Chronic neck pain is a widespread problem that causes individual suffering as well as large costs for the society. The knowledge about the pathophysiology is poor and therefore specific diagnosis and causal treatment are rare. Important knowledge for characterization of the disorders has been gained from research on sensorimotor functions in people with neck pain. Moreover, rehabilitation regimes including sensorimotor exercises indicate promising results. The main objectives of this thesis were to extend the knowledge on sensorimotor dysfunctions in chronic neck pain, and to develop a new exercise method for improving sensorimotor functions of the neck. The studies focused on aspects of postural control and movements of the arm and neck. These are vital functions for many activities of daily living. People with chronic (>3 months) neck pain were compared to healthy controls (CON). Neck pain related to trauma was referred to as whiplash associated disorders (WAD), while neck pain without association to trauma was referred to as non-specific (NS). Arm-functioning was assessed in a pointing task. WAD and NS had reduced pointing precision compared to CON. The reduced precision was associated with self-rated difficulties performing neck movements, physical functioning, and in WAD, also pain and balance disturbances. Postural control was assessed in quiet standing on a force platform without vision. The center of pressure signal was decomposed into it’s slow and fast components. WAD and NS were compared to CON. The results revealed an effect of age on the magnitude of the fast sway component, but no effect of group. The magnitude of the slow component was elevated in both WAD and NS. This increase was associated with self-rated balance disturbance, arm-functioning, difficulties to run and sensory alterations in WAD, while in NS, the increase in the slow sway component was associated with concurrent low back pain. Neck movements were assessed in a cervical axial rotation test with maximal speed. In total 8 variables representing basic kinematics, including variables reflecting movement smoothness and conjunct motions were calculated. NS were compared to CON. Linear discriminant modelling indicated Peak Speed and conjunct motions as significant classification variables that together had a sensitivity of 76.3% and specificity of 77.6%. Retest reliability was good for Peak Speed but poor for the measure of conjunct motions. Peak Speed was slower in NS compared to CON, and even slower in a sub-group of NS with concurrent low back pain. Reduced Peak Speed was associated with self-rated difficulties performing neck movements, car driving, running, sleeping disturbances and pain. The clinical applicability of a novel method for neck coordination exercise was assessed in a pilot study on persons with NS. The results supported the applicability and indicated positive effects of the exercise: reduced postural sway in quiet standing and increased smoothness in cervical rotations. Indications on improvement in self-rated disability and fear of movement were seen at six months follow up. In conclusion, sensorimotor functions can be altered in chronic neck pain, particularly in neck disorders with concurrent low back pain and WAD. The discriminative ability and clinical validity displayed in pointing precision, postural sway and cervical axial rotation speed imply that such tests can be valuable tools in the assessment of chronic neck pain patients, and for selecting and evaluating treatment interventions. Indications of improvements seen in the pilot-study support a future RCT.

<p>The study aimed to describe the knowledge and awareness of HPV infection and vaccine of female university students and to determine the predictors of vaccine acceptability.&nbsp / The study found that 70% of the participants were sexually active. Awareness and knowledge on HPV/vaccine were poor / with only 22% being aware of HPV and that a HPV vaccine was available in South Africa. A greater proportion (80%) reported willingness to be vaccinated. Being aware of the existence of a pap smear, higher knowledge about HPV, higher perceived vaccine effectiveness and higher perceived severity of HPV infection were significantly associated with increased willingness to be vaccinated.</p>

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

The purposes of this study were to: 1) determine absolute intrarater reliability of using the cervical range of motion device (CROM) for measuring cervical movements in older adults, and 2) determine the intrarater reliability and concurrent validity of the Candrive protocol, which uses a universal goniometer to measure rotation. Forty older adults (75.7 + 4.7 years of age) were tested in two sessions, one week apart, by two raters. Intrarater reliability scores were good for the CROM protocol (coefficient of variation (CV) values were 5.5% and 6.2 % for cervical rotation). The Candrive protocol values were higher (CV = 7.9 and 9.4%). Concordance analyses suggested that the Candrive protocol was less than good in terms of its validity, particularly when order effects were taken into consideration. In conclusion, the CROM protocol demonstrated good reliability for either group or individual analyses, whereas the Candrive protocol was less reliable and its validity marginal.

This dissertation observes the association between human papillomavirus (HPV) integration into the host cell genome and cervical intraepithelial lesions. The aim of this study is to determine how the grade of HPV16 DNA integration into the host cell genome (HPV E2 gene deletion) is related to cervical intraepithelial lesions. 253 women were screened for HPV infection and the majority was diagnosed with HPV type 16. The most frequently determined was HPV grade II integration. No statistically significant difference was defined while analyzing the relations between the status of HPV E2 gene integration and the grade of cervical intraepithelial lesions. The fact that integration of HPV type 16 was determined in low grade cervical squamous intraepithelial lesions or in cases with no intraepithelial lesions shows that virus integration occurs at the early stage of carcinogenesis. It is noteworthy that during the follow-up (secondary visit after 6 month) 50% of HPV positive women were identified with mRNR expression which probably establishes the presence of persistent active HPV infection. The research provided is highly significant for improvement of cervical cancer screening programms. Adjusting Pap smear, HPV DNA detection and determination of other HPV biomarkers (such as E2 gene deletion mRNR), it becomes possible to separate out HPV positive women with no clinical signs, although, belonging to the of high risk group for cervical carcinoma developing. / Disertacijoje nagrinėjama sąsaja tarp žmogaus papilomos viruso (ŽPV) integracijos į gimdos kaklelio epitelio ląstelių genomą ir intraepitelinių gimdos kaklelio pokyčių. Pagrindinis darbo tikslas – nustatyti, kaip 16 tipo ŽPV DNR integracijos laipsnis (ŽPV E2 geno iškrita) susijęs su intraepiteliniais gimdos kaklelio pokyčiais. Ištyrus 253 moteris nustatyta, kad dauguma moterų buvo infekuotos 16 tipo ŽPV. Dažniausiai nustatyta II laipsnio šio tipo ŽPV integracija. Statistiškai reikšmingo skirtumo analizuojant sąsajas tarp ŽPV E2 geno integracijos pobūdžio ir intraepitelinių gimdos kaklelio pokyčių laipsnio nenustatyta. Tai, kad integruotų 16 tipo ŽPV formų nustatyta esant nežymių arba net nesant intraepitelinių gimdos kaklelio pokyčių, rodo, jog viruso integracija yra ankstyvasis kancerogenezės įvykis. Pažymėtina, kad pakartotinio patikrinimo metu 50 proc. ŽPV infekuotų moterų konstatuota mRNR raiška, kas rodo besitęsiančią aktyvią ŽPV infekciją. Atliktas tyrimas yra svarbus gerinant patikros dėl gimdos kaklelio patologijos programas: derinant Pap testą ir ŽPV DNR bei kitų ŽPV žymenų nustatymą (mRNR, E2 geno iškrita) galima atrinkti infekuotas ŽPV moteris, kurioms dar nėra klinikinių požymių, tačiau jos priklauso didelės rizikos susirgti gimdos kaklelio vėžiu grupei.

Disertacijoje nagrinėjama sąsaja tarp žmogaus papilomos viruso (ŽPV) integracijos į gimdos kaklelio epitelio ląstelių genomą ir intraepitelinių gimdos kaklelio pokyčių. Pagrindinis darbo tikslas – nustatyti, kaip 16 tipo ŽPV DNR integracijos laipsnis (ŽPV E2 geno iškrita) susijęs su intraepiteliniais gimdos kaklelio pokyčiais. Ištyrus 253 moteris nustatyta, kad dauguma moterų buvo infekuotos 16 tipo ŽPV. Dažniausiai nustatyta II laipsnio šio tipo ŽPV integracija. Statistiškai reikšmingo skirtumo analizuojant sąsajas tarp ŽPV E2 geno integracijos pobūdžio ir intraepitelinių gimdos kaklelio pokyčių laipsnio nenustatyta. Tai, kad integruotų 16 tipo ŽPV formų nustatyta esant nežymių arba net nesant intraepitelinių gimdos kaklelio pokyčių, rodo, jog viruso integracija yra ankstyvasis kancerogenezės įvykis. Pažymėtina, kad pakartotinio patikrinimo metu 50 proc. ŽPV infekuotų moterų konstatuota mRNR raiška, kas rodo besitęsiančią aktyvią ŽPV infekciją. Atliktas tyrimas yra svarbus gerinant patikros dėl gimdos kaklelio patologijos programas: derinant Pap testą ir ŽPV DNR bei kitų ŽPV žymenų nustatymą (mRNR, E2 geno iškrita) galima atrinkti infekuotas ŽPV moteris, kurioms dar nėra klinikinių požymių, tačiau jos priklauso didelės rizikos susirgti gimdos kaklelio vėžiu grupei. / This dissertation observes the association between human papillomavirus (HPV) integration into the host cell genome and cervical intraepithelial lesions. The aim of this study is to determine how the grade of HPV16 DNA integration into the host cell genome (HPV E2 gene deletion) is related to cervical intraepithelial lesions. 253 women were screened for HPV infection and the majority was diagnosed with HPV type 16. The most frequently determined was HPV grade II integration. No statistically significant difference was defined while analyzing the relations between the status of HPV E2 gene integration and the grade of cervical intraepithelial lesions. The fact that integration of HPV type 16 was determined in low grade cervical squamous intraepithelial lesions or in cases with no intraepithelial lesions shows that virus integration occurs at the early stage of carcinogenesis. It is noteworthy that during the follow-up (secondary visit after 6 month) 50% of HPV positive women were identified with mRNR expression which probably establishes the presence of persistent active HPV infection. The research provided is highly significant for improvement of cervical cancer screening programms. Adjusting Pap smear, HPV DNA detection and determination of other HPV biomarkers (such as E2 gene deletion mRNR), it becomes possible to separate out HPV positive women with no clinical signs, although, belonging to the of high risk group for cervical carcinoma developing.

Cervical stenotic myelopathy (CSM) is an important musculoskeletal and neurologic disease of the horse. Clinical disease occurs due to malformations of the vertebrae in the neck causing stenosis of the cervical vertebral canal and subsequent spinal cord compression. The disease is multifactorial in nature, therefore a clearer understanding of the etiology and pathogenesis of CSM will allow for improved management and therapeutic practices. This thesis examines issues of equine CSM diagnosis, skeletal tissue pathology, and inherited genetic determinants utilizing advances in biomedical imaging technologies and equine genomics. Magnetic resonance imaging (MRI) data provided a more complete assessment of the cervical column through image acquisition in multiple planes. First, MRI was compared to standing cervical radiographs for detection of stenosis. Using canal area or the cord canal area ratio, MRI more accurately predicted sites of compression in CSM cases. Secondly, articular process skeletal pathology localized on MRI was found to be more frequent and severe in CSM horses compared to controls. In addition, lesions were generalized throughout the cervical column and not limited to the spinal cord compression sites. A subset of lesions identified on MRI was evaluated using micro-CT and histopathology. Osteochondrosis, osseous cyst-like structures, fibrous tissue replacement of bone, and osteosclerosis were observed. These lesions support likely developmental aberrations of vertebral bone and cartilage maturation with secondary biomechanical influences. Bone cyst-like structures are a novel finding in this disease. Finally, the long-standing question of the contribution of genetic determinants to CSM was investigated using a genome wide association study (GWAS). Multiple significant loci were identified supporting the influence of a complex genetic trait in clinical disease. A simple Mendelian trait controlled by one gene is unlikely given the detection of variants across multiple chromosomes. Major contributions from this research include documentation of articular process bone and cartilage pathology in horses with CSM, support for abnormal cervical vertebrae development being an important contributing factor in the etiology and/or pathogenesis of equine CSM, and evidence that multiple genetic loci contribute to the CSM disease phenotype.

Tyrimo objektas: lazerio terapijos poveikis. Tyrimo problema: Šiuo metu auga tyrimų poreikis, kurie mažintų individualią bei socialinę naštą esant stuburo kaklines dalies radikulopatijai, todėl mums yra būtina surasti efektyviausią kaklinės stuburo dalies radikulopatijos gydymo programą, techniką ar metodą (Gross et al., 2007). Daugumoje mokslinių straipsnių, kuriuose vertinamas fizikinių veiksnių poveikis kaklinės stuburo dalies radikulopatijos gydymui, teigiama, kad trūksta tyrimų su placebo efektu, kurie pateiktų dar tikslesnių rezultatų gydymo programų efektyvumui įvertinti (Leaver et al., 2010). Hipotezė: Esant kaklinės stuburo dalies radikulopatijai, pacientams, kuriems taikyta lazerio terapija, reabilitacija turėtų būti efektyvesnė, nei pacientams, kuriems taikytas placebo efektas. Tyrimo tikslas: Įvertinti lazerio terapijos poveikį skausmo intensyvumui ir kaklinės stuburo dalies judėjimo funkcijai esant kaklinės stuburo dalies radikulopatijai. Tyrimo uždaviniai: 1. Įvertinti lazerio terapijos, kineziterapijos bei masažo poveikį skausmo intensyvumui ir kaklinės stuburo dalies judėjimo funkcijai esant kaklinės stuburo dalies radikulopatijai. 2. Įvertinti placebo efekto, kineziterapijos bei masažo poveikį skausmo intensyvumui ir kaklinės stuburo dalies judėjimo funkcijai esant kaklinės stuburo dalies radikulopatijai. 3. Palyginti lazerio terapijos ir placebo efekto poveikį skausmo intensyvumui ir kaklinės stuburo dalies judėjimo funkcijai esant kaklinės stuburo dalies... [toliau žr. visą tekstą] / The object of the research: laser therapy effect. Problem of the research: Demand for research to reduce individual and social burden in upper cervical spine radiculopathy is currently growing, so it is necessary for us to identify the most effective cervical spine radiculopathy treatment program, technique or method (Gross et al., 2007). In many scientific articles that evaluate physical factors effects on upper cervical spine radiculopathy treatment it is stated a lack of studies using placebo effect that would provide even more accurate results to evaluate the effectiveness of treatment programs (Leaver et al., 2010). Hypothesis: In upper cervical spine radiculopathy rehabilitation of the patients undergoing laser therapy should be more effective than rehabilitation of the patients treated with placebo effect. Aim of the research: To evaluate laser therapy effect on pain intensity and upper cervical spine motor function in upper cervical spine radiculopathy. Tasks of the research: 1. To evaluate effect of laser therapy, physical therapy and massage on pain intensity and upper cervical spine motor function in upper cervical spine radiculopathy. 2. To evaluate effect of placebo, physical therapy and massage on pain intensity and upper cervical spine motor function in upper cervical spine radiculopathy. 3. To compare effects of laser therapy and placebo on pain intensity and upper cervical spine motor function in upper cervical spine radiculopathy. Research organization and... [to full text]

The purposes of this study were to: 1) determine absolute intrarater reliability of using the cervical range of motion device (CROM) for measuring cervical movements in older adults, and 2) determine the intrarater reliability and concurrent validity of the Candrive protocol, which uses a universal goniometer to measure rotation. Forty older adults (75.7 + 4.7 years of age) were tested in two sessions, one week apart, by two raters. Intrarater reliability scores were good for the CROM protocol (coefficient of variation (CV) values were 5.5% and 6.2 % for cervical rotation). The Candrive protocol values were higher (CV = 7.9 and 9.4%). Concordance analyses suggested that the Candrive protocol was less than good in terms of its validity, particularly when order effects were taken into consideration. In conclusion, the CROM protocol demonstrated good reliability for either group or individual analyses, whereas the Candrive protocol was less reliable and its validity marginal.

Magnetinio rezonanso tomografija (MRT) yra optimalus diagnostikos metodas vertinant gimdos kaklelio vėžio išplitimą. Pasaulyje pastaraisiais metais atlikta nedaug mokslinių tyrimų, kuriuose vertinamas gimdos kaklelio vėžys difuzinės MRT metodu. Daugumoje jų dalyvavo nedidelis tiriamųjų skaičius. Šis klinikinis tyrimas yra pirmasis Lietuvoje, kuriuo vertinamas gimdos kaklelio vėžys minėtu metodu, todėl jis turi nemažą mokslinę vertę optimizuojant MRT panaudojimo galimybes gimdos kaklelio vėžio diagnostikoje. Darbo tikslas – nustatyti konvencinės ir difuzinės MRT reikšmę vertinant gimdos kaklelio vėžio išplitimą ir chemospindulinio gydymo efektyvumą. Darbo uždaviniai: 1. Įvertinti konvencinės MRT metodu nustatytų gimdos kaklelio vėžio prognozės veiksnių tarpusavio ryšį su klinikinio ir histologinio tyrimų duomenimis. 2. Apskaičiuoti konvencinės MRT diagnostinės vertės parametrus gimdos kaklelio piktybiniam augliui ir liekamajam po chemospindulinio gydymo naviko audiniui. 3. Palyginti tariamojo difuzijos koeficiento (ADC) skaitinės reikšmės vidurkį sveikame gimdos kaklelyje, vėžio pažeistame ir po chemospindulinio gydymo. Nustatyti gimdos kaklelio vėžiui būdingą ADC skaitinės reikšmės ribą. Įvertinti ADC skaitinės reikšmės tarpusavio ryšį su įvairiais klinikinio ir histologinio tyrimų duomenimis. 4. Apskaičiuoti konvencinės ir difuzinės MRT derinio diagnostinės vertės parametrus gimdos kaklelio piktybiniam augliui ir liekamajam po chemospindulinio gydymo naviko audiniui. / Magnetic resonance imaging (MRI) is the optimal method for evaluation of spread of cervical cancer. Only a few diffusion–weighted (DW) MRI studies in the field of cervical cancer have been accomplished around the world. Most of them included a small number of subjects. This is the first clinical study in Lithuania that assesses the cervical cancer by DW–MRI and it has the scientific value in optimizing the use of MRI potential in the evaluation of the diagnostics and treatment efficiency of the mentioned illness. The aim – to identify the significance of conventional and DW–MRI in the assessment of the outspread of cervical cancer and of the efficiency of chemoradiation therapy. The objectives: 1. To assess the interrelationship of prognostic factors of cervical cancer detected by conventional MRI with clinical and histological findings. 2. To calculate the diagnostic value parameters of conventional MRI for the malignant cervical tumor and for the residual tumor tissue after chemoradiation therapy. 3. To compare the mean value of apparent diffusion coefficient (ADC) in a healthy, cancer affected cervix and the cervix after chemoradiation therapy. To identify the value range of ADC typical for cervical cancer. To evaluate the correlation of ADC with the various clinical and histological findings. 4. To calculate the diagnostic value parameters of conventional and DW–MRI combination for the malignant cervical tumor and for the residual tumor tissue after chemoradiation therapy... [to full text]