published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Anatomy / Master / Master of Philosophy

Bakgrund: Benign prostatahyperplasi påverkar åldrande män över hela världen och en fjärdedel av alla män beräknas ha symptom till följd av sjukdomen. Vid uppkomst av symptom drabbas mannens nedre urinvägar vilket kan leda till bland annat nedre urinvägssymptom, sexuell dysfunktion och psykiska besvär vilket kan antas påverka livskvalitén. Som referensram valdes livskvalité med utgångspunkt i Världshälsoorganisationens definition och Sprangers och Schwartz modell om response shift. Syfte: Att belysa livskvalitén hos män med symptomgivande benign prostatahyperplasi. Metod: Litteraturstudie med induktiv ansats. Resultat: Resultatet visade att livskvalitén påverkas negativt av symptomen vid benign prostatahyperplasi. Graden av påverkan berodde på vilket symptom samt symptomets allvarlighetsgrad. De mest framträdande och återkommande symptomen var nocturi, akut blåstömning, smärta samt sexuell dysfunktion. Slutsats: I resultatet framkom att benign prostatahyperplasi påverkade livskvalitén negativt. Dock saknades kvalitativ forskning för att beskriva hur livskvalitén påverkades. För att få en tydlig bild av att se hur livskvalitén förändras över tid kan modellen om response shift användas och därmed kan vården på ett bra sätt främja livskvalitén hos personer drabbade av benign prostatahyperplasi.

Orientador: Heron Fernando de Souza Gonzaga / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T05:15:05Z (GMT). No. of bitstreams: 1 Chaves_MarceloDonizetti_D.pdf: 1424400 bytes, checksum: 35e88d5e057e2d0b7214de851a1b8e3f (MD5) Previous issue date: 2005 / Resumo: A psoríase é uma doença cutânea crônica, cuja condição bucal mais freqüentemente associada é a língua geográfica. Fatores genéticos e ambientais estão relacionados com as mesmas. A descrição destes fatores mostra a importância do estudo da herdabilidade para determinação quantitativa da influência do genótipo e do ambiente. Este trabalho foi realizado com o objetivo de estudar a herdabilidade da psoríase cutânea e língua geográfica, através do estudo de genealogias de famílias com portadores destas condições. Foram estudados 356 heredogramas de pacientes com estas doenças, a partir de prontuários de um ambulatório dermatológico, independente da idade, gênero e grupo étnico. A amostra foi constituída por 128 propósitos com psoríase cutânea, do tipo vulgar e 257 língua geográfica. Os propósitos com psoríase cutânea apresentavam ou não simultaneidade de língua geográfica e os propósitos com língua geográfica apresentavam ou não simultaneidade de psoríase cutânea. Para a determinação da herdabilidade, utilizou-se o método de Falconer. Este método foi desenvolvido em genética quantitativa, para avaliar o comportamento de características de limiar, aplicado para dados da incidência das doenças, a fim de responder a questão relativa à importância da herança e do ambiente no desenvolvimento das mesmas. A partir dos resultados obtidos destas análises, constatamos que: a) a herdabilidade dos pais em famílias de portadores de psoríase foi de 89,2%, sendo esta considerada alta; b) o mesmo foi observado com relação aos filhos (86,8%) e filhas (84,4%) do propósito; c) verificou-se herdabilidade maior nos grupos de irmãos e irmãs que nos grupos dos pais do propósito, sendo todas as herdabilidades consideradas altas; d) as herdabilidades das irmãs (97%) e irmãos (98%) foram as maiores obtidas, sendo muito semelhantes entre si e maiores do que a dos pais do propósito (89,2%); e) verificou-se a correlação entre filhos/propósito (86,8%) e filhas/propósito (84,4%), ambas com herdabilidade alta e muito semelhante; f) com relação à língua geográfica, observou-se que o valor da herdabilidade filhos/propósito (80,2%) foi maior que a dos pais/propósito (41,6%), sendo o mesmo verificado para a herdabilidade filhas/propósito (68,6%) que na herdabilidade pais/propósito (41,6%); g) a herdabilidade irmãos/propósito (56,8%) foi maior que o valor para pais/propósito (41,6%) e irmãs/propósito (41,6%); h) na comparação entre as herdabilidades filhos/propósito (80,2%) e filhas/propósito (68,6%), observamos que esta foi maior na primeira que na segunda; i) observou-se herdabilidade maior na relação irmãos/propósito (56,8%) que na irmãs/propósito (41,6%); j) o cálculo da herdabilidade total para o grupo com psoríase indicou uma herdabilidade alta (92,1%); k) com relação ao grupo com língua geográfica, também se observou uma herdabilidade alta (51,5%). A partir destes dados, conclui-se que tanto na psoríase, quanto na língua geográfica existe um fator genético determinante / Abstract: Psoriasis is a chronic cutaneous disease whose oral condition is more frequently associated to benign migratory glossitis. Aspects as epidemiological association, basic lesions and microscopic characteristics similarly support the idea that benign migratory glossitis is the true form of oral psoriasis. This study was done having the objective of study the heritability to cutaneous psoriasis and benign migratory glossitis through the genealogy of family with holder these diseases. Were studied 356 heredograms of patients from the records of the dermatological ambulatory, independently of age, gender or ethnic group. The sample was made up of 128 propositi with cutaneous psoriasis and 257 with benign migratory glossitis. The patients suffering from cutaneous psoriasis presented benign migratory glossitis simultaneous or not and the patients of benign migratory glossitis group presented or not psoriasis simultaneously. To determination of heritability were applied Falconer¿s methods. This method was developed in quantitative genetics to analyze the behavior of threshold characteristics. It was applied to date of the incidence of the diseases, so as to answer the question about the role of the inheritance and environmental factors in development the psoriasis and benign migratory glossitis. The following constations were taking from the observed results: a) the heritability of parents in families with patients suffering from cutaneous psoriasis was 89,2%, being considered high; b) high heritability was observed to sons (86,8%) and daughters (84,4%) from propositi; c) it was verified heritability higher in groups of brothers and sisters than groups of parents from propositi, that showed high heritabilities; d) the heritabities of sisters (97%) and brothers (98%) were the higher obtained, and very similar among these and higher than parents from propositi (89,2%); e) it was verified the correlation among sons/propositi (86,8%) and daughters/propositi (84,4%), both having high heritability and very similar; f) beside to benign migratory glossitis, observed that value to heritability sons/propositi (80,2%) was high than parents/propositi (41,6%), being the same verified beside to heritability daughters/propositi (68,6%) that to heritability parents/propositi (41,6%); g) the heritability brothers/propositi (56,8%) was higher than the value to parents/propositi (41,6%) and sisters/propositi (41,6%); h) beside the heritabilities sons/propositi (80,2%) and daughters/propositi (68,6%), it was observed that the heritability was higher in first than second; i) it was observed heritability higher beside brothers/propositi (56,8%) than sisters/propositi (41,6%); j) the total heritability to group with cutaneous psoriasis indicated high heritability (92,6%); k) comparing to group with benign migratory glossitis was also observed a high heritability (54,8%). These data allow the conclusion that, both psoriasis and benign migratory glossitis have a determinant genetic factor / Doutorado / Patologia / Doutor em Estomatopatologia

Bakgrund: Långvarig benign smärta är ett stort hälsoproblem i samhället. För att räknas som långvarig smärta ska smärtan ha varat i minst tre månader. Personer upplever långvarig smärta som fysiskt och psykiskt påfrestande. Sjuksköterskan har en viktig roll i bedömning, smärtskattning och behandling av smärtan. Det är således av betydelse att ta reda på personers upplevelse av långvarig smärta.   Syfte: Syftet med studien var att beskriva personers upplevelse av att leva med långvarig benign smärta.   Metod: En litteraturöversikt med induktiv ansats. Databaserna CINAHL och PsycINFO användes för att göra litteratursökningen. Syftet besvarades med tio artiklar som användes för att bygga upp resultatet. Fribergs femstegsmodell användes för att bearbeta och analysera resultatet i artiklarna.   Resultat: I resultatet framkom två huvudteman som var: Bemötande i vården och Påverkan på det dagliga livet. Båda huvudtemana hade tre subteman.   Slutsats: Personerna behöver bli betrodda och bekräftade i upplevelsen av sin smärta. En ökad kunskap i bemötandet av personer med långvarig smärta behövs för att mötet ska upplevas givande. Ett givande möte kan leda till minskad smärta eller upplevelse av god hälsa, trots smärtan. / Background: Chronic benign pain is a big worldwide health problem in the society. To be defined as chronic the pain must have lasted for at least three months. The chronic pain causes physical as well as psychic stress. The caregiver has a vital role in judging, pain scaling and treatment. It is thereby of importance to find out how people experience the chronic pain.   Aim: The purpose of the study was to describe people's experience of living with benign chronic pain   Method: A literature review with inductive approach. The databases CINAHL and PsycInfo was used to make the literature search. The aim was answered with 10 qualitative results articles. Fribergs fivestepsmodell was used to process and analyse the articles result.   Result: In the result two heads themes emerged: Treatment in healthcare and  Impact on daily life. Both head themes consisted of three subheadings.   Conclusion: There is a need to be believed and acknowledge in the experience of pain. An increased knowledge in treatment of people with chronic pain is needed for the meeting to be experienced as rewarding. A rewarding meeting can lead to reduced pain or experience of good health, despite pain.

Bakgrund: Hysterektomi är en vanlig gynekologisk operation som kan utföras på tre olika sätt; abdominellt, vaginalt eller laparoskopiskt. En kvinna med en benign sjukdom med behov av en hysterektomi lider av många symtom som kan sänka kvinnans livskvalitet och sexuella funktion. Kvinnor kan preoperativt ha en ängslan och oro kring hur operationen kommer att påverka kvinnans livskvalitet och sexuella hälsa.   Syfte: Att undersöka hur kvinnor skattar sin livskvalitet och sexuella funktion efter en genomgången elektiv hysterektomi med benign orsak.   Metod: Litteraturstudie där 13 kvantitativa originalartiklar granskades. Resultaten av dessa sammanställdes och analyserades med en innehållsanalys.   Resultat: Den största delen av artiklarna rapporterade att kvinnornas livskvalitet och sexuella funktion förbättrades efter hysterektomin. Kvinnornas sociala funktion, fysiska funktion, psykiska funktion och deras smärtproblematik förbättrades. Den sexuella funktionen förbättrades hos majoriteten av kvinnorna med ökad sexuell frekvens och fler sexuellt aktiva men oförändrad sexuell lust. Kvinnorna skattade sin Female Sexual Function Index (FSFI) högre, däremot visade två studier på försämrad FSFI och därmed försämrad sexuell funktion. Trots den förbättrade FSFI-poängen skattar kvinnorna fortfarande lägre än normalpopulationen.   Slutsats: Majoriteten av de kvinnor som genomgått en hysterektomi på grund av benigna orsaker skattar sin livskvalitet bättre postoperativt genom att kvinnorna får en förbättrad social funktion, fysisk funktion och psykisk hälsa. Den sexuella funktionen skattas högre trots att kvinnorna fortfarande skattar lägre än vad normalpopulationen gör. Fler kvinnor blir sexuellt aktiva och får högre sexuell frekvens men den sexuella lusten upplevs oförändrad. / Background: Hysterectomy is a relatively common gynecological surgery that can be performed in three different ways: abdominally, vaginally or laparoscopically. It has been suggested that women with benign cause for a hysterectomy suffers from many symptoms that can lower a woman's overall quality of life and sexual function. Many women experience anxiety prior to the operation concerning the outcomes of the surgery.   Aim: The purpose is to investigate how women estimate their quality of life and sexual function after an elective hysterectomy with a benign cause.   Method: A literature review where 13 quantitative original articles were examined. The result was compiled and analyzed using a content analysis method.   Results: Most of the articles reported that women's quality of life and sexual function improved after the hysterectomy. The women's social function, physical function, mental function and their pain problems had improved. This included that the women’s sexual frequency and sexual activity improved but their sexual desire was unchanged. In a contrary note some women estimated their FSFI higher, whilst in two other studies it was shown that some had FSFI which also concluded an impaired sexual function. Although women estimated their FSFI higher postoperatively their scores still show lower FSFI score than the normal population.   Conclusion: Most women who go through with a hysterectomy because of benign diseases evaluate their quality of life to be higher postoperatively by improving their social function, physical function and mental health. Their sexual function is estimated to be higher than it was preoperatively, even though women still show lower FSFI score than the normal population.

5α-reductases (5αRs) catalyse reduction of 4-pregnene steroids, most notably the androgen testosterone to its more potent metabolite dihydrotestosterone (DHT). Well-characterised isozymes of 5αR are designated 5αR1 and 5αR2. Inhibitors of 5αR, finasteride (a 5αR2 inhibitor) and dutasteride (a dual 5αR1 and 5αR2 inhibitor), are utilised in conditions where a reduction in androgen action is desired, including benign prostatic hyperplasia. Although 5αR2 is predominantly expressed in reproductive tissues, both isozymes, but particularly 5αR1, are expressed in metabolic tissues including liver and adipose and both metabolise glucocorticoids as well as androgens; therefore inhibition of 5αR may have consequences for metabolic health. This thesis addresses the hypotheses that 5αR1 inhibition with dutasteride decreases insulin sensitivity and causes dysregulation of the HPA axis in humans. Metabolism and the HPA axis were studied in men prior to and following 3 months of dutasteride (0.5 mg daily; n=16), finasteride (5 mg daily; n=16) or control (tamsulosin MR; 0.4 mg daily; n=14). Glucose disposal during hyperinsulinaemia was the primary endpoint, measured during a hyperinsulinaemic euglycaemic clamp, with d2-glucose and d5-glycerol tracers. Peripheral insulin sensitivity for both glucose uptake and NEFA suppression decreased with dutasteride versus both finasteride and control, while hepatic insulin sensitivity was preserved. Body fat increased with dutasteride, though was not accompanied by changes in metabolic or inflammatory gene transcript abundance in subcutaneous adipose biopsies, nor any differences in abdominal adipose depots on post-treatment MRI. Subtle dysregulation of the HPA axis was evident with both 5αR inhibitors, though to a greater degree with dutasteride and changes were largely compensated for. In support of this study, this thesis also describes the development, validation and application of two novel liquid chromatography tandem mass spectrometry assays; establishing compliance by measuring serum drug levels, and demonstrating effects of 5αR inhibitors on androgen metabolism and adrenal steroidogenesis by measurement of testosterone, DHT and androstenedione. In conclusion, 5αR1 inhibition with dutasteride, but not finasteride, induces peripheral insulin resistance and increases body fat. Findings presented may have important implications for patients prescribed dutasteride for benign prostatic hyperplasia.

A podoplanina humana é uma glicoproteína que se expressa em várias células e tecidos normais e neoplásicos, inclusive aqueles de origem odontogênica. O objetivo deste estudo foi identificar a imunolocalização da podoplanina em tumores odontogênicos epiteliais com e sem ectomesênquima incluindo oito ameloblastomas, nove tumores odontogênicos adenomatóides, vinte tumores odontogênicos queratocísticos, cinco cistos odontogênicos ortoqueratinizados, um tumor odontogênico epitelial calcificante, dois fibromas ameloblásticos, quatro fibroodontomas ameloblásticos e cinco tumores odontogênicos císticos calcificantes. Todos os tumores odontogênicos foram submetidos a imuno-histoquímica para o anticorpo anti-podoplanina numa diluição de 1:100 e avaliados, microscopicamente, com base na distribuição tecidual e na intensidade da imunomarcação. Para os tumores odontogênicos queratocísticos e cistos odontogênicos ortoqueratinizados além da podoplanina foi determinado o índice de proliferação celular baseado na positividade nuclear das células do epitélio odontogênico imunomarcadas com o Ki-67 na diluição de 1:200 e comparados estatisticamente pelo coeficiente de correlação de Spearman. Os resultados mostraram uma forte expressão da podoplanina na membrana e no citoplasma do epitélio odontogênico da maioria dos tumores analisados, bem como, em células ectomesênquimais como os odontoblastos e suas extensões dentinárias. A ausência da podoplanina foi identificada nos ameloblastos completamente diferenciados, nas áreas de metaplasia escamosa, nas células fantasmas, nas áreas de calcificação e nos depósitos extracelulares de material eosinofílicos observados nos tumores odontogênicos. No tumor odontogênico queratocístico observou-se uma forte expressão da podoplanina na camada basal e suprabasal do epitélio, enquanto que, nos cistos odontogênicos ortoqueratinizados esta expressão estava ausente ou fracamente distribuída no epitélio. Houve uma correlação estatisticamente significativa (p=0,006) entre a expressão de podoplanina e o índice de proliferação celular dos tumores odontogênicos queratocísticos e cistos odontogênicos ortoqueratinizados. Estes resultados sugerem que a podoplanina participa dos processos de proliferação e diferenciação celular dos epitélios odontogênicos presentes nos tumores odontogênicos benignos dos ossos maxilares. / Human podoplanin is a glycoprotein expressed in various cells and normal and neoplastic tissues, including those of odontogenic origin. The aim of this study was to identify the immunolocalization of podoplanin in epithelial odontogenic tumors with and without ectomesenchyme, including eight ameloblastomas, nine adenomatoid odontogenic tumors, twenty keratocystic odontogenic tumors, five orthokeratinized odontogenic cysts, one calcifying epithelial odontogenic tumor, two ameloblastic fibromas, four ameloblastic fibro-odontomas and five calcifying cystic odontogenic tumors. All odontogenic tumors were submitted to immunohistochemistry using a podoplanin antibody at a dilution of 1:100 and evaluated microscopically, based on the tissue distribution and intensity of immunoreactivity. For keratocystic odontogenic tumors and orthokeratinized odontogenic cysts, in addition to podoplanin, the index of cell proliferation was determined based on the nuclear positivity of odontogenic epithelial cells immunostained with Ki-67 at a dilution of 1:200 and statistically compared by the Spearman correlation coefficient. The results showed strong expression of podoplanin in the membrane and cytoplasm of the odontogenic epithelium of most tumors analyzed, as well as in ectomesenchymal cells as odontoblasts and dentinal projections. Absence of podoplanin was observed in fully differentiated ameloblasts, in areas of squamous metaplasia, in ghost cells, in areas of calcification and extracellular deposits of eosinophilic material observed in odontogenic tumors. The keratocystic odontogenic tumor exhibited strong expression of podoplanin in basal and suprabasal epithelial layers, while in orthokeratinized odontogenic cysts this expression was absent or weakly distributed in the epithelium. There was statistically significant correlation (p=0,006) between the expression of podoplanin and the cellular proliferation index of odontogenic tumors and orthokeratinized odontogenic cysts. These results suggest that podoplanin participates in the processes of cell proliferation and differentiation of odontogenic epithelium present in benign odontogenic tumors of the jaws.

A podoplanina humana é uma glicoproteína que se expressa em várias células e tecidos normais e neoplásicos, inclusive aqueles de origem odontogênica. O objetivo deste estudo foi identificar a imunolocalização da podoplanina em tumores odontogênicos epiteliais com e sem ectomesênquima incluindo oito ameloblastomas, nove tumores odontogênicos adenomatóides, vinte tumores odontogênicos queratocísticos, cinco cistos odontogênicos ortoqueratinizados, um tumor odontogênico epitelial calcificante, dois fibromas ameloblásticos, quatro fibroodontomas ameloblásticos e cinco tumores odontogênicos císticos calcificantes. Todos os tumores odontogênicos foram submetidos a imuno-histoquímica para o anticorpo anti-podoplanina numa diluição de 1:100 e avaliados, microscopicamente, com base na distribuição tecidual e na intensidade da imunomarcação. Para os tumores odontogênicos queratocísticos e cistos odontogênicos ortoqueratinizados além da podoplanina foi determinado o índice de proliferação celular baseado na positividade nuclear das células do epitélio odontogênico imunomarcadas com o Ki-67 na diluição de 1:200 e comparados estatisticamente pelo coeficiente de correlação de Spearman. Os resultados mostraram uma forte expressão da podoplanina na membrana e no citoplasma do epitélio odontogênico da maioria dos tumores analisados, bem como, em células ectomesênquimais como os odontoblastos e suas extensões dentinárias. A ausência da podoplanina foi identificada nos ameloblastos completamente diferenciados, nas áreas de metaplasia escamosa, nas células fantasmas, nas áreas de calcificação e nos depósitos extracelulares de material eosinofílicos observados nos tumores odontogênicos. No tumor odontogênico queratocístico observou-se uma forte expressão da podoplanina na camada basal e suprabasal do epitélio, enquanto que, nos cistos odontogênicos ortoqueratinizados esta expressão estava ausente ou fracamente distribuída no epitélio. Houve uma correlação estatisticamente significativa (p=0,006) entre a expressão de podoplanina e o índice de proliferação celular dos tumores odontogênicos queratocísticos e cistos odontogênicos ortoqueratinizados. Estes resultados sugerem que a podoplanina participa dos processos de proliferação e diferenciação celular dos epitélios odontogênicos presentes nos tumores odontogênicos benignos dos ossos maxilares. / Human podoplanin is a glycoprotein expressed in various cells and normal and neoplastic tissues, including those of odontogenic origin. The aim of this study was to identify the immunolocalization of podoplanin in epithelial odontogenic tumors with and without ectomesenchyme, including eight ameloblastomas, nine adenomatoid odontogenic tumors, twenty keratocystic odontogenic tumors, five orthokeratinized odontogenic cysts, one calcifying epithelial odontogenic tumor, two ameloblastic fibromas, four ameloblastic fibro-odontomas and five calcifying cystic odontogenic tumors. All odontogenic tumors were submitted to immunohistochemistry using a podoplanin antibody at a dilution of 1:100 and evaluated microscopically, based on the tissue distribution and intensity of immunoreactivity. For keratocystic odontogenic tumors and orthokeratinized odontogenic cysts, in addition to podoplanin, the index of cell proliferation was determined based on the nuclear positivity of odontogenic epithelial cells immunostained with Ki-67 at a dilution of 1:200 and statistically compared by the Spearman correlation coefficient. The results showed strong expression of podoplanin in the membrane and cytoplasm of the odontogenic epithelium of most tumors analyzed, as well as in ectomesenchymal cells as odontoblasts and dentinal projections. Absence of podoplanin was observed in fully differentiated ameloblasts, in areas of squamous metaplasia, in ghost cells, in areas of calcification and extracellular deposits of eosinophilic material observed in odontogenic tumors. The keratocystic odontogenic tumor exhibited strong expression of podoplanin in basal and suprabasal epithelial layers, while in orthokeratinized odontogenic cysts this expression was absent or weakly distributed in the epithelium. There was statistically significant correlation (p=0,006) between the expression of podoplanin and the cellular proliferation index of odontogenic tumors and orthokeratinized odontogenic cysts. These results suggest that podoplanin participates in the processes of cell proliferation and differentiation of odontogenic epithelium present in benign odontogenic tumors of the jaws.

Magister Scientiae Dentium - MSc(Dent) / Aim To analyze the demographic profile, clinical data and radiographs of patients who had third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape over a 10 year period. Introduction Minor oral surgical procedures are carried out by Maxillofacial and Oral Surgeons daily. The surgical removal of third molars is a large part of Minor Oral Surgery which is common throughout the world. The general impression of third molar surgery performed by experienced professionals is the ease of the operation, however no-matter how experienced one may be, a simple procedure should never be underestimated (Carvalho and Do Egito Vasconselos, 2011). New surgical techniques, as well as extensive training, skill and experience have led to the evolution of oral surgery and allowed this procedure to be carried out in a less traumatic manner. Certain factors precipitate third molar surgery to be performed in theatre as opposed to the dental clinic setting. These factors will be discussed in this research report.