Thèses sur le sujet « Female Genitalia Diseases »
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Sartain, Hallie. « ChAT Expression in Chlamydia muridarum-infected Female Murine Genital Tract ». Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/honors/391.
Texte intégralMontoya, Vincent Keith. « Metagenomic analyses of two female genital tract diseases : bacterial vaginosis and ovarian cancer ». Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44333.
Texte intégralJohn, Grace Chiramukuthu. « Genital shedding and intrapartum transmission of HIV-1 / ». Thesis, Connect to this title online ; UW restricted, 2000. http://hdl.handle.net/1773/10956.
Texte intégralColeman, Nicholas. « The local immune response to human papillomavirus-related disease in the female genital tract ». Thesis, University of Cambridge, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.319959.
Texte intégralManente, Fernanda Dalphorno 1980. « Análise prospectiva do uso do mini sling - ophira 'MARCA REGISTRADA' para o tratamento da incontinência urinária de esforço feminina ». [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312263.
Texte intégralDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-18T22:47:40Z (GMT). No. of bitstreams: 1 Manente_FernandaDalphorno_M.pdf: 1640371 bytes, checksum: bb7045d453650447e32f75b7c7322b55 (MD5) Previous issue date: 2011
Resumo: Introdução: Os slings sintéticos marcaram a transição do tratamento invasivo para o tratamento minimamente invasivo da incontinência urinária de esforço feminina. Técnicas igualmente eficazes, porém com menores riscos de complicações têm sido pesquisadas. Os mini-slings, utilizando incisão única e de acesso exclusivamente vaginal podem representar uma alternativa à técnica de sling tradicional. Objetivo: Avaliar a eficácia do mini sling Ophira para o tratamento da incontinência urinária de esforço feminina. Material e Método: Foram avaliadas 49 mulheres que compareceram ao Ambulatório de Uroginecologia do HC da UNICAMP no período de abril de 2008 a maio de 2009 com queixa clínica de incontinência urinária de esforço. Todas as pacientes foram submetidas a Estudo Urodinâmico pré-operatório e avaliadas através de história clínica, exame físico, urina I e urocultura, teste de esforço, Pad test de uma hora e aplicação do questionário de qualidade de vida UDI-6. A colocação de mini sling Ophira foi realizada sob anestesia local em regime ambulatorial com alta após micção espontânea. As avaliações subsequentes foram realizadas após seis dias e um, três, seis e 12 meses após o procedimento, compreendendo exame físico, Pad test de uma hora e aplicação do UDI-6. A cura objetiva foi avaliada através do Pad test e do teste de esforço. A cura subjetiva foi avaliada pela queixa clínica e pelo questionário de qualidade de vida. Resultados: A análise da percepção subjetiva dos resultados demonstrou que, após 12 meses de seguimento, 37 pacientes (76%) referiram cura da IUE e sete (14%) melhora. O escore do questionário UDI-6, inicialmente com média de 41,29, caiu para 7,24 após 12 meses de seguimento. O Pad test de uma hora apresentou queda de 6,2g no préoperatório para 1g após o término do acompanhamento. Apenas seis pacientes apresentavam teste de esforço positivo no seguimento de 12 meses. Não houve complicações intra-operatórias. Apenas um caso de dor pós-operatória foi observado. Obteve-se taxa de extrusão do sling de 12,2%. Conclusão: O mini sling Ophira representa uma alternativa cirúrgica segura e eficaz para o tratamento da incontinência urinária de esforço feminina, no período de tempo avaliado
Abstract: Introduction: The synthetic slings marked the transition from invasive treatment to minimally invasive treatment of stress urinary incontinence. Techniques equally effective but with fewer risks of complications have been proposed. The minislings, with single incision and accessing exclusively the vaginal route represents an alternative to tradicional sling technique. Objective: To evaluate the efficacy of mini sling Ophira for the treatment of stress urinary incontinence in women. Methods: We evaluated 49 women attending the outpatient clinic of Urogynecology at the HC/UNICAMP from April 2008 to May 2009 with clinical complaints of stress urinary incontinence. All patients were initially submitted to urodynamic investigation, clinical and physical evaluation, urine analysis, stress test, 1-hour pad test and UDI- 6 Quality of life questionnaire. Mini sling Ophira was placed under local anesthesia and patients were dismissed after spontaneous voiding. Evaluation was undertaken 6 days after surgery and 1, 3, 6 and 12 months follow-up. Objective cure was assessed by Pad test and stress test. Subjective cure was assessed by QoL questionnaire. Results: Subjective analysis demonstrated that, after 12 months, 37 (76%) of patients referred themselves as cured and 7 (14%) as improved. UDI score significantly dropped from 41.29 to 7.24 and 1 hour Pad-test significantly decreased from 6.2 g to 1.0 g. Only 6 patients had persistent positive stress test. No intra operative complications occurred and only one patient complained of pain. Mesh erosion rate was 12.2%. Conclusion: Mini sling Ophira represents a safe and effective alternative to female stress urinary incontinence treatment, should the results proved to be long lasting
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências
Masson, Lindi. « The impact of sexually transmitted infections and inflammation in the female genital tract and blood on susceptibility to HIV-1 infection and disease progression ». Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/18609.
Texte intégralPires, Cristhiane Valério Garabello. « Prevalência de infecções genitais em mulheres com deficiência física por lesão medular ». Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-27012016-101516/.
Texte intégralBesides their physical disability, decreased or absent genitourinary sensitivity has a huge impact in women with spinal cord injury (SCI). Due to the absence of functional mobility and the architectonic barriers these women frequently do not have access to adequate gynecological care. Since about 80% of spinal cord injuries affect men, studies have rarely focused on the needs of women with SCI. Objective: To evaluate the prevalence of non-viral genital infections in women with SCI compared to mobile women. Methods: Fifty two women with SCI (study group) and 57 mobile women (control group) were evaluated in a case-control study. All answered a structured questionnaire and were submitted to the following microbiological tests: fresh examination of vaginal secretions for Trichomonas vaginalis and yeasts, Gram stain, general culture (agar-blood medium), yeast culture (Sabouraud medium) and endocervical sampling for Chlamydia trachomatis and Neisseria gonorrhorae (polymerase chain reaction) and Mycoplasmas sp. (U9, A7 medium). Results: A higher percentage of women with SCI had Candida sp detected by direct mycological examination than did women in the control group (p= 0.017). However there were no significant differences between the two groups in the frequency of yeast-positive cultures. The study group had a higher isolation frequency from the vagina of Escherichia coli (p= 0.002) and Corynebacterium sp (p= 0.023) and a lower frequency of Lactobacillus sp (p < 0.001). In both groups, there were no cases positive for T. vaginalis, C. trachomatis or N. gonorrhoeae. The evaluation of Nugent score for bacterial vaginosis showed a higher frequency of intermediate flora (Nugent score 4-7) in the study group (p= 0.039). Related to Mycoplasma sp isolation, the results were similar in both groups. Conclusion: The lower frequency of Lactobacillus sp isolation and the higher frequency of Corynebacterium sp and Escherichia coli isolation from the vagina in women with SCI, and the higher frequence of intermediate Nugent score, strongly suggests a disequilibrium of the vaginal microbiota away from a Lactobacillus sp dominated flora in these women. Since lactobacilli are essential for maintaining vaginal health and inhibiting growth of other bacteria, their relative absence in women with SCI may influence the occurrence of urogenital tract infections in these women. The higher frequency of yeast detection by microscopy in women with SCI suggests that these women may harbor a higher vaginal yeast concentration than do other women
Falk, Lars. « Urethritis and cervicitis with special reference to Chlamydia trachomatis and Mycoplasma genitalium : diagnostic and epidemiological aspects / ». Linköping : Univ, 2004. http://www.bibl.liu.se/liupubl/disp/disp2004/med858s.pdf.
Texte intégralOkonofua, Friday Ebhodaghe. « Female and male infertility in Nigeria : studies on the epidemiology of infertility in Nigeria with special reference to the role of genital tract infections and sexual and reproductive risk factors / ». Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-354-X/.
Texte intégralO'Keefe, Elissa J., et n/a. « Young, sexually active, senior high school women in the australian Capital Territory : prevalence and risk factors for genital Human papillomavirus infection ». University of Canberra. Health Sciences, 2004. http://erl.canberra.edu.au./public/adt-AUC20060410.140559.
Texte intégralGoshovska, A. V. « Features of the vascular component at the stage of the placental complex formation against a background of inflammatory diseases of the female genital organs ». Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18715.
Texte intégralLusoli, Rita de Cássia. « Prevenção e diagnóstico de lesões HPV induzidas e carcinoma anal em mulheres atendidas na rede básica de saúde da cidade de Botucatu pelo método escovado do canal anal / ». Botucatu, 2013. http://hdl.handle.net/11449/97711.
Texte intégralCoorientador: Sidney Roberto Nadal
Banca: Fábio Vieira Teixeira
Banca: Maria Aparecida C. Arruda Henry
Resumo: O Papiloma Vírus Humano (HPV), é considerado um problema mundial de saúde pública, sendo a doença sexualmente transmissível mais prevalente. Guarda uma relação direta com o risco e a incidência do câncer do canal anal. Seu diagnóstico, tratamento e seguimento são de extrema importância. Neste sentido o escovado do canal anal tem um papel fundamental no rastreamento e seguimento das lesões HPV induzidas e consequente evolução para o câncer anal. Determinar a ocorrência de lesão HPV induzida em mulheres que participam dos programas de prevenção do câncer de colo uterino nas Unidades Básicas de Saúde (UBS) no município de Botucatu. Trata-se de um estudo transversal observacional que teve 228 mulheres submetidas ao escovado do canal anal a fim de estabelecer a ocorrência de lesão HPV induzida e suas correlações com dados sociais e comportamentais. Os 11 casos que apresentaram alteração de ASCUS e LSIL no escovado do canal anal traziam relação com estado civil, baixa escolaridade, não prática do sexo seguro, e a prática do sexo anal
Abstract: Human Papillomavirus (HPV) has been a world concern in Public Health, and it is the most prevalent sexually transmitted disease. It has a direct association with the risk and incidence of cancer in the anal canal. Its diagnosis, treatment and follow-up are extremely important. Using this approach, the smear of the anal canal has a crucial role in the screening and follow up of HPV-induced lesions and in the resulting development of anal cancer. To determine the occurrence of HPVinduced lesions in women who attended programs of uterine cervix cancer prevention in Basic Health Units (BHU) in Botucatu city. It is a cross sectional observational study, in which 228 women underwent brushing of the anal canal in order to establish the occurrence of HPV-induced lesion and its correlation with social and behavioral data. The 11 cases which had ASCUS and LSIL changes in the smear of the anal canal were associated with marital status, low education level, practice of unsafe intercourse and anal intercourse
Mestre
Greatti, Mariana Morena de Vieira Santos [UNESP]. « Flora intermediária em mulheres em idade reprodutiva : aspectos inflamatórios, atividade de sialidases e carga bacteriana ». Universidade Estadual Paulista (UNESP), 2014. http://hdl.handle.net/11449/123317.
Texte intégralEspécies de lactobacilos são os principais componentes da microbiota vaginal e a manutenção do predomínio lactobacilar é importante para proteção desse ambiente contra possíveis patógenos. A vaginose bacteriana é uma condição em que se observa a perda de lactobacilos e substituição desses microrganismos por espécies bacterianas, anaeróbias em sua maioria. Tal condição pode acarretar inúmeras complicações ginecológicas e obstétricas, como o aumento do risco de aquisição de infecções sexualmente transmissíveis, parto prematuro e baixo peso ao nascimento. O principal método utilizado para o diagnóstico da vaginose bacteriana é o proposto por Nugent et al. (1991) e se baseia na classificação da microbiota vaginal em flora normal, intermediária e vaginose bacteriana. Enquanto que o perfil imunológico e microbiológico da vaginose bacteriana tenha sido amplamente estudado, pouco se sabe sobre tais características na flora intermediária. Portanto, o objetivo desse estudo foi caracterizar a flora intermediária quanto aos níveis cérvico-vaginais de Interleucina (IL)1-beta, IL-6, IL-8, IL-10, fator de necrose tumoral (TNF)-alfa, antagonista de receptor de IL-1(IL-1ra), sialidases bacterianas e quanto às cargas de Gardnerella vaginalise de bactérias totais, além de verificar se o perfil geral observado na flora intermediária se assemelha ao de mulheres com flora normal ou com vaginose bacteriana. Foi realizado um estudo transversal que incluiu 526 mulheres não grávidas em idade reprodutiva. Deste total, foram constituídos os grupos de estudo de acordo com o padrão de flora vagina, segundo Nugent et al. Todos os 145 casos de vaginose bacteriana foram incluídos nas análises, bem como os 63 casos de flora intermediária e 145 das 318 mulheres que apresentaram flora normal. A determinação dos níveis cérvico-vaginais de citocinas, sialidases e a carga bacteriana foram realizados por, respectivamente, ELISA, ...
Greatti, Mariana Morena de Vieira Santos. « Flora intermediária em mulheres em idade reprodutiva : aspectos inflamatórios, atividade de sialidases e carga bacteriana / ». Botucatu, 2014. http://hdl.handle.net/11449/123317.
Texte intégralCoorientador: Màrcia Guimarães da Silva
Banca: Andrea da Rocha Tristão
Banca: Ana Katherine da Silveira Gonçalves
Banca: Eliane Melo Brolazo
Banca: Cristina Maria Garcia de Lima Parada
Resumo: Espécies de lactobacilos são os principais componentes da microbiota vaginal e a manutenção do predomínio lactobacilar é importante para proteção desse ambiente contra possíveis patógenos. A vaginose bacteriana é uma condição em que se observa a perda de lactobacilos e substituição desses microrganismos por espécies bacterianas, anaeróbias em sua maioria. Tal condição pode acarretar inúmeras complicações ginecológicas e obstétricas, como o aumento do risco de aquisição de infecções sexualmente transmissíveis, parto prematuro e baixo peso ao nascimento. O principal método utilizado para o diagnóstico da vaginose bacteriana é o proposto por Nugent et al. (1991) e se baseia na classificação da microbiota vaginal em flora normal, intermediária e vaginose bacteriana. Enquanto que o perfil imunológico e microbiológico da vaginose bacteriana tenha sido amplamente estudado, pouco se sabe sobre tais características na flora intermediária. Portanto, o objetivo desse estudo foi caracterizar a flora intermediária quanto aos níveis cérvico-vaginais de Interleucina (IL)1-beta, IL-6, IL-8, IL-10, fator de necrose tumoral (TNF)-alfa, antagonista de receptor de IL-1(IL-1ra), sialidases bacterianas e quanto às cargas de Gardnerella vaginalise de bactérias totais, além de verificar se o perfil geral observado na flora intermediária se assemelha ao de mulheres com flora normal ou com vaginose bacteriana. Foi realizado um estudo transversal que incluiu 526 mulheres não grávidas em idade reprodutiva. Deste total, foram constituídos os grupos de estudo de acordo com o padrão de flora vagina, segundo Nugent et al. Todos os 145 casos de vaginose bacteriana foram incluídos nas análises, bem como os 63 casos de flora intermediária e 145 das 318 mulheres que apresentaram flora normal. A determinação dos níveis cérvico-vaginais de citocinas, sialidases e a carga bacteriana foram realizados por, respectivamente, ELISA, ...
Abstract: Not available
Doutor
SENA, ROSA M. M. de. « Efeitos da Terapia Fotodinâmica mediada por laser de emissão vermelha e azul de metileno em vaginite induzida por Candida albicans ». reponame:Repositório Institucional do IPEN, 2013. http://repositorio.ipen.br:8080/xmlui/handle/123456789/10598.
Texte intégralMade available in DSpace on 2014-10-09T13:59:41Z (GMT). No. of bitstreams: 0
Tese (Doutoramento)
IPEN/T
Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP
Kennard, Benjamin, Allison Cobble, Amy Gravitte, Kaleigh Galloway, Jen Kintner, Jennifer Hall et Stacy C. Brown. « Quantification of Progesterone and 17-β Estradiol in Mouse Serum by Liquid Chromatography-Tandem Mass Spectrometry ». Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/45.
Texte intégralMunrós, Feliu Jordina. « Nous mecanismes en la fisiopatologia de l’endometriosi profunda ». Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/667447.
Texte intégralEndometriosis is a benign gyneacologic condition, the pathogenesis of which is still under debate. It is now considered a chronic systemic inflammatory condition and several immunological, hormonal and inflammatory factors have been described. In the last few years, new pathogenic mechanisms of endometriosis related to inflammation and coagulation pathways have been described and it has been hypothesized that patients with endometriosis could be in an inflammatory and hypercoagulable state. Among the different subtypes of endometriosis, deep infiltrating endometriosis (DIE) is recognized as the most aggressive form of the disease. Furthermore, DIE could be considered as a specific entity since it seems to present specific pathogenic features in comparison to other endometriosis phenotypes. Higher levels of circulating cell-derived microparticles (cMP), neutrophil extracellular traps (NETs) and tissue factor have been observed in many inflammatory conditions, thrombotic diseases, and malignancy. In fact, these factors have been described to be involved in inflammation, blood coagulation and angiogenesis. Moreover, several recent studies have described the generation of cMP after surgical procedures as markers of cellular damage, and have characterized their potential contribution to postsurgical complications, such as inflammation and thrombosis. This work is composed of four articles that have been published in the scientific literature. Global results obtained from them show increased cMP and NETs plasmatic levels in endometriosis patients, and these levels seem to be attributed to the subgroup of patients with DIE. Among these patients, those with larger cumulative size of endometriotic implants showed higher cMP levels. These findings suggest an increased inflammatory and/or hypercoagulable systemic status in patients with DIE. Furthermore, the comparison between laser ablation and stripping for the surgical treatment of unilateral ovarian endometriomas showed higher but temporary cMP generation in the latter group compared with laser ablation. These results suggest that the stripping technique might trigger a more pronounced short-term inflammatory and procoagulant response, which may contribute to postsurgical complications and may negatively impact on ovarian reserve in these patients.
Lusoli, Rita de Cássia [UNESP]. « Prevenção e diagnóstico de lesões HPV induzidas e carcinoma anal em mulheres atendidas na rede básica de saúde da cidade de Botucatu pelo método escovado do canal anal ». Universidade Estadual Paulista (UNESP), 2013. http://hdl.handle.net/11449/97711.
Texte intégralO Papiloma Vírus Humano (HPV), é considerado um problema mundial de saúde pública, sendo a doença sexualmente transmissível mais prevalente. Guarda uma relação direta com o risco e a incidência do câncer do canal anal. Seu diagnóstico, tratamento e seguimento são de extrema importância. Neste sentido o escovado do canal anal tem um papel fundamental no rastreamento e seguimento das lesões HPV induzidas e consequente evolução para o câncer anal. Determinar a ocorrência de lesão HPV induzida em mulheres que participam dos programas de prevenção do câncer de colo uterino nas Unidades Básicas de Saúde (UBS) no município de Botucatu. Trata-se de um estudo transversal observacional que teve 228 mulheres submetidas ao escovado do canal anal a fim de estabelecer a ocorrência de lesão HPV induzida e suas correlações com dados sociais e comportamentais. Os 11 casos que apresentaram alteração de ASCUS e LSIL no escovado do canal anal traziam relação com estado civil, baixa escolaridade, não prática do sexo seguro, e a prática do sexo anal
Human Papillomavirus (HPV) has been a world concern in Public Health, and it is the most prevalent sexually transmitted disease. It has a direct association with the risk and incidence of cancer in the anal canal. Its diagnosis, treatment and follow-up are extremely important. Using this approach, the smear of the anal canal has a crucial role in the screening and follow up of HPV-induced lesions and in the resulting development of anal cancer. To determine the occurrence of HPVinduced lesions in women who attended programs of uterine cervix cancer prevention in Basic Health Units (BHU) in Botucatu city. It is a cross sectional observational study, in which 228 women underwent brushing of the anal canal in order to establish the occurrence of HPV-induced lesion and its correlation with social and behavioral data. The 11 cases which had ASCUS and LSIL changes in the smear of the anal canal were associated with marital status, low education level, practice of unsafe intercourse and anal intercourse
THEDREZ, PHILIPPE. « Ciblage therapeutique des cancers ovariens par des anticorps monoclonaux radiomarques ». Nantes, 1989. http://www.theses.fr/1989NANT2004.
Texte intégralNassour, Ibrahim. « Depot et mobilisation des lipides corporels au cours du cycle sexuel chez la truite arc-en-ciel : effets d'une carence en acides gras essentiels sur la composition en acides gras des differents tissus ». Paris 7, 1988. http://www.theses.fr/1988PA077128.
Texte intégralKulker, Anna. « Application de l'analyse quantitative des images au cyto-diagnostic des cancers du col de l'utérus ». Phd thesis, Grenoble 1, 1986. http://tel.archives-ouvertes.fr/tel-00321543.
Texte intégralPrud'Homme, Marie-Jeanne. « Contribution a l'etude des mecanismes de regulation de la motricite uterine chez la brebis ». Paris 6, 1987. http://www.theses.fr/1987PA066591.
Texte intégralJacobsson, Madeleine. « Dr. Eleine Mad ». Thesis, Kungl. Konsthögskolan, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:kkh:diva-587.
Texte intégralDr. Eleine Mad is Madeleine Jacobsson's spokesperson for the scientific and paranormal discoveries that arise in her worlds. She describes content, tecniques and aesthetics based on a categorization system where art is divided into different types of components and then decoded as they go. To understand the intuition's involvement in the work process, it is transformed into three separate roles by a Seeker, Collector and a Myntare(In swedish language the one who is a "myntare" -is verbally declaring a concept or term). With these roles I try to describe in what ways intuition is beneficial or devastating to the artistic work. The story of M is about a frog-like character, Delop, who leaves the home planet to seek out other worlds. In her search, Delop finds a world whose views and lifestyles differ from her experiences of "reality" as she learned to survive in it.
Recorded sound and image material of the presentation is available for private use.
Cheng, Jhih-Yan, et 鄭芷硯. « Development of Female Vaginal Fluid Collection Device for Female Genital Tract Disease ». Thesis, 2016. http://ndltd.ncl.edu.tw/handle/83878785299649658865.
Texte intégral« Cellular and molecular mechanisms underlying abnormal fluid formation in the female reproductive tract and its adverse effects on reproduction ». 2004. http://library.cuhk.edu.hk/record=b6073647.
Texte intégral"March 2004."
Thesis (Ph.D.)--Chinese University of Hong Kong, 2004.
Includes bibliographical references (p. 215-238).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.
Abstracts in English and Chinese.
Moodley, Nishila. « The impact of dual HIV and HPV vaccine strategies among adolescents in a resource constrained setting ». Thesis, 2017. http://hdl.handle.net/10539/23163.
Texte intégralIntroduction With the largest epidemic in the world, the consequences of human immunodeficiency virus (HIV) in South Africa extend far beyond its disease burden. In fact, patterns of HIV-related infection and mortality in South Africa still reflect social cleavages and inequalities. Similarly, poverty-related issues such as poor education, unemployment and subsequent low socio-economic status, rural residence and inadequate access to health care are all implicated in human papillomavirus (HPV) associated cervical cancer-related mortality (of which South Africa also has the highest globally). Despite the knowledge of reproductive functions and sexuality being poor among adolescents in South Africa, the majority commence their sexual activity early with an estimated national average of 15 years for girls and 14 years for boys. Further, many South African adolescents engage in sexual risk-taking behaviours including concurrent partners and unprotected sexual acts that considerably increase their vulnerability to sexually transmitted infections including HIV and HPV. In recognising the unique health needs of adolescents in South Africa, the national government has already pin-pointed school health services as a strategic arm of primary health care re-engineering. The aim of this body of work is to elaborate on restructuring of adolescent health care by introducing the HIV and HPV vaccine concomitantly in South Africa via a school-based sexual and reproductive health service. Methodology Data from four studies were analysed and are presented in three published and two unpublished papers. The first study evaluated the synergism between HIV and HPV in the South African context and formed the basis of the literature review. The second study considered HIV vaccine implementation alone. The third study assessed dual HIV and HPV vaccine strategies among females and the final study compared the dual vaccination strategy against recognised biomedical HIV prevention interventions. The studies evaluated the implementation of a hypothetical HIV vaccine and the bivalent HPV vaccine both individually and in combination when administered to school-going adolescents in South Africa. The health outcomes and the cost-effectiveness of these strategies were assessed. Assumptions were made regarding the hypothetical HIV vaccine (based on HIV vaccine studies conducted to date) including a coverage rate of 60% (uncertainty range: 30-70%), vaccine efficacy of 50% (uncertainty range: 30-70%) and vaccine price per dose of US$ 12 (uncertainty range: US$ 3-24). The uncertainty ranges were tested in the sensitivity analysis. Mortality statistics, disease transition parameters (for the individual diseases and the models representing joint disease) and HPV vaccine characteristics were drawn from the South African literature. The joint effectiveness of the dual vaccine strategy was considered multiplicative. Nine year old adolescents attending South African schools in 2012 were eligible for the intervention (vaccination) that was introduced opportunistically as part of the national health initiative introducing school-based sexual and reproductive health services. The learners were targeted prior to their reported sexual debut. The HIV vaccine was considered against the comparator of HIV counselling and testing (HCT) and the national roll-out of antiretroviral therapy (ART) that constituted the standard of care in South Africa. The HPV vaccine was modelled as prevention against HPV-related cervical cancer and pre-cancerous HPV-related cervical states. The health service provider (provider) perspective was adopted and the cohort was modelled through a lifetime horizon of 70 years with annual cycles. The economic costs and health outcomes were discounted at 3% with an uncertainty range between 0% and 6% assessed. Cost valuations were for 2012 and costs were adjusted to this common year. The quality-adjusted life year (QALY) was used as the outcome measure of health related quality of life and was used to calculate the incremental cost-effectiveness ratio (ICER) of the comparator against the vaccination interventions. The core model was a semi-Markov simulation with annual cycles. The study population entered the model HIV and HPV disease free and were exposed to the risk of acquiring each disease annually. The model structure was parameterised drawing from South African data available in the literature. One-way sensitivity analyses evaluated the impact of single assumptions on cost and outcomes. Probabilistic sensitivity analysis (PSA) with a bootstrapping technique explored the uncertainty in the model and evaluated the robustness of the results. The PSA data generated determined if the intervention fell below the willingness-to-pay (WTP) threshold. As South Africa does not have a pre-defined WTP threshold, the Gross Domestic Product (GDP) per capita (for 2012) was used as a proxy in accordance with the World Health Organization’s Guide to Cost-Effective Analysis. Additionally, benchmark interventions were used in the final comparison study as a measure of cost-effectiveness. Ethical approval for the study was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand. Findings The second study explored the implementation of the HIV vaccine on an individual and national, programmatic level. The simultaneous implementation of HIV vaccination services with current HIV management programmes would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the ICER was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to the duration of vaccine-mediated protection and to variations in the vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. Assessing this HIV vaccine model on a national programmatic level, yielded an ICER of US$ 5 per life-year gained (LYG) (95% CI US$ 3-12) compared with the comparator. This fell considerably below the national WTP threshold of cost-effectiveness. This also translated to an 11% increase in per capita costs from US$ 80 to US$ 89. National implementation of this intervention could potentially result in an estimated cumulative gain of 24 million years of life (95% CI 8–34 million years) among those adolescents aged between 10-19 years that were vaccinated. The 10 year absolute risk reduction projected by HIV vaccine implementation was 0.42% for HIV incidence and 0.41% for HIV mortality. The ICER was sensitive to the HIV vaccine efficacy, coverage and vaccine pricing in the sensitivity analysis. The third study assessed the impact of dual HIV and HPV implementation strategies. Programmes that involved the dual vaccine strategy were assessed as cost-saving. ICER values were sensitive to the HIV vaccine cost. The dual vaccine strategy resulted in 10 year absolute risk reductions in HIV incidence (5.24%), dual mortality (1.21%) and a reduction in HPV incidence (0.39%) compared with no vaccination. Importantly, the reduction in HIV incidence rate and dual mortality rate in the dual vaccine strategy exceeded the reductions noted with the use of the HIV vaccine alone. All scenarios assessed with the dual vaccine strategy were cost-effective. Lower vaccine prices and reduced discount rates were associated with improved ICER outcomes. The final study compared the biomedical interventions of oral pre-exposure prophylaxis (PrEP), voluntary medical male circumcision (VMMC) and the scaling-up of ART coverage against the vaccine strategies. When compared with other biomedical HIV prevention interventions, the dual vaccination intervention was the most cost-effective strategy (US$ 7 per QALY gained) and averted 29% of new HIV infections. VMMC (US$ 30 per QALY gained) proved more cost-effective than HIV vaccination alone (US$ 93 per QALY gained), though VMMC averted 6% more new infections than the HIV vaccine. PrEP interventions were the least cost-effective. Combined dual vaccination and VMMC strategies represent the only dominant intervention. Strategies involving oral PrEP were the least cost-effective. Conclusion The findings of this thesis have implications for school-based adolescent health care and HIV- and HPV-related disease prevention among adolescents, a highly susceptible population. The cost-effectiveness of the dual HIV and HPV vaccine strategy was demonstrated, and the improved health outcomes associated with the interventions quantified. Proposals were suggested regarding possible combinations of HIV prevention interventions that could yield the favourable health outcomes with the most efficient use of financial resources. Several important areas for future research were identified to shed light on improving adolescent health care and for optimising HIV prevention strategies. These include integrating HIV and HPV services as part of the re-engineering of primary health care in South Africa, and then formulating economic evaluations of HIV/HPV prevention strategies targeting adolescents specifically. Further, more effective methods of collecting data on socially marginalised populations such as young people need to be explored. Another vital research area is the discussion and implementation of existing school health documents with the ideals embodied in the school health programme envisaged under the National Health Insurance restructuring. Once these are integrated, the cost implication of the combined programmes need to be assessed.
MT2017
« Design and development of a robotic assistant for total laparoscopic hysterectomy ». 2013. http://library.cuhk.edu.hk/record=b5549278.
Texte intégral在普遍全腹腔鏡子宮切除術的流程中,名為舉宮器的手術儀器會被應用於手術中,以改變病人子宮的位置及方向。手術室內,除了負責為病人摘除子宮的醫生外,還需額外一名負責操作舉宮器的醫生在場,以促進手術的進行。於手術的過程中,為使摘除手術能更有效及順利地進行,這名醫生需以人手操作舉宮器以控制病人體內子宮的方位。一般而言,這項工作都是枯燥而疲憊的。然而,在負責進行摘除手術的醫生眼中,縱子宮的方位已被調整,其方位仍然未如理想的情況亦不屬罕見。
故此,一個能勝任代替醫生負責操作舉宮器的機械人助手將會是可行的解決方案之一。與此同時,機械人亦能將病人子宮方位的控制權交回負責進行摘除手術的醫生手中。
本論文提出一套以把醫生從操作舉宮器的工作中釋放為目標,並使子宮方位操作變得更準確及穩定的機械人系統。機械人系統由兩個部分構成,分別為一支一個自由度的電動舉宮器以及一台三個自由度的舉宮器方位操作機械人。
舉宮器方位操作機械人旨在模仿以往醫生操作舉宮器的動作,以負責把固定在它身上的舉宮器移動到及固定在指定的位置。舉宮器方位操作機械人共有三個關節,分別為旋轉關節、滑動關節以及線性關節。關節的佈置滿足特定的幾何約束以構成遠程運動中心,使機械人能把手術儀器從細小的開口(例如:子宮頸)中進行操作。本論文提出的舉宮器方位操作機械人備有配適器以兼容不同款式的舉宮器,例如市場上現存的舉宮器以及本論文提出的電動舉宮器,均可應用在本系統中。
本論文提出的電動舉宮器為系統中可選擇性的元件,它是個一自由度附帶可轉動末端的裝置,旨在延伸機械人系統末端執行器的可到達範圍。
本論文將論述這套機械人系統的設計,包括其機械設計與電子系統的部分、運動學與及工作空間。一台實驗用的樣機已被建造以作驗證設計之用。該樣機以醫學人體模型為對象的實驗結果亦會在本論文中提出。
Hysterectomy is one of the most frequently performed gynecologic procedures. In average, around 600,000 cases are recorded annually in the United States. Total laparoscopic hysterectomy (TLH) is one of the approaches of performing hysterectomy in which uterus of a patient is removed from an entirely laparoscopic approach.
In ordinary TLH procedures, a surgical apparatus, uterus manipulator, used for changing the position and orientation of the patient’s uterus is involved. In the operating theatre, apart from the primary surgeon who is responsible for the removal of uterus, an assisting surgeon is also involved for operating the uterus manipulator. Throughout the surgery, she/he has to manipulate the patient’s uterus using the uterus manipulator manually to facilitate the removal procedure. This task is generally tiring and boring. In addition, it is also common that the manipulated position is not satisfactory from the primary surgeon’s point of view.
Thus, a robotic assistant which is capable of taking up the task of this assisting surgeon as well as allowing the primary surgeon to have full control on the position of the patient’s uterus may be one of the potential solutions.
In this thesis, a robotic system aiming at providing more precise and stable manipulating motion and freeing the assisting surgeon who is responsible for operating the uterus manipulator is presented. The presented robotic system is composed of two parts, a motorized uterus manipulator of one degree of freedom and a robotic uterus manipulator positioner of three degrees of freedom.
Objective of the uterus manipulator positioner presented is to imitate what is doing by the assisting surgeon when operating the uterus manipulator. It holds and manipulates the uterus manipulator attached to it. The uterus manipulator positioner is a robotic system consisted of three joints, a revolute joint, a sliding joint and a translational joint. Arrangement of the joints is forced to satisfy specific geometric constraints so that a remote center of motion (RCM) is created to allow manipulation through small openings such as the cervix. Adaptors are included to enable the use of different uterus manipulators. Existing uterus manipulators and the motorized uterus manipulator presented in this thesis can be adapted to the system.
The motorized uterus manipulator presented in this thesis is an optional element of the robotic system. It is a device of one degree of freedom with a movable tip aiming at enhancing the reaching capability of the end-effector of the robotic system.
In this thesis, design of the robotic system in both mechanical and electronic aspects is presented. Kinematics and workspace of the system is also discussed. To verify the design, a prototype is built. Finally, verification experiments with the prototype on manikin are provided.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Yip, Hiu Man.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 96-98).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts also in Chinese.
Abstract --- p.i
摘要 --- p.iv
Acknowledgement --- p.vi
Table of Contents --- p.viii
List of Figures --- p.x
Chapter Chapter 1. --- Introduction --- p.1
Chapter 1.1. --- Total Laparoscopic Hysterectomy --- p.1
Chapter 1.2. --- Existing Uterus Manipulators --- p.4
Chapter 1.3. --- Existing Uterus Manipulator Positioners --- p.6
Chapter 1.4. --- Existing Medical Robots --- p.9
Chapter 1.5. --- Existing RCM Mechanisms --- p.11
Chapter 1.6. --- Motivation and Contribution --- p.12
Chapter Chapter 2. --- Conceptual Design --- p.15
Chapter 2.1. --- Design Requirements --- p.15
Chapter 2.2. --- Conceptual Design of Prototype --- p.16
Chapter Chapter 3. --- Design of Prototype --- p.23
Chapter 3.1. --- Mechanical Design of the Robotic System --- p.25
Chapter 3.1.1. --- Design of the Robotic Uterus Manipulator Positioner --- p.25
Chapter 3.1.2. --- Adaptor --- p.35
Chapter 3.1.3. --- Design of the Motorized Uterus Manipulator --- p.36
Chapter 3.2. --- Kinematics of the Robotic System --- p.38
Chapter 3.2.1. --- Coordinates of Points on a Sphere --- p.39
Chapter 3.2.2. --- The 2-DOF Uterus Manipulator Positioner --- p.40
Chapter 3.2.3. --- The 3-DOF Uterus Manipulator Positioner --- p.42
Chapter 3.2.4. --- The 4-DOF robotic system --- p.45
Chapter 3.2.5. --- Velocity --- p.50
Chapter Chapter 4. --- Design of Control System --- p.52
Chapter 4.1. --- Robot Controlling Unit --- p.52
Chapter 4.1.1. --- Size Reduced Controlling Unit --- p.53
Chapter 4.2. --- User Interface --- p.62
Chapter 4.2.1. --- Foot-Controlled Interface --- p.63
Chapter 4.2.2. --- Hand-Controlled Panel --- p.68
Chapter Chapter 5. --- Prototype and Experiments --- p.70
Chapter 5.1. --- Developed Prototype --- p.70
Chapter 5.2. --- Experiments --- p.72
Chapter 5.2.1. --- Robot Controller --- p.73
Chapter 5.2.2. --- Control Algorithm --- p.77
Chapter 5.2.3. --- Experiment on the Prototype --- p.79
Chapter 5.2.4. --- Experiment with Manikin --- p.87
Chapter Chapter 6. --- Conclusion and Future Work --- p.90
Chapter 6.1. --- Conclusion --- p.90
Chapter 6.2. --- Robot Positioning Platform --- p.92
Chapter 6.3. --- Reinforcement of the Robotic System --- p.94
Chapter 6.4. --- Extension of User Interfaces --- p.95
List of References --- p.96
Mswela, Mphoeng Maureen. « HIV/AIDS and the role of gender inequality and violence in South African Law ». Diss., 2009. http://hdl.handle.net/10500/3063.
Texte intégralConstitutional, International & Indigenous Law
LL.M.