Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, Durban, 1999. / The purpose of this study was to determine the relative effectiveness of adjusting the ipsilateral side of the fixated segment versus adjusting the side contralateral to that of the fixated segment, in patients with facet syndrome of the cervical spine, in terms of subjective and objective clinical fmdings, as well as patient comfort. The rationale for adjusting the cervical spine on the side contralateral to fixation is that the spinal dysfunction is of a soft tissue nature, as opposed to joint or bone. Thus the effectiveness of the spinal adjustment may be due to a reprogramming of the central nervous system, whereby the principal effect seems to be to stretch muscles to their normal resting length before spinal mobility can be restored. Adjusting the side opposite to the fixation may cause a sudden stretch of the muscle spindle resulting in a barrage of afferent impulses to the central nervous system, which reflexly turns down the gamma motor neuron tone. The resetting of the gamma motor neuron tone and resultant restoration of the muscle spindle's normal resting length, thereby helps to relieve the associated muscle spasm and possibly removes the fixation. This study was comprised of 30 subjects, all of whom were diagnosed with cervical facet syndrome. The subjects were randomly divided into two groups of 15 each with ap average age of24 years per group. The average male:female ratio was 1,1:1. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The paucity of clinical research into the efficacy and effects of the different treatment protocols available for cervical facet syndrome has led to a continued variation in standard care for this condition. The aim of this study was to determine the relative effectiveness of spinal manipulative therapy in conjunction with the administration of a nonsteroidal antiinflammatory drug (NSAID) versus spinal manipulative therapy in conjunction with the administration of a placebo medication in the treatment of cervical facet syndrome. It was hypothesised that treatment with spinal manipulative therapy and NSAIDs over a two week period, with a further four week follow-up period, would be more effective than spinal manipulative therapy and placebo medication in terms of the objective and subjective clinical findings. The study design chosen was that of a double-blind, comparative, clinical trial. Thirty consecutive patients diagnosed with cervical facet syndrome were randomly assigned either to the manipulation and NSAID group or the manipulation and placebo group. The age range of the patients extended from nineteen to fifty-three years. Forty percent of patient occupations in both groups involved work on a computer. Each patient in the NSAID group received 139.5mg of diclofenac free acid a day over five days. The placebo group received the same dosage of similar appearance and taste over the same period. Each group of fifteen patients received treatment three times a week for two weeks. After a follow-up period of four weeks the patients were re-assessed. The patients were assessed by means of obtaining subjective information consisting of three questionnaires: the McGill Short-Form Pain Questionnaire, the Numerical Pain / M

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1998. / The purpose of this study was to evaluate the relative effectiveness of adjusting the superior vertebral segment as opposed to adjusting the inferior vertebral segment, of the two vertebral motion segments forming the facet joint responsible for the patient's symptoms and resulting in the diagnosis of facet syndrome, in the treatment of mechanical low back pain. Thirty subjects with mechanical low back pain were screened for facet syndrome and randomly divided into two groups of fifteen. Each patient received spinal manipulation for six treatments over 4 weeks, but the contact vertebra was different for each group. In the one group, contact was taken on the superior of the two vertebrae making up the facet syndrome, whereas contact was taken on the inferior of the two involved vertebrae in the second group. In the 'superior' group, the manipulative thrust was directed in the direction of the motion palpation findings, whereas in the 'inferior' group, the manipulative thrust was directed in the opposite direction to the motion palpation findings of the superior segment. Both groups were evaluated in terms of subjective and objective clinical findings by making use of questionnaires (Oswestry Back Pain and Disability Index; Numerical Pain Rating Scale-1 01; Short Form McGill) and goniometer measurements respectively. / M

This investigation is concerned, with the problem of the normative constraints upon scientific research within the broad theoretical framework of the sociology of knowledge, i.e., the contention that knowledge is functionally related to the social system. The concepts "knowledge" and "Social system" are open to wide interpretation; however, in this study knowledge refers to an empirically verifiable variable and the social system is synonomous with the normative system.

M.Tech.

MSc(Med), Epidemiology and Biostatistics, Faculty of Health Sciences, 2009 / Background: Soul City Institute for Health and Development Communication (SC IHDC), a Non Governmental Organisation (NGO) set up to promote health through media tackled cervical cancer in 2006. The Soul City cervical cancer educational programme was developed and broadcasted on South African Broadcasting Cooperation (SABC1) television and radio stations across the country. This paper assesses the relationship between exposure to educational programme and knowledge and practise of South African women on cervical cancer. Objective: To investigate if there is an association between exposure to Soul City educational programme on cervical cancer and knowledge and practice of South African women in relation to cervical cancer. Methods: An analytical cross sectional study design was employed. Secondary data from a Soul City study was used and all South African women aged 16 – 65 years who enrolled into the 2006 leg of the study were included. The data was analysed using Stata 9 utilising logistic regression models. Results: There were 1013 women aged between 16 and 65 years in this study and the average age was 35 years. Most women lived in metropolitan areas (53%), were employed (41%), had secondary education (74%) and had knowledge about cervical cancer and Pap smear (>50%). Lack of knowledge about cervical cancer and Pap smear was observed amongst rural residents (>60%), illiterate women (>54%), and Black South African women (>54%). Generally, participation in cervical screening was low among these women. The iv majority of women had never been screened for cervical cancer in the past (49%) as well as in the previous 12 months (79%). However, a higher proportion of women aged 30 years and above had been for cervical screening test in the past (59%). Although many women aged 30 years and above had been screened sometime in the past, more than three quarters of them were not screened in the last 12 months. Low uptake of Pap smear in 2006 was observed amongst rural residents (6%), older women (9%), illiterate (4%), Coloured (20%) and Black (20%) South African women. Overall knowledge about cervical cancer and Pap smear was associated with exposure to Soul City educational programme on cervical cancer through different media more especially television. Women who watched Soul City on television were more likely to have knowledge about cervical cancer (OR = 1.97, and 95% CI = (1.12; 3.47)) and Pap smear (OR = 2.08, and 95% CI = (1.24; 3.47)) than those who did not watch the programme. Participation of women aged 30 years and above in cervical cancer screening in 2006 was not associated with exposure to the Soul City educational programme. Conclusion: The study findings suggest that Soul City educational programme is associated with knowledge about cervical cancer and Pap smear. There was no evidence that exposure to Soul City educational programme was associated with participation in cervical cancer screening in 2006.

The frequency of variations in nine morphological features of the cervical column in a South African (S.A.) black and white example of human skeletons was investigated to determine whether there Was a greater degree of morphological variability in the black as compared with the white sample. These findings were compared with other population groups. Intertribal, sex and side differences were examined, The possible aetiology of these variations was explored. [Abbreviated abstract. Open document to view full version] / GR 2016

O câncer cervical é o segundo câncer mais comum entre as mulheres em todo o mundo. A infecção por Papilomavirus (HPV) do tipo oncogênico é causa necessária. Estudos internacionais sugerem importante papel de carotenóides e tocoferóis séricos e dietéticos na redução do risco para lesões precursoras, mas os resultados dos estudos prévios são inconsistentes. Indivíduos e métodos: O presente estudo de casos e controles de base hospitalar conduzido na cidade de São Paulo analisou a associação entre concentrações séricas de carotenóides (licopeno, β-caroteno), tocoferóis (α- e γ-), consumo alimentar e casos incidentes, com confirmação histopatológica, de neoplasia intraepitelial cervical (NIC) graus 1,2,3 e câncer cervical. O estudo incluiu 453 mulheres do grupo controle (sem lesões de colo uterino) e 4 grupos de casos (NIC1, n=140; NIC2, n=126; NIC3, n=231; câncer cervical, n=108) recrutadas em dois hospitais públicos de referência entre 2003 e 2005. Resultados. A concentração sérica de licopeno foi inversamente associada à NIC1, NIC3 e câncer cervical com os seguintes Odds Ratio (OR) (intervalo de confiança de 95%), respectivamente: 0,53 (0,27-1,00; p de tendência=0,05); 0,48 (0,22-1,04; p de tendência=0,05) e 0,18 (0,06-0,52; p de tendência=0,002) quando comparado o maior com o menor tercil após ajuste por variáveis de confusão e grupos de HPV. O maior tercil de β-caroteno sérico foi inversamente associado ao câncer quando comparado ao menor: OR ajustado = 0,36 (0,13-1,03: p de tendência=0,04). Maiores concentrações de α- e γ-tocoferóis foram inversamente associadas a NIC3 com redução do risco em 50%, após ajuste por covariáveis e HPV. Maior tercil de consumo do grupo de folhas verde-escuras, legumes e frutas de cor alaranjada ou amarela escura foi inversamente associado ao risco para NIC3: OR ajustado comparado ao menor foi 0,52 (0,27-1,00; p de tendência=0,05). Conclusão: Os resultados do presente estudo sugerem que maiores concentrações séricas de antioxidantes e o consumo de alimentos ricos em carotenóides podem reduzir o risco para NIC3 e câncer cervical em mulheres brasileiras. / Cervical cancer is the second most common cancer in women worldwide. Human papillomavirus (HPV) infection has been recognized to be a necessary cause for cervical cancer. Serum concentrations and dietary carotenoids and tocopherols have been associated with the risk for cervical dysplasia, but results from previous studies were not consistent. Subjects and methods: In this hospital-based case-control study conducted in São Paulo city, Brazil, we evaluated the association of serum carotenoids (β-carotene, lycopene), tocopherols (α- and γ-), and dietary intakes with the risk of incident histologically confirmed cervical intraepithelial neoplasia (CIN) grades 1, 2, 3, and cervical cancer. The sample included 453 controls and four groups of cases (CIN1, n= 140; CIN2, n= 126; CIN3, n= 231; invasive cancer, n=108) recruited from two major public hospital-based clinics between 2003 and 2005. Results. Concentrations of serum lycopene were negatively associated with CIN1, CIN3 and cancer, with odds ratio (OR) (95% confidence interval) for the highest compared with the lowest tertile of 0.53 (0.27-1.00, p trend=0.05) for CIN1, 0.48 (0.22-1.04, p trend=0.05) for CIN2 and 0.18 (0.06-0.52, p trend= 0.002) for cervical cancer adjusted for confounding variables and HPV status. The adjusted OR for cancer of the highest versus the lowest tertile of serum β-carotene was 0.36 (0.13-1.03, p trend= 0.04). Increasing concentrations of serum α- and γ-tocopherols were associated with 50% decreasing risk of CIN3, for the women in the highest compared with the lowest quartile after adjusting for confounding variables and HPV. Increased dietary intakes of dark green and deep yellow vegetables and fruits were inversely associated with CIN3 among women in the highest compared to the lowest tertile (adjusted OR= 0.52, 95%CI = 0.27-1.00; p trend=0.05). Conclusion: These results support the evidence that high serum levels of antioxidants as well as dietary intakes may reduce the risk for CIN3 and invasive cancer in Brazilian women.

O objetivo do estudo foi verificar se o tempo de exposição do muco cervical ao ar atmosférico, por ocasião do exame especular, pode alterar o valor do pH do muco. A determinação dessa alteração se justifica pela possível interferência na interação mucoespermática, já que um pH ácido é desforável à penetração espermática e está associado à infertilidade por fator cervical. Para tal, foram estudadas 20 pacientes com muco de boa qualidade, avaliado através do volume, filância, cristalização e coloração ao superaquecimento, livres de medicação e de patologia ginecológica e que concordaram em participar do estudo. As medidas do pH do muco ecto e endocervical foram realizadas in situ, com eletrodo de vidro, aos zero, cinco e dez minutos de exposição da cérvice. Os resultados mostraram alcalinização progressiva do pH do muco com o tempo de exposição ao ar, observando-se, no muco ectocervical, valores médios de pH de 6,91 , 7,16 e 7,27 aos zero, cinco e dez minutos respectivamente, ao passo que, no muco endocervical, os valores médios foram de 7,09, 7,34 e 7,46 aos zero, cinco e dez minutos, respectivamente. Houve diferenças estatisticamente significativas entre osvalores obtidos aos zero e cinco minutos e aos zero e dez minutos ( p < 0,05 ) em ambos os sítios. Não foram encontradas diferenças significativas entre os valores registrados aos cinco e dez minutos num e noutro sítio. Concluiu-se que o tempo de exposição ao ar afeta o pH do muco cervical de forma significativa. Como os testes empregados até o momento para avaliar a interação mucoespermática não consideram essa possibilidade, sugere-se que os mesmos sejam realizados imediatamente após a coleta do muco a fim de evitar uma possível interferência nos valores obtidos e, conseqüentemente, na interpretação de tais testes. Futuros estudos são necessários para determinar o momento exato, no intervalo entre os zero e cinco minutos. em que as alterações de pH do muco cervical promovidas pela exposição ao ar atmosférico têm início.

Objective: To detect the most prevalent human papillomavirus (HPV) genotypes samples of asymptomatic Peruvian women by analyzing the correlation betwe ienn c Pearvpiacnailc somlaeoaur (PAP)-stained cervical tests and PCR-sequencing. Methods: A total of 254 women attending routine gynecological examinations were included in pthaitsh ostluogdiys.t Tahned scalmaspsliefise dw ebrye tahnea Blyeztehde sbdya PsAysPt etmec.h HnPiqVu ea manpdli feicxaatmioinn ewda su nddoenre au msinicgr othsceo pprei mbeyr as specific for E1 region and positive specimens were confirmed by direct sequencing. Results: The prevalence of HPV was investigated in 254 cervical scrape samples by PCR. PAP smear showed that 94.9% cases had normal morphology and 5.1% had an inflammatory pattern; 2p0r.e5v%a lwenert eg efonuontydp teo ibne c ionrfreeclatetido nw iwthit hH PchVa, ncgoems pinri scienrgv i2c0a dl icfyfetorelongt yg.enotypes. HPV16 was the most Conclusions: Our results suggest the HPV is very frequent even in women with negative PAP, eannddo PceCrRvi csaele smasm tpol ebs.e Itdheen tbifeicsat toiopnt ioofn t htoe HdePtVe rgmeinnoety tphee inc aaussyamtipvteo magateinc tw oofm HePnV m ianyf eaclltoiown t hine nimatpulreaml henisttaotriyo no fo tfh ea pdpisroepasreia aten dp rthope hsyulbascetqicu emnet adseuvreelso pwmheicnht omf acye rhviacvael ma adliirgencatn icmy.pact / jdelvall@upc.edu.pe / This work has been partially supported by Universidad Peruana de Ciencias Aplicadas (UPC), Instituto de Investigación Nutricional and Instituto de Investigación de Efrnomfe rtmheed pardoegsr aImnf ecciosas, Lima, Peru. JR has a fellowship I3, of the ISCIII (Grant No. CES11/012), and LJDV from the Generalitat de Catalunya (2009SGR1208). / Revisión por pares