Thesis (M.S.)--Medical University of Ohio, 2005. / "In partial fulfillment of the requirements for the degree of Master of Science in Nursing." Major advisor: Joanne Ehrmin. Includes abstract. Document formatted into pages: vi, 125 p. Title from title page of PDF document. Title at ETD Web site: The lived experience of a family member who suffers from mental illness. Includes bibliographical references (p. 111-116).

Thesis (M.S.)--University of Michigan, 1983.

Thesis (Ph. D.)--University of Missouri-Columbia, 2005. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "May 2005" Includes bibliographical references.

Att drabbas av eller leva med kronisk sjukdom som ungdom eller ung vuxen innebär även en livslång kontakt med sjukvården. De unga har både livsdrömmar och funderingar över framtiden som kan behöva omvärderas på grund av deras sjukdom. Syftet med föreliggande studie var att belysa ungdomar och unga vuxnas upplevelse av att leva med en kronisk sjukdom. Studien genomfördes som en litteraturstudie med induktiv ansats. Fyra teman framträdde: Upplevelse av att vilja känna sig normal, upplevelse av hälsa och livskvalitet, upplevelser i relation till framtiden och upplevelse av självständighet. Det fanns en vilja hos unga med kronisk sjukdom att bli accepterad och behandlad som andra. Mental styrka och livsanpassning sågs som viktiga faktorer för hälsan. Sammanfattningsvis upplevde de unga ett varierande behov av stöd varför det behövs kunskap hos sjukvårdspersonal för att anpassa detta. Ytterligare forskning gällande problemområdets specifika åldersgrupper och ett behov av ökad kunskap på området är väsentligt för sjuksköterskan i mötet med ungdomar och unga vuxna med kronisk sjukdom. / To live with a chronic disease as an adolescent or a young adult is combined with a lifelong reliance on, and frequent contact with the healthcare system. Young people have both life dreams and thoughts of the future that may have to be revalued due to their chronic disease. The study was made as inductive literature review. The aim was to illuminate the experience of adolescence and young adult living with a chronic disease. Four themes emerged: experience of wanting to feel normal, perception of health and quality of life, experiences in relation to the future and experience of independence. The young people with a chronic disease had a desire to be accepted and treated as anyone else. Mental strength and adaption to life were seen as important factors of health. The conclusion was that young people experienced a varying need of support why it is needed knowledge among health care professionals to adapt this. Further research about this specific age group is needed and increased knowledge about this phenomenon is vital for nurses meeting adolescence and young adults with chronic disease.

Submitted by MONIQUE YNDAWE CASTANHO ARAUJO null (mo_castanho@hotmail.com) on 2016-05-17T15:06:15Z No. of bitstreams: 1 dissertação MYCA 13-05-signed.pdf: 1845562 bytes, checksum: 09cb69365609868915483407107f50dd (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-05-19T13:19:49Z (GMT) No. of bitstreams: 1 araujo_myc_me_prud.pdf: 1845562 bytes, checksum: 09cb69365609868915483407107f50dd (MD5) / Made available in DSpace on 2016-05-19T13:19:49Z (GMT). No. of bitstreams: 1 araujo_myc_me_prud.pdf: 1845562 bytes, checksum: 09cb69365609868915483407107f50dd (MD5) Previous issue date: 2016-04-29 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O aumento da expectativa de vida vem acompanhado de conseqüências econômicas e sociais, onde destaca-se o aumento das doenças crônicas e dos gastos com saúde. As doenças crônicas não transmissíveis são as principais causas de morte no mundo e estão presentes de forma mais intensa na população idosa, tendo como alguns de seus fatores de risco o tabagismo, uso de álcool, inatividade física e obesidade. Dessa forma, o objetivo da presente pesquisa foi analisar associação entre agregação de fatores/comportamentos de risco à saúde e perda de produtividade laboral e aumento dos custos com saúde em adultos atendidos no Sistema Único de Saúde. Para tanto, 342 pacientes foram convidados a fazer parte da pesquisa e foram avaliados quanto a associação dos custos com tratamento na atenção primária e perda de produtividade com fatores/comportamentos de risco como adiposidade corporal, nível de atividade física, consumo de álcool e tabagismo e com variáveis de desfecho das doenças crônicas como os distúrbios do sono e dor lombar, e ainda, às variáveis sexo e idade de aposentadoria. Os fatores/comportamentos de risco foram agregados para constituir uma única variável de risco, assim, a amostra foi subdividida em três grupos: (i) nenhum comportamento/fator de risco, (ii) 1 comportamento/fator de risco, (iii) 2 ou mais comportamentos/fatores de risco, e o grau de influência de cada fator de risco nos custos com perda de produtividade foi verificado isoladamente e agregado a outros fatores de risco. A análise estatística foi composta pelos testes de Kolmogorov-Smirnov, Levene, Kruskal Wallis para comparação de três ou mais grupos (Mann Whitney, como post-hoc quando necessário) e Mann Whitney para comparação de dois grupos, qui-quadrado, regressão logística binária e Hosmer-Lemeshow, os procedimentos foram realizados no programa BioEstat 5.0 com significância adotada em 5%. Verificou-se que não houve associação entre agregação dos fatores/comportamentos de risco e gastos na atenção primária, no entanto maiores gastos foram encontrados para as variáveis distúrbios do sono, dor lombar, idade de aposentadoria e sexo. Para os fatores de risco e as varáveis de desfecho, observou-se que tabagismo (p-valor= 0,023) e distúrbios do sono (p-valor= 0,027) se associam aos gastos com perda de produtividade por absenteísmo. Gastos com perda de produtividade por aposentadoria por invalidez foram maiores para pacientes com distúrbios de sono (p-valor= 0,004) e dor lombar (p-valor= 0,001). A agregação dos fatores de risco obesidade, sedentarismo, uso de álcool e tabagismo, esteve associada a gastos com perda de produtividade por aposentadoria por invalidez (p-valor= 0,036), e ainda, observou-se que obesidade situa o paciente no maior quartil de perda de produtividade por aposentadoria por invalidez OR= 2.47 [95%IC= 1.20 – 5.06]. Conclui-se que fatores e comportamentos de risco às doenças crônicas não transmissíveis, bem como, suas variáveis de desfecho estão associados a gastos com saúde e perda de produtividade laboral em adultos atendidos na atenção básica do sistema de saúde da cidade de Presidente Prudente/SP. / The increase in life expectancy is accompanied by economic and social consequences, which highlights the increase in chronic diseases and health spending. Noncommunicable chronic diseases are the leading causes of death worldwide and are present more intensely in the elderly, having as some of its risk factors, smoking, alcohol use, physical inactivity and obesity. Thus, the objective of this study was to analyze the association between the aggregation of factors / risk behaviors to health and productivity loss and the raise on health care costs in adults treated at the Health System. Therefore, 342 patients were invited to join the study and were evaluated concerning the association of treatment costs in public primary health care services and productivity loss with factors / risk behaviors such as body fat, physical activity level, alcohol consumption and smoking, with outcome variables of chronic diseases such as sleep disorders and back pain; moreover, the gender and age of retirement. The factors / risk behaviors were aggregated to constitute a single risk variable, so the sample was subdivided into three groups: (i) no behavior / risk factor, (ii) one behavior / risk factor, (iii) 2 or more behaviors / risk factors and the degree of influence of each risk factor in productivity loss costs was checked separately and added to other risk factors. Statistical analysis was made by the Kolmogorov-Smirnov, Levene, Kruskal Wallis tests for comparison of three or more groups (Mann Whitney as post-hoc where necessary) and Mann Whitney test for comparison of two groups, chi-square test, binary logistic regression and HosmerLemeshow, the procedures were performed at 5.0 BioEstat program at 5% significance adopted. It was found that there was no association between aggregation of factors / risk behavior and expenses in public primary health care services but higher expenses were found for the variable sleep disorders, back pain, retirement age and sex. For risk factors and outcome variables it was observed that smoking (p = 0.023) and sleep disorders (p = 0.027) are associated with expenses on productivity loss by absenteeism. Costs on productivity loss by disability retirement were higher for patients with sleep disorders (p = 0.004) and low back pain (p = 0.001). The aggregation of risk factors such as, obesity, physical inactivity, alcohol consumption and smoking was associated with expenses on productivity loss disability retirement _ (p-value = 0.036) and it was observed that obesity places the patient in the highest quartile of productivity loss due to disability retirement OR = 2.47 [95% CI = 1:20 to 5:06]. It is concluded that factors and risk behaviors for noncommunicable chronic diseases as well as their outcome variables are associated with health expenses and loss of labor productivity in adults seen in the public primary health care service in the health system of the city of Presidente Prudente / SP. / FAPESP: 2014/09645-7

Previous research indicates that elderly people want to be independent and have the opportunity to stay in their own homes for as long as possible despite chronic disease. The district nurse can, by promoting the persons ability to self-management, create conditions for the elderly to be able to live at home. In this study, a conceptual analysis of self-management was done. Self-management is a term that has no clear definition and is under development. There is no matching swedish word. The purpose was to illustrate how self-management is used in relation to elderly people living with chronic disease. The study has an inductive approach. The method is based on Rodgers' evolutionary concept analysis, a valid method for developing knowledge in nursing science. The result shows that self-management in relation to elderly people with chronic disease can imply both benefits and risks. The benefits can be increased confidence in their own ability as well as increased knowledge about the disease. The risks may be loneliness and anxiety. In summary, the study shows that research should focus on how the district nurse can contribute knowledge in order for older people to adopt self-management, but also the importance of including the negative aspects that self-management can cause. / Tidigare forskning indikerar att äldre personer vill vara självständiga och ha möjlighet att bo kvar i det egna hemmet så länge som möjligt trots kronisk sjukdom. Distriktssköterskan kan genom att främja personens förmåga till self-management skapa förutsättningar för att de äldre ska kunna klara sig hemma. Studien genomfördes som en begreppsanalys av self-management. Self-management är ett begrepp som inte har någon entydig definition och som är under utveckling. Det finns inte något motsvarande svenskt ord. Syftet var att belysa hur self-management används i relation till äldre personer som lever med kronisk sjukdom. Studien har en induktiv ansats. Metoden utgår från Rodgers evolutionära begreppsanalys, en metod för att utveckla kunskap inom omvårdnadsforskningen. Resultatet visar att selfmanagement i relation till äldre personer med kronisk sjukdom kan innebära både förtjänster och risker. Förtjänsterna kan vara en ökad tilltro till den egna förmågan samt ökad kunskap om sjukdomen. Riskerna kan vara ensamhet och ångest. Sammanfattningsvis så visar studien att forskningen framöver bör fokusera på hur distriktssköterskan kan bidra med kunskap för att äldre personer ska kunna anta selfmanagement. Det är viktigt att även inkludera de negativa aspekter som selfmanagement kan medföra.

BACKGROUND. Unhealthy lifestyle behaviours such as physical inactivity are global risk factors for chronic disease. Despite this, a substantial proportion of the UK population fail to achieve the recommended levels of physical activity. This may partly be because the health messages presently disseminated are not sufficiently potent to evoke behaviour change. There has been an exponential growth in the availability of digital health technologies within the consumer marketplace. This influx of technology has allowed people to self-monitor a plethora of health indices, such as their physical activity, in real-time. However, changing movement behaviours is difficult and often predicated on the assumption that individuals are willing to change their lifestyles today to reduce the risk of developing disease years or even decades later. One approach that may help overcome this challenge is to present physiological feedback in parallel with physical activity feedback. In combination, this approach may help people to observe the acute health benefits of being more physically active and subsequently translate that insight into a more physically active lifestyle. AIMS. Study One aimed to review existing studies employing fMRI to examine neurological responses to health messages pertaining to physical activity, sedentary behaviour, smoking, diet and alcohol consumption to assess the capacity for fMRI to assist in evaluating health behaviours. Study Two aimed to use fMRI to evaluate physical activity, sedentary behaviour and glucose feedback obtained through wearable digital health technologies and to explore associations between activated brain regions and subsequent changes in behaviour. Study Three aimed to explore engagement of people at risk of type 2 diabetes using digital health technologies to monitor physical activity and glucose levels. METHODS. Study One was a systematic review of published studies investigating health messages relating to physical activity, sedentary behaviour, diet, smoking or alcohol consumption using fMRI. Study Two asked adults aged 30-60 years to undergo fMRI whilst presented personalised feedback on their physical activity, sedentary behaviour and glucose levels, following a 14-day wear protocol of an accelerometer, inclinometer and flash glucose monitor. Study Three was a six-week, three-armed randomised feasibility trial for individuals at moderate-to-high risk of developing type 2 diabetes. The study used commercially available wearable physical activity (Fitbit Charge 2) and flash glucose (Freestyle Libre) technologies. Group 1 were offered glucose feedback for 4 weeks followed by glucose plus physical activity feedback for 2 weeks (G4GPA2). Group 2 were offered physical activity feedback for 4 weeks followed by glucose plus physical activity feedback for 2 weeks (PA4GPA2). Group 3 were offered glucose plus physical activity feedback for six weeks (GPA6). The primary outcome for the study was engagement, measured objectively by time spent on the Fitbit app, LibreLink app (companion app for the Freestyle Libre) as well as the frequency of scanning the Freestyle Libre and syncing the Fitbit. RESULTS. For Study One, 18 studies were included in the systematic review and of those, 15 examined neurological responses to smoking related health messages. The remaining three studies examined health messages about diet (k=2) and physical activity (k=1). Areas of the prefrontal cortex and amygdala were most commonly activated with increased activation of the ventromedial prefrontal cortex predicting subsequent behaviour (e.g. smoking cessation). Study Two identified that presenting people with personalised feedback relating to interstitial glucose levels resulted in significantly more brain activation when compared with feedback on personalised movement behaviours (P < .001). Activations within regions of the prefrontal cortex were significantly greater for glucose feedback compared with feedback on personalised movement behaviours. Activation in the subgyral area was correlated with moderate-to-vigorous physical activity at follow-up (r=.392, P=.043). In Study Three, time spent on the LibreLink app significantly reduced for G4GPA2 and GPA6 (week 1: 20.2±20 versus week 6: 9.4±14.6min/day, p=.007) and significantly fewer glucose scans were recorded (week 1: 9.2±5.1 versus week 6: 5.9±3.4 scans/day, p=.016). Similarly, Fitbit app usage significantly reduced (week 1: 7.1±3.8 versus week 6: 3.8±2.9min/day p=.003). The number of Fitbit syncs did not change significantly (week 1: 6.9±7.8 versus week 6: 6.5±10.2 syncs/day, p=.752). CONCLUSIONS. Study One highlighted the fact that thus far the field has focused on examining neurological responses to health messages using fMRI for smoking with important knowledge gaps in the neurological evaluation of health messages for other lifestyle behaviours. The prefrontal cortex and amygdala were most commonly activated in response to health messages. Using fMRI, Study Two was able to contribute to the knowledge gaps identified in Study One, with personalised glucose feedback resulting in a greater neurological response than personalised feedback on physical activity and sedentary behaviour. From this, Study Three found that individuals at risk of developing type 2 diabetes were able to engage with digital health technologies offering real-time feedback on behaviour and physiology, with engagement diminishing over time. Overall, this thesis demonstrates the potential for digital health technologies to play a key role in feedback paradigms relating to chronic disease prevention.

Philosophiae Doctor - PhD (School of Public Health) / Access to medicines (ATM), specifically for those medicines that are related to the priority health needs of a population has been cited as a fundamental part of universal health coverage and a key element for service delivery and high-quality care. Therefore, ensuring reliable access to and appropriate use of safe, effective and affordable medicines is one of the core functions of an effective health system. With the rising demand for treatment of chronic diseases (e.g. HIV, diabetes and hypertension), ATM has increasingly received global attention. Yet as of 2011, it was estimated that at least one third of the world's population had no regular access to medicines. Globally, there is a dearth of in-depth country level evidence to influence policy responses, coupled with inadequate understanding of how pharmaceutical systems operate within broader health systems. This thesis comprises two main parts: 1) a situational analysis of the state of chronic medicines provision in the public sector in the Eastern Cape and Western Cape provinces of South Africa; and (2) an evaluation of an existing ATM model in one province. To situate this study within the ATM discourse, a conceptual framework was developed from a review of empirical and theoretical literature. The framework incorporated six ATM dimensions (availability, affordability, acceptability, accessibility, accommodation and quality) and their interplay at multiple levels including: health facility, individual, household and community levels. Then, at a health system level, the interaction of medicines (a health system building block) with other building blocks (information, financing, human resources, infrastructure and governance).

Made available in DSpace on 2015-07-22T20:50:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-25 / Objetivo: Descrever a mortalidade (por todas as causas e por doenças cardiovasculares) e as incidências de diabetes e hipertensão entre nipo-brasileiros segundo a presença de obesidade abdominal definida a partir de diferentes medidas antropométricas. Material e Métodos: Neste estudo de coorte, utilizaram-se dados de 1567 nipo-brasileiros para o estudo de mortalidade (n = 727 para o estudo de incidência de diabetes e n = 655 para o estudo de incidência de hipertensão), com idade 30 anos e de ambos os sexos. Os indivíduos foram acompanhados por 14 anos e coletaram-se, na linha de base, informações sobre dados sócio-demográficos, de estilo de vida, metabólicos e antropométricos. Definiram-se, como variáveis dependentes (desfechos), a condição ao final do estudo (vivo versus óbito por todas as causas ou vivo versus óbito por doenças cardiovasculares) e a ocorrência de casos novos de diabetes ou de hipertensão (sim versus não). A presença de obesidade abdominal segundo cada uma das três medidas antropométricas (perímetro de cintura, razão cintura quadril e razão cintura estatura), na linha de base do estudo, foi a variável independente de principal interesse. Estimaram-se os coeficientes de mortalidade e de incidência de diabetes e hipertensão, por ponto e por intervalo com 95% de confiança. Em análise múltipla utilizou-se o modelo de Poisson para obter as razões ajustadas entre os coeficientes de mortalidade ou de incidência e a presença de obesidade abdominal. Utilizou-se, para cada sexo separadamente, a curva ROC na identificação dos pontos de corte das variáveis antropométricas com melhor capacidade preditiva dos desfechos de interesse. Resultados: O coeficiente geral de mortalidade foi de 10,68/1000 pessoas-ano e os de incidência de diabetes e de hipertensão foram, respectivamente, 20,28/1000 pessoas-ano e 49,81/1000 pessoas-ano. Observou-se, no início do estudo, elevada prevalência de obesidade abdominal (valores entre 38,5% e 74,4%). Em análise com modelo de regressão múltiplo, verificou-se que a presença de obesidade abdominal, pela razão cintura quadril, associou-se a mortalidade. Além disso, o sexo masculino, a idade 60 anos e ter hipertensão arterial foram fatores de risco independentes para a mortalidade e exercer atividade profissional foi fator de risco para o desenvolvimento do diabetes. Os pontos de corte identificados para o perímetro de cintura, razão cintura quadril e razão cintura estatura, como indicativos da presença de obesidade abdominal, especialmente entre os homens, foram menores que os propostos na literatura Conclusões: A prevalência de obesidade abdominal foi elevada entre os nipo-brasileiros e a razão cintura quadril elevada foi fator de risco independente para a mortalidade. É necessário reavaliar os pontos de corte propostos na literatura, particularmente entre os homens, considerando as diferenças na composição corporal dos distintos grupos étnicos. / Objective: To describe mortality (all causes and cardiovascular diseases) and incidences of diabetes and hypertension among Japanese-Brazilians according to the presence of abdominal obesity defined from different anthropometric measures. Methods: In this cohort study, we used in the mortality study data from 1567 Japanese-Brazilians (n = 727 in the diabetes incidence study and n = 655 in the hypertension incidence study) aged 30 years and both genders. The subjects were followed for 14 years and we collected at baseline socio-demographic, lifestyle, metabolic and anthropometric data. We defined as dependent variables (outcomes) the status at the end of the study (alive versus death from all causes or live versus death from cardiovascular diseases) and the occurrence of new cases of diabetes or hypertension (yes versus no). The presence of abdominal obesity at baseline according to each of the three anthropometric measures (waist circumference, waist-to-hip ratio and waist-to-height ratio) was the independent variable of principal interest. We estimated mortality rates and incidence of diabetes and hypertension, by point and by 95% confidence intervals. In multivariable analysis we used the Poisson model to obtain the adjusted mortality or incidence rate ratios and the presence of abdominal obesity. The ROC curve was used to identify anthropometric variables cutoff points with the best capacity to predict the interest outcomes, for each gender separately. Results: The overall mortality was 10.68/1,000 person-years and the diabetes and hypertension incidences were, respectively, 20.28/1,000 person-years and 49.81/1,000 person-years. It was noted at the beginning of the study, high prevalence of abdominal obesity (values between 38.5% and 74.4%). In analysis with multiple regression models, it was found that the presence of abdominal obesity by waist-to-hip ratio was associated with mortality. In addition, male gender, age 60 years and have hypertension were independent risk factors for mortality and work placement was a risk factor for developing diabetes. The cutoff points identified for waist circumference, waist-to-hip ratio and waist-to- height ratio, as indicative of the presence of abdominal obesity, especially among men, were lower than those proposed in the literature Conclusions: The prevalence of abdominal obesity was high among Japanese- Brazilians and waist-to-hip ratio was an independent risk factor for mortality. It is necessary to reevaluate the cutoff points proposed in the literature, particularly among men, considering the differences in body composition of different ethnic groups. / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-03T19:24:13Z No. of bitstreams: 1 DISSERTAÇÃO PAULA MENEZES. 2014.pdf: 1259105 bytes, checksum: 0b2ef0024390f3b92b7f8e7fbd062b7a (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-07T14:09:49Z (GMT) No. of bitstreams: 1 DISSERTAÇÃO PAULA MENEZES. 2014.pdf: 1259105 bytes, checksum: 0b2ef0024390f3b92b7f8e7fbd062b7a (MD5) / Made available in DSpace on 2014-10-07T14:09:49Z (GMT). No. of bitstreams: 1 DISSERTAÇÃO PAULA MENEZES. 2014.pdf: 1259105 bytes, checksum: 0b2ef0024390f3b92b7f8e7fbd062b7a (MD5) / A dor crônica vem ganhando cada vez mais relevância na prática clínica como importante fonte de sofrimento para o doente, impondo aos profissionais de saúde a necessidade de apreendê-la enquanto problema de saúde. Pelo seu caráter subjetivo, experiencial, privado e contingente a dor é um objeto deslocado dentro da Biomedicina, expondo as lacunas do conhecimento biomédico e desafiando os profissionais a lidar com a experiência de adoecimento vivenciada pelo sujeito acometido. Neste contexto, as clínicas de dor têm se configurado como espaços institucionais de cuidado que reconhecem a dor crônica. Este trabalho tem como objetivo “Analisar os sentidos atribuídos por profissionais de saúde de um Ambulatório de Dor (Ambdor) à dor crônica e ao cuidado em dor crônica”. Trata-se de um estudo com abordagem qualitativa inscrito no campo das ciências sociais em saúde. Em 2011, foram realizados dois grupos focais (GF) com profissionais de um Ambdor localizado no nordeste brasileiro. Estes GF foram filmados e transcritos. Procedeu-se a análise a partir da construção de núcleos de significação. Alguns elementos da caracterização da dor crônica, apontados pelos profissionais, desafiam a perspectiva biomédica sobre a doença, podendo estar relacionados a diversos deslocamentos nas concepções sobre o cuidado. Contudo, notamos a existência contradições presentes no processo de legitimação da doença e do doente. Por fim, a análise dos GF indicou que o tempo de experiência profissional em Clínica de Dor é um fator de influência importante para a sedimentação de mudanças nas concepções e valores sobre a dor e o cuidado em dor crônica.