Pregnancy and childbirth are critical life events and women and their families require physical as well as emotional support and care. The concepts continuity of care, choice and a sense of control are prominent in the literature on women’s satisfaction with as well as outcomes of care. Midwives have globally been identified as important role players in women-centred care for low risk pregnant women. To be able to offer their women safe, supportive care they need not only a certain degree of autonomy, but also the support of other health care professionals such as obstetricians to whom they can refer women with risk factors or complications. Maternity care has become “medicalised” and the overuse of interventions such as caesarean section is prevalent in many countries. South African women make use of either the public or private health sector for care during pregnancy and birth. The public sector is overburdened and women do not have a high level of continuity of care. The private sector is mainly obstetrician-led and intervention-driven, even for low risk women. The estimated caesarean section rate is higher than 70%. Private midwife-led care is available in South Africa, but is concentrated in the major cities. Private midwives practise at hospitals, birth centres, “active birth units” and women’s homes. No evidence could be found on the outcomes of private midwife-led care in South Africa. The objectives of this study were to explore and describe the outcomes of births attended by private midwives in Gauteng over a two year period and to compare these outcomes with the latest Cochrane review on midwife-led care. A retrospective cohort design was chosen to audit the birth registers of private midwives in Gauteng and conduct quantitative analyses. Gauteng midwives’ patients, when compared with the Cochrane review that juxtaposes midwife-led care with other models of care, had a significantly lower percentage of interventions such as induction of labour (9.6% versus 18.6%) but caesarean sections were performed significantly more frequently (19.3% for the women in Gauteng versus 12.5% for the women in the review). Women in Gauteng also made significantly less use of medications in labour. Maternal and neonatal outcomes were reassuring. Significantly more Gauteng women had intact perineums (53.4% versus 31.4%). A higher percentage of postpartum haemorrhage was found in the Gauteng sample (7.9% versus 6.2%). The difference is significant, although, only three women were admitted to high care units as a result of postpartum haemorrhage. Overall foetal loss (4.3% versus 6.7%) and neonatal ICU admissions (0.3% versus 2.9%) occurred significantly less frequently in the Gauteng sample. The study findings indicate that private midwife-led care in Gauteng compared well with that in the rest of the world in terms of intervention rates and outcomes. / MCur, North-West University, Potchefstroom Campus, 2015

Master of Science / Department of Statistics / Leigh W. Murray / The term retrospective power describes methods for estimating the true power of a test after data have been collected. These methods have been recommended by some authors when null hypothesis of a test cannot be rejected. This report uses simulations to study power as a construct of an observed effect, variance, sample size, and set level of significance under the balanced one-way analysis of variance model for normally distributed populations with constant variance. Retrospective power, as a construct of sample data, is not recommended when the null hypothesis of a test cannot be rejected. When the p-value of the test is large, estimates for true power tend to fall below the 0.80 level and width-minimized confidence limits for true power tend to be wide.

<p>Diss. (sammanfattning) Umeå : Umeå universitet, 1980 härtill 4 uppsatser</p> / digitalisering@umu

Single frame ultrasound B-mode image quality is largely governed by the ability to focus the ultrasound beam over a range in depths both in transmission and reception. By developing a comprehensive understanding of acoustic wave propagation two signal processing methods were identified for solving the transmission problem. We made use of both the impulse response using the classical point spread function (PSF) and the spatial sensitivity function (SSF) which describes the spatial distribution at a particular time. Using the angular spectrum method, an accurate analytical model was developed for the field distribution arising from a finite geometry, apodized and focused, plane piston transducer. While there is a thorough understanding of the radiated field arising from uniformly excited plane piston transducers, the focused equivalent (i.e., one that allows a continuous change in phase over the plane piston surface) is incomplete and assumes the Fresnel approximation. Our model addresses the effects of diffraction and evanescent waves without the use of the Fresnel approximation and is applicable at all near- and far-field locations in a lossless medium. The model was analyzed to identify new insights into wave propagation and compared with the Fresnel approximation and the spherically-focused, concave transducer. The piston transducer model was then extended to an attenuating and dispersive medium. After analysing existing models of power-law frequency dependent attenuation, a causal, spherical wave Green’s function was derived from the Navier-Stokes equation for a classical viscous medium. Modifications to the angular spectrum method were presented and used to analyze the radiated field of a focused, planar piston transducer. Finally, after presenting our signal processing strategy for improving imaging spatial resolution through minimization of the SSF, two signal processing methods were derived and analysed in simulation: a deconvolution technique to remove the effects of the ultrasound excitation wave and suppress additive noise from the received ultrasound signal, and a retrospective transmit focusing method that changed the response from a predefined transmit focus to an arbitrary transmit focal depth. Proof-of-concept simulations were presented using a variable number of scatterers and compared with the traditional matched filtering and envelope detection technique.

Divorce has long been described as one of the most stressful experiences that any human being can ever experience. The process of divorce implies numerous sudden and highly stressful changes to any individual affected by it, including children. The literature review of the present study revealed valuable insight regarding the effects of divorce, in particular on children. The studies among them which were found to have identified some of the more detrimental implications of divorce for children in particular, included the studies by Jonsson, Njardvik, Olafsdottir and Gretarsson (2000); Eldar-Avidan, Haj-Yahia and Greenbaum (2009); and Yu, Pettit, Lansford, Dodge and Bates (2010). Despite numerous research studies having been done on the phenomena of divorce both in South Africa and globally, it appears that the majority of these studies mostly focused on its detrimental implications for both children and adults. Few of these studies were found to have focused on possible optimal implications or on effective coping with divorce. Some studies that were found to have touched on the potential optimal effects of parental divorce included the studies by Mullis, Mullis, Schwartz, Pease and Shriner (2007); Graff-Reed (N.D.); and Spalding and Pretorius (2001). One particularly influential study that was, however, identified to have been done on the phenomena of coping with parental divorce, was conducted by Roux (2007) who focused specifically on children’s coping with parental divorce. This study focused exclusively on children and involved interviews with children themselves at the time of their parents’ divorce. No research could be identified on how young adults in South Africa had attempted to cope with their parents’ divorce during their childhood and/or adolescent years. This determination led to an attempt to fill this apparent void in the literature and expand on the study that had been conducted by Roux (2007) by completing the present study. The focus of the present study subsequently fell on how young adults had coped with the divorce of their parents during their childhood and/or adolescent years. The aims of the present study were: * To investigate and obtain a clearer understanding of young adults’ coping with divorce during their childhood and/or adolescent years. * To determine if there were factors that played a role in coping with parental divorce. * To determine what recommendations could be made to the parents of children undergoing divorce. * To determine what recommendations could be made to children while undergoing parental divorce. The research questions that were included in the present study for the aforementioned purpose included the following: * How did young adults cope with the divorce of their parents during their childhood and/or adolescent years? * Were there factors that played a role in their coping and if so what were the factors? * What would they recommend to the parents of children during and after divorce? * What would they recommend to children during and after parental divorce? Semi-structured retrospective interviews were conducted with 15 participants in the completion of the present study. Each of these interviews where transcribed and the relevant data were analysed from these transcriptions by firstly reading of the protocols, followed by dividing them into natural meaning units (NMUs), performing linguistic transformation, integrating the NMUs with related themes, synthesising the data and developing a general description before it was finally documented and published. Selection of the participants was made by means of snowball sampling, as young adults nominated acquaintances whom they believed may also be willing to participate in the research (Whitley, 2002). The value of the present study was that it expanded the knowledge base regarding young adults’ coping with parental divorce during their childhood and/or adolescent years. It also culminated in the creation of a set of recommendations for both children and adults that would promote effective coping among them with parental divorce. It is hoped that these insights and recommendations will enable psychologists, social workers, counsellors, health care practitioners and/or any other individual/s involved with assisting families during divorce, to cope more effectively with this event. It is also hoped that further future research and follow-up studies into this particularly relevant and far reaching phenomenon will continue to be conducted by other researchers both in South Africa and abroad. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014

Global health is an emerging concern in a rapidly changing world in which health issues transcend international borders. This study developed and validated a new self-report questionnaire to assess self-perceived global health competencies among international medical students and how they are influenced by international clinical experiences. A tool consisted of two scales and four subscales with moderate internal consistency. Comparisons between participants who completed retrospective pretest (after the intervention retrospectively) and those who completed traditional pretest (before the intervention) revealed that those participants who completed the questionnaires retrospectively provided lower pretest scores, suggesting that response-shift bias had occurred. Significant increases in scores after international clinical experience were reported for the majority of global health competency measures in IFMSA group. Linear regression identified participant’s age, gross national income (GNI) of country of medical studies, GNI of the country visited, duration of international clinical experience and years of medical school completed, as significant predictors of global health scores. This study contributes valuable information about the newly developed global health competencies measurement tool.

A research report submitted to the Faculty of Health Sciences in fulfilment of the requirements for the degree of Master of Medicine, in Internal Medicine at the University of Witwatersrand, Johannesburg. September 2017 / Differentiating ischaemic left ventricular dysfunction (ILVD) from non-ischaemic left ventricular dysfunction (NILVD) is crucial since appropriately selected patients may benefit from coronary revascularisation. The aim of this study was to evaluate the diagnostic utility of myocardial perfusion imaging (MPI) in patients presenting with left ventricular dysfunction using coronary angiography (CA) as the gold standard. Methods This single centre retrospective study was conducted in 52 patients with heart failure with a reduced ejection fraction (EF< 40%) who had both MPI as well as CA at CHBAH between January 2005 and December 2012. ILVD was diagnosed when the distribution and severity of coronary disease on CA was sufficient to account for the degree of left ventricular dysfunction. Results From a total of 52 patients, 33 (63%) had ILVD and 19 (37%) had NILVD. As compared to patients with NILVD, those with ILVD were more likely to be Indian and White (p=0.0014), have more coronary risk factors (5(2) vs 3(2), p < 0.0001) and more commonly have q waves on the ECG (0% vs 55%, p < 0.0001). MPI had a sensitivity of 100% (95% CI 66-100%) and specificity of 52.63% (95% CI 30.18 - 75.08) for the diagnosis of ILVD. The presence of fixed perfusion defects on MPI was the best predictor of ILVD. Conclusion MPI has high sensitivity but low specificity for the diagnosis of ILVD. This makes it a useful screening test for the exclusion of coronary artery disease in patients presenting with heart failure. / MT2018

Aproximadamente 40% dos casos de Linfoma não Hodgkin (LNH) se originam fora dos linfonodos, sendo então denominados linfomas extralinfonodais. No trato gastrointestinal (TGI), o estômago é o local mais freqüentemente envolvido, representado pelo linfoma MALT e pelo linfoma difuso de grandes células B (LDGCB). No Brasil, apesar da sua freqüência e importância, existem poucos dados epidemiológicos em relação aos linfomas, especialmente no que se refere aos linfomas de origem extralinfonodal. Para avaliar as características dos linfomas primários gástricos em uma população brasileira, 60 casos foram avaliados retrospectivamente. Trinta e oito (63,3%) foram classificados como LDGCB e 22 (36,6%) como MALT. Entre os dois grupos, não houve diferenças significativas em termos de sexo, idade, sintomas dispépticos, sintomas B, presença de massa Bulky, infiltração de medula óssea, estádio, infecção por H. pylori, achados laboratoriais e endoscópicos. Foram adotados diferentes protocolos de tratamento. A taxa de remissão completa foi de 73,1% no LDGCB e de 95% no linfoma MALT. A taxa de sobrevida livre de doença em 7 anos foi de 84,8% no LDGCB e de 94,1% no linfoma MALT. A taxa de sobrevida global em 7 anos foi de 65,7% no LDGCB e de 92,9% em 5 anos no linfoma MALT. Como não conseguimos demonstrar diferenças entre os dois tipos histológicos, concluímos que o diagnóstico histológico correto é essencial para a terapêutica mais adequada. / Approximately 40% of the non-Hodgkins Lymphoma arises outside lymph node tissue, being then termed extranodal lymphoma. In the gastrointestinal tract, gastric is the commonest localization represented by MALT and diffuse large B-cell lymphoma (DLBCL). In Brazil, despite its importance and frequency there are very few epidemiological data concerning lymphomas, specially the extranodal ones. In order to study the primary gastric lymphoma features in a Brazilian population, 60 patients were retrospectively evaluated. Thirty eight cases (63.3%) were classified as DLBCL and 22 (36.6%) as MALT lymphoma. There were no significant differences between the 2 groups in terms of sex, age, gastric symptoms, B symptoms, Bulky disease, bone marrow infiltration, stage, H. pylori infection, laboratory and endoscopic findings. Different treatment methods were adopted. The complete remission rate was 73.1% for DLBCL and 95% for MALT lymphoma. The disease free survival in 7 years was 84.8 for DLBCL and 94.1% for MALT lymphoma. The 7 year overall survival (OS) rate for DLBCL was 65.7% and 5 year OS for MALT was 92.9%. Because we could not demonstrate differences between the two histological groups, we conclude that the correct histological diagnosis is essential for choosing the best therapeutic approach.

O lúpus eritematoso foi pouco estudado na infância, principalmente nas formas cutânea crônica, subaguda e bolhosa que são infreqüentes nessa faixa etária. Este trabalho tem por objetivo estudar as diversas formas de lúpus eritematoso em crianças. Para tanto, realizamos um estudo retrospectivo por meio da análise de prontuários de pacientes com lúpus eritematoso que teve início até os 16 anos de idade e que foram acompanhados na Divisão de Dermatologia do Hospital das Clínicas da Universidade de São Paulo entre 1991 e 2006. Os pacientes incluídos tiveram o diagnóstico feito pelo quadro clínico e confirmado pela histologia cutânea de uma lesão específica. Foram observados 48 pacientes: 33 com lesões discóides, dois com lúpus profundo, quatro com lúpus eritematoso cutâneo subagudo, quatro com lúpus eritematoso cutâneo agudo sem outras lesões específicas e cinco com lúpus eritematoso bolhoso. Analisadas as características clínicas, laboratoriais, histológicas e de imunofluorescência direta. Dezenove casos preencheram critérios para lúpus eritematoso sistêmico. Houve predomínio discreto no sexo feminino. Casos familiares de lúpus eritematoso estavam presentes em 10% dos pacientes. Vinte e quatro por cento das crianças com lesões discóides preencheram critérios para lúpus eritematoso sistêmico, sendo que 75% apresentavam lesões generalizadas. No lúpus eritematoso sistêmico, as manifestações mais freqüentes foram: cutânea, articular e renal. A glomerulonefrite proliferativa difusa foi a forma mais freqüente de nefrite. Foram observadas alterações hematológicas no limite inferior ou abaixo das taxas relatadas na literatura. Acometimento neurológico ocorreu em 68%. Acometimento cardíaco, pulmonar e do sistema digestivo foram pouco freqüentes. O FAN estava positivo em 95% dos casos e o anticorpo anticardiolipina estava presente em 21%. Dois dos quatro pacientes com lúpus eritematoso cutâneo subagudo preencheram critérios para lúpus eritematoso sistêmico e apresentaram convulsões e nefrite, sendo que um necessitou de transplante renal. Todos referiam fotossensibilidade e o anticorpo anti-Ro estava presente em três dos quatro casos. Todos os pacientes com lúpus eritematoso sistêmico bolhoso preencheram critérios para lúpus eritematoso sistêmico com acometimento renal e baixos níveis de complemento. Nenhum dos dois pacientes com lúpus profundo apresentou critérios para lúpus eritematoso sistêmico. Ambos apresentavam quadro disseminado com histologia típica. O quadro histológico nos demais casos também foi característico e a IgM foi o imunodepósito mais freqüente à imunofluorescência direta. A coloração de PAS (ácido periódico/reagente de Schiff) mostrou espessamento da membrana basal em 37 dos 40 casos estudados. Concluímos que o lúpus eritematoso da infância é semelhante ao do adulto, porém apresenta algumas peculiaridades como menor predomínio no sexo feminino, alta taxa de história familiar de lúpus eritematoso e maior associação com lúpus eritematoso sistêmico nas crianças com lesões discóides. Crianças com lúpus eritematoso cutâneo subagudo e critérios para lúpus eritematoso sistêmico tiveram acometimento sistêmico grave. O acometimento renal foi freqüente nas crianças com lúpus eritematoso sistêmico bolhoso / Lupus erythematosus was not well studied in childhood, especially in its chronic cutaneous, subacute and bullous forms that are uncommon at this age group. The present work aims to study the various forms of childhood lupus erythematosus. We retrospectively studied through medical records patients with lupus erythematosus whose disease had started until 16 years of age who were followed at Dermatology Division of Hospital das Clínicas of University of São Paulo between 1991 and 2006. The patients included had the diagnosis established on clinical grounds and confirmed by histological examination of a specific lesion. We found 48 patients: 33 with discoid lesions, two with lupus profundus, four with subacute cutaneous lupus erythematosus, four with acute cutaneous lupus erythematosus without other specific lesion and five with bullous lupus erythematosus. We analyzed the clinical, laboratorial, histological and direct immunofluorescence findings. Nineteen cases fulfilled the criteria for systemic lupus erythematosus. There was a slight female predominance. Familiar history of lupus erythematosus was present in 10% of cases. Twenty four percent of children with discoid lesions fulfilled the criteria for systemic lupus erythematosus and 75% showed disseminated lesions. The most frequent clinical manifestations in systemic lupus erythematosus were cutaneous, articular and renal. Diffuse proliferative glomerulonephritis was the most frequent form of nephritis. Hematological involvement was bellow or in the bottom of normal limits reported in the literature. Neuropsychiatric disease occurred in 68% of patients. Cardiac, pulmonary and gastrointestinal involvement was not frequent. ANA was positive in 95% of cases and. anticardiolipin antibodies were present in 21%. Two of four subacute cutaneous lupus erythematosus patients fulfilled the criteria for systemic lupus erythematosus and had convulsions and nephritis; one of them was submitted to renal transplantation. All of them referred photosensitivity and anti-Ro was present in three of four cases. All patients with bullous lupus erythematosus fulfilled the criteria for systemic lupus erythematosus and presented renal involvement and low complement levels. None of the two patients with lupus profundus fulfilled the criteria for systemic lupus erythematosus. Both had disseminated lesions and typical histology. Histological examination was also characteristic in the other cases and IgM was the most frequent immunodeposit at direct immunofluorescence. PAS staining showed thickening of basement membrane in 37 of 40 cases studied. To conclude, childhood lupus erythematosus is similar to adult lupus erythematosus, however shows some peculiarities as lower female predominance, high proportion of familiar history of lupus erythematosus and greater association with systemic lupus erythematosus in children with discoid lesions. Children with subacute cutaneous lupus erythematosus and criteria for systemic lupus erythematosus had severe systemic involvement. Renal disease was frequent in children with bullous systemic lupus erythematosus

Introdução: A presente dissertação foi desenvolvida com o intuito de investigar as possíveis mudanças na dinâmica das famílias incestuosas, após intervenção do tratamento psicoterapêutico. A hipótese é de que mudanças primárias e secundárias ocorrem nas famílias encaminhadas ao Centro de Estudos e Atendimentos Referente ao Abuso Sexual (CEARAS) a partir do tratamento proposto. Essa dissertação foi elaborada a partir de uma perspectiva psicanalítica, com enfoque psicossocial, na qual o sujeito é considerado a partir de sua imersão na cultura. Para tanto, se tomou como base de reflexão o trabalho desenvolvido por este Centro de Estudos, em relação às famílias incestuosas. Objetivo: Refletir sobre as mudanças primárias e secundárias apresentadas pelas famílias incestuosas que foram atendidas no CEARAS. Metodologia: Trata-se de uma pesquisa retrospectiva documental. Foram analisados os prontuários de 19 famílias atendidas no CEARAS no período de 1993 a 2013 que compuseram a amostra final. Levantaram-se as informações sobre os atendimentos, condições de prontuários e quanto ao tratamento. As mudanças descritas nos prontuários foram divididas em dois grupos: mudanças primárias e secundárias. Uma análise descritiva e quantitativa das variáveis foi realizada. Resultados: A maior parte das famílias que foram encaminhadas para o CEARAS não finalizaram o tratamento proposto. Em relação às mudanças observadas, 53% das famílias apresentaram mudanças primárias e secundárias, 37% primárias e 10% secundárias. Em relação às mudanças primárias, a simbolização das funções familiares foi a mais frequente e a autonomia do membros familiares a menos frequente nos prontuários analisados. Não houve predomínio de mudanças secundárias. Observou-se um maior número de mudanças nas familías que não passaram pelo processo de troca de terapeutas. Conclusão: Percebeu-se a viabilidade do trabalho, o quanto ele se faz necessário. A pesquisa apontou que as mudanças primárias e secundárias são possíveis de acontecer através da terapia familiar. A transferência das famílias não ocorre somente com a instituição, mas também com os terapeutas envolvidos no tratamento / Introduction:This research aims to investigate possible changes to the dynamics of incestuous families after the commencement of psychotherapeutic treatment. Hypothetically, primary and secondary changes happen to the families taken to the Sexual Abuse Study and Help Center (Centro de Estudos e Atendimentos Referente ao Abuso Sexual - CEARAS) from the proposed treatment. This essay has been elaborated from a psychoanalytical perspective with psychosocial emphasis, in which the individual is considered from his cultural context. To do so, the grounds for the analysis is the work developed by the Study Center with the incestuous families. Objective: To think about the primary and secondary changes that arose from the therapeutic treatment provided by CEARAS to the dysfunctional families. Methodology: This is a retrospective document research. The handbook of the 19 families supported by CEARAS from the period between 1993 and 2013 which were part of the final sample have been analysed. The information about the calls, handbook conditions and treatment have been searched. The changes described in the handbooks were split in two groups: primary and secondary changes. Results: Most families under CEARAS\' care have not finished the proposed treatment. In relation to the changes detected, 53% of the families have shown primary and secondary changes; 37% have shown primary; and 10% secondary. It has been observed in the handbooks under analysis that, in relation to primary changes, the simbolization of the family functions was the most outstanding change whereas the autonomy of the family members was the least. There was no predominance of secondary changes. There has been a higher number of changes in families that did not have to change therapists. Conclusion: It is noticeable that the work is feasible and how necessary it is.The research shows that the primary and secondary changes are possible to take place by way of family therapy. The transfer in families does not happen only with the institution but also with the therapists involved in the treatment