Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.

There is very little data on physical and psychological long-term outcome after severe burn injury. The aim of the present thesis was to improve current instruments for assessment of these issues, to assess long-term outcome in a cohort of patients with burn injuries, and to explore the contribution of the individual factors of personality and coping on perceived outcome. Patients treated at the Burn Unit, Uppsala University Hospital, between 1980 and 1995 were included on a consecutive basis if they were 18 years of age or older at follow-up, had burn injuries of ten percent or more, or hospitalization times of seven days or more. A total of 350 patients fulfilled these inclusion criteria. A factor analytic approach was used to derive a 40-item instrument called the Burn Specific Health Scale-Brief (BSHS-B), resulting in nine well-defined domains. Most burn patients reported a very good perceived outcome but a subgroup reported problems years after injury. On a group level most problems were related to Heat Sensitivity, Work and Body Image. The depth of injury, gender, marital status and living conditions were all related to outcome. Neurotic personality traits were related to perceived health, and were not confined only to psychological aspects of life but also included physical aspects. A 33-item burn-specific coping scale, the Coping with Burns Questionnaire (CBQ), with six clearly separated domains with acceptable internal consistencies was developed. Coping strategies were strongly related to outcome in the subgroup of patients reporting most problems in perceived health, and coping contributed more to psychosocial than physical health. Avoidant coping and Emotional support seeking had independent effects on outcome. The observation that Neuroticism and Avoidant coping strategies are related to bad outcome after severe burn injury indicates that patients with such characteristics should be given special attention during rehabilitation.

Long term care and social services (LTCaS) for older people are an important part of the Scandinavian welfare state. The fast growing number of elderly people in Sweden has caused many concerns about increases in future needs (and particularly costs) of age-related social programs such as LTCaS. The general aim of this dissertation is to examine how projected demographic changes may affect future needs for long-term care and services in Sweden assuming different trends in morbidity and mortality. The following data sources are used: national population registers, register data on inpatient/outpatient health care from region Skåne, the Swedish National Survey on Living Conditions (SNSLC) for the period 1975-1999. Three alternative methods to inform simple demographic extrapolations of needs for health and social care for the elderly are presented. Furthermore, a new method for demographic projections has been developed. According to our studies, the health of older people (measured as the prevalence of severe ill-health) has improved during the study period. Taking into account health status, when projecting future needs for LTCaS, will result in a fairly substantial reduction of the rate of the demographically influenced increase in projected LTCaS needs. The changes in population composition regarding education and mortality differentials per educational level may have a significant impact on the number of the elderly in the future. On the other hand, the projected increase in the number of older people suffering from severe ill-health, as a consequence of population ageing, may be counterbalanced to a large extent by changes in the educational composition towards a higher proportion of the population having a high educational level and lower prevalence of severe ill-health. We need to improve our planning tools in order to support policy-makers to plan for uncertainty concerning future needs and demand for LTCaS.

Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients. A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years. Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group. The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen. The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders. Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse. The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.

The intertwined relationship between physical and psychological problems is a topic of much interest in the rehabilitation of severely injured patients, e.g. after a burn. The present study aims at gaining further knowledge concerning the impact of psychological factors and psychiatric morbidity on short and long-term adaptation after burn injury. Outcome was assessed for three main areas: pruritus, return to work and psychiatric health. Three separate samples of previous or current adult patients treated at the Uppsala Burn Unit during different time periods: 1980-1995 (n=248), 1996-2000 (n=86), and 2000-2005 (n=73), were assessed. Chronic burn-related pruritus is more common than previously reported and psychological factors such as anxiety-related personality traits and coping are significantly associated with its presence. Only a small group of former patients with work-related accidents were not working an average of nine years after injury. The unemployed reported more pain and worse perceived health, particularly in psychosocial domains. Returning to work was explained by both injury severity and personality characteristics. Those who were not working had lower health-related quality of life and poorer traumarelated physical and psychological health, and more pain. Preburn psychiatric morbidity is high in a lifetime perspective. Two thirds of the sample had at least one disorder according to the Structured Clinical Interview for DSM-IV Axis I disorders. Affective disorders were especially highly represented. A logistic regression showed that having a history of preburn disorders was associated with a higher risk of both PTSD and depression one year after the injury. In this material it was actually uncommon for a patient without a preburn psychiatric history to develop postburn psychiatric symptomatology. The results have strengthened the overall model for adaptation after burn injury by showing that psychological factors and psychiatric history are important moderators of the adaptation process after the injury.

In Healthy People 2010, mental health is listed as a major public health concern as evidenced by an alarming increase in the number of individuals who suffer from mental disorders. Mental disorders are a treatable public health condition. However, health disparities in the treatment of mental disorders are evident. The purpose of this study was to examine factors that affected health outcomes of persons with mental disorders. Two specific aims were addressed: Aim 1: to examine the relationships of population characteristics (predisposing factors and enabling resources), health behaviors (health services use and health practice); and health outcomes (physical health status and mental health status); Aim 2: to determine the differences in the usual source of care and health outcomes between individuals with self-reported mental disorders and individuals without mental disorders. This study was a secondary analysis of existing data collected from 2006 Medical Expenditure Panel Survey Household Component Consolidated file. A sample of U.S. civilian non-institutionalized adults (N=622) was grouped according to three self-reported health conditions: mental disorders (MD), physical illnesses (PI) and co-morbid mental disorders and physical illnesses (CM). This sample was predominantly male, White non-Hispanic and married; had a high school diploma, middle to high income, and private insurance; and preferred office-based clinics as the usual source of care, F(2,29)=5.94, p = .007. No statistically significant differences between groups in usual source of care (p=.069) and physical health status (p=.490) but there was a significant difference in mental health status (p=.001). Participants with CM had a poorer mental health status than those with PI and MD, F (2,619) =21.8, p= .000. The mental health status of individuals with PI was significantly better than that of participants with MD. Awareness of disparities in the usual source of care, health services use, and health outcomes among individuals with mental health conditions is imperative if barriers to care are to be eliminated. Innovative interventions pertinent to decreasing barriers to accessing health care and improving the health outcomes among individuals with MD must be tested. Advocating for mental health care policies that reduce health care services disparities among individuals with self-reported MD must be encouraged.

Bakgrund: När människor drabbas av venösa bensår kan vardagen drastiskt förändras. Ett stort antal individer drabbas av bensår och incidensen ökar med åldern. För att kunna ge en god omvårdnad behöver vårdpersonalen ökade kunskaper för att förstå bensårens inverkan på individens dagliga liv. Syfte: Syftet med studien var att beskriva hur det är att leva med venösa bensår. Metod: Studien utfördes som en allmän litteraturstudie. Fjorton empiriska studier ingick. Resultat: I samband med bensår förekommer en rad faktorer som på olika sätt påverkar det dagliga livet. Framträdande faktorer var smärta, svullna ben, lukt och läckage, rädsla och välbefinnande. Smärta var det funktionella hälsotillstånd som hade störst inverkan på det dagliga livet. Smärtan ledde till störd nattsömn, försämrad rörlighet och social isolering. Slutsats: Patienter med smärtsamma bensår har svårt att leva det liv som de önskar. Om distriktssköterskan synliggör sambandet mellan dagligt liv och funktionellt hälsotillstånd, kan specifika omvårdnadsåtgärder genomföras. Patienterna kan då uppnå ett önskvärt dagligt liv oavsett funktionellt hälsotillstånd. / Background: When people suffer from venous leg ulcers, their everyday life can be drastically changed. A large number of individuals suffer from leg ulcers and the incidences increase with age. In order to provide good nursing, care staff need more knowledge in order to understand the effects of the ulcers on the individual's daily life. Purpose: The purpose of this study was to describe what it is like to live with venous leg ulcers. Method: The study was carried out as a general literature review. Fourteen observational studies were included. Results: In connection with leg ulcers there are a number of factors that affect the patients’ daily lives in different ways. Important factors were pain, swollen legs, odor and leakage, fear and well-being. Pain was the functional state of health which had the greatest impact on daily life. The pain led to interrupted sleep, impaired mobility and social isolation. Conclusion: Patients with painful leg ulcers have difficulty living the life they desire. If the district nurse makes the connection between daily life and functional health status explicit, specific care measures can be implemented. Then patients can achieve a desirable everyday life regardless their functional state of health.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Canada’s population is aging rapidly, and understanding living arrangements and their determinants plays a critical role in supporting healthy aging. This thesis examined, using a population-based longitudinal survey, the Canadian Multicentre Osteoporosis Study, the effects of clinically-significant change in physical and mental health on future living arrangements, employing generalized estimating equations logistic regression models. Clinically-significant decline in SF-36 Physical Component Score (PCS) increased likelihood of not remaining community-dwelling, or “aging in place” over stable or improved scores by 41%. SF-36 Mental Component Score (MCS) did not show a statistically significant effect on aging in place. Older age and employment status of retired or unemployed increased likelihood of not aging in place, whereas living with a partner, pursuing moderate or vigorous physical activity, and having children increased the likelihood of aging in place. Study findings will inform social and health policy development to support aging in place in Canada and elsewhere.

There are significant differences between developed countries and developing countries in education, life style and health behaviour to identify the effects of the standard of living in both countries on social and health aspects. Information on the negative and positive aspects of every culture is essential in the overall health context to enable policy makers to improve the populations’ general health. The aim of this study was therefore to determine the health and fitness status of sport science students in Germany and Egypt and to identify any relevant differences in these two populations in order to derive possible strategies to promote health in a higher education setting in both countries. The sample of this study was selected from university students as they represent the future elite of companies, communities and countries. 193 students were selected from Germany as a developed country - females (n = 104) and males (n = 89) and 406 were selected from Egypt as a developing country - females (n = 167) and males (n = 238). Sport science students firstly filled in a health questionnaire, and then they participated in anthropometric and fitness tests. The data collection was first contucted on German sport science students at Chemnitz University of Technology in October 2009 (one week). In November 2010 the second year (third and fourth term) sport science students of Menofia University (two weeks). In the comparison between Germany and Egypt in the General health section the results showed that there are significant differences between the German group and the Egyptian group in describing their health status (p = .044) and in looking after their health (p = .000) in females. However, in the male group of both countries no significant difference was found regarding the item looking after their health (p = .370). The overall comparison between the German sample (both genders) and the Egyptian sample (both genders) show that there are significant differences in the items describing their health status (p ≤ 0.05) as well as in looking after their health care (p = .000). In the physical and mental health comparison there is no significance difference in the “chronic pain” section in German females and Egyptian females and German and Egyptian males (p ≥ 0.05), while there are significant differences in all other items (p ≤ 0.05). In the German sample comparison of both genders there are no significant differences in: “Stomach problems”, “Abdominal discomfort”, “Weight loss/weight gain/loss of appetite” whereas there are significant differences in all another items (p≤ 0.05). In the Egyptian group there are significant differences in all another items (p≤ 0.05) except for “Weight loss/weight gain/loss of appetite”. In study and university related problems between Germay and Egypt in both genders, there is no significant difference in the item “problems during study” while there are significant differences in all other items (p≤ 0.05). In the Egyptian group, both gender comparisons show no significant differences in the items: “social isolation”, and the same prospects about “working conditions”. However, there are significant differences in all another items (p≤ 0.05). In the German group in the same context no significant differences were found (p ≥ 0.05). The comparison between Germany and Egypt in the nutrition section showed significant differences in all food types (p≤ 0.05), whereas in the German group there is a significant difference between females and males (p≤ 0.05), and in the Egyptian group there is no significant difference in Healthy food consumption (p ≥ 0.05). The results in the media usage section show a significant difference regarding the media usage behaviour between the German group and the Egyptian group and in the comparison between German group of both genders, and the Egyptian group comparison of both genders where (p ≤ 0.05). Regarding the fitness tests section the results prove that there are significant differences in all tests among the German and the Egyptian group (p≤ 0.05), except in the static pull ups test between German males and Egyptian males (p ≥ 0.05). Significant correlations were found between one of the food types (unhealthy food), some between physical and mental health problems and BMI. There are significant correlations between some items of study and university related problems, and food types and blood pressure, and between fat %, VO2max, and physical activity. A significant link between bad dietary habits in regards to healthy food consumption and students’ own health assessment in Germany was found (95% CI below = 0.10, 95% top = 0.99) with OR = 0.10 and in Egypt (95% CI below = 0.35, 95% CI top = 0.92) with OR = 0.56. Another significant link between a reduced health consciousness and insufficient physical activity in Germany (95% CI below = 0.06, 95% CI top = 0.99) was proven with OR = 0.24. The key results from this study can be summarised in the following points: 1) There is a significant difference between German and Egyptian students in health parameters. 2) Egyptian students have significantly more physical and mental health problems than their German counterparts. 3) The Egyptian students present significantly more study and university related problems compared to German students. 4) The Egyptian students show a significantly higher media usage. 5) Egyptian students participate significantly less in physical activity and therefore perform significantly less well in most fitness test parameters. 6) A high correlation was found between the anthropometric data and some physical and mental health problems as well as study and university related problems and food types. Furthermore, a high correlation between VO2max and physical activity could be identified. 7) Significant link between bad dietary habits in regards to healthy food consumption and their own health assessment. 8) Significant link between a reduced health consciousness and insufficient physical activity. It is evident from this study that there are significant differences between the developed country Germany and the developing country Egypt in regards to general well-being, health problems, which in some parameters is also gender specific in Egypt, physical activity and fitness. The aim of this study was to identify these differences in order to direct future interventional studies in this area as a next step in improving the health of students in different countries. This information could potentially aid policy makers in improving the infrastructure in health care and physical activity and thereby change and/or develop society. / Es gibt signifikante Unterschiede zwischen Industrieländern und Schwellenländern bzgl. Bildung, Lebensstil und gesundheitsbezogenes Verhalten. Daher sind Informationen über die negativen und positiven Aspekte jeder Kultur im Gesundheitskontext essentiell, um Entscheidungsträger in die Lage zu versetzen die allgemeine Gesundheit der Bevölkerung zu verbessern. Die Zielsetzung dieser Studie war in diesem Zusammenhang den Gesundheits- und Fitnessstatuts von Studenten der Sportwissenschaft in Deutschland und Ägypten zu bestimmen und relevante Unterschiede in den beiden Populationen aufzudecken, um daraus mögliche Strategien abzuleiten, Gesundheit im univesitären Bereich in beiden Ländern zu fördern. Die Stichprobe für diese Studie rekrutierte sich aus Universitätsstudenten, da diese die zukünftige Elite von Firmen, Gemeinden und ganzen Ländern darstellen. 193 Studenten aus Deutschland, als Industrieland, wurden eingeschlossen – 104 weibliche und 89 männliche. Weitere 406 Studenten wurden in Ägypten, als Schwellenland, rekrutiert – wovon 167 Frauen und 238 Männer waren. Die Probanden füllten zuerst einen Gesundheitsfragebogen aus und nahmen dann an anthroprometrischen Messungen und Fitnesstests teil. Die Datenerhebing wurde zuerst an den Sportstudenten der TU-Chemnitz in Deutschland im Oktober 2009 duchgeführt. Im November 2010 wurden dann die Sportstudenten an der Menofia Univesität in Äypten getestet. Die Ergebnisse im Vergleich des Allgemeinen Gesundheitsteils zwischen Deutschland und Ägypten zeigte signifikante Unterschiede zwischen der deutschen und der ägyptischen Gruppe bzgl. des Items Beurteilung des eigenen Gesundheitszustandes (p = 0.44) und in Auf seine Gesundheit achten (p = 0.000) bei den Frauen. Allerdings konnte kein signifikanter Unterschied bei den Männern beider Länder nachgewiesen werden (p = 0.370). Der Gesamtvergleich der deustchen und der ägyptischen Stichprobe (beide Geschlechter) wiesen signifikante Unterschiede auf bzgl. der Items Beurteilung des eigenen Gesundheitszustandes (p ≤ 0.05) und auch Auf seine Gesundheit achten (p = 0.000). In der Sektion körperliche und geistige Gesundheit konnte kein signifikanter Unterschied festegestellt werden in den Items „Rücken-, Nacken- und Schulterschmerzen zwischen der ägyptischen und deutschen Population (beide Geschlechter) (p ≥ 0.05), aber dafür in allen anderen Items (p ≤ 0.05). In der deutschen Gruppe wurden keine Unterschiede gefunden bei „Magenbeschwerden/Gewichtszunahme/ Appetitlosigkeit“ – allerdings wurden signifikante Unterschiede in allen anderen Items gefunden (p ≤ 0.05) – in der ägyptischen Gruppe verhielt es sich ebenso. In der Sektion Studium und universitätsbezogene Probleme wurde zwischen Ägypten und Deutschland, auβer bei „Mangelnde praktische Relevanz des Studiums, Tests und Seminararbeiten“, in all anderen Items signifikante Unterschiede nachgewiesen (p ≤ 0.05). Der Geschlechtervergleich der ägyptischen Stichprobe zeigte keine signifikanten Unterschiede in den Items „Anonymität und Isolation an der Uni, und generelle Isolation“ wie auch „Schlechte Karriere, Arbeitslast zusätzlich zur Uni, schlechte Arbeitsbedingungen“. Jedoch sind signifikante Unterschiede zwischen den Geschlechtern in allen anderen Items zu verzeichnen (p ≤ 0.05). Dies traf jedoch nicht auf die deutsche Stichprobe zu (p ≥ 0.05). Der Vergleich zwischen den deutschen und ägyptischen Studenten in der Sektion Ernährung zeigte signifikante Unterschiede in allen Nahrungstypen (p ≤ 0.05) und zusätzlich in der deutschen Gruppe noch signifikante Unterschiede in der Ernährungsweise zwischen Män und Frauen (p ≤ 0.05). Die Ergebnisse in der Sektion Mediennutzung zeigten signifikante Unterschiede zwischen der gesamten deutschen und ägyptischen Stichprobe – wie auch innerhalb deutschen und ebenso ägyptischen Geschlechtervergleich (p ≤ 0.05). Bzgl. der Fitnessektion zeigten die Ergebnisse signifikant bessere Ergebnisse in der deutschen Kohorte im Vergleich zur Ägyptischen (p ≤ 0.05), mit der Ausnahme der „Statischen Klimmzüge“ bei den männlichen Studenten in Deutschland und Ägypten (p ≥ 0.05). Des Weiteren wurden signifikante Korrelationen gefunden zwischen dem Nahrungstypus „ungesundes Essen“ und einigen Parametern der körperlichen und geistigen Gesundheitsprobleme wie auch BMI. Es gibt ebenfalls signifikante Korrelationen zwischen weiteren Items der Sektion Studiums und universitätsbezogenen Problemen, und Nahrungstypen und Blutdruck – wie auch Körperfett %, VO2max und körperlicher Aktivität. Eine signifkante Verbindung der Wahrscheinleichtkeiten wurde zwischen schlechten Ernährungsgewohnheiten bzgl. Konsum von gesundem Essen und der Selbsteinschätzung der Gesundheit der Studenten wurde festgestellt (95% CI below = 0.10, 95% top = 0.99) mit einer OR = 0.10 und in Ägypten (95% CI below = 0.35, 95% CI top = 0.92) mit einer OR = 0.56. Ein weiterer signifikante Wechselbeziehung konnte zwischen einem reduzierten Gesundheitsbewuβtsein und unzureichender körperlicher Aktivität in Deutschland nachgewiesen werden (95% CI below = 0.06, 95% CI top = 0.99), mit einer OR = 0.24. Die Kernergebnisse dieser Studie lassen sich in folgenden Punkten zusammenfassen: 1) Es gibt eine signifikante Differenz zwischen deutschen und ägyptischen Studenten bzgl. Gesundheitsparameter. 2) Ägyptische Studenten haben signifikant mehr körperliche und mentale Gesundheitsprobleme als die deutsche Stichprobe. 3) Die ägyptischen Studenten zeigten signifikant mehr Studiums- und universitätsbezogene Probleme als die deutschen Studenten. 4) Die ägyptischen Studenten hatten einen signifikant höheren Medienkonsum als die deutsche Stichprobe. 5) Ägyptische Studenten wiesen signifikant weniger körperliche Bewegung auf als die deutschen Studenten und schnitten daher auch mit einer signifkant geringeren Leistung in den Fitnesstests ab. 6) Eine hohe Korrelation konnte nachgewiesen werden zwischen den anthropometrischen Daten und einigen körperlichen und psychischen Gesundheitsproblemen. Des Weiteren wurde erwartungsgemäβ auch eine hohe Korrelation zwischen VO2max und körperlicher Aktivität gezeigt. 7) Es gibt einen signifikantnten Zusammenhang zwischen schlechten Ernährungsgewoheiten bei dem Konsum von gesunden Nahrungsgewohnheiten bei dem Konsum von gesunden Nahrungsmitteln und der eigenen Gesundheitseinschätzung. 8) Des Weiteren gibt es einen signifikanten Zusammenhang zwischen einem reduzierten Gesundheitsbewusstsein und unzureichender körperlicnher Aktivität. Es ist durch die Ergebnisse dieser Studie evident, dass es signifikante Unterschiede zwischen Industrieländern und Schwellenländern gibt bzgl. des allgemeinen Wohlbefindens, Gesundheitsproblemen, von denen einige Parameter in der ägyptischen Population auch geschlechtsspezifisch sind, körperlicher Aktivität und Fitness. Das Ziel dieser Studie war es diese Unterschiede zu identifizieren und damit zukünftigen Interventionsstudien Anhaltspunkte zu liefern, um im nächsten Schritt die Gesundheit von Studenten in verschiedenen Ländern zu verbessern. Diese Informationen kann potentiell Entscheidungsträgern helfen, die Infrastruktur bzgl. Gesundheitsversorgung und die Rahmenbedingungen für körperlicher Aktivität zu verbessern und dadurch die Gesellschaft zum positiven zu verändern bzw. weiterzuentwickeln.