Despite a rise in breast cancer incidence, mortality rates have fallen. This improvement in mortality is due to the success of anti-cancer treatments such as chemotherapy and radiotherapy. Such treatments, however, are known to be associated with a range of symptoms. A number of studies exploring patients’ chemotherapy-related symptom experiences have shown that patients consistently rate nausea and fatigue highly, not only in relation to severity, but also in relation to the associated distress they experience. The subjective and non-observable nature of both nausea and fatigue complicates their assessment. While a range of assessment tools exists to evaluate patients’ experiences of these two symptoms, there is currently no gold standard assessment tool for assessing either symptom. Moreover, while a range of pharmacological and non-pharmacological interventions have been developed for both symptoms, further evaluation is often needed to provide the level of evidence required to recommend their implementation in real life clinical environments. The SNA↔P (structured nursing assessment into practice) study arose in response to this clinical situation. The SNA↔P study was a longitudinal study that evaluated the impact of a complex evidence-based intervention, incorporating structured multidimensional symptom assessment and multiple symptom management techniques, on patients’ experiences of nausea and fatigue during a course of chemotherapy for breast cancer. Using complementary quantitative and qualitative research methods not only allowed in-depth understanding of patients’ experiences and patterns of nausea and fatigue during a course of chemotherapy, but also facilitated a rounded evaluation of the intervention, incorporating both statistical elements and those of personal significance. The use of these methods showed that the implementation of the SNA↔P intervention in routine clinical practice has significant potential for improving patients’ symptom experiences during a course of chemotherapy. In so doing, it also highlighted a number of areas in which clinical practice can be influenced, and research conducted, to further improve patients’ symptom experiences.

由於社會環境的急劇變遷，公部門扮演之角色，不若往昔僅僅處於被動服務態勢，主動出擊已成為必要作為。且地方政府各項服務措施與人民日常洽公辦理之事務息息相關，因此為了符合民眾期待進而感動民眾，各地方政府不僅意識到「服務」與「創新」的重要性，也不斷地藉由各類創新以及便民措施的精進，來提高民眾對於政府的信賴，「服務創新」因而成為地方政府展現積極作為的一個代表性象徵。 而政府資源「取之於民，用之於民」，任何政策的推動不應因為大部份民眾的漠視與無考量成本與公共利益的旨向，而貿然推動缺乏照顧弱勢的福利政策。故本文以服務創新文獻以及政策評估之相關理論為基礎，評估新北市政府於102年推動「跨區服務」政策產生之副作用為何，藉以提出短、中長期之政策建議。採用之評估模型則以Vedung之副作用模型(side-effect model)為基礎，結合Dunn所提出之評估的標準形式，即效能性、效率性、充分性、公平性、回應性、適當性等面向，從政策規劃端、政策執行端與政策接收端（含受益者與其利害關係人）三類別為分析面向，從深度訪談與描述性統計角度，探討該政策在人力、成本與服務上所產生之可預期與非預期之副作用。 / Due to rapid change of social environment, the public sector no longer plays a passive role in service delivery. It is essential for it to take a more active role. It is especially true for local governments, as their functions are closely related to the people’s daily lives. In order to meet the expectations of the people and get them moved, various local governments are not only aware of the importance of "service" and "innovation", but also continue to formulate various innovation and convenience measures to enhance the people's trust to the government. "Service innovation" has become a symbol to show an activism of local governments. Government resources come from the people, so they should be used for the people. We should not take no account of cost and public interest in figuring out a welfare policy for the disadvantaged. Therefore, this thesis makes use of the literature of service innovation and the theory of policy evaluation to assess the side effects generated by the "cross-district service" policy initiated by the New Taipei City Government in 2013, in order to suggest some short-, medium- and long-term recommendations. The evaluation model this thesis adopts is based on Vedung’s side effects model accompanied with Dunn’s evaluation criteria: effectiveness, efficiency, adequacy, fairness, responsiveness and appropriateness. The analytical dimensions are composed of the points of policy planning, policy implementation and policy receiving (including beneficiaries and other stakeholders). Through in-depth interviews along with descriptive statistical analysis, it explores anticipated and unanticipated side effects of the policy generated in terms of manpower, cost and service.

Les antipsychotiques atypiques sont des options de traitement de première ligne pour la schizophrénie. Cependant, la prise d’antipsychotiques atypiques, comme l’olanzapine, est associée à des effets secondaires métaboliques : l’augmentation du poids, la dyslipidémie et l’intolérance au glucose. Les mécanismes en lien avec ces effets secondaires sont à ce jour peu connus. Ce mémoire étudie l’évolution de différents paramètres, tant au niveau biométrique (poids, IMC, circonférence abdominale), qu’au niveau sérique (bilan lipidique, glycémie à jeun, insuline, leptine, ghreline) et clinique (mesures des symptômes positifs, négatifs et généraux de la schizophrénie, de même que des comportements alimentaires) chez des sujets schizophrènes, traités pendant 16 semaines avec l’olanzapine. Des examens de résonance magnétique, structurale et fonctionnelle, ont été effectués au début et à la fin du traitement d’olanzapine chez les sujets schizophrènes et chez un groupe de sujets contrôles afin d’identifier les régions cérébrales dont les volumes ou les activations pourraient être associés aux mécanismes d’effets secondaires métaboliques. Nos résultats confirment l’émergence de multiples effets secondaires métaboliques, associés à des modifications des comportements alimentaires, en lien avec la prise d’olanzapine auprès de notre échantillon. Des associations ont été retrouvées entre les changements métaboliques et les volumes de plusieurs régions cérébrales, notamment les hippocampes, les précunei et le gyrus orbitofrontal droit. De plus, des différences en terme d’activations cérébrales entre les sujets contrôles et les patients schizophrènes, qui ont été accentuées par le traitement d’olanzapine, ont aussi été décrites notamment au niveau amygdalien, cérébelleux et des insulas, suggérant l’implication de mécanismes neuronaux dans l’apparition des troubles métaboliques associés aux antipsychotiques atypiques. / Atypical antipsychotics are first line treatment options for schizophrenia. Nevertheless atypical antipsychotics, such as olanzapine, are associated with metabolic adverse effects: weight gain, dyslipidemia and glucose intolerance. Mechanisms underlying these side effects are still poorly understood. This thesis represents a study of the evolution of biometric (body weight, BMI, abdominal circumference), biological (lipid profile, fasting glucose, insulin, leptin, ghrelin) and clinical parameters (positive, negative and general symptoms of schizophrenia as well as eating behavior measures) in schizophrenia patients treated with olanzapine during 16 weeks. Healthy subjects and schizophrenia patients passed structural and functional magnetic resonance examinations (one examination for healthy controls and two examinations for schizophrenia patients, one at the beginning and one after 16 weeks of olanzapine treatment) in order to identify cerebral regions where grey matter volumes or activations could be associated with metabolic side effects mechanisms. Our results confirm that various metabolic adverse effects emerged in our sample of patients during the 16 weeks olanzapine treatment. Eating behavior changes have also been associated with specific metabolic changes. Many associations have been found between cerebral volumes (e.g. bilateral hippocampi and précunei and right orbitofrontal cortex) and metabolic changes. Moreover, cerebral activations differences between healthy controls and schizophrenia patients, that were increased following olanzapine treatment, were also described in the amygdala, cerebellum and insulas, suggesting that neuronal mechanisms were involved in the development of metabolic disorders associated with atypical antipsychotics.

Purpose: Previous clinical studies have suggested a positive effect of low-frequency pulsed electromagnetic fields (PEMF) on wound healing and inflammation in the eye. We tried to test the value of PEMF treatment in a hyphema animal model with well-defined conditions. Methods: After injection of citrated autologous blood for the production of hyphema, 16 rabbit eyes were treated with 10 or 20 mT for 60 min on 4 days within the postoperative week. Two control groups with hyphema alone (n = 8) and PEMF irradiation without hyphema (n = 4) were also included. The rate of resorption was recorded daily. Histopathologic evaluation was performed. Results: The incidence of endothelial cell damage and fibrotic clots was markedly reduced in the 10-mT group while the resorption time of 8 days was identical with the control group. In the 20-mT group, the complication rate and the resorption time was increased versus the control group. Conclusions: The use of PEMF treatment is of some, however, limited value as it did not reduce the resorption time of hyphema but displayed a dose-dependent, beneficial influence on some serious side effects. Future clinical studies with low-dose PEMF irradiation are justified and should determine the optimal dosage and suitable indications of PEMFs as an adjunctive treatment in ocular inflammation or trauma. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Tyrimo tikslas - įvertinti sergančiųjų lėtiniu virusiniu C hepatitu gyvenimo kokybę ir nustatyti ją įtakojančius veiksnius. Tyrimo uždaviniai. Įvertinti demografinių veiksnių įtaką sergančiųjų lėtiniu virusiniu C hepatitu gyvenimo kokybei. Ištirti sergančiųjų lėtiniu virusiniu hepatitu C žinių apie šią ligą lygį. Įvertinti sergančiųjų lėtiniu virusiniu C hepatitu turimų žinių įtaką gyvenimo kokybei. Įvertinti specifinio priešvirusinio gydymo šalutinių reiškinių įtaką gyvenimo kokybei. Įvertinti slaugytojų vaidmenį gerinant šių pacientų gyvenimo kokybę. Tyrimo populiacija. VUL Santariškių klinikų Hepatologijos, gastroenterologijos ir dietologijos centre gydomi virusiniu hepatitu C sergantys 52 pacientai. Tyrimo metodai. Tyrimas atliktas pritaikant anketavimo ir medicininių dokumentų analizės metodus. Taikyta pacientų apklausos anketa žinių apie ligą ir specifinį gydymą įvertinimui ir SF- 36 gyvenimo kokybės vertinimo klausimynas. Statistinė analizė atlikta naudojant „Microsoft Office Excel 2003“ ir SPSS 15,0 for Windows versijos statistinę programą. Darbo rezultatai ir išvados. Tyrimo metu nustatyta, kad statistiškai patikimai žemesniais balais vyrai vertino šias gyvenimo kokybės sritis – „aktyvumo apribojimą dėl fizinių problemų“ ir „socialinę veiklą“, lyginant su tais pačiais moterų rodikliais. Amžius bei išsilavinimas neturėjo įtakos pacientų gyvenimo kokybei. Ištyrus sergančiųjų lėtiniu VHC žinių apie ligą lygį, nustatyta, kad jų žinios apie ligą nepakankamos. Geriausios... [toliau žr. visą tekstą] / The aim of the research work – to evaluate chronic hepatitis C patients quality of life and to determine the quality of life affecting factors. The goals of the research work. To assess an impact of demographic factors on the quality of life of patients with chronic viral hepatitis C. To investigate a level of knowledge about chronic hepatitis C in patients suffered with this disease. To determine an impact of available knowledge about the disease on quality of life in patients with chronic hepatitis C. To evaluate the specific antiviral treatment side effects influence on the quality of life. To assess the role of nurses in improving the quality of patients life. The research population. 52 chronic hepatitis C patients undergone antiviral therapy in VUL “Santariškių klinikos” Centre of Hepatology, Gastroenterology and Dietetics were studied. The research methods. The research was carried out using methods for analysis of surveys and medical documents. Patients knowledge about the disease and antiviral treatment side effects was evaluated using survey questionnaire and SF-36 quality of life assessment questionnaire. Statistical analysis was performed using the Microsoft Office Excel 2003 and SPSS 15.0 for Windows statistical program. The results and conclusions. During the research it was found that men statistically worse, as compared with the same characteristics of women, scored following domains of the quality of life: "the activity limitation due to physical problems"... [to full text]

This study aims to highlight patients´ experiences about and thoughts of side effects fromelectroconvulsive therapy (ECT), a therapeutic method commonly used when having severedepressions. The framing of questions were how the respondents of this study describe theirlife before, during and after ECT-treatment, how the treatment has affected their daily life andhow these experiences may contribute to the awareness of power in professional relations.The study is based on three semi-structured narrative interviews and the main result showedthat, according to my interpretation, ECT as a treatment obliterated memories, quality of lifeand daily structure for all participants. Unfortunately they have all become subjects ofpsychiatric power and have faced considerable difficulty in getting professional recognitionaccording to their severe memory issues. The respondents have lost the ability to relate totheir past which clearly makes them struggle in their present context. A point in commonamong them is that neither of them wanted ECT but, because of the lack of communicationbetween them as patients and the health care in general, they all ended up getting it.

[Truncated abstract] Glucocorticoids are critical for the maturation of the fetus late in pregnancy. Indeed, clinical administration of glucocorticoids is used to accelerate fetal lung maturation in mothers at risk of pre-term delivery. Increased glucocorticoid exposure, however, can have detrimental effects on fetal and placental growth and increase the risk of disease in later life. Many studies have focused on the effect of an increase in the transplacental passage of glucocorticoids on both fetal growth and subsequent postnatal development. But there is a growing body of evidence to suggest that the impact of glucocorticoids on fetal growth is mediated, in part, via their direct effects on the placenta . . . Overall, these studies quantify the labyrinth zone-specific increases in placental expression of PPARG and VEGF in association with a marked increase in vascularisation observed near term. Furthermore, this study demonstrates for the first time that these increases in gene expression are prevented by maternal dexamethasone treatment which also inhibits growth of the fetal capillary network. Elevated expression of SFRP4 in the regressing basal zone late in gestation and in both placental zones after dexamethasone-induced placental growth restriction is consistent with a role for SFRP4 in glucocorticoid-mediated inhibition of wnt signalling. Collectively, the data presented in this thesis show that glucocorticoid inhibition of fetal growth is mediated in large part via effects on the placenta, specifically through inhibition of signals that promote proliferation and vascularisation.

Orientador: Rinaldo Poncio Mendes / Resumo: A paracoccidioidomicose (PCM) é micose granulomatosa sistêmica causada por fungos termodimórficos do gênero Paracoccidioides. O presente estudo teve como objetivos avaliar a atividade da liriodenina, extraída de Annona macroprophyllata Donn. Sm, sobre isolados clínicos e cepas padrão de fungos do gênero Paracoccidioides e outras espécies que causam micoses sistêmicas e, através de um estudo-piloto realizado em modelo murino, avaliar a absorção da liriodenina e possíveis efeitos indesejáveis. A concentração inibitória mínima (CIM) e concentração fungicida mínima (CFM) da liriodenina foram determinadas pelo método de microdiluição. As alterações celulares causadas pela liriodenina em P. brasiliensis / cepa padrão Pb18 foram avaliadas pela microscopia eletrônica de transmissão (MET) e de varredura (MEV). Em estudo-piloto, quatro camundongos isogênicos albinos, da linhagem BALB/c, foram utilizados para avaliar a absorção e os efeitos indesejáveis da liriodenina. Os animais, sem infecção, foram divididos em dois grupos: grupo 1, com dois camundongos que receberam a dose de 0,75 mg.kg-1 e grupo 2, com dois camundongos que receberam a dose de 1,50 mg.kg-1, em única tomada. Após seis e 12 horas após a administração, os animais foram sacrificados e amostras de sangue foram coletadas para a determinação dos níveis séricos. Os intestinos foram coletados para exame histológico. O teste de sensibilidade in vitro revelou que a liriodenina possui atividade sobre parte dos fungos do gênero P... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Paracoccidioidomycosis (PCM) is systemic granulomatous mycosis caused by thermodymorphic fungi of the genus Paracoccidioides. The present study aimed to evaluate the activity of liriodenine, extracted from Annona macroprophyllata Donn. Sm on clinical isolates and standard strains of fungi of the genus Paracoccidioides and other species that cause systemic mycoses and, through a pilot study conducted in a murine model, to assess the absorption of liriodenine and possible undesirable effects. The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (CFM) of liriodenine were determined by the microdilution method. Cellular alterations caused by liriodenin in P. brasiliensis / Pb18 standard strain were evaluated by transmission electron microscopy (SEM) and scanning electron microscopy (SEM). In a pilot study, four albino isogenic mice of the BALB / c strain were used to assess the absorption and undesirable effects of liriodenine. The animals, without infection, were divided into two groups: group 1, with two mice receiving the dose of 0.75 mg.kg-1 and group 2, with two mice receiving the dose of 1.50 mg.kg- 1 , in single outlet. After six and 12 hours after administration, the animals were sacrificed and blood samples were collected for the determination of serum levels. The intestines were collected for histological examination. The in vitro sensitivity test revealed that liriodenine has activity on part of fungi of the genus Paracoccidioides, with MIC v... (Complete abstract click electronic access below) / Doutor

The word "cancer" has different meanings for different people. In general, it is synonymous with fatality, either imminent or in the forseeable future. How each person perceives and attributes meaning to this personal experience, varies according to idiosyncratic factors. These factors are constituted by each individual's unique internal make up and by external influences and it is the combination of the multiplicity of factors that bring about the personal attributions of meaning for each individual. The thesis examines the attributions of meaning of a sample of 42 women with breast cancer, through administration of a semi-structured interview and questionnaire, with follow up interviews. The theoretical concepts which are explored, examine the shift away from the traditional, Newtonian, linear-causal, neutral observer model (as in the traditional medical model), towards an ecosystemic, a-causal, contextual, holistic stance. Ecosystemic thinking is utilised in this research work, and this way of thinking is applied to the findings. In addition, a qualitative, descriptive approach is adopted, so that an in depth emphasis rather than a quantitative, empirical view of the patients in the sample, is undertaken. The applied questionaire focuses on the patient's experience of cancer diagnosis, with more specific reference to the side effects of the chemotherapy. The emphasis is towards the issue of anticipatory nausea and emesis and the possible use of hypnosis in relation to these effects. Each patient's attribution of meaning to these aspects forms the core of the thesis. The study discloses the wide variety of attributions of meaning held by different women in a similar predicament towards different aspects of that predicament. Concomitantly, the study highlights the limitations of the traditional, medical model which contribute to diminishing the personal understanding of each patient, and the impact of this on both treatment and outcome for each patient. / Psychology / D.Phil. (Psychology)

Made available in DSpace on 2015-07-22T20:50:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-28 / Introdução: Os estudos que contra-indicam o uso de um aparelho intra-oral (AIO) para tratamento da Síndrome da Apnéia Obstrutiva do Sono (SAOS) na presença de sinais e/ou sintomas da disfunção temporomandibular (DTM), ou que relatam o abandono ou suspensão do seu uso devido à dor causada pela DTM, não seguiram o mesmo critério de diagnóstico para a DTM. Desde que a qualidade de vida dos indivíduos com SAOS e DTM fica ainda mais comprometida devido à presença de ambas as síndromes, é importante um diagnóstico seguro e um tratamento eficaz para a DTM. Entre os tratamentos, os exercícios mandibulares são tidos como terapias de suporte (TS) para as DTM. Objetivo: Avaliar, em indivíduos com SAOS e DTM, a eficácia de uma terapia de suporte com exercícios mandibulares para a DTM, na redução da dor, na melhora da qualidade de vida, com o fim de alcançar o aumento da adesão ao tratamento com o AIO. Casuística e Métodos: Todos os pacientes foram avaliados no início, e após 120 dias de uso do AIO com: Questionário do sono de Fletcher e Lucket, Escala de Sonolência de Epworth, Inventário de qualidade de vida SF 36, polissonografia, diário de sono e de uso do AIO, avaliação clínica e radiográfica dos dentes, das estruturas ósseas e exame da ATM pelos critérios diagnósticos de DTM (RDC). Os pacientes foram aleatoriamente divididos em 2 grupos: terapia de suporte para DTM (TS) e terapia placebo (TP). Resultados: De 87 pacientes com diagnóstico de SAOS leve à moderada e encaminhados para uso de AIO, 45 tiveram diagnóstico confirmado pelo RDC de (DTM). Vinte e nove pacientes cumpriram os 120 dias de tratamento (15 pacientes no grupo da TS, e 14 no grupo da TP). Os pacientes do grupo TS mostraram melhora significativa nas queixas do sono, e melhora em maior número de domínios da qualidade de vida quando comparados com o grupo de TP. No decorrer do avanço do AIO foi observado um número significativamente maior de pacientes com dor persistente no grupo da TP em comparação com o grupo da TS. Houve redução da intensidade da dor no grupo de TS comparado ao grupo TP. Após o avanço do AIO, foi observada maior adesão ao uso do AIO no grupo da TS. Conclusão: A TS com exercícios mandibulares resultou em melhora significativa na qualidade de vida e na qualidade do sono nos pacientes com SAOS e DTM tratados com AIO, além de ter sido efetiva na redução da dor e no aumento na adesão ao tratamento com o AIO. / Introduction: The studies that contra-indicate the use of an oral appliance (OA) for the treatment of Obstructive Sleep Apnea Syndrome (OSA) in the presence of signs and / or symptoms of temporomandibular disorders (TMD), or that report abandonment or suspension of their use due to pain caused by TMD, did not follow the same diagnosis criteria for TMD. Since the quality of life of individuals with OSA and TMD is further compromised by the presence of both syndromes, it is essential a assure diagnosis and a effective treatment for TMD. Among the treatments, the jaw exercises are considered as a supportive therapy (ST) in TMD. Objective: To assess the effectiveness of mandibular exercises, with support therapy for TMD in subjects with OSA and TMD considering the in reduction of pain, improved of the quality of life, and the compliance to treatment with the OA. Patients and Methods: All patients were evaluated prior and to 120 days after the use of the OA by means Fletcher & Lucket sleep questionnaire, the Epworth Sleepiness Scale, the SF-36 Inventory of quality of life, polysomnography, sleep and daily usage OA, clinical and radiographic evaluation of teeth and bone structure, and exam to observed sings and/or symptoms for TMD by the RDC/TMD criteria. The patients were randomized in two groups: support therapy (ST) and placebo therapy (PT). Results: Forty-five out of the 87 patients who were diagnosed with mild to moderate OSA referred to the use of the OA had their diagnosis confirmed by the RDC/TMD. Twenty-nine of those patients completed the 120 days treatment (15 patients in the ST group and 14 in the PT group). Patients in the ST group showed a significant improvement in their sleep complaints and improvement in a higher number of life quality domains when compared to the group of PT. As advances were made in OA positioning a significantly higher number of patients with persistent pain was observed in the PT group, in comparison to the ST group. There was reduction of pain intensity in the ST group compared to PT group. After advancement of the OA, higher compliance to the use of OA was observed in the ST group than in the PT group. Conclusion: Support Therapy with mandibular exercises showed significant improvement in quality of life and quality of sleep in patients with OSA and TMD who were treated with OA, being also effective in reducing pain and the increase the compliance to the OA treatment. / TEDE / BV UNIFESP: Teses e dissertações