Background: Reactive attachment disorder (RAD) has been described as one of the least researched and most poorly understood psychiatric disorders (Chaffin et al., 2006). Despite this, given what is known about maltreatment and attachment, it is likely that RAD has profound consequences for child development. Very little is known about the prevalence and stability of RAD symptoms over time. Until recently it has been difficult to investigate the presence of RAD due to limited measures for informing a diagnosis. However this study utilised a new observational tool Method: A cross sectional study design with a one-year follow-up explored RAD symptoms in maltreated infants in Scotland (n=55, age range= 16-62 months) and associated mental health and cognitive functioning. The study utilised the Rating of Inhibited Attachment Behavior Scale (Corval, et al., unpublished 2014) that has recently been developed by experts in the field along side The Disturbances of Attachment Interview (Smyke & Zeanah, 1999). Children were recruited as part of the BeST trial, whereby all infants who came in to the care of the local authority in Glasgow due to child protection concerns were invited to participate. The study sample was representative of the larger pool of data in terms of age, gender, mental health and cognitive functioning. Results: The sample was found to be representative of the population of maltreated children from which it was derived. Prevalence of RAD was found to be 7.3% (n=3, 95% CI [0.43 – 14.17]) at T1, when children are first placed in to foster care. At T2, following one year in improved care conditions, 4.3% (n=2, 95% CI [below 0 – 10.16]) met a borderline RAD diagnosis. Levels of observed RAD symptoms decreased significantly at T2 in comparison to T1 but carer reported symptoms of RAD did not. Children whose RAD symptoms did not improve were found to be significantly older and showed less prosocial behaviour. RAD was associated with some mental health and cognitive difficulties. Lower Verbal IQ and unexpectedly, prosocial behaviour were found to predict RAD symptoms. Conclusions: The preliminary findings have added to the developing understanding of RAD symptoms and associated difficulties however further exploration of RAD in larger samples would be invaluable.

Ph.D. / Background: Most recent data have shown a slight reduction in the incidence of malaria in Nigeria. However, cases of malaria in children younger than five years of age have continued to escalate amidst ‘simple’ and ‘effective’ treatment options. The realisation of the Millennium Development Goals (MDGs) – to halve the burden of malaria by 2015 – is becoming increasingly unrealistic in Nigeria following the alarming rates of malaria in children. Apart from the ecological and environmental factors, socio-cultural and behavioural factors might be responsible for the staggering cases of malaria in children in local communities in Nigeria. It was against this background that a sociological study of health care service utilisation was conducted among caregivers of children with malaria. The study investigated the perceived threat of malaria; how the local understanding of malaria affects the recognition of signs and symptoms, perceived aetiology, treatment-seeking patterns and the use of insecticide treated nets (ITNs). The socio-generational changes in the healthcare seeking behaviour between young and older mothers as well as differences in the patterns of health care service utilisation between rural and urban subjects were also interrogated. Method: This study adopted a qualitative research design using complementary methods. A total of 40 semi-structured interviews, 20 in-depth interviews and four focus group discussions (FGDs) were conducted with caregivers and health workers. The respondents included young and older parents between the ages of 25 and 80 years whose children or wards below the age of five had manifested malaria symptoms at one time or another. A purposive sampling procedure was used to select sample for the study. The study was conducted in two selected rural areas; Okanle and Fajeromi; and one urban centre; Ilorin, Kwara State of Nigeria. Findings: The research indicated that the perceived aetiology, symptoms and treatment of malaria in children were largely influenced by the socio-cultural patterns of the communities studied. The study found that the first line of treatment for children with malaria in the communities of study was usually home treatment using traditional herbal medicines. The use of modern health care facilities is usually seen as the last resort. The traditional beliefs about causes of malaria, affordability and trust in herbal medicines, on the one hand, were found to be responsible for the widespread use of herbal medicines in the treatment of malaria in children. On the other hand, poor service delivery, lack of money, attitudes of medical personnel, mixed feelings about the efficacy of modern medicines and lack of trust in the community health centres were some factors found to be responsible for delays in seeking modern health care services when children have malaria. More importantly, the decision to seek treatment from either traditional or modern sources was largely influenced by the network of informal social interaction and social support at household and community levels. In addition, the study also found some changes in the patterns of health care seeking behaviour of young and older caregivers but generally found no differences in the patterns of health care seeking behaviour between rural and urban participants. Finally, the study found that the majority of the respondents were not aware of the effectiveness of the ITNs. Consequently, there was a high dependence on the use of traditional preventive measures which included a local leaf known as “ewe-efon” translated as “mosquito leaf”. Apart from the perceived corruption and mismanagement at the level of distribution of the ITNs, lack of appropriate knowledge about the effectiveness of the ITNs was discovered to be responsible for the widespread non-acceptance of the ITN in the prevention of malaria in children.

This thesis presents six studies concerned with the psychological status of people with audiological disorders, particularly tinnitus and hearing loss. Study One (Part I of the thesis) employed a structured interview and the General Health Questionnaire to investigate the emotional status of subjects with a variety of audiological symptoms. Psychological disorder was found to be more prevalent among subjects complaining of vertigo (64%) than among those complaining of tinnitus (45%); the prevalence of psychological disorder among subjects complaining of hearing loss was lower than among tinnitus subjects (27%). A higher prevalence of disturbance was found among subjects with multiple symptoms. A previous history of psychological distress correlated with current ratings of disturbance. Studies Two and Three (Part II) are concerned with the psychology of cochlear implantation. Methodological issues concerning psychological assessment in this context are discussed. Study Two uses Repertory Grid Technique to assess the psychological consequences of using an implant. Eight out of ten subjects reported important changes in psychological well-being related to their use of the device. Study Three identifies a group of subjects applying for an implant while having a non-organic hearing loss. The implications for the use of standardised assessment procedures are discussed. Studies Four, Five and Six (Part III) assess the cognitive functioning of subjects with tinnitus. Tinnitus subjects' performance on neuropsychological tests is compared with that of hearing impaired control subjects. Subjects were also assessed using the Cognitive Failures Questionnaire (CFQ). The emotional status of the subjects was assessed using the Speilberger State-Trait Anxiety Inventory. The Beck Depression Inventory was also used in Study Six. The groups were not distinguished by a number of neuropsychological tests, however it was found, in Studies Four and Five, that Tinnitus subjects' performance on verbal fluency tests was Significantly poorer than the Control subjects, after hearing loss was controlled for. In Study Six it was found that both Tinnitus and Control subjects performed less well than expected on the STROOP test; this was more apparent in the Tinnitus group. The Tinnitus group also obtained higher CFQ scores in Studies Four and Five. Trait anxiety was a feature of the Tinnitus groups. The implications for the cognitive functioning of both tinnitus and hearing impaired subjects are discussed in terms of Baddeley's model of working memory. The importance of these findings for complaint about tinnitus and hearing loss are considered.

Magister Scientiae - MSc / This investigation aimed to determine factors that influence women's utilisation of maternal health services, with specific focus on the quality of care and services available to disadvantaged communities in South Africa. It used the women's perspectives to assess the quality of maternal healthcare services in peri-urban commercial farming and rural areas with the purpose of understanding why women utilise maternal services the way they do. / South Africa

Alkoholkonsumtionen i Sverige är idag högre än för 100 år sedan. Många barn växer upp i familjer med vuxna som har en riskfylld eller skadlig alkoholkonsumtion. En hög alkoholkonsumtion hos föräldrarna kan påverka barnen negativt. Det nationella Riskbruksprojektet (2004-2010) var ett regeringsuppdrag med syftet att hälso- och sjukvård skulle arbeta mer aktivt för att minska alkoholkonsumtionen. Sedan 2008 har BVCsjuksköterskor i Stockholm erbjudits utbildningar inom Riskbruksprojektets regi. Ett nytt arbetssätt för alkoholprevention har utvecklats vilket innebär att sjuksköterskor på barnavårdscentral (BVC) har korta upprepade samtal om alkohol med föräldrar. Syftet med denna studie var att beskriva föräldrars tankar om alkoholkonsumtion i samband med föräldraskap och deras upplevelser av alkoholpreventivt arbete inom barnhälsovården. Tio föräldrar från Stockholm intervjuades. Insamlingen av data genomfördes under maj 2011. Intervjusvaren analyserades med innehållsanalys. I resultatet framkom sex kategorier: Umgängets betydelse, Barnets utsatthet, Samtal vid hembesök; svårt att minnas, Samtal i grupp skapar medvetenhet, Stärkt inställning och Otydligt budskap. Det visade sig att föräldrarna hade många tankar om alkohol i samband med föräldraskap och samtliga av de intervjuade ansåg att alkoholfrågan var viktig och berörde dem på olika sätt. De menade att alkoholfrågan skulle tas upp inom barnhälsovården. Flera av föräldrarna hade svårt att minnas att alkoholfrågan hade tagits upp i samband med hembesöket. Alkoholsamtal i samband med föräldragrupp hade skapat nya tankar och en medvetenhet om alkohol i samband med föräldraskap. Slutsatsen av denna studie är att föräldrar har många tankar om alkohol i samband med föräldraskap och att alkoholsamtalen inom barnhälsovården tycks väcka nya tankar och medvetandegöra föräldrar om alkohol i samband med föräldraskap. Det synes vara av stor betydelse för föräldrar med alkoholprevention inom barnhälsovården. / The consumption of alcohol in Sweden is today higher than a hundred years ago. Many children grow up in families where adults have a risky or harmful drinking. A high parental consumption of alcohol may affect the children negatively. The national Risky Drinking Project (2004-2010) was a commission from the government aiming at the health care working actively to decrease the consumption of alcohol among Swedish inhabitants. Since 2008 the nurses in the Child Health Services were educated by the Risky Drinking Project. A new way of alcohol prevention in the Child Health Services has been developed. It means that the nurses in the Child Health Services discuss with the parents about alcohol in relation to parenthood. The aim of this study was to describe parents' thoughts about alcohol in relation to parenthood and parents' experiences of the alcohol preventive work within the Child Health Services. Ten parents from Stockholm were interviewed. The collection of data was performed in May 2011. The data was analysed with content analysis. The result displayed six categories: The importance of the company, The exposure of the child, The dialog at the homevisit; hard to remember, The group dialog creates awareness, Strengthened attitude and Unclear message. The findings showed that the parents had lots of thoughts about alcohol inrelation to parenthood and all of the parents thought that the alcohol issue was important and concerned them in various ways. They meant that alcohol in relation to parenthood should be discussed with parents in the Child Health Services. Many of the parents thought that it was hard to remember what has been said about alcohol at the home visit. The dialog connected with the parents group had increased their awareness about alcohol and had given them new perspective. The conclusion of this study is that parents have many thoughts about alcohol in relation to parenthood and it looks as if the alcohol preventive work in Child Health Services can give new thoughts and awareness of alcohol. It seems to be of significance to discuss alcohol with parents in the Child Health Services.

Bakgrund: Att äta och därigenom tillgodogöra sig näring är av stor vikt för hälsa och tillfredsställande tillväxt. Flera faktorer påverkar ett barns matvanor och det finns ett flertal orsaker till uppfödningssvårigheter hos barn. Föräldrar till barn med uppfödningssvårigheter kan uppleva stress och oro. Specialbarnavårdscentralen (Special-BVC) är ett komplement till BVC och erbjuder råd samt psykosocialt stöd till föräldrar till barn med svåra matproblem.   Syfte: Att undersöka föräldrars upplevelser av råd och stöd givna av Special-BVC angående uppfödningssvårigheter hos barn. Metod: En kvalitativ intervjustudie med explorativ och deskriptiv design tillämpades. Intervjuer genomfördes med tolv föräldrar till barn med uppfödningssvårigheter som varit inskrivna på Special-BVC. Intervjuerna spelades in, transkriberades och analyserades med kvalitativ innehållsanalys. Resultat: Innehållsanalysen resulterade i fyra kategorier: Upplevelser och intryck av Special-BVC, Skillnader kring råd och stöd mellan BVC och Special-BVC, Förväntningar inför kontakten med Special-BVC och Upplevelser kring uppfödningssvårigheter. Föräldrarnas upplevelser skiljdes åt men var övervägande positiva även då barnets uppfödningssvårigheter kvarstod till viss del. Slutsats: Föräldrar till barn med uppfödningssvårigheter vittnar om stress och oro samt uttrycker behov av råd och stöd. Special-BVC har genom ett professionellt bemötande, stor kunskap samt erfarenhet kunnat guida föräldrarna i rätt riktning och hjälpt dem att utöva egenvård. Distriktssköterskan möter och vårdar människor i olika faser och situationer i livet och bör inneha ett holistiskt och etiskt förhållningssätt. Det är av stor vikt att människor som upplever svårigheter erbjuds individuellt anpassad vård för att uppnå bästa möjliga hälsa. / Background: To eat and thereby assimilate nutrients is of great importance regarding health and a satisfactory growth. Several factors influence food habits and different reasons to food intake difficulties can be found. Parents to children with food intake difficulties can experience stress and anxiety. The Special Child Health Care Centre (Special-BVC) is a complement to the ordinary Child Health Care and offers counselling and psychosocial support to parents with children experiencing severe food intake difficulties.        Objective: To investigate parents’ experiences of advice and support given by the Special-BVC regarding food intake difficulties.                                                                             Method: A qualitative interview study with exploratory and descriptive design was applied. Interviews were conducted with twelve parents of children with food intake difficulties who were enrolled at Special-BVC. The interviews were recorded, transcribed and analysed with qualitative content analysis.                                              Results: The content analysis generated four categories: Experiences and impressions regarding Special-BVC, Differences about advice and support between the Child Health Care Centre and Special-BVC, Expectations before the contact with Special-BVC and Experiences regarding food intake difficulties. The experiences were different among the parents but predominantly positive even when the child’s food intake difficulties partly remained.                                                                                                 Conclusion: Parents to children with food intake difficulties expresses stress and anxiety and the need of counselling and support. Special-BVC could guide the parents in the right direction through a professional personal treatment, great knowledge and experience, and thereby help them practice self care. The district nurse meets and cares for individuals in different phases and situations in life and ought to possess a holistic and ethic approach. It is of a great importance that people experiencing difficulties, in this case parents to children with food intake difficulties, offers an individually adjusted care to achieve optimal health.

No description available.

Despite the increasing acceptance of biopsychosocial models of pain and multidisciplinary treatments for pain, relatively little is known about the specific psychological variables and social processes related to postoperative pain in children, especially in an outpatient setting. The present study examined demographic, medical, and psychological predictors of children's pain and parents' administration of pain medication. Two hundred and thirty-six families with children aged 2 to 12 undergoing day surgery participated in the study. This included a subset of 100 children aged 6 to 12, who were asked to complete self-report measures of anxiety, expected pain, coping style, and pain. Parents of all children completed measures of expected pain, expected benefit from medication, perspective taking, and negative attitudes towards analgesics. Parents and school-aged children completed pain diaries on the day of surgery and two days following surgery. The prevalence of clinically significant pain was somewhat lower than in previous studies, but both pain and undertreatment (parents who gave less than the recommended amount of pain medication) remained common. Predictors of pain were examined by multiple regression, using data from the subset of 100 children aged 6 to 12. More intense pain was related to more invasive surgery, a constellation of analgesic-related variables (more doses of analgesia given, the use of a regional block, the use of local infiltration), high anxiety, high expectations of pain, and a tendency to cope with pain by acting out and catastrophizing. Predictors of dosing were examined by multiple regression, using data from the entire sample of 236 children. Parents gave more medication when their children had invasive surgery and high levels of pain, when they expected a lot of pain, and when they were relatively unconcerned about the negative effects of pain medication. In each case, the psychological variables, entered as a block, were significant predictors of pain even after controlling for demographic and medical variables. Health care providers should be aware of psychological factors predicting pain, as they may help to identify families that are at "high risk" for pain and undermedication. In addition, the variables identified in this study are appropriate targets for further research on psychological factors that cause, mediate or contribute to pain processes, and as such may contribute to the development of theoretical models of pain and pain management. / Arts, Faculty of / Psychology, Department of / Graduate

Summary: Adiposity is defined as the property of containing fat. Excessive adiposity is a cause of both morbidity and mortality in adults. Important consequences include increased risks of type 2 diabetes, coronary heart disease and stroke, (particularly through the increased risks of high blood pressure, dyslipidaemia and insulin resistance associated with adiposity), osteoarthritis, gall bladder disease and some cancers (particularly endometrial, breast, and colon). There is concern, both in the UK and in other settings, that levels of adiposity have risen during the past 20-30 years or so, both in adults and in children and adolescents, in whom relative increases in risk have been particularly large. Key adiposity indicators include markers of general adiposity, of which body mass index weight (kg)/height2 (m2) is the most commonly used and markers of central adiposity, of which waist circumference is the most commonly used; central adiposity is particularly related to increased risks of cardiovascular disease and type 2 diabetes. High levels of body mass index, and, increasingly waist circumference, have been used to define overweight and obesity, although the definition of cut-offs for abnormality is difficult, especially in children and adolescents. In British adults, there are marked geographic, social and ethnic variations in the occurrence of adiposity. Higher levels of adiposity have been reported in Northern England and Wales when compared to Southern England, in lower social class groups compared to higher ones and among South Asians compared to White Europeans. However, there is limited information on the extent of geographic, social and ethnic variation in adiposity in children. Although raised adiposity in an individual fundamentally reflects an imbalance between energy intake and expenditure, many potential determinants of adiposity have been identified. These include not only recent and previous dietary factors and physical activity, but also early life exposures and parental influences. In a population-based study of British 13-16 year-olds, this Thesis sets out to address four overall aims;- (i) to examine patterns of adiposity, including the interrelationships of different adiposity markers; (ii) to explore geographic, social and ethnic differences in adiposity and relate them to patterns observed in adults; (iii) to examine the association of three individual factors – current physical activity pattern, infant feeding and parental BMI – with adiposity; (iv) to examine the associations between adiposity markers, blood pressure and insulin resistance, particularly to determine which adiposity measures are most strongly related to these factors in adolescence.

Sleep is an important part of everyday life. It directly affects daytime cognition and general performance. In children, sleep is a crucial requirement for growth and learning and lack of sleep may manifest itself as a long lasting developmental deficit. Sleep disorders which disrupt the normal continuity of sleep therefore benefit from early identification and treatment. A common cause of sleep disruption is sleep disordered breathing which can be associated with frequent arousals from sleep. Many relevant areas of sleep research continue to generate new and interesting findings utilising biosignals such as EEGs. Respiratory cycle related EEG change (RCREC) is a good example of this. The method for quantification of RCREC relies on the appropriate application of signal processing and the signals involved in the procedure are polysomnographic. Furthermore, RCREC is thought to reflect morbid micro-arousals in sleep and is hence also of clinical importance. Given that the field of RCREC research is a recently established one, there is much room for constructive investigation. The current state of RCREC research is therefore expanded in this thesis. The method for calculation of respiratory cycle related EEG change (RCREC) is replicated and expanded in this project. Shortcomings of the method have been identified and accounted for where appropriate. In particular, the sensitivity of RCREC to airflow signal segmentation is addressed and alternative segmentation approaches are suggested. The general influence of airflow segmentation on RCREC is investigated and a mathematical explanation for RCREC sensitivity is given. Additionally, the ability of RCREC related parameters to predict daytime cognitive functions is assessed. Results suggest that RCREC parameters are capable of predicting quality of episodic memory, power (speed) of attention and internal processing speed.