A toxicidade vestibular pode ser definida como danos que uma substância química causa sobre a estrutura e a função vestibular. Entre as drogas que podem causar a vestibulotoxicidade estão os agentes antineoplásicos como os derivados da platina. OBJETIVO: Identificar a frequência de ocorrência de alteração vestibular em pacientes oncológicos tratados com derivados da platina, os sinais e sintomas vestibulares nestes pacientes, e se a alteração vestibular pré-existente exacerba os sintomas eméticos durante a quimioterapia com derivados da platina. METODOLOGIA: Amostra foi composta por pacientes adultos com câncer que realizaram tratamento com drogas derivadas da platina. O protocolo para o monitoramento vestibular foi composto pelo questionário Dizziness Handicap Inventory (DHI) Brasileiro, Testes da Função Vestibular (manobra de Dix-Hallpike e vecto-eletronistagmografia) e pela descrição de sintomas eméticos e tontura durante a quimioterapia e avaliação vestibular. RESULTADOS: Quarenta e oito pacientes realizaram a avaliação vestibular pré-quimioterapia, sendo que 23 (48%) apresentaram avaliação vestibular dentro da normalidade. Dezesseis pacientes submeteram-se ao monitoramento vestibular com avaliação antes e após tratamento, sendo que após o tratamento dois pacientes (12,5%) apresentaram avaliação vestibular dentro da normalidade e 14 (87,5%) apresentaram algum tipo de alteração vestibular, evidenciada somente pela prova calórica. Nenhum paciente referiu queixas vestibulares ao DHI na avaliação pré-tratamento, assim como quase todos os pacientes, exceto um, na avaliação pós tratamento. Apenas um (6,3%) com avaliação vestibular alterada pós-tratamento apresentou grau leve no DHI. A dose de cisplatina entre os pacientes que mostraram piora do quadro vestibular variou entre 160 e 400 mg/m² e dois pacientes foram tratados com carboplatina com dose de 2306 mg/m² e 1801 mg/m². Não houve diferença de manifestação dos sintomas eméticos/tontura durante a avaliação vestibular ou após quimioterapia entre os pacientes com e sem alteração vestibular prévia. Entretanto, os pacientes que referiram sintomas eméticos durante os ciclos de quimioterapia foram aqueles que manifestaram maior desconforto na PC, independente da dose de quimioterapia ou da alteração vestibular. CONCLUSÃO: Alteração vestibular ou a modificação do quadro vestibular ocorreu em 50% dos pacientes com câncer tratados com derivados da platina. O sinal mais frequente de alteração nos testes vestibulares foi a hiporreflexia à prova calórica, sem sintomas vestibulares relatados na vida diária destes pacientes. As alterações vestibulares pré-existentes não exacerbaram os sintomas eméticos durante a quimioterapia / Vestibular toxicity may be defined as a damage that chemical substances cause on the structure and the function of the vestibular system. Among the drugs that may cause vestibulotoxicity there are antineoplastic agents, such as those derived from platinum. OBJECTIVE: To identify the frequency of occurrence of vestibular alterations in cancer patients treated with platinum-based chemotherapy; the vestibular signs and symptoms in these patients, and whether the pre-existing vestibular alterations exacerbate emetic symptoms during chemotherapy with platinum-based drugs. METHODS: The sample was composed of adults who were treated of the cancer with platinum-based chemotherapy. The vestibular monitoring protocol involved the Brazilian Dizziness Handicap Inventory (DHI), Vestibular Function Tests (positioning nystagmus with Dix-Hallpike maneuver and vectoelectronystagmography) and the description of emetic symptoms and dizziness during chemotherapy and vestibular evaluation. RESULTS: Forty-eight subjects performed the pre-treatment vestibular evaluation, and 23 of them (48%) presented vestibular assessment within the normal range. Sixteen patients underwent the vestibular monitoring evaluation before and after treatment: after the treatment two patients (12.5%) showed normal vestibular assessment while 14 (87.5%) showed a vestibular disorder, basically in the caloric tests, but the alteration was considered a modification in their baseline stage in eight patients (50%). None of the patients reported complaints in the pre-treatment assessment, with a DHI scores within the normal range, as well as all the patients, except one, in the post treatment assessment (81,3%). Only one patient (6.3%) had a score above normal (mild complaint) with altered vestibular evaluation in the post treatment assessment. The dose of cisplatin among these patients who had a modification in the vestibular function varied from 160 to 400 mg/m² and two patients were treated with carboplatin with do of 2306 mg/m² and 1801 mg/m². There was no difference of emetic symptoms/dizziness during the chemotherapy or the vestibular evaluation among patients with or without previous vestibular alterations. However, patients who reported more emetic symptoms during chemotherapy cycles were those who showed greater discomfort in the caloric test, regardless of the dosage of chemotherapy or vestibular alteration. CONCLUSION: Vestibular alterations or modification of the baseline alteration were found in 50% of cancer patients treated with platinum-based chemotherapy. The most common sign of vestibular alteration in the vestibular tests was the hiporeflexia at the caloric test with no reported symptoms in their daily life. The preexisting vestibular alterations did not exacerbate emetic symptoms during chemotherapy

O presente estudo avaliou a eficácia do equipamento de biofeedback Vertiguard®), que utiliza a informação vibrotátil como substituto sensorial (SS) de apoio ao sistema vestibular. Foram selecionados 13 pacientes com comprometimento severo do equilíbrio corporal e não obtiveram resultado satisfatório à terapia de reabilitação vestibular convencional. Os sujeitos foram randomizados entre dois grupos controle (GC), que utilizou o estímulo vibratório e estudo (GE), que treinou com o equipamento desligado. Os indivíduos foram treinados com o equipamento durante dez dias e foram orientados a corrigir o alinhamento corporal sempre que recebessem um estímulo vibrotátil de um cinto com quatro vibradores dispostos em ângulo de 90°entre eles, que informava o desvio corporal para aquele lado e o risco de queda. Para avaliação pré e pós tratamento foi utilizada o protocolo Teste de Integração Sensorial (TIS) da Posturografia Dinâmica Computadorizada (PDC) e duas escalas de auto percepção do equilíbrio: ABC (Activities-specific Balance Confidence) e DHI (Dizziness Handicap Inventory). O GE apresentou melhora estatisticamente significante em C5 (p=0,007) e C6 (p= 0,012) após treinamento. Na escala ABC houve diferença significante entre o início e o final do tratamento apenas no GE (p=0,04). No questionário DHI ocorreu diferença significante no aspecto físico nos GC e GE, e no aspecto funcional (p=0,0427) apenas no grupo GE. Os resultados observados demonstram que o estímulo de substituição sensorial vibratório oferecido pelo sistema Vertiguard®, propicia a melhor integração das redes neurais envolvidas na manutenção da postura, melhorando as estratégias utilizadas na recuperação do equilíbrio corporal / This study evaluated the effectiveness of biofeedback equipment Vertiguard® that uses vibrotactile information as sensory substitution (SS) of the vestibular system. We selected thirteen patients with severe impairment of balance who did not obtain enough improvement from conventional vestibular rehabilitation. A randomization list was used to distribute the patients in Control Group (CG), who received the vibrotactile stimulus and Study Group (SG), who trained without any stimulus. During ten days of training, the patients in both groups used the equipment attached to the waist. They were instructed to correct body alignment when vibrotactile stimulus received from one of the four vibrators arranged at an angle of 90° signaling the risk of f alling. The results of the treatment were evaluated by the protocol sensory organization test (SOT) of the computerized dynamic posturography (CDP), ABC scale (Activities-specific Balance Confidence) and DHI (Dizziness Handicap Inventory). After treatment the SG showed a statistically significant improvement in C5 (p = 0.007) and C6 (p = 0.012). In the ABC scale there was significant difference between the beginning and end of treatment only in the SG (p = 0.04). The Dizziness Handicap Inventory questionnaire (DHI) showed in the after training a significant difference in functional in both CG and SG, and in physical aspects (p = 0.0427) only in SG. The present findings show that sensory substitution using the vibrotactile stimulus of Vertiguard (R) system promotes the improvement of neural networks involved in maintaining posture, improving the strategies used in the recovery of body balance

Purpose: The purpose of this study was to evaluate the effectiveness of triaging patients with motion-provoked dizziness into a benign paroxysmal positional vertigo (BPPV) clinic. Method: A retrospective chart review was performed of veterans who were tested and treated for BPPV in a triaged BPPV clinic and veterans who were tested and treated for BPPV in a traditional vestibular clinic. Results: The BPPV triage clinic had a hit rate of 39%. On average, the triaged BPPV clinic reduced patient wait times by 23 days relative to the wait times for the traditional vestibular clinic while also reducing patient costs. Conclusion: Triaging patients with BPPV is one method to improve access to evaluation and treatment and a mechanism for the effective use of clinic time and resources.

O presente trabalho consiste na formulação, no desenvolvimento e exame da hipótese de que o conto de Machado de Assis produz um “efeito de vertigem”, desestabilização inquietante na leitura, corte com uma pretensa linearidade, e que, sustentamos, encontra-se ligado à estrutura da narrativa. O “efeito de vertigem” apresenta-se em contos que, podemos dizer, são representativos da força do estilo de Machado, por uma razão não qualquer – funcionam como “operadores de passagem”: a vertigem joga com continuidade/descontinuidade, fascínio/ perturbação, as simultaneidades, o enigma na lida com os limites, com o real, na ficção e na vida. Encontramos nos contos, na proximidade e em relação ao efeito de vertigem, o trato ficcional que põe em questão as descontinuidades fundamentais, interrogantes da condição humana – o sexo e a morte; as mesmas que configuram as perguntas que se colocaram para Freud, em toda sua obra, pelo viés da clínica psicanalítica. A verdade subjetiva tem íntima relação com a ficção, portanto escolhemos seguir examinando a proximidade da forma da narrativa machadiana com sua vertigem, do trabalho de Freud com as “passagens” na relação ao inconsciente (aqui ganha destaque a relação entre o chiste, a obliqüidade e a ironia) e da elaboração de Lacan com relação à estrutura do sujeito, com a topologia da banda de Moebius. Neste ponto, as teses de Ricardo Piglia sobre a forma do conto integram o exame sobre a estrutura, assim como a consideração do termo das “passagens” sobre as quais tanto trabalhou Walter Benjamin. A conclusão leva à consideração do “efeito de vertigem” como um princípio de composição (não chave de leitura) do conto, presente em contos que podemos situar como representativos da obra de Machado de Assis. Passagens paradoxais, lugares de trânsito dos enigmas que são transportados do imaginário social para a grande ficção, recorte de algo singular, mas que diz também de uma dimensão do coletivo de um contexto e de um tempo, via o “relâmpago” da forma conto, ao modo machadiano. / The present work consists in formulating, developing and examining the hypothesis in which Machado de Assis’ tale produces a “vertigo effect”, disturbing destabilization during the process of reading, cut with an intended linearity, and that, we sustain, is connected to the narrative structure. The “vertigo effect” is present in tales that, we can say, represent the strength of Machado’s style, not for any reason – they work as “passage operators”: the vertigo plays with the continuity/discontinuity, fascination/perturbation, simultaneities, the enigma in dealing with the limits as the reality, in fiction and in life. We find in the tales, in the proximity and in relation to vertigo effect, the fictional trait that interrogates the fundamental discontinuities, questions of the human condition – sex and death; the same that configured the inquiries which came to Freud throughout his production, through the psychoanalytical clinic. The subjective truth has an intimate relation with fiction, so that we chose to keep on following the proximity of the Machado’s narrative form with its vertigo, of Freud’s work with the “passages” in relation tothe unconsciousness (point in which the relation among the joke, obliquity and irony is highlighted) and of the elaboration by Lacan on the structure of the subject, with the topology of the “Moebius band”. At this point, the assessment of Ricardo Piglia on the form of the tale integrates the exam about the structure as well as the consideration of the term “passages”, so much developed by Walter Benjamin. The conclusion takes into consideration the “vertigo effect” as a composition principle (not as reading key) of the tale, present in tales that we can situate as representative of Machado de Assis’ work. Paradoxal passages, transitory places of the enigmas that are transported from the social imaginary to the great fiction, cut of something unique, but that also brings a dimension of the collectivity of a context and of a time, through the “bolt” of the form tale, in Machado’s way.

O presente trabalho consiste na formulação, no desenvolvimento e exame da hipótese de que o conto de Machado de Assis produz um “efeito de vertigem”, desestabilização inquietante na leitura, corte com uma pretensa linearidade, e que, sustentamos, encontra-se ligado à estrutura da narrativa. O “efeito de vertigem” apresenta-se em contos que, podemos dizer, são representativos da força do estilo de Machado, por uma razão não qualquer – funcionam como “operadores de passagem”: a vertigem joga com continuidade/descontinuidade, fascínio/ perturbação, as simultaneidades, o enigma na lida com os limites, com o real, na ficção e na vida. Encontramos nos contos, na proximidade e em relação ao efeito de vertigem, o trato ficcional que põe em questão as descontinuidades fundamentais, interrogantes da condição humana – o sexo e a morte; as mesmas que configuram as perguntas que se colocaram para Freud, em toda sua obra, pelo viés da clínica psicanalítica. A verdade subjetiva tem íntima relação com a ficção, portanto escolhemos seguir examinando a proximidade da forma da narrativa machadiana com sua vertigem, do trabalho de Freud com as “passagens” na relação ao inconsciente (aqui ganha destaque a relação entre o chiste, a obliqüidade e a ironia) e da elaboração de Lacan com relação à estrutura do sujeito, com a topologia da banda de Moebius. Neste ponto, as teses de Ricardo Piglia sobre a forma do conto integram o exame sobre a estrutura, assim como a consideração do termo das “passagens” sobre as quais tanto trabalhou Walter Benjamin. A conclusão leva à consideração do “efeito de vertigem” como um princípio de composição (não chave de leitura) do conto, presente em contos que podemos situar como representativos da obra de Machado de Assis. Passagens paradoxais, lugares de trânsito dos enigmas que são transportados do imaginário social para a grande ficção, recorte de algo singular, mas que diz também de uma dimensão do coletivo de um contexto e de um tempo, via o “relâmpago” da forma conto, ao modo machadiano. / The present work consists in formulating, developing and examining the hypothesis in which Machado de Assis’ tale produces a “vertigo effect”, disturbing destabilization during the process of reading, cut with an intended linearity, and that, we sustain, is connected to the narrative structure. The “vertigo effect” is present in tales that, we can say, represent the strength of Machado’s style, not for any reason – they work as “passage operators”: the vertigo plays with the continuity/discontinuity, fascination/perturbation, simultaneities, the enigma in dealing with the limits as the reality, in fiction and in life. We find in the tales, in the proximity and in relation to vertigo effect, the fictional trait that interrogates the fundamental discontinuities, questions of the human condition – sex and death; the same that configured the inquiries which came to Freud throughout his production, through the psychoanalytical clinic. The subjective truth has an intimate relation with fiction, so that we chose to keep on following the proximity of the Machado’s narrative form with its vertigo, of Freud’s work with the “passages” in relation tothe unconsciousness (point in which the relation among the joke, obliquity and irony is highlighted) and of the elaboration by Lacan on the structure of the subject, with the topology of the “Moebius band”. At this point, the assessment of Ricardo Piglia on the form of the tale integrates the exam about the structure as well as the consideration of the term “passages”, so much developed by Walter Benjamin. The conclusion takes into consideration the “vertigo effect” as a composition principle (not as reading key) of the tale, present in tales that we can situate as representative of Machado de Assis’ work. Paradoxal passages, transitory places of the enigmas that are transported from the social imaginary to the great fiction, cut of something unique, but that also brings a dimension of the collectivity of a context and of a time, through the “bolt” of the form tale, in Machado’s way.

O presente trabalho consiste na formulação, no desenvolvimento e exame da hipótese de que o conto de Machado de Assis produz um “efeito de vertigem”, desestabilização inquietante na leitura, corte com uma pretensa linearidade, e que, sustentamos, encontra-se ligado à estrutura da narrativa. O “efeito de vertigem” apresenta-se em contos que, podemos dizer, são representativos da força do estilo de Machado, por uma razão não qualquer – funcionam como “operadores de passagem”: a vertigem joga com continuidade/descontinuidade, fascínio/ perturbação, as simultaneidades, o enigma na lida com os limites, com o real, na ficção e na vida. Encontramos nos contos, na proximidade e em relação ao efeito de vertigem, o trato ficcional que põe em questão as descontinuidades fundamentais, interrogantes da condição humana – o sexo e a morte; as mesmas que configuram as perguntas que se colocaram para Freud, em toda sua obra, pelo viés da clínica psicanalítica. A verdade subjetiva tem íntima relação com a ficção, portanto escolhemos seguir examinando a proximidade da forma da narrativa machadiana com sua vertigem, do trabalho de Freud com as “passagens” na relação ao inconsciente (aqui ganha destaque a relação entre o chiste, a obliqüidade e a ironia) e da elaboração de Lacan com relação à estrutura do sujeito, com a topologia da banda de Moebius. Neste ponto, as teses de Ricardo Piglia sobre a forma do conto integram o exame sobre a estrutura, assim como a consideração do termo das “passagens” sobre as quais tanto trabalhou Walter Benjamin. A conclusão leva à consideração do “efeito de vertigem” como um princípio de composição (não chave de leitura) do conto, presente em contos que podemos situar como representativos da obra de Machado de Assis. Passagens paradoxais, lugares de trânsito dos enigmas que são transportados do imaginário social para a grande ficção, recorte de algo singular, mas que diz também de uma dimensão do coletivo de um contexto e de um tempo, via o “relâmpago” da forma conto, ao modo machadiano. / The present work consists in formulating, developing and examining the hypothesis in which Machado de Assis’ tale produces a “vertigo effect”, disturbing destabilization during the process of reading, cut with an intended linearity, and that, we sustain, is connected to the narrative structure. The “vertigo effect” is present in tales that, we can say, represent the strength of Machado’s style, not for any reason – they work as “passage operators”: the vertigo plays with the continuity/discontinuity, fascination/perturbation, simultaneities, the enigma in dealing with the limits as the reality, in fiction and in life. We find in the tales, in the proximity and in relation to vertigo effect, the fictional trait that interrogates the fundamental discontinuities, questions of the human condition – sex and death; the same that configured the inquiries which came to Freud throughout his production, through the psychoanalytical clinic. The subjective truth has an intimate relation with fiction, so that we chose to keep on following the proximity of the Machado’s narrative form with its vertigo, of Freud’s work with the “passages” in relation tothe unconsciousness (point in which the relation among the joke, obliquity and irony is highlighted) and of the elaboration by Lacan on the structure of the subject, with the topology of the “Moebius band”. At this point, the assessment of Ricardo Piglia on the form of the tale integrates the exam about the structure as well as the consideration of the term “passages”, so much developed by Walter Benjamin. The conclusion takes into consideration the “vertigo effect” as a composition principle (not as reading key) of the tale, present in tales that we can situate as representative of Machado de Assis’ work. Paradoxal passages, transitory places of the enigmas that are transported from the social imaginary to the great fiction, cut of something unique, but that also brings a dimension of the collectivity of a context and of a time, through the “bolt” of the form tale, in Machado’s way.

O presente estudo avaliou a eficácia do equipamento de biofeedback Vertiguard®), que utiliza a informação vibrotátil como substituto sensorial (SS) de apoio ao sistema vestibular. Foram selecionados 13 pacientes com comprometimento severo do equilíbrio corporal e não obtiveram resultado satisfatório à terapia de reabilitação vestibular convencional. Os sujeitos foram randomizados entre dois grupos controle (GC), que utilizou o estímulo vibratório e estudo (GE), que treinou com o equipamento desligado. Os indivíduos foram treinados com o equipamento durante dez dias e foram orientados a corrigir o alinhamento corporal sempre que recebessem um estímulo vibrotátil de um cinto com quatro vibradores dispostos em ângulo de 90°entre eles, que informava o desvio corporal para aquele lado e o risco de queda. Para avaliação pré e pós tratamento foi utilizada o protocolo Teste de Integração Sensorial (TIS) da Posturografia Dinâmica Computadorizada (PDC) e duas escalas de auto percepção do equilíbrio: ABC (Activities-specific Balance Confidence) e DHI (Dizziness Handicap Inventory). O GE apresentou melhora estatisticamente significante em C5 (p=0,007) e C6 (p= 0,012) após treinamento. Na escala ABC houve diferença significante entre o início e o final do tratamento apenas no GE (p=0,04). No questionário DHI ocorreu diferença significante no aspecto físico nos GC e GE, e no aspecto funcional (p=0,0427) apenas no grupo GE. Os resultados observados demonstram que o estímulo de substituição sensorial vibratório oferecido pelo sistema Vertiguard®, propicia a melhor integração das redes neurais envolvidas na manutenção da postura, melhorando as estratégias utilizadas na recuperação do equilíbrio corporal / This study evaluated the effectiveness of biofeedback equipment Vertiguard® that uses vibrotactile information as sensory substitution (SS) of the vestibular system. We selected thirteen patients with severe impairment of balance who did not obtain enough improvement from conventional vestibular rehabilitation. A randomization list was used to distribute the patients in Control Group (CG), who received the vibrotactile stimulus and Study Group (SG), who trained without any stimulus. During ten days of training, the patients in both groups used the equipment attached to the waist. They were instructed to correct body alignment when vibrotactile stimulus received from one of the four vibrators arranged at an angle of 90° signaling the risk of f alling. The results of the treatment were evaluated by the protocol sensory organization test (SOT) of the computerized dynamic posturography (CDP), ABC scale (Activities-specific Balance Confidence) and DHI (Dizziness Handicap Inventory). After treatment the SG showed a statistically significant improvement in C5 (p = 0.007) and C6 (p = 0.012). In the ABC scale there was significant difference between the beginning and end of treatment only in the SG (p = 0.04). The Dizziness Handicap Inventory questionnaire (DHI) showed in the after training a significant difference in functional in both CG and SG, and in physical aspects (p = 0.0427) only in SG. The present findings show that sensory substitution using the vibrotactile stimulus of Vertiguard (R) system promotes the improvement of neural networks involved in maintaining posture, improving the strategies used in the recovery of body balance

The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) is a worldwide pandemic that affects the lives of millions of people across all ages. Its devastating effects are far-reaching and affect all aspects of an individual’s daily life. HIV/AIDS is responsible for widespread clinical manifestations involving the head and neck. Disorders of the auditory and vestibular systems are often associated with HIV/AIDS, however the extent and nature of these vestibular manifestations is still largely unknown. The main aim of this research study was to investigate vestibular functioning and pathology in adults with HIV/AIDS. This was achieved through three main research steps: a systematic literature review of the body of peer-reviewed literature on HIV/AIDS related vestibular manifestations and pathology, a description and comparison of vestibular involvement in adults with and without HIV/AIDS and an investigation to determine if HIV/AIDS influence the vestibulocollic reflex (VCR) pathways. For the first study a systematic literature review related to vestibular findings in individuals with HIV infection and AIDS was conducted. A varied search strategy was used across several electronic databases to identify relevant peer-reviewed reports in English. Several databases (Medline, Scopus and PubMed) and search strategies were employed. Where abstracts were not available, the full paper was reviewed, and excluded if not directly relevant to the study’s aims. Articles were reviewed for any HIV/AIDS associated vestibular symptoms and pathologies reported. For the second and third study, a cross-sectional, quasi-experimental comparative research design was employed. A convenience sampling method was used to recruit subjects. The sample consisted of 53 adults (29 male, 24 female, aged 23-49 years, mean = 38.5, SD = 4.4) infected with HIV, compared to a control group of 38 HIV negative adults (18 male, 20 female, aged 20-49 years, mean = 36.9, SD = 8.2). A structured interview probed the subjective perception of vestibular complaints and symptoms. Medical records were reviewed for cluster of differentiation 4+ (CD4+) cell counts and the use of antiretroviral (ARV) medication. An otologic assessment and a comprehensive vestibular assessment (bedside assessments, vestibular evoked myogenic potentials, ocular motor and positional tests and bithermal caloric irrigation) were conducted on all subjects. The systematic literature review identified 442 records, reduced to 210 after excluding duplicates, reviews, editorials, notes, letters and short surveys. These were reviewed for relevance to the scope of the study. There were only 13 reports investigating vestibular functioning and pathology in individuals affected by HIV/AIDS. This condition can affect both the peripheral and central vestibular system, irrespective of age and viral disease stage. Post-mortem studies suggest direct involvement of the entire vestibular system, while opportunistic infections such as oto- and neurosyphilis and encephalitis cause secondary vestibular dysfunction resulting in vertigo, dizziness and imbalance. The second study showed an overall vestibular involvement in 79.2% of subjects with HIV in all categories of disease progression, compared to 18.4% in those without HIV. Vestibular involvement increased from 18.9% in the Centers for Disease Control and Prevention (CDC) category 1 to 30.2% in category 2. Vestibular involvement was 30.1% in category 3. There was vestibular involvement in 35.9% of symptomatic HIV positive subjects and 41.5% in asymptomatic HIV positive subjects. Individuals with HIV were 16.6 times more likely to develop vestibular involvement during their lifetime, than among individuals without this disease. Vestibular involvement may occur despite being asymptomatic. The third study showed that abnormal cervical vestibular evoked myogenic potentials and caloric results were significantly higher in the HIV positive group (p=.001), with an odds ratio of 10.2. Vestibulocollic reflex and vestibulo-ocular reflex involvement increased with progression of the disease. There were more abnormal test results in subjects using ARV therapies (66.7%) compared to those not using ARV therapies (63.6%), but this difference was not statistically significant. Vestibular involvement was significantly more common in subjects with HIV than among those without this disease. This disease and its associated risk profile include direct effects of the virus on the vestibular system as demonstrated by postmortem studies. Opportunistic infections may compromise the functioning of the sensory and neural structures of hearing and the vestibular system indirectly, causing vertigo, dizziness or disequilibrium. Ototoxicity may also be related to vestibular dysfunction, due to the ototoxic nature of certain ARV medications. HIV/AIDS influence not only the vestibulo-ocular reflex, but also the vestibulocollic reflex pathways. Primary health care providers could screen HIV positive patients to ascertain if there are symptoms of vestibular involvement. If there are any, then they may consider further vestibular assessments and subsequent vestibular rehabilitation therapy, to minimize functional limitations of quality of life. / Thesis (DPhil)--University of Pretoria, 2014. / lk2014 / Speech-Language Pathology and Audiology / DPhil / Unrestricted

Hintergrund: Schwindel ist ein häufig vorgetragenes Symptom beim Hausarzt. Seine erhöhte Vergesellschaftung mit Ängstlichkeit und Depressivität ist aber bisher zu wenig untersucht worden, ebenso wenig ist dieser Zusammenhang Gegenstand der hausärztlichen Behandlung von Schwindelpatienten. Zielstellung: Kommen unbekannte psychische Hintergründe in Kombination mit Schwindel im hausärztlichen Patientengut häufiger vor als ohne Schwindel? Ergeben sich daraus als Konsequenz unterschiedliche Versorgungsformen durch den Hausarzt? Wie verhält es sich mit deren subjektiven Gesundheitszustand, dem Erfolg der hausärztlichen Behandlung, dem ihnen entgegengebrachten Verständnis und der Häufigkeit der Arztbesuche der Betroffenen? Studiendesign: Prospektive Multicenterstudie in der Allgemeinpraxis Untersuchungsregion: Zehn Hausarztpraxen in Halle a.d. Saale und Nordsachsen/ Leipzig im städtischen und ländlichen Einzugsbereich, welche von Fachärzten für Allgemeinmedizin geführt wurden. Methodik: Die Studie untersuchte insgesamt 590 zufällig am Untersuchungstag eintreffende Patienten in jeweils einer von insgesamt zehn Hausarztpraxen. Die Ausprägung von Schwindelbeschwerden und eventuell vorhandene Merkmale von Ängstlichkeit und Depressivität beim jeweiligen Patienten wurden mit Elementen des Gießener Beschwerdebogens 24 und der Hospital Anxiety and Depression Scale (deutsche Version) untersucht. Ergebnisse: Die Patienten wurden in eine Gruppe mit relevanten (29,7%, n=175) und in eine Gruppe ohne relevante Schwindelbeschwerden (70,3%, n=408) eingeteilt (Cut off >=8 nach GBB 24). Die Gruppe mit relevantem Schwindel wies häufiger Merkmale für Ängstlichkeit (p<0,001) und Depressivität (p<0,001) in allen Altersgruppen auf, zeigte sich unzufriedener mit ihrem Behandlungserfolg (p=0,004), schätzte ihren aktuellen Gesundheitszustand schlechter ein (p<0,001) und konsultierte ihren Hausarzt in den letzten zwölf Monaten häufiger (p=0,020). Sie stellten sich nach ICPC-2 häufiger wegen neurologischer (p<0,001), psychologischer (p=0,026) und unspezifischer Beschwerden (p<0,001) vor. Sie erhielten mehr Diagnosen aus den ICD-10-Kapitel V (Psychische und Verhaltensstörungen) (p=0,030). Diese Patienten waren nach HADS-D auch häufiger psychisch auffällig (p<0,001). Relevanter Schwindel kam bei Frauen aller Altersgruppen häufiger vor als bei Männern (p<0,001). Dennoch ergaben sich keine Behandlungsunterschiede durch die Hausärzte zwischen beiden Gruppen (p=0,101 bis 0,930 je nach ärztlicher Maßnahme). Schlussfolgerung: Schwindelpatienten weisen häufger Ängstlichkeit und Depressivität auf, welche den Schwindel unterhalten. Dieser Zusammenhang sollte in der Sprechstunde bedacht werden. Die psychischen Hintergründe sollten vom Hausarzt aufgedeckt und behandelt werden. Dadurch könnte der Schwindel und damit der subjektive Gesundheitszustand der betroffenen Patienten verbessert und die Inanspruchnahme des Gesundheitswesens verringert werden.

Abstract Uppsats:  I denna uppsats analyseras kvinnlig ilska genom ett feministiskt perspektiv, med fokus på hur den porträtteras och tolkas i filmen Mean Girls, specifikt genom karaktären Regina George. Genom att tillämpa teorier om stereotyper, genus och postfeminism diskuteras olika tolkningar av Reginas ilska. Där betonas Reginas styrka och självständighet, medan andra ser hennes ilska som svag och okvinnlig. Uppsatsen utforskar även hur dessa tolkningar kan påverkas av samhälleliga normer och hur dessa förändras över tid, med en särskild reflektion över postfeministiska perspektiv. Genom att kontextualisera och studera stereotyper kring kvinnlig ilska uppmuntrar uppsatsen en diskussion kring etiska och samhälleliga aspekter såsom jämställdhet. Genom att integrera dessa perspektiv bidrar uppsatsen till en mer omfattande förståelse av kvinnlig ilska och dess relevans för samhälleliga frågor och den populärkultur vi lever i idag. Abstract Media Produktion:  Jag vill återintroducera filmklassiker till den nya generationens ciniaster. Dagens filmsamhälle är trångt i och med den mängd filmer som produceras dagligen. Detta kan i sin tur leda till att de filmer som startade det hela lätt glöms bort i smeten. Filmstaden  har därför valt att införa något de valt att kalla för “klassiker veckan”. En vecka i månaden väljer filmstaden ut en känd regissör från förr och visar denna personens filmer under veckans gång. Första regissören som valts är Alfred Hitchcock och hans två filmer Psycho och Vertigo.  Jag har fått i uppgift att skapa rörliga teasers och affischer för denna klassiska filmvecka i marknadsföringssyfte.