Lic.-avh. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 2 uppsatser.

Thesis (DR. P.H.)--University of Michigan.

Thesis (Ph. D.)--Oregon State University, 1998. / Typescript (photocopy). Includes bibliographical references (leaves 105-108). Also available on the World Wide Web.

Thesis (DR. P.H.)--University of Michigan.

Thesis--University of Florida. / Description based on print version record. Typescript. Vita. Includes bibliographical references (leaves 88-95).

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1990.

Orientador: Júlio Defaveri / Resumo: A paracoccidioidomicose (Pbmicose) é micose sistêmica causada pelo fungo dimórfico Paracoccidioides brasiliensis, que acomete principalmente trabalhadores rurais do sexo masculino. A doença tem como principais manifestações clínicas a forma aguda/subaguda e a forma crônica. Métodos sorológicos têm considerável valor na Pbmicose e diferentes testes têm sido utilizados no diagnóstico e monitoramento da resposta do paciente ao tratamento. O objetivo deste estudo foi avaliar a IFI, a ID e o ELISA antes e após introdução do tratamento de pacientes com a forma aguda/subaguda e a forma crônica da Pbmicose. Para cada teste, os seguintes parâmetros foram avaliados: sensibilidade (SE), especificidade (EP), valor preditivo positivo (VPP), valor preditivo negativo (VPN) e eficiência (EF). No período pré-tratamento a IFI teve SE=92,3%, VPP= 87,5%, VPN= 92% e EF=88,6%. A ID teve SE=94,93%, VPP=97,4%, VPN=95% e EF=96,2%. Para o ELISA, SE=100%, VPP=95%, VPN=100% e EF=97,4%. No grupo de doadores de sangue, a EP da IFI, da ID e do ELISA foram, respectivamente, de 93,3%, 100% e 100%. Em soros de pacientes com outras micoses sistêmicas (histoplasmose, criptococose, actinomicose, aspergilose e adiaspiromicose), as EP para os testes foram de 60%, 90% e 80%, respectivamente. Durante o tratamento, maior correlação foi obtida entre a ID e o ELISA (r= 0,61591, p<0,05), obtendo-se baixas correlações com a IFI. O tempo necessário para negativar o ELISA (Md= 20,0 meses) foi maior do que a ID (Md= 13,5 meses). O ELISA se negativou em geral nove meses após a ID, o que sugere que este teste passe a ser um referencial para suspensão do tratamento de manutenção. Devido à sua elevada sensibilidade, especificidade, VPP, VPN e eficiência, o ELISA deve ser incluído na rotina sorológica de pacientes com Pbmicose. / Abstract: Pararaccidioidomycosis (Pbmycosis) is a systemic mycosis caused by the dimorphic fungus Paracoccidioiodes brasiliensis, which often affects rural workers, usually male adults. The overt disease is manifested by two clinical forms, acute/subacute and chronic forms. Serological methods are of considerable value in Pbmycosis, and various tests has been utilized in the diagnostic and monitoring the patient's response to treatment. The aim of this study was to evaluated the reliability of the double immunodiffusion test (ID), indirect immunofluorescence (IIF) and immunoenzymatic assay (ELISA) in the pre-treatment and during the period of treatment of patients with acute/subacute and chronic forms of Pbmycosis. For each test the following parameters were evaluated: Sensitivity (SE), Specificity (SP), Positive and Negative Predictive Values (PPV and NPV) and Efficiency (EF). In the pre-treatment period these values for IFI were SE=92.3%, PPV=87.5%, NPV=92% and EF=88.6%. For ID: SE=94.9%, PPV=97.4%, NPV=95% EF=96.2%. For ELISA: SE=100%, PPV=95%, NPV=100% and EF=97.4%. In the group of blood donors, for IFI, ID and ELISA the ES were, respectively, 93.3%, 100% and 100%. In patients with other deep mycosis (histoplasmosis, cryptococcosis, actinomycosis, aspergillosis and adiaspiromycosis) the ES for these tests were respectively 60%, 90% and 80%. During the period of treatment, the highest correlation was observed between ID and ELISA (r= 0,61591, p<0,05), and the lowest correlations with IFI. The time elapsed to negative the ELISA was larger (Md=20 months) than for ID (Md= 13,5 meses). In overall, the ELISA negativated nine months after ID. This result suggests that the ELISA may be a referential test to monitoring the time for interruption of the treatment in Pbmycosis. Moreover, owing to its high values of SE, SP, PPV, NPV and EF, ELISA should be included in the serological routine for patients with Pbmycosis. / Mestre

<b>Background:</b> The survival rate of preterm children has risen steadily due to advances in obstetric and neonatal intensive care. Children born extremely preterm (&le;28 weeks of gestation) are at high risk of long term developmental problems, including cerebral palsy, motor and cognitive impairment, visual and auditory deficits and behavioural problems. This can have serious implications for their quality of life and that of their family and carers. These children take up a disproportionate amount of neonatal intensive care unit resources and overall costs, and as they grow up are more likely to require additional health and social care services beyond routine care to compensate for their functional limitations. The early identification and management of factors that mediate long term outcome is necessary to assist healthcare professionals in selecting appropriate treatment pathways, and to develop, target and evaluate interventions. Many risk factor analyses for neurodevelopmental impairment have been published in preterm populations, but this vast literature has not been formally summarised. Furthermore, there is a dearth of studies reporting longitudinal analysis of neurodevelopmental trajectories from early childhood to adulthood. <b>Objectives:</b> The first aim of this thesis was to perform a comprehensive systematic review of the world literature over the last two decades, to consolidate the evidence about the prognosis of neurodevelopmental outcome in children born very preterm or with very low birth weight. The second aim was to conduct a longitudinal analysis of a cohort of extremely preterm participants followed up into early adulthood to investigate the trajectories of long term sequelae over time, and to examine the association of neurodevelopmental course in relation to the predictive factors identified in the systematic review. <b>Methods:</b> A systematic review was conducted using MEDLINE, EMBASE and PyscINFO databases to identify studies published between January 1 1990 and June 1 2014 reporting multivariable prediction models for the neurodevelopment of children born &le;32 weeks of gestation or with a birth weight &le;1250 grams (protocol registration number CRD42014006943). Seventy-eight studies reporting 222 risk factor models for neurodevelopmental outcome were identified. Two independent reviewers extracted key information about study design, outcome definition, risk factor selection, model development, reporting, and conducted a risk of bias assessment. To address the second objective of the study, a longitudinal analysis of cognitive and behavioural trajectories was conducted using a prospective, population-based cohort study in the United Kingdom and the Republic of Ireland. Three hundred and fifteen surviving infants born less than 26 completed weeks of gestation recruited at birth in 1995 and 160 term-born classroom peers recruited at age six were followed-up to 19 years. Participants were invited for up to four standardized, blinded cognitive assessments and the parent-completed Strengths and Difficulties Questionnaire was used to assess behavioural problems. <b>Results:</b> The systematic review of risk factors for motor impairment in children born very preterm or with very low birth weight provided strong evidence that neonatal brain injury is a robust prognostic factor for cerebral palsy, and some evidence that the use of postnatal steroids increases the risk and the use of antenatal steroids reduces the risk of cerebral palsy. There was moderate evidence that male sex was prognostic for motor impairment at school age in children free of major disability. The systematic review of risk factors for cognitive impairment identified male sex, non-white ethnicity, lower levels of parental education and lower birth weight as significant predictors of global cognitive dysfunction in early infancy, with parental education having a sustained impact after five years of age. There was also evidence that male sex was predictive of delayed language development in early infancy. Gestational age was found to be of limited use as prognostic factor for cerebral palsy, motor and cognitive impairment in cohorts restricted to &le;32 weeks of gestation. There was a dearth of good quality studies investigating risk factors for behavioural problems and psychiatric disorders and the findings of this review were inconclusive. The only factors that appeared to be consistent predictors of general behavioural problems were markers of socio-economic deprivation, neurodevelopmental or cognitive delay, and an abnormal behavioural screen in early infancy. In the longitudinal analysis of the prospective, population-based cohort of extremely preterm children, cognitive trajectories were stable in both the extremely preterm and term-born groups over time with persistent deficit in the extremely preterm group of 25.2 IQ points (95&percnt; CI: -27.8 to -22.6, p&LT;0.001) and only minimal catch-up over time. Participants with neonatal brain injury and of male sex had the largest deficits, but a lower level of maternal education and earlier gestational age at birth were also associated with reduced IQ scores. Behavioural problems were also more prevalent among the extremely preterm participants who had a mean Total Difficulties Score of 4.81 points above their term-born peers (95&percnt; CI: 3.76 to 5.87, p&LT;0.001) and which persisted over the time period. Behavioural difficulties were mainly due to hyperactivity, inattention and peer problems and were strongly associated with a positive behavioural screen in early infancy. <b>Conclusions:</b> The most robust predictors of poor neurodevelopmental outcome identified by the systematic review were neonatal brain injury, male sex, and markers of social disadvantage. The unclear findings for many risk factors may reflect differences in study design, study population, methodological quality and lack of standardization of measures. Or it may simply reflect the fact that prognostic modelling in such a heterogeneous population is challenging and complex, with multiple risk factors acting sequentially over time, and often with the existence of multiple impairments within the same individual. The main conclusions from the longitudinal analysis of children born extremely preterm is that being born too soon appears to place limits on brain plasticity and function which is not recovered over time; with the most vulnerable being males and those with evidence of brain injury early in life. These structural abnormalities may disturb neurodevelopmental processes and impede the brain from maintaining a normal developmental trajectory. If extremely preterm children fail to achieve optimum levels of cognitive function and are still experiencing behavioural problems once they have reached maturity, then this has implications for health and well-being in later adulthood and old age. Cognitive test scores in infancy and early childhood reflect early adult outcomes and a positive behavioural screen in infancy is strongly associated with early adult behavioural outcomes. <b>Recommendations:</b> The systematic review revealed some shortcomings in methodology and reporting that could be improved in future studies, and confirmed that that there is a dearth of properly designed and well-conducted prognostic modelling studies in this field. The findings and recommendations of this critical review should be used as a basis for the design, analysis and reporting of future studies seeking to develop multivariate risk factor or prognostic models in this population. There is an urgent need for larger population cohorts followed up routinely beyond two years as subtle outcomes such as impairment of executive function and fine motor skills cannot be reliably assessed at this age, and the natural course of some disorders may have their onset later in childhood. / Studies with larger sample sizes and greater power are needed for studying less common conditions in preterm populations and there should be more standardisation of outcome and risk factor measurements, particularly with the use of standard diagnostic evaluations to assess psychiatric disorders. Future studies should include a term-born comparison group and adopt appropriate statistical analysis techniques to analyse longitudinal outcome data and the impact of risk factors on these trajectories. Additional research is required to improve the prediction of individual differences, and to identify the neuropathological differences underlying different developmental trajectories and their interaction with environmental influences over time.

Bakgrund: Fler kvinnor överlever sin bröstcancer tack vare tidig upptäckt och behandling av tumörer. Den primära behandlingen för bröstcancer är omfattande med operation, cellgifter samt strålning som ger biverkningar. Den ökade överlevnaden ställer krav på uppföljningsvården, där uppgiften är att följa upp förändringar i hälsan efter avslutad primär behandling. Syfte: Syftet var att belysa kvinnors upplevelser av vården efter primär behandling för bröstcancer. Metod: En litteraturöversikt genomfördes enligt Fribergs metod. Databassökningen av resultatartiklar gjordes med sökord relaterade till “bröstcancer”, “uppföljningsvård” samt “upplevelser” eller “erfarenheter” i MEDLINE with Full Text samt Cinahl Complete. Sökningarna gjordes med begräsningen att artiklarna skulle ha publicerats mellan åren 2008 och 2018. Nio kvalitativa studier samt en med mixad metod analyserades avseende likheter/skillnader och tematiserades. Resultat: Analysen resulterade i tre teman. Kvinnornas informationsbehov som har två underteman: Informationsbrist angående uppföljningsvården som handlar om informationsbrist från specialistvården vid utskrivning av primär behandling som påverkade kvinnorna i tiden efter och informationsbrist i uppföljningsvården som handlar om informationsbrist under uppföljningar. Det andra huvudtemat är: Hur kvinnorna föredrogs att följas upp och kontinuitet. Det tredje huvudtemat är: Stressade besök och att inte bli bemött utifrån sina behov. Diskussion: I metoddiskussionen diskuteras litteraturöversiktens styrkor samt svagheter. I resultatdiskussionen diskuteras resultatet utifrån bakgrunden, annan forskning samt Antonovskys teori om känsla av sammanhang. Resultatet visar att kvinnor efter avslutad primär behandling upplever att det finns informationsbrister. Författarna diskuterar sjuksköterskans roll i uppföljningsvården av bröstcancerpatienter. / Background: More women survive their breast cancer due to early detection and treatment of the tumour. The primary treatment for breast cancer is extensive with surgery, chemotherapy, radiation and side effects. The increased survival poses higher demands for the follow-up care, where the task is to monitor changes in health after completion of primary treatment. Aim: The aim was to explore women's’ experience of care following end of primary treatment for breast cancer. Method: A literature review was performed according to Friberg's method. The following electronic databases were searched: Cinahl Complete and Medline with Full Text. Terms related to “breast cancer”, “follow upp care” samt “experience” eller “perceptions” were used in all searches. One mixed method and nine qualitative articles, published between 2008 and 2018, were included in the review. Results were thematized based on similarities and differences. Results: The analysis resulted in three themes. Women's information needs that have two sub-themes: Lack of information regarding follow-up care, which is about the lack of information from the specialist care which affected women posttreatment and The lack of information in the follow-up care which is about information shortages during follow-ups. The second main theme is: Womens preference about follow-up care and continuity. The third main theme is: Stressful visits and not being met from their needs. Discussion: In the method discussion the literature review strength and weaknesses are discussed. In the result discussion, the results are discussed based on the background, new research, and Antonovsky's theory of sense of coherence. The result shows that there are information shortages. The authors discuss the role of the nurse in the after care for breast cancer patients.