O uso de técnicas de mineração de dados tem produzido resultados importantes em diversas áreas, tais como bioinformática, atividades de transações bancárias, auditorias de computadores relacionados à segurança, tráfego de redes, análise de textos, imagens e avaliação da qualidade em processos de fabricação. Em medicina, métodos de mineração de dados têm se revelado muito eficazes na realização de diagnósticos automáticos, ajudando na tomada de decisões por equipes médicas. Além do uso de mineração de dados, dados médicos podem ser representados por redes complexas, de modo a incluir conexões entre seus elementos. Por exemplo, no caso do cérebro, regiões corticais podem representar vértices em um grafo e as conexões podem ser definidas através das atividades corticais. Com isso, pode-se comparar a estrutura do cérebro de sujeitos sadios com a de pacientes que apresentam doenças mentais de modo a definir métodos para diagnóstico e obter conhecimento sobre como a estrutura do cérebro está relacionada com alterações comportamentais e neurológicas. Nesse trabalho, estamos interessados em usar métodos de mineração de dados e redes complexas para classificar pacientes portadores de quatro diferentes tipos de doenças mentais, isto é, esquizofrenia, autismo, déficit de atenção/desordem de hiperatividade e paralisia progressiva nuclear. / A data mining and knowledge discovery is in a field of research, with applications in different areas such as bioinformatics, customer transaction activity, security related computer audits, network traffic, text analysis and quality evaluation in manufacturing. In medicine, data mining methods have proven very effective in performing automatic diagnostics, helping in making decisions by medical teams. In addition to the use of data mining, medical data can be represented by complex networks in order to include connections between its elements. For example, in the case of the brain, cortical regions can represent vertices in a graph and the connections can be defined through cortical activities. Thus, we can compare the brain structure of healthy patients with those of patients with mental disorder in order to define methods for diagnosis and to obtain knowledge about how the structure of the brain is related to behavioral and neurological changes. Here, we are interested in using data mining methods and complex networks to classify patients with four different types of mental desorders, that is, schizophrenia, autism, attention deficit / hyperactivity disorder, and progressive supranuclear paralysis.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-07-19T19:19:05Z No. of bitstreams: 1 MylenaTorres.pdf: 2864310 bytes, checksum: a7111bcb49d38339665fb9a2f9ef7055 (MD5) / Made available in DSpace on 2017-07-19T19:19:05Z (GMT). No. of bitstreams: 1 MylenaTorres.pdf: 2864310 bytes, checksum: a7111bcb49d38339665fb9a2f9ef7055 (MD5) Previous issue date: 2016-06-27 / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) / Canine distemper and ehrlichiosis are two diseases affecting dogs, which have neurological symptomatology. The former is a contagious viral disease, with a high incidence and mortality that affects dogs and other canids; the latter is a bacterial disease highly frequent. The treatment of neurological diseases is based on drug administration, which may act both on etiologic agent as reducing the progression of the disease; or on supportive therapy, in cases of canine distemper. Looking for an alternative treatment for diseases with neurological conditions, low-cost, easy to administrate and with satisfactory effects in the remission of clinical signs, this study aimed to evaluate the effectiveness of Morinda citrifolia (noni) in the treatment of dogs with neurological symptoms caused by canine distemper virus and Ehrlichia canis. To evaluate the effect of M. citrifolia vegetable drug in animals with ehrlichiosis, ten animals were used, divided into two groups, one treated with the standard drug, doxycycline (10 mg/kg, BID, orally) and complex B vitamins (0.2 mg/kg, BID, orally), and the other treated with the experimental protocol (500 mg of M. citrifolia vegetable drug, SID, orally). Thirty days post-treatment, blood collection was made to evaluate hematological parameters. Although noni has led to the improvement of these parameters, especially platelets, animals did not show clinical cure, which demonstrated its inefficacy in the treatment of ehrlichiosis. To evaluate the effect of the vegetable drug in animals with canine distemper, fifteen animals were used, divided into two groups, one treated with the conventional drugs and the other with the experimental protocol. After thirty days, was observed that the animals treated with noni showed remission of clinical signs, demonstrating its efficacy against distemper neurological signs. As the last step of this work, were assessed the lesions in the central nervous system of dogs in an advanced stage of distemper, which were euthanized. Several brain areas of seven dogs were collected (cerebellum, rostral colliculus, caudal colliculus, obex, cerebellar peduncle and telencephalon), to perform histopathological and immunohistochemical analyses. In histopathological analysis was observed that the cerebellar peduncle was the most affected area and that inflammation and demyelination were the major findings. Immunohistochemistry confirmed histopathological results, with markings in all areas of the brain and, contrary to the literature; neurons were the cells that presented more viral particles. / A cinomose e erliquiose são duas doenças que acometem cães e que possuem sintomatologia neurológica. A primeira é uma doença viral contagiosa, de alta incidência e mortalidade, que acomete cães domésticos e várias espécies de carnívoros; já a segunda é de origem bacteriana, que apresenta alta frequência em cães. O tratamento de doenças neurológicas é baseado na administração de fármacos, que podem atuar tanto no agente etiológico como na diminuição da progressão da doença; ou na terapia de suporte, no caso da cinomose. Visando tratamentos alternativos para as doenças com quadros neurológicos, que sejam de baixo custo, fácil administração e com efeitos satisfatórios na remissão dos sinais clínicos, esta pesquisa teve como objetivo avaliar a eficácia de Morinda citrifolia (noni) no tratamento de cãescom sintomatologia neurológica causada pelo vírus da cinomose e pela Ehrlichia canis. Para avaliação do efeito da droga vegetal de M. citrifolia em cães com erliquiose, foram utilizados 10 cães, divididos em dois grupos, um tratado com a droga padrão doxiciclina (10 mg/kg, BID/PO) e complexo de vitaminas B (0,2 mg/kg, BID/PO), e outro tratado com o protocolo experimental (500 mg da droga vegetal de M. citrifolia, SID/PO). Após trinta dias, foi realizada coleta de sangue para avaliação dos parâmetros hematológicos. Foi observado que, embora o noni tenha levado à melhora dos parâmetros hematimétricos, principalmente das plaquetas, os animais não apresentaram cura clínica da doença, o que demonstrou a sua ineficácia no tratamento da erliquiose. Para a avaliação da droga vegetal de M. citrifolia em animais com cinomose, foram utilizados 15 animais, divididos em dois grupos, um tratado com as medicações convencionais e outro com o protocolo experimental. Após trinta dias, foi observado que os animais tratados com noni apresentaram remissão dos sinais clínicos, demonstrando sua eficácia no combate aos sinais neurológicos da cinomose. Como última etapa deste trabalho, buscou-se avaliar as lesões no sistema nervoso de cães com estado avançado de cinomose, que foram submetidos à eutanásia. Foram coletadas várias áreas do encéfalo de 7 cães (cerebelo, colículo rostral, colículo caudal, obex, pedúnculo cerebelar e telencéfalo) para análises histopatológicas e imunohistoquímicas. Após avaliação histopatológica, foi observado que a área mais afetada foi o pedúnculo cerebelar, e os principais achados foram processo inflamatório e desmielinização. A imunohistoquímica confirmou os resultados histopatológicos, com marcações em todas as áreas do encéfalo e, contrariando a literatura os neurônios foram as células que apresentaram mais marcações virais.

Introdução: A exposição ambiental ao chumbo é uma questão séria do ponto de vista de saúde pública, pois quando ocorre nos primeiros meses e anos de vida pode levar a sequelas neurológicas e comportamentais graves. Objetivos: 1- Determinar a concentração de chumbo obtida por meio de microbiópsias de esmalte realizadas in vivo em esmalte de dentes permanentes ou decíduos de pacientes com problemas neurológicos em tratamento ambulatorial no HCFMRP-USP e comparar os resultados em diferentes grupos de acordo com o diagnóstico. 2- Verificar o perfil dos valores de chumbo segundo informações relacionadas à exposição a esse metal dos referidos pacientes. Método: Uma microbiópsia foi realizada in vivo na superfície do esmalte de crianças de 5 a 12 anos, de ambos os gêneros, atendidas sequencialmente, sem conhecimento sobre a doença, em dois ambulatórios da área de Neurologia do HCFMRP-USP. O chumbo foi medido por espectrometria de absorção atômica com forno de grafite, e o fósforo foi medido colorimetricamente para determinarmos a profundidade da microbiópsia. Uma vez que a profundidade da microbiopsia não pode ser prevista, mas é um factor que influencia o resultado e que temos conhecimento que as concentrações de chumbo diminuem a partir da superfície para o interior do esmalte uma fórmula matemática foi utilizada para calcular a quantidade de chumbo que seria teoricamente encontrada em cada dente à mesma profundidade, e à profundidade seleccionada foi a média de todas as profundidades. As mães ou acompanhantes responderam a um questionário sobre fatores de risco de exposição ao chumbo. Os diagnósticos neurológicos foram obtidos por análise dos prontuários, posteriormente às microbiópsias, sendo criados cinco grupos independentes de crianças, com base na queixa principal: 1 - síndrome motora, SM (N=31); 2 - epilepsia, E (N=25); 3 - cefaléia, C (N=13); 4 - dificuldade escolar, DE (N=11); 5 - distúrbio do comportamento, DC (N=32). Resultados: A profundidade média das microbiópsias foi 3,16 m. Nas concentrações de chumbo obtidas não houve distribuição de Gauss, assim os valores de média, valores máximos e mínimos obtidos em cada grupo foram: 1 - 103,0, 395,0; 2,0. 2 - 64,8, 233,0; 4,0. 3 - 140,3, 434,0; 10,0. 4 - 135,8, 366,0; 38,0. 3 - 158,3, 476,0; 1,9. A análise dos valores de chumbo evidenciou que não houve correlação entre a idade das crianças e os valores de chumbo (Pearson r = -0,016; p = 0,86). Não se observou diferença significativa entre os gêneros (t-test p = 0,55) e também entre os dentes decíduos e permanentes (t-test p= 0,11). Quanto aos grupos com diagnósticos neurológicos, comparando os cinco grupos (ANOVA oneway), houve significância com valor de p= 0,004. O pós teste de Tukey evidenciou diferença significativa, sendo menores os valores de chumbo no grupo com epilepsia em relação aos grupos com dificuldade escolar e distúrbio de comportamento. Na análise dos fatores de risco, ocorreu maior número de crianças que brincam com pilhas no grupo cuja queixa principal era cefaléia em relação ao grupo com deficiência motora (p= 0,002). Não houve diferenças significativas, em nível de 5%, quanto aos valores de chumbo entre os casos com respostas positivas (p=0,53) ao questionário, nem entre as negativas (p=0,99) e nem entre ambos, comparando-se cada um dos fatores. O mesmo ocorreu na análise intragrupo para cada um dos cinco grupos de diagnósticos e entre os grupos. Conclusões: No presente estudo, encontramos maiores valores de chumbo no esmalte superficial em grupos de crianças com dificuldade escolar e distúrbio do comportamento em relação àquele com epilepsia; e ainda, o achado de que os fatores ambientais de risco estudados não tiveram relação com as diferenças observadas entre esses grupos suscita indagações e necessidade de aprofundamento em pesquisas sobre os efeitos danosos do chumbo no tecido neural, mesmo quando se trata de uma população que vive em áreas consideradas sem risco ambiental e com valores de chumbo no sangue (quando são medidos, o que não é o caso deste estudo) abaixo do limite de intervenção. / Background: The environmental exposure to lead is a serious issue from the standpoint of public health, because when it occurs in the first months and years of life it can lead to serious neurological and behavioral consequences. Objectives: 1 - To determine the concentration of lead obtained by an micro biopsy in vivo on permanent teeth enamel or deciduous teeth of patients with neurological problems in outpatient treatment in HCFMRP-USP and compare results in different groups according to diagnosis. 2 - To check the profile of the values of lead according to information related to exposure to the metal of these patients. Method: A micro biopsy was performed in vivo on enamel of children 5-12 years of both genders, attended sequentially, without knowledge of the disease in two clinics in the area of Neurology, USP-HCFMRP. Lead was measured by graphite-furnace atomic absorption spectrometry, and phosphorus was measured colorimetrically to determine the depth of the micro biopsy. Since the micro biopsy depth cannot be anticipated, but is a factor that does influence the result, since lead concentrations are known to decrease from the surface to the inner enamel, a mathematical formula was used to calculate how much lead would be theoretically found in each tooth at the same depth, and the depth selected was the mean of all depths obtained. The mothers or caretakers answered a questionnaire on risk factors for lead exposure. The neurological diagnoses were obtained by analyzing the charts, then the micro biopsy, and created five independent groups of children based on chief complaint: 1 - motor impairment, MI (N = 31), 2 - epilepsy, E (N = 25), 3 - headache, H (N = 13), 4 - school difficulties, SD (N = 11), 5 - behavioral disorder, BD (N = 32). Results: The mean micro biopsy depth of all tests was 3.16 m. The lead concentrations obtained did not follow Gaussian distribution, and median, maximal and minimum values for each group are as follows: 1 - 103,0, 395,0; 2,0. 2 - 64,8, 233,0; 4,0. 3 - 140,3, 434,0; 10,0. 4 - 135,8, 366,0; 38,0. 3 - 158,3, 476,0; 1,9. The analysis of lead values showed no correlation between the age of the children and the values of lead (Pearson r = -0.016, p = 0.86). There was no significant difference between genders (t-test p = 0.55) and also between the primary and permanent teeth (t-test p = 0.11). As for the groups with neurological disorders, comparing the five groups (one-way ANOVA) showed significant p-value = 0.004. The post Tukey test showed significant differences, with smaller values of lead in the group with epilepsy compared to those with school difficulties and behavior disorders. In the analysis of risk factors, a greater number of children playing with piles in the group whose main complaint was headache in the group with motor disabilities (p = 0.002). There were no significant differences in the 5% level, about the values of lead among the cases with positive responses (p = 0.53) to the questionnaire or between the negative (p = 0.99) nor between the two, comparing each of the factors. The same is true for the intragroup each of the five diagnostic groups and between groups. Conclusions: In the present study, we found higher values of lead in the enamel surface in groups of children with school difficulties and behavioral disturbances in relation to that with epilepsy, and also the finding that environmental risk factors studied were not associated with the differences observed between these groups raises questions and need for further research on the harmful effects of lead on neural tissue, even when the population leaves in an environment with no known contamination with lead and shows blood lead concentrations (which is not the case of this study) that are lower than the values considered harmful to health.

Intravenous immunoglobulin (IVIG) is a common treatment for the neurological autoimmune diseases multiple sclerosis, multifocal motor neuropathy, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy. However, there is scant literature regarding the psychological effects of this treatment on quality of life (QOL). Using illness intrusiveness theory and personal control theory, this correlational, cross-sectional study examined the relationship between the IVIG treatment experience and QOL in neurological autoimmune patients. Surveys were employed to collect data from 79 patients at a neurological infusion center in Phoenix, AZ. Quantitative analyses included correlation, multiple regression, and mediation analyses to determine whether (a) IVIG treatment experience predicted QOL measured by 10 Neuro-QOL scales, (b) illness intrusiveness mediated the relationship between IVIG treatment experience and QOL, and (c) personal control mediated the relationship between illness intrusiveness and QOL. IVIG treatment experience predicted QOL in 1 Neuro-QOL subscale; illness intrusiveness mediated 9 of the Neuro-QOL subscales using bias-corrected bootstrapping for statistical significance; and personal control did not mediate the relationship between illness intrusiveness and QOL. These results may affect social change by increasing the understanding of physicians, nurses, and patients regarding the psychosocial impact of IVIG treatment. Results from the study may provide insight for interventions to assist patients in adjusting to this form of treatment.

The acute nervous system toxicity of organophosphate (OP) pesticides is well described. However, the reported long-term effects of OP pesticides on the nervous system are inconsistent. This inconsistency may be due to imprecise estimates of pesticide exposure, variability of central nervous system (CNS) and peripheral nervous system (PNS) assessment, small samples, and poor control of confounding. The primary goal of this research was to examine the association between long-term OP pesticide use on CNS and PNS function among pesticide applicators. An additional goal was to examine the association between high pesticide exposure events (HPEEs), which typically do not result in acute toxicity, and CNS function. Study participants were recruited from among applicators enrolled in the Agricultural Health Study (AHS) in Iowa and North Carolina. In 2006-2008, 701 male pesticide applicators completed a battery of neurobehavioral (NB) and neurological tests. Information about individual pesticide use was obtained from previous AHS interviews and a questionnaire administered during NB testing. Associations between pesticide use and neurological outcomes were estimated with linear and logistic regression models while controlling for covariates. When associations were examined between agent-specific pesticide use and nine NB tests, significantly poorer performance was observed on four tests and significantly better performance on five tests. Additionally, for some pesticides, we observed differential associations by state, suggesting that regional differences in pesticide practices may influence neurotoxicity. Overall, our results did not provide strong evidence that OP pesticide use was associated with adverse NB test performance. A history of at least one HPEE was reported by 23 percent of participants. Significant adverse associations were observed between HPEEs and two of the nine NB tests. Participants with HPEEs were, on average, 4.9 seconds slower on a test of visual scanning/processing, and 2.2 seconds slower on a test of visual scanning/motor speed. Overall, small but meaningful associations were observed between HPEEs and adverse CNS function. When associations were examined between pesticide use and PNS function, five of six neurological physical examination outcomes were associated with ever-use of one or more OP pesticides. Odds ratios ranged from 1.9 to 3.1. However, mostly null associations were observed between OP pesticide use and electrophysiological tests, hand strength, sway speed and vibrotactile threshold. This study provides some evidence that long-term exposure to OP pesticides is associated with impaired PNS function. In summary, our results suggest that exposure to a few individual OP pesticides as well as HPEEs may contribute to adverse neurological function. The observed exposure-effect associations were present after adjustment for confounding and were independent of past-diagnosed pesticide poisoning. We believe this research contributes important new evidence to an inconsistent literature. Reducing pesticide exposure and preventing HPEEs among pesticide applicators remain important public health goals.

No description available.

<p>Det har länge varit känt att patientens perioperativa position kan orsaka symtom som förmodas uppstå genom tryck och sträckningar. Positionen vid laparosko-piska operationer anses öka risken för symtom och därför är perioperativ om-vårdnad av betydelse. Syftet var därför att undersöka hur frekvent positions- relaterade symtom förekommer vid laparoskopiska ingrepp och vilken betydelse de har för patienten. Studien genomfördes som en deskriptiv tvärsnittstudie och datainsamlingen gjordes med hjälp av symtomskattning och semistrukturerade intervjuer. Totalt 60 respondenter i åldern 19 till 75 år deltog i studien som pågick under åtta månader. Resultatet visade att en fjärdedel av respondenterna drab-bades av nytillkomna eller förvärrade symtom. Dessa uppmärksammades postoperativt eller några dagar efter operationen och var oberoende av ingrepp, perioperativ tid eller armarnas position. Några av respondenterna upplevde smärta och domningar i nacke, axlar och händer som ledde till inskränkningar i det dagliga livet och krävde hjälp av närstående. Det är viktigt att fortsätta arbetet med att förebygga positionsrelaterade skador, för att förhindra postoperativa symtom, genom att placera patienten så nära ett neutralläge som möjligt och ge denne möjlighet att känna efter hur det känns före nedsövning.</p> / <p>It has long been assumed that a patient’s perioperative position can cause symp-toms which appear from pressure and strains on the body. The position in lapa-roscopic surgery is considered to increase the risk of symptoms, perioperative care is therefore important. The scope of this study was therefore to survey how frequent symptoms associated with the patient’s position occur and why they are important to the patient. The survey was made as a descriptive cross-section study. The data collection was made by way of patients own estimates of their symptoms and by semistructured interviews. 60 respondents aged between 19 and 75 took part in the study. The result showed that a fourth of the respondents experienced new or aggravated symptoms. These were observed postoperatively or a few days after surgery and were independent of operations, perioperative time or position of the arms. Some of the respondents felt pain and numbness in the neck, shoulders and hands which led to restrictions in their daily life and required help from someone close. It is important to continue working with preventing postoperative symptoms, by placing the patient as close to a neutral position as possible and give her the possibility to feel comfortable before the anesthetization.</p>

Background: The challenges of research in economically stunted countries’ settings remains a profound concern and is linked to socioeconomic development of these countries. More research is needed regarding psychiatric morbidity in rural areas of the developing and poverty stricken countries. The present studies were undertaken within the framework of a broader ongoing community-based project on the course and outcome of major psychiatric disorders in the rural Butajira district located in Ethiopia. This thesis treats the course and outcome of bipolar I disorder in the district. Objectives: Through appraising mental health and population based research in a rural Ethiopian district, to evaluate the utility of modern research instruments, and to obtain baseline information relating to bipolar I disorder in the poverty stricken rural Butajira district of Ethiopia. The specific objectives were: 1. Evaluating and comparing two different screening methods of case detection and identification for schizophrenia and bipolar I disorder in the adult population of Butajira district. 2. Assesing the prevalence and clinical characteristics of of bipolar I disorder in Butajira at the community level. 3. Evaluating short-term outcome at follow-up of bipolar I disorder in the Butajira district. 4. Determining Neurological Soft Signs in community-identified cases of bipolar I disorder in Butajira district in comparison with healthy controls. 5. Assessing the burden of care among caregivers of those affected by bipolar I disorder identified in the Butajira Study. Methods: The district’s entire adult population aged 15-49 was identified through a double-sampling design. In the first stage of screening, door-to-door interviews were conducted by lay trained high school completed individuals who knew the culture of the people. Females interviewed females whereas males interviewed males. Additionally, the key-informants method was used to identify cases that would be missed by the CIDI or otherwise. The final confirmatory diagnostic interview was conducted by clinicians using the SCAN on door-to-door basis as well. The probable cases that fulfilled the lifetime DSM-IV diagnosis of bipolar I disorder were assigned for assessment by other baseline research instruments such as Neurological Evaluation vii Scale (NES), Young Mania Rating Scale, Hamilton Rating Scale for Depression, LCSS, PANS and SANS, BISS, BII, FIS and so on. Cases so identified with bipolar I disorder were subject to a follow-up for upto 2.5 years on the average (range 1 to 4 years). Two of the main clinical outcomes assessed were relapse to a mood episode, and remission from a mood episode. Outcomes were assessed annually by the instruments, and were further assessed monthly by trained psychiatric nurses. We also did a cross-sectional study of caregivers of bipolar I disorder cases, and assessed objective burden on the caregivers as considered from social, family strain, occupational and financial domains. Results: Information provided by the key informants was better at detecting schizophrenia or chronic psychiatric disease, whereas the CIDI was better at detecting affective disorders. Of the around 100 000 adults living in Butajira, 83.3% were found by the project’s census, of which 82% (68,378 subjects) were successfully screened by the CIDI, yielding 2,161 CIDI positive. These, together with 719 cases identified by the key informants, were invited for the SCAN interview, of which 74.7% agreed. This yielded 315 SCAN positive cases for bipolar I disorder, and complete information could be collected on 295 of these. Lifetime prevalence was estimated as 0.6% for males and 0.3% for females. The mean age of onset of the manic phase was 22.0 years and that of the depressive phase was 23.4 years. For 22.7% of the cases the illness started with a depressive episode and for the remaining 77.3% it started with a manic episode. Over half of the cases (55.9%) had never sought help from modern health care sector, and only 13.2% had ever been admitted to psychiatric hospital. At follow-up, 65.9% had exprerienced a relapse and 31.1% had persistent illness, while only 5% of the patients were in remission for most of the follow-up time. The bipolar I cases, as compared with healthy controls, performed worse on several items of NES, thus having more neurological dysfunction compared to controls. Caregives were largely (80.3%) first-degree relatives and spouses. Overall, 84% of the caregivers reported difficulties in at least one of the domains of family burden. Of these, 58.7% reported a severe degree of difficulties. Caregivers reported a high level of difficulties in intrafamilial relationships and social restrictions, disruption in earning a livelihood, and financial difficulties. Conclusions: The prevalence of bipolar I disorder is comparable to the prevalences reported from other countries, and our findings support the cross-cultural validity of the concept of bipolar I disorder. Majority of the cases are not treated in contrast to that in the developed countries. The burden of care for the caregivers is substantial in the population studied.

Det har länge varit känt att patientens perioperativa position kan orsaka symtom som förmodas uppstå genom tryck och sträckningar. Positionen vid laparosko-piska operationer anses öka risken för symtom och därför är perioperativ om-vårdnad av betydelse. Syftet var därför att undersöka hur frekvent positions- relaterade symtom förekommer vid laparoskopiska ingrepp och vilken betydelse de har för patienten. Studien genomfördes som en deskriptiv tvärsnittstudie och datainsamlingen gjordes med hjälp av symtomskattning och semistrukturerade intervjuer. Totalt 60 respondenter i åldern 19 till 75 år deltog i studien som pågick under åtta månader. Resultatet visade att en fjärdedel av respondenterna drab-bades av nytillkomna eller förvärrade symtom. Dessa uppmärksammades postoperativt eller några dagar efter operationen och var oberoende av ingrepp, perioperativ tid eller armarnas position. Några av respondenterna upplevde smärta och domningar i nacke, axlar och händer som ledde till inskränkningar i det dagliga livet och krävde hjälp av närstående. Det är viktigt att fortsätta arbetet med att förebygga positionsrelaterade skador, för att förhindra postoperativa symtom, genom att placera patienten så nära ett neutralläge som möjligt och ge denne möjlighet att känna efter hur det känns före nedsövning. / It has long been assumed that a patient’s perioperative position can cause symp-toms which appear from pressure and strains on the body. The position in lapa-roscopic surgery is considered to increase the risk of symptoms, perioperative care is therefore important. The scope of this study was therefore to survey how frequent symptoms associated with the patient’s position occur and why they are important to the patient. The survey was made as a descriptive cross-section study. The data collection was made by way of patients own estimates of their symptoms and by semistructured interviews. 60 respondents aged between 19 and 75 took part in the study. The result showed that a fourth of the respondents experienced new or aggravated symptoms. These were observed postoperatively or a few days after surgery and were independent of operations, perioperative time or position of the arms. Some of the respondents felt pain and numbness in the neck, shoulders and hands which led to restrictions in their daily life and required help from someone close. It is important to continue working with preventing postoperative symptoms, by placing the patient as close to a neutral position as possible and give her the possibility to feel comfortable before the anesthetization.

Context: As one of the major causes of death and disability in Canada, research into the treatment and prevention of acute cerebrovascular syndrome (ACVS) remains a priority for clinicians, researchers and the general public. Understanding the relationship between current treatment practices of a rapid stroke clinic and patient outcomes is an essential part of measuring success and considering opportunities for quality improvement. Objective: This study compared the 90-day and 1-year hospital admission and mortality outcomes of patients who were referred to and seen in a rapid stroke clinic (the shows) following an initial transient neurological event (TNE) with those who were referred to but not seen in the same clinic (the no-shows). The specific outcomes examined were stroke events, cardiovascular events and all other hospital events. Methods: In this post-test only non-equivalent group design, data on patient outcomes was collected in the Victoria-based Stroke Rapid Assessment Unit (SRAU) between 2007 and 2013. Analysis included an assessment of group equivalency for possible confounders (age, sex and severity score) and two sets of multivariate logistic regressions were conducted on nine outcomes. Results: An independent t-test revealed there was a statistically significant difference between the mean age of the shows (mean= 68.26) and no-shows (mean= 69.90) (p<0.01). While the proportion of males and females in each of the groups was similar (Fisher’s Exact test, p = 0.831, ns), the severity score of the treatment group (mean= 3.64) was statistically more severe in the show group than the no-show group (mean= 3.50; t = 2.137, p<0.05). Controlling for age, sex and severity score, the odds ratios (ORs) were calculated to compare the odds of various outcomes in the treated (shows) versus the untreated (no-shows) patients groups. ORs for the 90-day and 1-year hospital admissions for stroke-related events were 0.071 (p<0.01) and 0.091 (p<0.01), respectively; the OR for 1-year stroke deaths was 0.167 (p<0.01), indicating a strong protective factor related to attending the clinic appointment. For the cardiovascular outcomes, the ORs for hospitalizations were 0.967 (ns) at 90-days and 0.978 (ns) within 1-year and the OR for the 1-year cardiac-related deaths was 0.391 (ns). For all other outcomes, the ORs were 0.525 (p<0.01) for hospitalizations within 90-days, 0.579 (p<0.01) for hospitalizations within 1-year and 0.299 (p<0.01) for deaths within 1-year. These findings remained consistent with re-analysis excluding subjects who had an event within 5.4 days of their initial TNE. These latter finding largely rules out the possibility that the primary reason the no-shows did not make their clinic appointment, was due to a subsequent hospital event. Conclusion: The ORs for the outcomes show a protective effect of stroke and all other hospital outcomes (but not cardiac events) for patients treated in the rapid assessment clinic. The exclusion of patients who experienced an outcome while waiting for a clinic appointment, lowered the protective effect of the treatment and emphasized the need for rapid assessment but did not alter the main study conclusions. Future research that explores factors influencing appointment adherence and patient attitudes towards acute treatment of TNEs might reveal strategies that could help to reduce the number of patients that remain untreated and at a higher risk for poor outcomes. / Graduate