Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

<p>Stress is known to play an important role in the natural history of gastrointestinal diseases, and functional disorders in particular. In health, activation of the stress response serves to maintain homeostasis in response to harmful stimuli. However, prolonged activation of the stress response can become maladaptive and contribute to the initiation and maintenance of symptoms in disorders such as irritable bowel syndrome (IBS). The mechanisms underlying this detrimental effect are unclear. This thesis investigates this relationship by examining the influence of 10 days of water avoidance stress on a murine model of acute bacterial gastroenteritis; a known trigger in a subset of IBS patients. Results indicate that stress can increase the level of the stress hormone norepinephrine in the gut. However, the overall influence of host stress during infection proves to be beneficial in this model, with decreased colonic inflammation and earlier clearance of the pathogen. Next, we utilized the olfactory bulbectomy (OBx) model of depression comorbid anxiety, which shows a heightened stress response, to examine mechanism underlying stress-mediated susceptibility in a more chronic setting. OBx resulted in increased neural activity and motility in the gut, and a change in composition of gut microbiota. These responses were not accompanied by changes in gut permeability or immune activation. Thus stress alters the habitat of commensal bacteria via a neurally mediated change in colonic motility. These results have bearing on the ability of stress to alter the microbiota: a feature of functional GI disorders.</p> / Doctor of Philosophy (Medical Science)

Background. There are inconclusive findings regarding whether danger and loss events differentially predict the onset of anxiety and depression. Method. A community sample of adolescents and young adults (n=2304, age 14–24 years at baseline) was prospectively followed up in up to four assessments over 10 years. Incident anxiety and depressive disorders were assessed at each wave using the DSM-IV/M-CIDI. Life events (including danger, loss and respectively mixed events) were assessed at baseline using the Munich Event List (MEL). Logistic regressions were used to reveal associations between event types at baseline and incident disorders at follow-up. Results. Loss events merely predicted incident ‘pure’ depression [odds ratio (OR) 2.4 per standard deviation, 95% confidence interval (CI) 1.5–3.9, p<0.001] whereas danger events predicted incident ‘pure’ anxiety (OR 2.3, 95% CI 1.1–4.6, p=0.023) and ‘pure’ depression (OR 2.5, 95% CI 1.7–3.5, p<0.001). Mixed events predicted incident ‘pure’ anxiety (OR 2.9, 95% CI 1.5–5.7, p=0.002), ‘pure’ depression (OR 2.4, 95% CI 1.6–3.4, p<0.001) and their co-morbidity (OR 3.6, 95% CI 1.8–7.0, p<0.001). Conclusions. Our results provide further evidence for differential effects of danger, loss and respectively mixed events on incident anxiety, depression and their co-morbidity. Since most loss events referred to death/separation from significant others, particularly interpersonal loss appears to be highly specific in predicting depression.

Background: Earlier clinical studies have suggested consistent differences between anxious and non-anxious depression. The aim of this study was to compare parental pathology, personality and symptom characteristics in three groups of probands from the general population: depression with and without generalized anxiety disorder (GAD) and with other anxiety disorders. Because patients without GAD may have experienced anxious symptoms for up to 5 months, we also considered GAD with a duration of only 1 month to produce a group of depressions largely unaffected by anxiety. Method: Depressive and anxiety disorders were assessed in a 10-year prospective longitudinal community and family study using the DSM-IV/M-CIDI. Regression analyses were used to reveal associations between these variables and with personality using two durations of GAD: 6 months (GAD-6) and 1 month (GAD-1). Results: Non-anxious depressives had fewer and less severe depressive symptoms, and higher odds for parents with depression alone, whereas those with anxious depression were associated with higher harm avoidance and had parents with a wider range of disorders, including mania. Conclusions: Anxious depression is a more severe form of depression than the non-anxious form; this is true even when the symptoms required for an anxiety diagnosis are ignored. Patients with non-anxious depression are different from those with anxious depression in terms of illness severity, family pathology and personality. The association between major depression and bipolar disorder is seen only in anxious forms of depression. Improved knowledge on different forms of depression may provide clues to their differential aetiology, and guide research into the types of treatment that are best suited to each form.

Hintergrund. Angst- und depressive Störungen treten sehr häufig auf. Die Komorbidität zwischen beiden Störungsgruppen ist hoch. Quer- und Längsschnittstudien legen nahe, dass vorausgehende Angststörungen das Risiko sekundärer Depression erhöhen, wobei wenig zur Rolle klinischer Charakteristika von Angststörungen in diesem Zusammenhang bekannt ist. Es liegen eine Fülle von Befunden zu Risikofaktoren für Angst- und depressive Störungen vor, die bei genauerer Betrachtung allerdings eine Reihe methodischer Limitationen und offener Forschungsfragen aufweisen (z.B. viele Querschnittserhebungen, klinische Stichproben, keine vergleichenden Analysen der Risikofaktoren von Angststörungen versus Depression). Eine reliable Bewertung der diagnostischen Spezifität vs. Unspezifität von Vulnerabilitäts- und Risikofaktoren von Angst- und depressiven Störungen mit den bislang vorliegenden Ergebnissen schwer möglich ist. Fragestellungen. Es wurden Gemeinsamkeiten und Unterschieden hinsichtlich der Korrelate und Risikofaktoren von reinen Angst- versus reinen depressiven Störungen untersucht. Durch einen Vergleich reiner Angst- mit reinen depressiven Störungen sollte eine reliablere Einschätzung der Spezifität versus Unspezifität der untersuchten Vulnerabilitäts- und Risikofaktoren erfolgen. Der zweite Fokus lag in der Analyse der Rolle von primären Angststörungen und der mit ihnen assoziierten klinischen Merkmale bei der Entwicklung sekundärer Depressionen. Methoden. Die „Early Developmental Stages of Psychopathology (EDSP)“- Studie ist eine prospektive, longitudinale Studie. Eine repräsentative Bevölkerungsstichprobe von ursprünglich 3021 Jugendlichen und jungen Erwachsenen (zu Baseline 14-24 Jahre alt) wurde dreimal befragt (eine Baseline-Erhebung sowie zwei Folgebefragungen). Zusätzlich wurden die Eltern der Probanden, die am ersten Follow-Up teilgenommen hatten, in einem Elterninterview direkt interviewt. Von 2548 Probanden lagen diagnostische Informationen von der Basisbefragung und des Follow-Up-Zeitraumes vor. Psychische Störungen wurden mit Hilfe des M-CIDI nach DSM-IV Kriterien erfasst. Darüber hinaus wurden eine Vielzahl potenzieller Risikofaktoren (z.B. Behavioral Inhibition, kritische Lebensereignisse) erhoben. Ergebnisse. Die drei wichtigsten Ergebnisse dieser Arbeit waren: a)Es konnten gemeinsame, aber auch einige spezifische Risikofaktoren für Angststörungen versus depressive Störungen nachgewiesen werden. b)Die Angststörungen stellen eine heterogene Gruppe dar: Auch innerhalb der Gruppe der Angststörungen zeichnen sich spezifische Risikofaktoren für spezifische Angststörungen ab (d.h. es fanden sich Unterschiede zwischen Spezifischer und Sozialer Phobie). c)Es wurden starke Assoziationen zwischen Angststörungen sowie der mit ihnen assoziierten Merkmale (Beeinträchtigung, Komorbidität, Panikattacken) und der Entwicklung sekundärer depressiver Störungen gefunden. Im multiplen Modell, das alle klinischen Merkmale beinhaltete, stellte sich der Faktor schwere Beeinträchtigung als bedeutendster Prädiktor heraus. Diskussion und Schlussfolgerungen. Insgesamt befürworten die Befunde dieser Arbeit eher die sog. Splitters-Perspektive von zumindest teilweise unterschiedlichen Risikofaktoren für Angst- und depressive Störungen. Einer der potentesten Risikofaktoren für depressive Störungen scheinen vorausgehende Angststörungen zu sein, der Schweregrad der Beeinträchtigung durch die Angststörung spielt dabei eine entscheidende Rolle. Eine rechtzeitige, effektive Behandlung dieser Angststörungen könnte eine sehr erfolgversprechende Strategie in der Prävention depressiver Störungen sein. Der Beeinträchtigungsgrad durch die Angststörung kann dabei zur Identifizierung von sog. Hoch-Risiko-Personen genutzt werden. / Background. Anxiety disorders and depression are frequent mental disorders; comorbidity is high. Although cross-sectional and longitudinal studies suggest that anxiety disorders increase the risk of subsequent depression, little is known about the role of clinical characteristics of anxiety disorder in this association. Furthermore, there are a lot of studies investigating risk factors of anxiety disorders and depression. Most of these studies, however, have some substantial limitations (e.g., cross-sectional design, clinical samples, lack of analyses comparing risk factors of anxiety disorders versus depression) preventing a reliable assessment of the specificity of vulnerability and risk factors for anxiety disorders and depression. Aims. The first aim of the study was to examine common and specific correlates and risk factors of pure anxiety disorders versus pure depression. The second aim was to analyse the association between anxiety disorders and subsequent depression and the role of clinical characteristics of anxiety disorders in this associations. Methods. The data are from the Munich Early Developmental Stages of Psychopathology (EDSP) study. The EDSP study is a 4-year prospective-longitudinal community study, which includes both baseline and follow-up data on 2548 adolescents and young adults 14 to 24 years of age at baseline. Parents of those probands participated at the first follow-up of the study were also interviewed. DSM-IV diagnoses were made using the Munich-Composite International Diagnostic Interview (M-CIDI). A range of risk factors were assessed (e.g., behavioral inhibition, life events). Results. There were both common and specific risk factors of anxiety disorders and depression. Furthermore, specific risk factors for specific anxiety disorders could be identified (i.e. different risk factors of specific phobia versus social phobia were found). Anxiety disorders and their clinical characteristics (impairment, comorbidity, panic attacks) were significantly associated with the development of subsequent depression. In the final model, which included all clinical characteristics, severe impairment remained the only clinical feature that was an independent predictor of subsequent depression. Discussion and conclusions. The findings suggest that there are specific risk factors of anxiety disorders and depression. Anxiety disorders are a very powerful risk factor for subsequent depression whereas severe impairment seems to play a major role in this association. Effective treatment of anxiety disorders, specifically those associated with extreme disability, might be important for targeted primary prevention of depression. The degree of impairment of anxiety disorders could be used for the identification of individuals at highest risk for onset of depression.

Los trastornos mentales, como la ansiedad y depresión, son un problema de salud pública. Una de las poblaciones más afectadas son los estudiantes universitarios, debido a que están expuestos a diversos factores estresantes. Se ha demostrado que el ejercicio físico tiene una relación inversa con las variables psicológicas de ansiedad y depresión. El objetivo principal de este estudio es describir la relación entre los grados de actividad física con los niveles de ansiedad y depresión en estudiantes de Medicina Humana del primer al sexto año de estudios de una universidad de Lambayeque, año 2022. Los instrumentos de recolección de datos fueron Cuestionario Internacional de Actividad Física (IPAQ) versión corta, Inventario de Ansiedad de Beck (BAI) e Inventario de Depresión de Beck 2da versión (BDI-II). Se utilizó el Coeficiente de correlación Spearman y un modelo de regresión logística binaria (técnica multivariada) para medir la correlación entre las variables estudiadas. El estudio incluyó 188 estudiantes, que cumplieron con criterios de inclusión, con edad media 20 años. Se encontró que en su mayoría los estudiantes presentaron síntomas de ansiedad leves (37.8%), síntomas depresivos graves (8.5%) y realizaba un grado de actividad física bajo (40.4%) En el modelo de regresión logística binaria, se encontró que existe relación inversa entre las variables actividad física y depresión OR es 0.477 (con un intervalo de confianza al 95% del 0.254 al 0.895) con un p-valor es menor a 0.05. No se encontró correlación estadísticamente significativa entre las variables actividad física con ansiedad. / Mental disorders, such as anxiety and depression, are a public health problem. One of the most affected populations are university students, because they are exposed to various stressors. It has been shown that physical exercise has an inverse relationship with the psychological variables of anxiety and depression. The main objective of this study is to describe the relationship between the degrees of physical activity with the levels of anxiety and depression in Human Medicine students from the first to sixth year of studies at a university in Lambayeque, year 2022. The data collection instruments were International Physical Activity Questionnaire (IPAQ) short version, Beck Anxiety Inventory (BAI) and Beck Depression Inventory 2nd version (BDI-II). The Spearman correlation coefficient and a binary logistic regression model (multivariate technique) were used to measure the correlation between the variables studied. The study included 188 students, who met the inclusion criteria, with an average age of 20 years. It was found that the majority of students presented mild anxiety symptoms (37.8%), severe depressive symptoms (8.5%) and carried out a low degree of physical activity (40.4%). In the binary logistic regression model, it was found that there is an inverse relationship between the variables Physical activity and depression, OR is 0.477 (with a 95% confidence interval of 0.254 to 0.895) with a p-value of less than 0.05. No statistically significant correlation was found between the physical activity variables and anxiety.

Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.

HINTERGRUND: Die Typ-D-Persönlichkeit (von distressed personality) etablierte sich in den letzten Jahren als ein Risikofaktor für den Verlauf kardiovaskulärer Erkrankungen. Die bisherigen Studien waren in den Niederlanden oder Belgien durchgeführt worden. Das Ziel der hier vorliegenden Arbeit war eine unabhängige Überprüfung der Ergebnisse an einer Stichprobe deutscher kardiologischer Patienten. Zusätzlich sollte untersucht werden, ob die Typ-D-Persönlichkeit und ihre Dimensionen der negativen Affektivität (NA) und der sozialen Inhibition (SI) über den Untersuchungszeitraum stabil blieben. METHODEN: Hierzu wurden 1040 stationär oder ambulant kardiologisch behandelte Patienten rekrutiert. Mithilfe der Typ-D-Skala (DS14) und der Hospital Anxiety and Depression Scale (HADS) wurden die Merkmale einer Typ-D-Persönlichkeit sowie Depressivität und Ängstlichkeit erhoben. Zusätzlich wurden klinisch relevante Daten, wie z. B. Geschlecht, Alter und kardiale Vorerkrankungen, erfasst. Endpunkt der Studie war die Gesamtmortalität. Mit Cox-Regressionsanalysen wurde das relative Sterblichkeitsrisiko der Probanden ermittelt. ERGEBNISSE: Hinsichtlich der Stabilität von Typ-D, NA und SI ergaben sich über einen Zeitraum von 5,9 Jahren Re-Test Stabilitäten an der unteren Grenze des Erwarteten. Es gab also eine gewisse Stabilität der Typ-D-Persönlichkeit, diese war aber nicht wesentlich höher als beispielsweise die von Angst und Depressivität, und auf Ebene des individuellen Patienten kam es häufig zu Veränderungen. Der Überlebensstatus ließ sich für 977 Studienteilnehmer ermitteln, hiervon waren 172 im Beobachtungszeitraum verstorben. In univariater und multivariater Analyse waren weder Typ-D noch NA oder SI Prädiktionsfaktoren einer höheren Gesamtmortalität. Im Gegensatz zu anderen Studien wies unsere Stichprobe ein heterogenes kardiales Erkrankungsprofil auf. Eine hierdurch bedingte Verschleierung eines Einflusses des Typ-D-Musters konnten wir durch separate Untersuchung der KHK-Patienten ausschließen. SCHLUSSFOLGERUNG: Zusammenfassend lässt sich sagen, dass unsere Studie zu den größten zählt, die bisher zur Evaluation des Einflusses der Typ-D-Persönlichkeit auf die Gesamtmortalität kardiologischer Patienten durch-geführt worden ist. Nach mehr als 5 Jahren Beobachtungszeit, mit 5764 Menschenjahren und 172 beobachteten Todesfällen hat sie suffiziente Ausdruckskraft, relevante Effekte der Typ-D-Persönlichkeit auf die Mortalität aufzudecken. Die klare Abwesenheit dieses Effektes in univariater und multivariater Analyse legt den Schluss nahe, dass die Typ-D-Persönlichkeit und ihre Dimensionen NA und SI bei deutschen kardiologischen Patienten nicht mit einer erhöhten Mortalität assoziiert sind. Die Diskrepanz zwischen unseren Ergebnissen und den Ergebnissen von Denollet und seiner Arbeitsgruppe macht weitere Forschung an anderen Stichproben nötig. Kulturelle Unterschiede in der Verarbeitung negativer Affekte sind als mögliche Ursache unserer abweichenden Ergebnisse zu diskutieren und sollten in zukünftigen Studien weiter untersucht werden.

Introdução: A Síndrome dos Ovários Policísticos (SOP) é uma doença que acomete de 5 a 10% das mulheres. A SOP tem sido relacionada em alguns estudos à disfunção sexual, ao aumento da ansiedade e depressão e à redução da qualidade de vida. Essas alterações podem estar relacionadas às alterações fenotípicas da SOP como o aumento do peso e das circunferências de quadril e cintura resultantes do hiperandrogenismo. A alteração no estilo de vida, principalmente envolvendo a prática de exercícios físicos, tem sido relevante na melhora das condições de saúde. Até o momento, há poucos estudos avaliando os efeitos do treinamento físico aeróbio sobre a função sexual em mulheres com SOP. Objetivo: Avaliar o efeito do treinamento físico aeróbico na função sexual de mulheres com a Síndrome dos Ovários Policísticos. Métodos: Trata-se de um ensaio clínico controlado com alocação aleatória e randomização estratificada pelo índice de massa corporal (IMC) em 3 grupos paralelos: grupo treinamento aeróbio contínuo (GAC), grupo treinamento aeróbio intermitente (GAI) e grupo controle sem treinamento (GC), sendo GAC com 23 voluntárias, o GAI com 22 voluntárias e o GC com 24 voluntárias. As avaliações ocorreram antes e após o período de 16 semanas de intervenção do treinamento físico aeróbio ou de observação no grupo controle. Foi realizada dosagem plasmática de testosterona, antes e após a intervenção. A função sexual, o risco de ansiedade e depressão e a qualidade de vida foram avaliados respectivamente, por meio dos questionários validados para o Português: Índice de Função Sexual Feminina (IFSF), Escala de Ansiedade e Depressão Hospitalar (HAD), e Questionário de Qualidade de Vida - SF-36. Resultados: Houve diferença significante na RCQ no grupo GAI (p = 0.047) e redução nos níveis de testosterona nos grupos GAC (p < 0.01) e GAI (p = 0.04). Na avaliação do IFSF no GC não houve qualquer alteração antes e após as 16 semanas. Contudo no GAC ocorreu aumento nos escores IFSF total (p = 0.048), satisfação (p = 0.049) e dor (p = 0.03). No GAI foram observados aumentos nos escores: IFSF total (p < 0.01), desejo (p < 0.01), excitação (p < 0.01), lubrificação (p < 0.01), orgasmo (p < 0.01) e satisfação (p = 0.02). Já na avaliação do questionário HAD observou- se diminuição tanto na ansiedade (p = 0.01) e (p < 0.01), quanto na depressão (p < 0.01) e (p = 0.02) nos grupos GAC e GAI respectivamente. Com relação ao SF-36 no GAC foram identificados aumento do escores: aspectos físicos (p = 0.01); estado geral de saúde (p = 0.02); vitalidade (p < 0.01); aspectos sociais (p < 0.01); aspectos emocionais (p = 0.03) e saúde mental (p < 0.01). No GAI houve elevação dos escores: capacidade funcional (p < 0.01); estado geral de saúde (p < 0.01); vitalidade (p < 0.01); aspectos sociais (p < 0.01); aspectos emocionais (p = 0.03) e saúde mental (p < 0.01). Conclusão: Ambos os protocolos de treinamento físico aeróbio foram eficazes na melhora da função sexual, ansiedade e depressão e qualidade de vida, observando maior efetividade no treinamento físico aeróbio intermitente. / Introduction: Polycystic Ovarian Syndrome (PCOS) is a disease that affects 5 to 10% of women. PCOS has been linked in some studies to sexual dysfunction, increased anxiety and depression, and reduced quality of life. These changes may be related to phenotypic changes in PCOS such as increased weight and hip and waist circumferences resulting from hyperandrogenism. The change in lifestyle, mainly involving the practice of physical exercises, has been relevant in improving health conditions. To date, there are few studies evaluating the effects of aerobic exercise training on sexual function in women with PCOS. Objective: To evaluate the effect of aerobic physical training on the sexual function of women with Polycystic Ovarian Syndrome. Methods: This is a controlled clinical trial with random allocation and randomization stratified by body mass index (BMI) in 3 parallel groups: continuous aerobic training group (GAC), intermittent aerobic training group (GAI) and control group without training (GC), GAC with 23 volunteers, GAI with 22 volunteers and GC with 24 volunteers. Evaluations occurred before and after the 16-week intervention period of aerobic or observational physical training in the control group. Testosterone plasma levels were measured before and after the intervention. Sexual function, risk of anxiety and depression, and quality of life were evaluated, respectively, using validated questionnaires for Portuguese: Female Sexual Function Index (IFSF), Hospital Anxiety and Depression Scale (HAD), and Questionnaire Quality of Life - SF-36. Results: There was a significant difference in WHR in the GAI group (p = 0.047) and reduction in testosterone levels in the groups GAC (p <0.01) and GAI (p = 0.04). In the evaluation of IFSF in the CG there was no change before and after 16 weeks. However, in GAC, there was an increase in total IFSF (p = 0.048), satisfaction (p = 0.049) and pain (p = 0.03). GAI showed increases in scores: total IFSF (p <0.01), desire (p <0.01), excitation (p <0.01), lubrication (p <0.01), orgasm (p <0.01) and satisfaction (p = 0.02). In the evaluation of the HAD questionnaire, both anxiety (p = 0.01) and (p <0.01) and depression (p <0.01) and (p = 0.02) in the GAC and GAI groups respectively. Regarding the SF-36 in the GAC was identified increase of the scores: physical aspects (p = 0.01); general health status (p = 0.02); vitality (p <0.01); social aspects (p <0.01); emotional aspects (p = 0.03) and mental health (p <0.01). In GAI there was elevation of the scores: functional capacity (p <0.01); general health status (p <0.01); vitality (p <0.01); social aspects (p <0.01); emotional aspects (p = 0.03) and mental health (p <0.01). Conclusion: Both aerobic physical training protocols were effective in improving sexual function, anxiety and depression and quality of life, observing greater effectiveness in intermittent aerobic physical training.

[Truncated abstract] Veterinarians have considerable potential for exposure to several known reproductive hazards such as radiation, anaesthetic gases, pesticides, long working hours and occupational stress. Reproductive effects are a concern to female veterinarians, especially now that about 65% of graduates from Australian veterinary science schools are female. In the last two decades, there have been reports on the possible associations between occupational exposures and adverse reproductive outcomes in female veterinarians, but most of them have been equivocal and the whole area remains controversial. More evidence is needed before firm conclusions can be drawn. The Health Risks of Australian Veterinarians project (HRAV) was conducted as a questionnaire-based survey of all graduates from Australian veterinary schools during the 40-year period 1960-2000. Of 5,748 eligible veterinarians who were sent the questionnaires (73% of the whole cohort), 2,800 replied including 1,197 females (42.8%). Among women veterinarians eligible to participate, 59% participated . . . Identification of these associations may provide the opportunity for preventing harmful exposures and thus reduce the risk of any adverse reproductive outcomes not only for veterinarians, but also for other groups exposed to these risks such as veterinary nurses, animal laboratory technicians, anaesthetists, dentists, dental assistants, and other similar professional groups. The author of this thesis, having completely addressed the research objectives of her doctoral candidacy, has set out and acted on a future research agenda designed to explore the association between perceived occupational stress and pregnancy outcomes and infertility in Australian female veterinarians.