京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13258号 / 論医博第2176号 / 新制||医||1037(附属図書館) / (主査)教授 別所 和久, 教授 武藤 学, 教授 小西 靖彦 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22146号 / 医博第4537号 / 新制||医||1039(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 大森 孝一, 教授 富樫 かおり, 教授 武田 俊一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bakgrund: Livmoderhalscancer är en av världens vanligaste cancerform hos kvinnor. Det finns olika behandlingsmetoder beroende på kvinnans cancerstadium och hälsotillstånd. Vid samtliga behandlingar uppkommer vanligen biverkningar av olika  karaktär, som påverkar kvinnorna på olika sätt. Sjuksköterskan har som ansvar att informera och stötta kvinnor som drabbats av livmoderhalscancer och arbeta utifrån ett holistiskt förhållningssätt. Syfte: Syftet var att beskriva kvinnors upplevelse av behandling mot livmoderhalscancer. Metod: En litteraturöversikt gjord med kvalitativ och induktiv ansats baserad på tolv artiklar med kvalitativ data användes. Artikelsökningen gjordes i Medline, Cinahl, samt Psycinfo. Resultat: Resultatet redovisade två kategorier med tillhörande sex subkategorier. Kategorierna var: Upplevelse av behandlingens inverkan på kropp och själ, samt det psykosociala behovet. Biverkningar som uppkom efter behandling yttrades i både på fysisk, psykisk och social karaktär och ledde till omfattande utmaningar för kvinnor att hantera. Kvinnor upplevde behov av olika typer av stöd och att samtliga förändringar påverkade dem själva och sin relation med omgivningen både positivt och negativt. Slutsatser: Kvinnor som genomgått behandling mot livmoderhalscancer upplevde ett försämrat hälsotillstånd. Litteraturöversikten hoppas ge sjukvårdspersonal ökad kunskap i hur de ska bemöta och stötta kvinnor med livmoderhalscancer, samt främja vårdförloppet för kvinnorna och dess närstående. / Background: Cervical cancer is one of the most common cancers in the world for women. In all treatments side effects can occur, which affect women in different ways. The nurse is responsible for informing and supporting women affected by cervical cancer and work from a holistic perspective. Aim: The purpose was to describe women's experience of treatment for cervical cancer. Method: A literature review made with a qualitative and inductive approach based on twelve articles with qualitative data were used. The article search was done in Medline, Cinahl, and Psycinfo. Results: The result presented two categories with six subcategories. The categories were: The experience of the treatment's effect on body and soul, and the psychosocial needs. Side effects that arose affected both physical, mental and social levels. Conclusion: Women who have gone through treatment for cervical cancer experienced an deteriorated health condition as a result of treatments. The literature review hopes to give healthcare professionals an insight into how to respond to and support women with cervical cancer and promote the care process for the relatives and the woman.

Health is one of the most important issues in the lives of human beings and has a direct effect on the well-being of a country’s citizens and its economy. Researchers emphasise the role of communication in maintaining health and well-being, and in preventingdisease by changing behaviour. In a multilingual society such as South Africa, health communication documents are often translated for distribution to different language groups. However, the translation of health-related communication documents, specifically for use by low-literate target audiences, poses many challenges, especially in cases where there is a considerable distance between the source text and the target cultures. Translators who work in the field of health communication require specific strategies that will enable them to effectively transfer health-related information that is steeped in cultural meaning while taking into consideration aspects such as stigma and taboo. This study explores the challenges faced during the translation from English into isiZulu of a photonovel called An ounce of prevention, a health document about cervical cancer originally developed for a Latin American audience. This text relies heavily on cultural elements to convey messages. Through an overview of Christiane Nord’s model of Functionality +Loyalty (2005), as well as Larkey and Hecht’s (2010) model of Effects of Narratives as Culture-Centric Health Promotion, a set of analytic heuristics was distilled and applied as a tool to systematically identify cultural elements in the photonovel to ensure that a translation into isiZulu would be culturally acceptable to a Zulu target audience. The purpose of analytic heuristics is to assist translators’ understanding of the communicative situation in which the source text was produced. Once they have been equipped with necessary knowledge of the communication situation and have a sound understanding of the photonovel as a text, translators should be able to systematically identify culture-specific elements in the source text. Thereafter they can establish the cultural distance between the source text culture and the target text communication situation to ensure that all narrative characteristics from both the personal and socio-cultural levels of the narrative inform the concepts of transportation, identification and social profiling. Translators are thus equipped to make informed decisions regarding the translation of specific challenges identified in the source text that would make the target text culturally unacceptable to the target culture. Once the heuristics have been applied to excerpts from the photonovel that pose intercultural challenges, it is concluded that cultural elements and linguistic norms have been successfully identified in the source text and have been appropriately re-contextualised in the target text to ensure that the original message is conveyed. It is assumed that the analytic heuristics will also be useful in ensuring the effective translation of other culture-centric texts without changing the original message. / Mini Dissertation (MA)--University of Pretoria, 2018. / African Languages / MA / Unrestricted

Background: Cervical cancer among Black women is a major individual and public health concern. Despite advancements in medical technology and policy, disparities in cervical cancer diagnosis and mortality still exist between White and Black women, with Black women having higher rates of diagnosis (10.0 vs 7.1 per 100,000) and mortality (4.1 vs 2.0 per 100,000). Previous studies have focused heavily on barriers to obtaining cervical cancer screening among Black women and efforts to improve screening rates. Despite speculation by researchers that gaps in receipt of quality follow-up care may contribute to disparities, its role in disparate mortality rates between Black and White women has yet to be formally studied. Purpose: The goals of the present research were to (1) assess differences in Pap screening rates and (2) rates of adherence to recommended follow-up care after abnormal Pap results between Black and White women, (3) evaluate how specific factors of the Health Belief Model (HBM) influence the decision-making process for obtaining Pap screening and (4) receiving recommended follow-up Pap care, and (5) evaluate the role of ethnic centrality as a factor in health decision-making. Results: Results indicated that HBM facets functioned similarly in predicting engagement in Pap screening and follow-up care, although there were differences in the influence of different facets by race. Ethnic centrality showed little applicable influence on adherence to follow-up care among Black women. An exploratory analysis revealed that doctor recommendation was the most influential factor predicting follow-up care use for both racial groups. Conclusion: The present study offers support for increased education and training on provider recommendation of appropriate follow-up care, as well as effective provider communication of results and services using messaging that appeals to the values and concerns of patients.

Knowledge and attitudes to HPV immunisation IV Author: Tereza Jelínková Thesis supervisor: PharmDr. Eva Zimčíková, Ph.D. Introduction HPV infection is one of the most common sexually transmitted diseases causing, apart from genital warts, other malignancies, most often cervical cancer. The most effective way of prevention is vaccination. So far, there have been 3 types of vaccines, most recent one being the nonavalent vaccine providing up to 90 % protection against cervical cancer- causing HPV, in contrast to the previously available 70 % protection from bivalent or quadrivalent vaccines. Aims The main aim of this thesis was to investigate the knowledge and attitudes towards vaccination against HPV, and knowledge about HPV in general, among secondary school students. Furthermore, to determine their vaccination status and compare the findings with data from previous theses, including a comparison of their knowledge about HPV and relevant prevention. Methodology The data was obtained by means of a questionnaire survey, which took place at three secondary schools. In December 2017 at Gymnázium in Mladá Boleslav, then during June 2018 at Gymnázium in Brandýs nad Labem, and finally in September 2018 at Gymnázium Chotěboř. The obtained data was recorded in a Microsoft Excel spreadsheet and then...

Background: More than 90 % of anal cancers are caused by high-risk human papillomavirus (HR HPV) infection and a history of cervical intraepithelial neoplasia (CIN) and cervical cancer is established as possible risk factor. The aim of this study was to demonstrate relationship between anal and cervical HPV infection in women with different grades of CIN and microinvasive cervical cancer and to determinate potential risk factors for concurrent cervical-anal HPV infection. Methods: A total of 272 women were enrolled in the study. The study group included 172 women who underwent conization for high-grade CIN or microinvasive cervical cancer. The control group consisted of 100 women with non-neoplastic gynecologic diseases or biopsy- confirmed CIN 1. All participants completed a questionnaire detailing their medical history and sexual risk factors and were subjected to anal and cervical HPV genotyping using Lynear array test (Roche). Results: Cervical, anal, and concurrent cervical-anal HPV infections were detected in 82.6 %, 48.3 % and 42.4 % of women in the study group, and in 28.0 %, 26.0 % and 8.0 % of women in the control group, respectively. The prevalence of the HR HPV genotypes was higher in the study group and significantly increased with the severity of cervical lesion. Concurrent infections...

Ziel dieser Arbeit ist die retrospektive Auswertung der operativ mit ventraler Dekompression und intersomatischer Fusion (ACDF) durch stand alone Cage versorgten Patienten und die Diskussion, ob eine postoperative Sinterung Einfluss auf das Outcome hat. Material und Methoden: Es wurden 33 Segmente operativ durch ACDF mit standalone-Cage bei 17 Patienten (11 Frauen und 6 Männer) Durchschnittsalter 56 Jahre (33 bis 82 Jahre) versorgt und nach durchschnittlich jeweils 8 und 26 Monaten klinisch, radiologisch und durch Scoreerhebung nachuntersucht. Ergebnisse: 70,6 % der Patienten (12/17) und 50,5% der Segmente (18/33) zeigten eine Sinterung. 36,3% der Sinterungen (12/33) bereits zur 1. NU nach 8 Monaten. Zur 2. NU nach 26 Monaten fand sich bei 100% eine Fusion ohne Pseudarthrose. Zusammenfassung: Die Sinterung des Cages hat keinen negativen Einfluss auf das Outcome. Wesentlich für das Outcome sind das Ausmaß und die Dauer der vorbestehenden Symptome. Es sollte besonders bei festgestellter Myelopathie frühzeitig eine operative Intervention erfolgen.:1. Einleitung 1 2. Zielsetzung 4 3. Grundlagen 5 3.1. Pathophysiologie 5 3.2. Symptome 8 3.2.1. Allgemeine Symptome 8 3.2.2. Radikulopathie 9 3.2.3. Myelopathie 10 3.3. Diagnostik 13 3.3.1. Anamnese und klinische Untersuchung 14 3.3.2. Bildgebende Diagnostik 15 3.3.3. Spezielle Zusatzdiagnostik 16 3.3.4 Differenzialdiagnosen 17 3.4. Therapie 18 3.4.1. Konservative Therapie 18 3.4.2. Operative Therapie 19 4. Material und Methoden 28 4.1. Patientenkollektiv 28 4.2. Vor - und Nachuntersuchung 30 4.2.1. Oswestry Neck Disability Index 31 4.2.2. Pain DETECT - Fragebogen 33 4.2.3. Die gesundheitsbezogene Lebensqualität – MOS SF – 36 33 4.2.4. Visuelle Analogskala (VAS) 34 4.3. Cagesystem und Implantatmaterial 35 4.4. Operationsverfahren 37 4.5. Radiologische Messungen 42 4.6. Statistische Auswertung 43 5. Ergebnisse 44 5.1. Ergebnisse des Gesamtkollektives 45 5.1.1. Auswertung Schmerzen 45 5.1.2. Auswertung Alltagsbeeinträchtigung 46 5.1.3. Auswertung der gesundheitsbezogenen Lebensqualität 47 5.2. Ergebnisse nach Geschlecht 48 5.3. Ergebnisse nach Alter 52 5.4. Ergebnisse des Sinterungsverhaltens 56 5.4.1. Schmerzen abhängig vom Sinterungsverhalten 59 5.4.2. Alltagsbeeinträchtigung abhängig vom Sinterungsverhalten 61 5.4.3. Lebensqualität nach MOS- SF 36 abhängig vom Sinterungsverhalten 61 5.5. Komplikationen 62 6. Diskussion 64 7. Zusammenfassung 79 8. Literaturverzeichnis 83 9. Tabellenverzeichnis 107 10. Abbildungsverzeichnis 108 11. Erklärung über die eigenständige Abfassung der Arbeit 111 12. Lebenslauf und wissenschaftlicher Werdegang 112 13. Danksagung 114 14. Anlagen 115 Anlage 1 - Oswestry Neck Disability Index Fragebogen 115 Anlage 2 - Pain Detect Fragebogen 117 Anlage 3 - MOS SF 36 Fragebogen 119

Thesis (MPH.) -- University of Limpopo, 2020 / Background of the study: Cervical cancer is a disease that is described as the state of overgrowth of tissue resulting from the disorganisation of cell division that is preceded by several earlier cervical changes, especially at the squamocolumnar junction of the cervix. Factors such as HPV, which is a sexually transmitted infection (STI), low socioeconomic status (SES), intercourse at a very early age, numerous childbirths, poverty and limited access to health care, are some of the contributing risk factors for cervical cancer. Most women in developing countries only seek professional help once the malignancy is already at an advanced stage. Purpose of the study: The aim of the study was to investigate the determinants of cervical cancer in patients seen in the gynaecology clinic at Mankweng hospital. And the objectives were: to profile the sociodemographic characteristics; to profile the contributory risk factors; and, to determine the association of risk factors for cervical cancer with the socio-demographic characteristics of the patients seen in the gynaecology clinic at Mankweng hospital. Research methodology: A quantitative, cross-section descriptive study, which has been validated and used in several studies globally, was conducted at Mankweng hospital, which is a tertiary referral academic hospital in the Limpopo Province, following all cervical cancer patients consulting at gynaecology outpatient clinic during the study period. Data were collected using a structured questionnaire and entered into computer software and analysed. Research findings: Thirty-seven percent of the women who participated in this study were single, 27% were married, 27% widowed and only 9% were divorced. Nearly half (46%) of the participants had secondary education and only 8% had tertiary education. The majority (91%) of the women were unemployed and only 9% were employed. The majority (40%) of the women were at stage II cervical cancer. Nearly two-thirds (62%) had had multiple partners. At the time of the study, 94% of the participants did not have multiple partners. Nearly two-thirds (64%) of the participants had heard about Pap smears before their current diagnosis and 62% of the participants had had a Pap smear before the current results. Few participants smoked cigarette (2%) or used contraceptive (3%). The young age group, single, divorced, with secondary and v tertiary education were more likely to be HIV positive. And the elderly, divorced, widowed and less educated were more likely to have high parity. Recommendations and conclusions: Information about the risk factors for developing cervical cancer, specifically the transmission of HPV, needs to be disseminated to young people. Rather than initiating cervical screening by age group, which may result in young women being refused screening irrespective of their risk, cervical screening guidelines should stipulate the initiation of cervical screening and HPV vaccine from the age of 15 onwards. Present study suggests that young women may be more prone to HPV and HIV due to the fact that young women who are single or divorced, with tertiary education were more likely to have multiple partners, which places them in a risk-based cervical screening target group. A final recommendation and conclusion is that a long-term, in-depth study on cervical cancer in young women in relation to the presence of the risk-factors should be carried out. Attempts should be made to reach women who rarely visit health care services.

The anterior approach to cervical spine surgery is associated with many possible complications. Dysphagia has commonly been reported as one of these complications. A closer examination of the reports of dysphagia following anterior cervical spine surgery, however, reveals that while new onset transient dysphagia is often mentioned, long-term (greater than 48 hours) dysphagia has not been well described. In this article, we report the case of a 29-year-old female with long-term recurrent dysphagia following cervical spine surgery using the anterior approach. The important point about this case is that our patient's symptoms suddenly recurred for the first time after, nearly a two-month period of normal swallowing. Consequently, this patient has required multiple dilations. As a result, despite an initial lack of swallowing dysfunction or the return of normal swallowing, clinicians should be aware of the importance of reassessing swallowing in patients who have undergone cervical spine surgery using the anterior approach.