abstract: Reproductive hormones are recognized for their diverse functions beyond reproduction itself, including a vital role in brain organization, structure, and function throughout the lifespan. From puberty to reproductive senescence, the female is characterized by inherent responsiveness to hormonal cyclicity. For most women, a natural transition to menopause occurs in midlife, wherein the endogenous hormonal milieu undergoes significant changes and marks the end of the reproductive life stage. Although most women experience natural menopause, many women will undergo gynecological surgery during their lifetime, which can lead to an abrupt surgical menopause. It is of critical importance to better understand how endogenous and exogenous reproductive hormone exposures across the lifespan influence cognitive and brain aging, as women are at a greater risk for developing a variety of diseases after menopause, including dementia. Using rodent models, this dissertation explores how the etiology of reproductive senescence, that is, whether it is transitional or surgical, influences the female phenotype to result in divergent cognitive outcomes dependent upon a variety of factors, with an emphasis on age at the time of intervention playing a key role in brain outcomes. Furthermore, the impact of exogenous hormone therapy on cognition is evaluated in the context of surgical menopause. A novel rat model of hysterectomy is also presented, with results demonstrating for the first time that the nonpregnant uterus, which is typically considered to be a quiescent organ, may play a unique, direct role in modulating cognitive outcomes. Neurobiological mechanisms associated with reproductive hormones and aging are assessed to better recognize neural correlates underlying the observed behavior changes. The overarching goal of this dissertation was to elucidate novel factors contributing to cognitive aging outcomes in females. Collectively, the data presented herein indicate that the age at the onset of reproductive senescence has significant implications for learning and memory outcomes, and that variations in gynecological surgery can have unique, long-lasting effects on the brain and cognition. Translationally, this series of experiments moves the field forward toward the goal of improving the health and quality of life for women throughout the lifespan. / Dissertation/Thesis / Doctoral Dissertation Psychology 2019

Kvinnan uppfattar ofta livmodern som en symbol för kvinnlighet och sexualitet. Efter en hysterektomioperation upplever många kvinnor både fysiska och psykiska förändringar. Syftet med denna studie var att beskriva sjuksköterskans omvårdnad i samband med hysterektomi från patientens och sjuksköterskans perspektiv, rörande kvinnors behov och hur sjuksköterskan kan bemöta kvinnorna. Denna litteraturstudie återspeglar innehållet av 7 vetenskapliga artiklar som alla granskades enligt Polit m fl (2001). Resultatet visade att information, erfarenhet och kunskap samt god relation mellan kvinnan och sjuksköterskan var viktiga faktorer i omvårdnaden. En adekvat utbildning som ger sjuksköterskan säkerhet att kunna agera professionellt gentemot patienten är av stor betydelse. / Woman often percept their uterus as a symbol for feminity and sexuality. After a hysterectomy many women will experience fysical and psychological changes. The aim of this study was to describe the nursing care from the patients' and the nurses' perspectives, concerning the women's needs and how the nurses answer. This literature review contained of 7 scientific articles all examined according to Polit et al (2001). The result showed that information, experience, knowledge and good relation between the woman and the nurse was important factors in the postoperative care. An adequate education which probably will give the nurse a more professional approach is if great importance.

Vulvovaginal candidiasis is a common gynecologic diagnosis that can be treated empirically with fluconazole. We present a patient that developed post-operative () fungemia after being empirically treated for vulvuovaginal candidiasis with fluconazole multiple times throughout the year prior to robotic total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. is becoming increasingly resistant to azole antimycotic therapy. It is likely that this patient had undertreated fluconazole-resistant vulvovaginitis prior to surgery, and that the pelvic infection was the source of fungemia.

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Cheung, Tak Hong. / "July 2011." / Thesis (M.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 166-199). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

Introducción: Siendo el útero crucial en la identidad social de la mujer, ya que su significado simbólico se refleja en la conexión sociocultural con la feminidad, el ciclo menstrual y la maternidad, y con el interés de tener un conocimiento previo de la mujer que ha sido candidata a histerectomía, la cual conlleva en su realización múltiples connotaciones tanto orgánicas como psicológicas que impactan en su vida cotidiana posterior a la cirugía. Objetivo: Determinar las características clínicas y sociodemográficas de pacientes histerectomizadas del servicio de Ginecología del Hospital Almanzor Aguinaga Asenjo durante el año 2019. Materiales y Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo, censal. empleándose estadística descriptiva, tomándose como población a pacientes histerectomizadas. Resultados: El mayor porcentaje de pacientes fueron amas de casa, multíparas, con educación secundaria, procedentes de la región Lambayeque, con edad mediana de 48 años, con motivo de consulta de sangrado uterino anormal y con indicación quirúrgica de Miomatosis Uterina seguido de neoplasias ginecológicas. Dentro de los más frecuentes antecedentes: la cesárea fue en lo quirúrgico; otras neoplasias en los familiares y la ausencia de antecedentes en los personales patológicos y no patológicos. La histerectomía más frecuente realizada es la total, seguido por la radical, siendo el abordaje abdominal el más usado, y la salpinguectomía y ooforectomía uni/bilateral la intervención concomitante más realizada. No se encontraro complicaciones inmediatas, mediatas o tardías.

Bakgrund: I Sverige är det vanligaste större gynekologiska ingreppet hysterektomi, som innebär att livmodern avlägsnas. Denna operation kan vara påfrestande för kvinnan på grund av att livmodern ofta har stor betydelse som symbol för kvinnlighet och fertilitet, vilket gör att operationen kan medföra psykiska påföljder så som depression. En av sjuksköterskans uppgifter vid operationen är att göra patienten delaktig i sin vård. Delaktighet kräver en god vårdrelation där patienten får adekvat information. Syfte: Syftet med litteraturöversikten var att beskriva patienters behov av information från vårdpersonal i samband med hysterektomi. Metod: En litteraturöversikt baserad på 11 vetenskapliga artiklar som svarade på syftet. Artiklarna inhämtades från databaserna Cinahl Complete och PubMed. Båda författarna läste och granskade artiklarna för att sammanställa de meningsbärande enheterna. I de meningsbärande enheterna fann författarna likheter och skillnader. Materialet sorterades och presenteras under huvudteman med tillhörande underteman. Resultat: Resultatet presenteras i tre huvudteman, varav två av dem har underteman. Huvudtemana består av; Behov av att få veta, Individanpassad information och Konsekvenser av bristande information. Kvinnor upplevde att de hade ett behov av att få veta vad som väntade dem och när detta inte uppfylldes ledde det till bland annat oro och rädsla. Konsekvenserna av bristande information från vårdpersonalen var även att kvinnors delaktighet i vården påverkades och att information söktes på annat håll. Diskussion: Hildegard Peplaus omvårdnadsteori användes vid resultatdiskussionen, då denna kan vara ett stöd för sjuksköterskan vid undervisande och informativa möten. Det diskuteras kring att utvecklingen av vårdrelationen har stor betydelse för hur information ges och på vilket sätt det uppfattas. Vidare diskuteras på vilket sätt vårdrelationen och delaktighet kan integreras i vården för att sjuksköterskan ska kunna ge en god omvårdnad. / Background: In Sweden the most common gynecological surgery is hysterectomy which is a procedure where the uterus is removed. This kind of surgery might be difficult for the patient because the uterus has great significance as a symbol of femininity and fertility. This means that the operation can lead to reactions such as mental depression. One of the nurses functions at surgery is to participate the patient in their care. Participation of the patient requires a good nurse-patient relationship in which the patient receives adequate information. Aim: The aim of this literature review was to describe patient’s needs for information from health professionals during hysterectomy. Method: A literature review that was based on 11 original papers which also responded to the purpose. The used databases were Cinahl Complete and PubMed. Both authors read and reviewed the articles to compile their meaningful units. In the meaningful units the authors found similarities and differences. The material was then sorted and presented under main themes with matching subthemes. Results: The results are presented in three main themes, where two of them has subthemes. The mainthemes are; The need to know, Individualized information and The consequenses of insufficient information. Women experienced that they had a need to know what was going to happen, and when this was not fullfilled it caused feelings such as anxeity and fear. The consequenses of insufficient information from health professionalswas that women's participation in their care was affected and they ended up seeking information elsewhere. Discussion: The discussion is based on Hildegard Peplau's nursing theory, which can be used as a support for the nurse in educational and informative meetings. It is discussed that the development of the nurse-patient relationship has great significance for how information is being presented and how it is being perceived. Further discussed is in what way the nurse-patient relationship and participation can be integrated within the care in order to provide a good care.

Systematic reviews and meta-analyses have been a central pillar of evidence-based practice and policy-making in healthcare over recent years. Traditionally, this has focused on effectiveness evidence from trials.. There is increasing understanding, however, that other study designs also provide essential information and this has led to interest in developing ways to review and synthesis such evidence. Qualitative research has unique potential to illuminate the patient experience. This research has three aims: 1) To review and compare the proposed methods of systematic review and synthesis of qualitative research. 2) To develop and assess two methods of systematic review and synthesis of qualitative research. 3) To compare these two methods and suggest how they might be used in a policy-making context. In addressing these aims, this thesis substantially contributes to debates about the purpose and practice of systematic review and synthesis of qualitative research, particularly in the context of health technology assessment and related pOlicy-making. I undertake a unique critical comparison of the methods suggested for reviewing and synthesising qualitative research, based on their approach to key stages of systematic review. This is used to produce a comprehensive framework for good practice~ I use the framework in two systematic reviews, one about heavy menstrual bleeding using meta-ethnography, and one about hysterectomy using meta-study. These two reviews allow a comparison of the two methods, and in particular explore the impact of expanding the meta-ethnography approach through meta-study, which adds explicit steps to assess the impact of study methodology and theory on findings. The ability of meta-study to unpack the procedures and theories that produce particular findings is key and illuminates the importance of theory in systematic reviews of qualitative research. Through the two systematic reviews, my thesis also contributes to understanding of these reproductive health topic areas through the creation of new insights and concepts from the synthesis. The synthesis of heavy menstrual bleeding studies produced a detailed patient illness model based on women's experiences. In addition, it allowed an understanding of elements that contribute to women's certainty or uncertainty about whether or not their periods could be seen as problematic and requiring medical help. This helps to establish the limitations of the medical model for doctors, as well as women who suffer from heavy menstrual bleeding. The synthesis of hysterectomy studies produced a detailed description of the journey that women make to, and through, hysterectomy, based on their experiences. I also created a theoretical framework, which shows that hysterectomy needs to be understood in the context of personal, physical experiences, together with sociocultural forces that affect the way in which hysterectomy is experienced, and that the interaction of these micro- and macro-concerns mediate through, and affect, relationships with key other people. Methodology affected the research questions posed and the conclusions of research. Comparing the two methods of review and synthesis showed the importance of taking account of the methods and theories that produce research findings. However this additional detail may be at the expense of certainty and requires additional resources.