Thesis (Ph.D.)--Victoria University (Melbourne, Vic.), 2009.

Thesis (Ph.D.)--University of Wyoming, 2009. / Title from PDF title page (viewed on July 6, 2010). Includes bibliographical references.

Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2004. / "A dissertation in nursing." Advisor: Peggy Ward-Smith. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed feb. 27, 2006. Includes bibliographical references (leaves 124-131). Online version of the print edition.

Thesis (M.A.)--State University of New York at Binghamton, Department of Anthropology, 2008.

Studies of cognitive performance among persons with chronic fatigue syndrome (CFS) have yielded largely inconsistent results. The present study sought to contribute to findings in this area by examining intraindividual variability as well as level of performance in cognitive functioning. A battery of cognitive measures was administered to 14 CFS patients and 16 healthy individuals on 10 weekly occasions. Analyses comparing the two groups in terms of level of performance as defined by latency and accuracy scores revealed that the CFS patients were slower in their reaction speeds than healthy persons. Comparing the groups with respect to intraindividual variability (as measured by intraindividual standard deviations and coefficients of variation) revealed greater intraindividual variability within the CFS group, although the results varied by task and time frame used. Intraindividual variability was found to be fairly stable across time, and consistent across tasks on each testing occasion. The present findings support the proposition that intraindividual variability is a meaningful correlate of cognitive performance in CFS patients. / Graduate

Introduction Older adults’ sexuality has been linked with a number of factors associated with wellbeing. Despite sexual practices changing across the lifespan, sexuality remains an important part of the identity of older adults. The ageing population of the United Kingdom is placing increasing demands on care homes, yet despite the recognised benefits of older adults’ sexuality best practice guidelines for care homes either fail to comment on residents’ sexuality or provide recommendations which are too minimal or vague to operationalise. Most research exploring older adults’ sexuality in care homes has focussed on the views of health and social care practitioners who report on their lack of willingness to engage with residents about their sexuality needs. Research which attempts to explore older adults’ sexuality in care homes from the perspective of residents favours quantitative research methods, an approach which arguably fails to acknowledge the changes in sexual expression which occur with age. Furthermore, the lack of consensus regarding the conceptualisation of the term ‘sexuality’ across the literature limits the extent to which research findings can be synthesised. This research sought to contribute to understandings of older adults’ sexuality experiences in care homes from a first-person perspective by adopting a prospective planning approach to explore prognostications about how transitioning to a care home might impact upon experiences of sexuality and participants’ hopes and fears regarding care provision. To increase the interpretability of findings and contextualise responses, the definition of sexuality from the perspective of older adults was also considered. Methods Semi-structured interviews were conducted with ten participants to explore three broad questions: (1) How do older adults define ‘sexuality’? (2) What impact might a care home have on sexuality experience? (3) How would individuals like sexuality to be acknowledged by care services? Face-to-face and telephone interviews were audio recorded, transcribed, and analysed using a hybrid inductive/deductive thematic analysis approach at a mixed manifest/latent level. Results Participants defined sexuality as a multifaceted component of self-identity which held individual meaning and changed across the lifespan. Participants’ definitions of sexuality were compared with the World Health Organisation’s (WHO) working definition of sexuality, and areas of difference and similarity were identified. Participants anticipated that becoming a resident of a care home would prompt significant (and often negative) changes with regards to how they could experience sexuality. Participants wanted services to demonstrate attempts to minimise the environmental impact on sexuality and promote positive experiences in a manner that was responsive to individual need. Discussion While used as an ageless term, ‘sexuality’ has different understandings and applications across the lifespan and remains an important part of the identity of older adults. Findings from this study indicated that participants expected to embody the role of the non-sexual resident when transitioning into a care home, changes in identity which were predicated on living in an environment which was predicted to neither acknowledge nor facilitate positive sexuality experiences.

La polyarthrite rhumatoïde (PR) est une maladie inflammatoire chronique d’étiologie inconnue. L’inflammation présente dans cette pathologie est fortement dépendante de la cytokine pro-inflammatoire qu’est le TNFα. Cette molécule possède deux récepteurs : le TNFR1 et le TNFR2. Le TNFR1 est un récepteur exprimé à la surface de toutes les cellules. L’activation de sa voie de signalisation déclenche la mort cellulaire et elle est souvent associée à des phénomènes inflammatoires. Le TNFR2, quant à lui, est exprimé à la surface des cellules immunitaires, des cellules endothéliales et des cellules neuronales. L’activation de la signalisation du TNFR2 conduit à la survie et à la prolifération cellulaire. Le TNFR2 est de plus, associé à des mécanismes anti-inflammatoires. Les lymphocytes T régulateurs (Treg), cellules clé dans le contrôle de la réponse immunitaire, sont caractérisés par l’expression du facteur de transcription Forkhead box P3 (FoxP3) et sont défectueux chez des patients atteints de PR. Ces cellules expriment les deux récepteurs du TNFα et sont capables d’inhiber l’action des cellules inflammatoires et particulièrement des T effecteurs par différents mécanismes d’immunosuppression. Les Treg exprimant le TNFR2 représentent la population la plus immunosuppressive actuellement recensée. L’objectif de notre travail a été de mieux comprendre le rôle des Treg exprimant le TNFR2 dans le contrôle de l’inflammation dépendante du TNFα. Tout d’abord, nous avons montré que la signalisation TNFα-TNFR2 sur les Treg augmentait le maintien de l’expression de FoxP3 ainsi que la prolifération de ces cellules. L’expression du TNFR2 est en outre liée à une stabilité accrue de ces cellules. Ces résultats peuvent expliquer le rôle important que pourraient jouer les Treg TNFR2+ dans le contrôle de l’inflammation dépendante du TNFα. Afin de confirmer cette hypothèse, nous avons démontré, dans deux modèles expérimentaux d’inflammation dépendants du TNFα (arthrite et psoriasis), que les Treg TNFR2+ jouaient un rôle prépondérant dans le contrôle de l’inflammation. Enfin, des expériences effectuées chez des patients atteints de PR ont mis en évidence que les traitements anti-TNFα conduisaient à une augmentation de la fréquence des Treg TNFR2+ circulants chez des patients répondeurs. En démontrant le rôle prépondérant des Treg TNFR2+ dans la résolution de l’inflammation, ce travail ouvre la voie vers l’élaboration de thérapies ciblant le système TNFα/TNFR plus spécifiques pour le traitement de la PR et d’autres pathologies dépendantes du TNF. / Rheumatoid arthritis (RA) is a chronic inflammatory disease with unknown etiology. In this pathology, inflammation is mainly dependent on the pro-inflammatory cytokine TNFα. This molecule acts through two receptors: TNFR1 and TNFR2. TNFR1 is expressed on almost all cell types. Activation of this pathway mainly leads to cell death and is often associated with pro-inflammatory response. In contrast, TNFR2 is expressed on immune, epithelial and neuronal cells. Activation of TNFR2 signaling triggers cellular survival and cell proliferation. Furthermore, TNFR2 pathway is associated with anti-inflammatory mechanisms. Regulatory T cells (Treg) play a pivotal role in the control of inflammation and are defective in RA. They are characterized by the expression of transcriptional factor Forkhead box P3 (FoxP3). Tregs express both TNFα receptors and are able to inhibit inflammatory cells, specifically effector T cells using various immunosuppressive mechanisms. Treg expressing TNFR2 have been identified as the most suppressive Treg population. The aim of this study was to elucidate the role of TNFR2+ Tregs in TNFα mediated - inflammation by. Firstly, we have shown that TNFα-TNFR2 signaling on Tregs increased their proliferation and helped to maintain FoxP3 expression. Moreover, TNFR2 expression was associated with increased Treg stability. These results could explain the potential role of TNFR2+ Tregs in control of TNFα mediated - inflammation. To confirm this hypothesis, we demonstrated, in two models of inflammation mediated by TNFα (arthritis and psoriasis), that TNFR2+ Tregs play a major role in the control of inflammation. Finally, our experiments in RA patients highlighted that anti-TNFα treatments increased circulating TNFR2+ Treg frequency in responder RA patients. By demonstrating the major role of TNFR2+ Tregs in resolution of inflammation, our work paves the way for therapies targeting more specifically TNFα/TNFR system to cure RA and others TNFα - mediated pathologies.

Background: Thai culture venerates caring for elders, thus care homes are stigmatised as the domain of poor older adults with no family. This impacts negatively on the psychological wellbeing of older residents and the high prevalence of depression reported among them. However, little is understood about the key factors influencing the depressive symptoms and how such stigma is experienced among care home residents. This study explored factors associated with depressive symptoms, internalised stigma, self-esteem, social support and coping strategies among residents from the perspectives of residents and staff. Methods: Mixed methods research (convergent parallel design) was conducted in two care homes in northeast Thailand using a cross-sectional questionnaire, in-depth interview and non-participant observation. A cross-sectional questionnaire study was conducted with 128 older care home residents (with a response rate of 98.46%) using the 15-Item Thai Geriatric Depression Scale, Internalised Stigma of Living in a Care Home Scale, Thai Version of Rosenberg Self-Esteem Scale, Thai Version of Multidimensional Scale of Perceived Social Support and a Coping Strategies Inventory Short Form. Qualitative interviews were conducted with 30 older residents and 20 care home staff purposively sampled from both care homes. Non-participant observation was conducted in various public spaces of the care homes in both care homes for one month. Quantitative data was analysed using the Statistical Package for Social Science (SPSS) IBM PASW Version 22.0 for Windows. Thematic analysis was used to analyse the qualitative data. Results: Depressive symptoms were significantly correlated with internalised stigma, self-esteem and social support (r= 0.563, -0.574, -0.333; p< 0.001), respectively. Perceived internalised stigma of living in a care home was the strongest predictor of care home residents reporting depressive symptoms (odds ratio=9.165). In addition, the qualitative research explained the dynamics of the process of stigma related to three elements: the causes of stigma, the manifestation of stigma and the mitigating factors. Negative beliefs about care homes and people who live in them, coupled with negative attitudes and stereotypes toward older people, are the causes of stigma which are dominated by negative societal attitudes towards care homes. In addition, care home features contributing to stigma and staff issues are negative perceptions and experiences among residents whilst living in care homes. These factors trigger residents exhibiting negative emotions and behaviours (including depressive symptoms). However, the mitigating factors help to diminish or control the manifestation of stigma. These include coping strategies, social support and activities provided in care homes. Conclusion: Older adults who perceived high internalised stigma of LiCH were over nine times as likely to report experiencing depressive symptoms. This was related to the dynamics of the process of stigma with three elements (the causes, the manifestation and the mitigating factors of stigma). The causes of stigma are the factors creating the negative emotions and behaviours among residents living in Thai care homes. In addition, the mitigating factors help to diminish the manifestations of stigma. The most compelling need to improve the physical and mental wellbeing of elderly residents of care homes in Thailand is to combat the societal and cultural stigma associated with this population. This may be achieved through media collaboration, educational interventions in the care home setting and organising social activities for residents and their families.

Background/aim: Chronic low back pain (CLBP) is a variant of chronic pain and an overarching term for a diverse number of painful and benign conditions of the lower spine. Research has shown that CLBP challenges biomedical explanation and treatments and incurs passive coping strategies. Despite the enduring nature of CLBP there are few longitudinal studies. The aim of this investigation was to gain understandings of any consistencies and changes in the experiences of participants' experiences of living with CLBP. Design: A qualitative, longitudinal IP A research project that explored participants' pain experiences over two years (2005-2007). Methods: Semi-structured interviews were conducted with a purposeful sample of ten participants recruited from the waiting list of a chronic pain clinic. Each participant was interviewed prior to attendance and twice after treatment. The data were recorded and transcribed accounts were analysed using IPA. Results: The participants foreground the physicality of the pain. Further interpretive work showed that whilst participants emphasised the physicality of their condition they experienced embodied, multidimensional experiences characterised by loss. Most participants' continued to manage their pain within a biomedical model of understanding and behavioural focused coping strategies. In comparison, participants who experienced a period of painlessness due to medical interventions demonstrated a reappraisal of their situation and a trend towards adopting a wider, biopsychosocial understanding accompanied by changing coping strategies. Conclusion: The accounts revealed the relationship between the participants' painful body and self concept. For some participants, a respite from pain paralleled increasing psychosocial coping strategies and a future orientation that reflected changes in illness beliefs in the absence of a formal psychological intervention. In comparison, remaining participants continued to demonstrate a narrow repertoire of coping and loss orientation. Participants' responses to CLBP resonated with the grieving processes of bereaved individuals. Clinical implications are discussed with recommendations for future research.

The impact of pain intensity upon tasks of attention and memory was investigated, with the specific aim of evaluating differences in effortful versus automatic processing, implicit versus explicit memory, and right versus left hemisphere measures. All research participants in the study had been diagnosed with chronic pain conditions and each person completed memory and attention tasks, measures of intelligence, emotional functioning, and cognitive failures, and provided pain intensity ratings. Ratings regarding level of fatigue, quality of sleep, perceived control over pain, and perceived effect of pain on attention and memory were also obtained. With age, education, fatigue, and self-efficacy controlled, performance on the cognitive tasks was used to predict pain intensity through a series of hierarchical multiple regressions. Performance on the cognitive tasks was not able to account for a significant amount of the variance in pain intensity. Self-efficacy and fatigue were also noted as strong predictors of pain intensity among this sample. Implications are discussed in view of rehabilitation and neuropsychological assessment of persons with chronic pain, as well as clinical interventions with this population. / Graduate