se basa en la necesidad de desarrollar una solución que permita una monitorización eficiente de la actividad uterina en primigestas con la finalidad de identificar posibles anomalías que ponen en riesgo la salud de la madre y el feto. Al realizarse una revisión detallada de la literatura, se pudo identificar la oportunidad de implementar una solución con sensores de bajo costo y una técnica para medir contracciones uterinas mediante impulsos eléctricos del sistema nervioso llamada “electromiografía”. Esto en conjunto con una aplicación móvil, que permitirá monitorear las contracciones de la gestante y alertar a ella y a su obstetra de posibles parámetros irregulares, cubre la brecha de investigaciones en mobile health enfocada en el electrodiagnóstico. Del mismo modo, la solución propuesta permitirá hacer uso eficiente de los recursos del centro de salud en el que está implementado al tener conocimiento del estado de salud de la madre en tiempo real. Para desarrollar nuestra solución, hemos considerado los aspectos tecnológicos, médicos y legales que permitan garantizar la alineación correcta con las necesidades de todas las partes interesadas. / The following research work is based on the need to develop a solution that allows efficient monitoring of uterine activity with the determination to identify possible abnormalities that may put the health of the mother and fetus at risk. Conducting a detailed review of the literature, the opportunity to implement a low-cost sensor solution and a technique to measure uterine contractions using electrical impulses from the nervous system called "electromyography" was identified. This together with a mobile application to monitor the contractions of the pregnant woman and alert her and her obstetrician of possible irregular parameters, covers the gap of research on mobile health issues focused on electrodiagnostic. At the same time, the proposed solution makes efficient use of the resources of the health center in which it is implemented by knowing the mother's health state in real-time. To develop our solution, we have considered the technological, medical, and legal aspects to guarantee a correct alignment with the needs of all stakeholders. / Trabajo de investigación

The thesis evaluates the results of experimental protocol involving the fertility sparing treatment procedure in early stage cervical carcinoma (LAP I protocol). Sentinel lymph node detection and experimental extirpation of afferent channels using laparoscopy and its technical aspects were analysed in prospective group of 85 women. The oncologic results and early/late morbidity show that established surgical procedures can be considered safe with minimal morbidity, provided that the indication criteria are met. The second part analyses the results of 148 women with no further pregnancy plans suffering from cervical tumors less than 2 cm in size with invasion less than half of the stroma (LAP II protocol). The oncological results in our defined group are very good and comparable to 'standard' procedure of modified radical hysterectomy type B or C with lower morbidity. In the separate section the thesis analyses the possibilities of laparoscopy in endometrial cancer treatment including the potentials of use of sentinel lymph node detection and technical aspects of laparoscopy in obese women. Currently the biggest controversy is the use of laparoscopy in malignant ovarian tumors. Our oncogynaecological study group at FN Motol prefers the laparotomic approach and we chose to include the set of advanced...

<p> The age at which a juvenile female reaches sexual maturity can be modulated by a variety of environmental and social factors. Experiments described in this thesis were designed to enhance the current understanding of the relationships among three variables that influence the onset of sexual maturation in female mice (Mus musculus), including: [1] exposure to dietary phytoestrogens during development, [2] variations in prenatal androgens, and [3] the presence or absence of genetically-unrelated males after weaning. For the first time, age at onset of male-induced female puberty was investigated using non-invasive behavioural and fertility measures. Through enzyme immunoassay procedures, daily output of urinary creatinine, 17P-estradiol, and progesterone was profiled in developing females that were either isolated or exposed to adult males. Uterine and ovarian tissue was also measured in such females, and male exposure was observed to increase reproductive tissue mass and was influenced by prior androgen exposure in interaction with diet and male presence. Male-exposed females fed a diet containing phytoestrogens immediately became sexually receptive when housed directly with males, and they conceived earlier than females in other conditions. Females with longer anogenital distance, which reflects higher in utero androgen exposure, displayed more escape attempts and aggressive posturing in the direct presence of males, especially when they had been housed near males and fed the phytoestrogen-containing diet. Urinary 17P-estradiol was substantially reduced in females raised on the phytoestrogenfree diet. Urinary output of progesterone was not strongly influenced by diet. Maleexposed females ' output of progesterone and 17P-estradiol was more dynamic in comparison to that of isolated females. The size of this effect depended on diet, prior androgen exposure, and whether urinary steroid measures were adjusted by urinary creatinine. Urinary creatinine was elevated by the low phytoestrogen diet and reduced by male exposure. These data suggest that dietary phytoestrogens and in utero androgen exposure interact with presence or absence of males in determining the age at onset of sexual maturity in developing females. </p> <p> A final experiment was designed to examine two components of adult male urine, preputial gland emissions and unconjugated estrogens, that have been posited to act on females to advance reproductive maturation. Intact and preputialectomized males were compared in their output of urinary creatinine, 17~-estradiol, and testosterone, and in their influence on reproductive tissue in juvenile females. Lack of preputial glands did not hinder the capacity of males to induce uterine and ovarian growth in females. Male urinary creatinine was reduced by exposure to juvenile females. Creatinine-adjusted 17~estradiol and testosterone were greater in female-exposed males, regardless of whether the preputial glands were present. Based on these findings and those reported elsewhere, it is probable that male excreted urinary steroids are important in regulating reproductive changes in developing females exposed to males. </p> / Thesis / Doctor of Philosophy (PhD)

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A model was developed in this study to understand women's cervical screening behaviour. It revealed that the interaction among institutional factors, risk appraisal, coping appraisal, and health beliefs and cultural factors contributed to the complex nature of screening behaviour among Chinese women. The institutional component provided the contextual factors within which women perceived the risk of cervical cancer, perceived the practice of cervical screening, and decided to take or not to take cervical screening. Risk appraisal provided the premise factor that induces women to seek coping strategies to reduce or remove the risk. During the process of coping appraisal, women's motivation to have cervical screening could be increased or decreased as the perceived benefits and costs of screening interacted with each other. The importance of the women's health beliefs and cultural factors was reflected in the way that they were affected by their notions of health behaviour and their cultural beliefs about cervical cancer risk and cervical screening participation. Commitment to participate in screening was a reinforcing factor inducing women to take up an offer of cervical screening. / Aim: To explore the knowledge and the perception of the risk of cervical cancer, identify the factors determining cervical screening behaviour, and develop a model to understand cervical screening behaviour among women in mainland China. / Background: Cervical cancer is the most common type of cancer, and is the second most common cause of cancer death in women in mainland China. Cervical screening is the most important intervention for the secondary prevention of cervical cancer. Theories of health behaviour and empirical research highlight risk perception as a significant factor motivating people to opt for cancer screening. However, little is known about the risk perception of cervical cancer and the factors influencing the screening participation of women in mainland China. / Conclusion: This study provides evidence of the complex factors influencing cervical screening behaviour and contributes new knowledge to the understanding of cervical screening behaviour within the Chinese cultural context. It further informs programmes for the promotion of cervical screening among this population. / Methods: A mixed method design consisting of two phases was used, employing both quantitative and qualitative methods of data collection. First, a cross-sectional survey was conducted to collect a baseline assessment of women's knowledge of cervical cancer and screening, their perceptions of the risk of cervical cancer, and the relationship between these factors and their cervical screening behaviour. Findings from this phase also guided the purposive sampling of participants in phase two. / Results: The findings from phase one demonstrated that the availability of an organized screening programme was a major motivator for women to opt for cervical screening. Multivariate analysis shows that having children (OR=2.57, p=0.026), a perception that visiting doctors regularly is important for health (OR-2.66, p=0.025), average (OR-4.84, 1)=0.006) and high levels of knowledge about cervical screening (OR-9.66, p=0.001) were significantly associated with having been screened in the previous three years. / Then in phase two, qualitative research was conducted using semi-structured interviews of 27 women, 16 of whom had been screened and 11 had not. The interview structure was based on an initial analysis of the data from phase one and from a review of the related literature. The data from the interviews were analyzed using latent content analysis, involving an interpretative reading of the symbolism underlying the surface structure in the text. The audio recordings of the interviews were transcribed verbatim in Chinese, and then the key phrases which were important for the objectives of the study were identified. The key phrases and words were grouped according to their commonality of meaning. Then, these groups of data were sorted and classified to create categories and sub-categories, which were mutually exclusive, explicit and accurate without overlapping. / Two themes emerged from the qualitative data from phase two. Theme I was that perceptions of cervical cancer and cervical screening included five categories: the perceived effects of suffering from cervical cancer; the perception of cervical screening; a lack of understanding about cervical cancer and screening; the perceived risk of cervical cancer; and factors related to the cultural beliefs system. Theme II was that the institutional and health care practitioner system included two categories: availability of an organised physical examination programme and the role of the health care practitioner in encouraging cervical screening utilization. / Gu, Can. / Adviser: Chan, Carmen. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 244-267). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

In Uganda, there are an estimated 200,000 women suffering from obstetric fistula, with 1,900 new cases expected annually. These figures, combined with a persistently high maternal mortality rate, have led to an international discourse that claims the solution to improving maternal health outcomes is facility-based delivery with a skilled birth attendant. In accord with this discourse, the Ugandan government criminalized traditional birth attendants in 2010. In this study, I examine the lived experience of traditional birth attendants and women who have suffered from an obstetric fistula in eastern Uganda. Using data collected from open-ended, semi-structured interviews, focus groups, and participant-observation, I describe the biocultural determinants of obstetric fistula. Based on findings, I argue that although emergency obstetric care is critical to prevent obstetric fistula in cases of obstructed labor, the criminalization of the locally constructed system of care, TBAs, serves as yet another layer of structural violence in the lives of rural, poor women. Results demonstrate how political-economic and cultural determinants of obstetric fistula are minimized in favor of a Western prescribed, bio-medical solution, which is heavily resource dependent. This solution is promoted through a political economy of hope fueled by the obstetric imaginary, or the enthusiastic belief in Western-style biomedical obstetric care’s ability to deliver positive health outcomes for women and infants regardless of local context and constraints. Recommendations include increased obstetric fistula treatment facilities with improved communication from medical staff, decriminalization of traditional birth attendants and renewed training programs, and engaging local populations in maternal health discourse to ensure culturally competent programs. / Graduation date: 2013