The aim of the present study was to examine the prevalence of eating disorder symptoms in patients with obsessive-compulsive disorder (OCD). Additional aims were to assess whether having comorbid eating disorders could influence the treatment outcome for OCD, and if symptoms of eating disorders were reduced after treatment for OCD. The sample consisted of 93 patients with a primary diagnosis of OCD. The patients underwent assessment with the Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory, and Eating Disorder Inventory both prior to and after treatment. First, the analysis showed that the sample of OCD patients had higher prevalence of eating disorders than a population of physically active students. Moreover, the women in the sample had significantly more symptoms of eating disorders than the men. Correlational analysis showed that eating disorders did not affect the treatment outcome for OCD; the patients generally had a significant improvement of OCD symptoms. On the other hand, symptoms of eating disorders were not significantly reduced after treatment. Summarized, this study concludes that there is a high prevalence of eating disorder symptoms among patients with OCD. It further shows that comorbid eating disorders does not hinder the effect of treatment for OCD. However, as the symptoms of eating disorders persist after such treatment, an implication of the present study is that these symptoms may need closer attention.

I förarbeten till lagarna LVM och LPT framkommer det att det finns en problematik kring vården av personer som lider av både missbruk och psykisk ohälsa. Det framgår att samarbetet mellan psykiatri och socialtjänst i vissa avseende är att anse som bristfälligt och att brukarna faller mellan stolarna. Syftet med studien har varit att, genom granskning av rättskällorna, ta reda på och tydliggöra vad som ska ses som gällande rätt, för om en person med både missbruk och psykisk ohälsa ska få vård enligt LVM eller LPT. Metoden som har använts är en rättsvetenskaplig metod där fokus legat på granskning av rättskällorna. En rättsfallsstudie har även gjorts för att bredda bilden av hur rekvisiten för lagstiftningarna tillämpas. Resultatet har analyserats och redovisats utifrån den rättsdogmatiska metoden. Rättsfallen har tematiserats och redovisats i diagram. Studien visar att det finns gällande rätt kring ämnet, men att gällande rätt varierar beroende på personens situation. Huvuddraget i resultatet är att LPT vid allvarlig psykisk ohälsa bör gå före LVM. Vidare framkommer det att det inte finns något hinder, för att under en kortare period, vårdas enligt båda lagstiftningarna samtidigt. / In the preparatory works to the laws of LVM and LPT it has been pointed out that there is a problem regarding the care of persons that both suffer from an addiction as well as mental illness. It appears that the cooperation between psychiatry and social services is deficient and that the users are falling through the cracks. The purpose of the study has been, through review of the sources of law, to find out and define what is to be considered a correct, application of the law for a person that suffers from an addiction as well as a mental illness. Is it to be admitted to compulsory care and treatment according LVM or LPT? The method and material used for this purpose is the sources of law. To broaden the picture a study of court cases has also been made, regarding how the legislation is applied by a lower administrative court. The results has been analyzed and reported through the legal method. Court cases has been thematized and presented in different diagrams. The study shows that the outcome of the law varies depending on the person’s situation. The main feature of the result is that if someone is suffering from serious mental illness, LPT should be chosen instead of LVM. Further it is possible, during a shorter time, to be treated according to both LVM and LPT simultaneously.

Systemic Lupus Erythematosus (SLE) is a multi-organ autoimmune disorder that may result in death due to cardiac dysfunction. This dysfunction often occurs due to an endocarditis, known as Libman-Sacks, which presents on heart valves. The condition is hard to clinically diagnose and is often observed postmortem. Heart damage has been observed in the NP-SLE Lewis rat model positive for SLE. However, research has not been done in this model on the correlation between SLE and Libman-Sacks endocarditis. Numbers of occurrence have ranged from 3-50% in SLE patients. The presence of Libman-Sacks endocarditis should likewise occur in 3-50% of NP-SLE Lewis rats. There will be seven NP-SLE Lewis rats, five negative serum control rats, and five saline injected control rats. By performing this controlled study in rats, the correlation between SLE and Libman-Sacks will be better understood. / Department of Physiology and Health Science

Tinnitus ist eine Erkrankung mit hoher Prävalenz, welche häufig psychische Störungen nach sich zieht, Mit der Studie sollte untersucht werden, in welchen konkreten Dimensionen die gesundheitsbezogene Lebensqualität bei Tinnituspatienten eingeschränkt ist, und wie sich diese Einschränkungen während und nach Therapie, einschließlich hyperbarer Sauerstofftherapie, ändern. 120 ambulant oder stationär behandelte Patienten mit Tinnitus wurden zu drei Zeitpunkten untersucht. Eingesetzt wurden die Hospital Anxiety and Depression Scale, das Multidimensinal Fatigue Inventory und der Lebensqualitätsfragebogen EORTC QLQ-C30. Im Vergleich zu Personen der Allgemeinbevölkerung waren die Tinnituspatienten in allen Bereichen beeinträchtigt, am stärksten in den Skalen Soziale, Kognitive, Emotionale und Rollen-Funktionsfähigkeit sowie im Bereich finanzielle Schwierigkeiten. Im Laufe der Therapie verbesserten sich die Werte, so dass sich der Abstand zum Niveauder Allgemeinbevölkerung etwa halbierte.

Objective: This thesis focuses on design and evaluation of a disease prediction system that be able to detect hidden and upcoming diseases of an individual. Unlike previous works that has typically relied on precise medical examinations to extract symptoms and risk factors for computing probability of occurrence of a disease, the proposed disease prediction system is based on similar patterns of disease comorbidity in population and the individual to evaluate the risk of a disease. Methods: We combine three machine learning algorithms to construct the prediction system: an item based recommendation system, a Bayesian graphical model and a rule based recommender. We also propose multiple similarity measures for the recommendation system, each useful in a particular condition. We finally show how best values of parameters of the system can be derived from optimization of cost function and ROC curve. Results: A permutation test is designed to evaluate accuracy of the prediction system accurately. Results showed considerable advantage of the proposed system in compare to an item based recommendation system and improvements of prediction if system is trained for each specific gender and race. Conclusion: The proposed system has been shown to be a competent method in accurately identifying potential diseases in patients with multiple diseases, just based on their disease records. The procedure also contains novel soft computing and machine learning ideas that can be used in prediction problems. The proposed system has the possibility of using more complex datasets that include timeline of diseases, disease networks and social network. This makes it an even more capable platform for disease prediction. Hence, this thesis contributes to improvement of the disease prediction field. / Graduate / 0800 / 0766 / 0984 / mehrdadmansouri@yahoo.com

Denna studie undersökte samsjuklighet mellan smärta och social ångest i en smärtpopulation genom klusteranalys. Syftet var att undersöka om det fanns en undergrupp bland smärtpatienter som skattade högt på social ångest samt högt på upplevd invalidering före och efter smärtbehandling. Syftet var vidare att se om denna undergrupp skattade annorlunda vad gäller funktion jämfört med smärtpatienter med låg grad av social ångest samt se hur individer rörde sig mellan kluster över tid. Data bestod av självskattningsformulär från 157 smärtpatienter. Resultatet visade att det fanns en undergrupp som skattade högt på social ångest och upplevd invalidering. Individer i denna undergrupp hade lägre funktion innan såväl som efter behandling och tenderade att stanna kvar i de undergrupper som skattade högt på social ångest. / Comorbidity between pain and social anxiety in a sample of chronic pain patients was examined with cluster analysis. The purpose was to examine if there was a subgroup among pain patients that scored high on social anxiety and perceived invalidation before and after pain treatment. An additional purpose was to analyze if this subgroup scored differently on functioning compared to other pain patients and to explore movements between clusters over time. Data was based on self-report questionnaires from 157 pain patients. The results revealed an existing subgroup which scored high on social anxiety and perceived invalidation. The clusters with high social anxiety showed a lower level of functioning before and after pain treatment. These individuals tended to remain in the clusters scoring high on social anxiety over time

Objective: Past research indicates that comorbid anxiety and depression in youth is associated with greater functional impairment than anxiety alone. To elucidate those factors which may increase vulnerability to depressive disorders, the current study examined several clinical correlates (i.e., feelings ratings, parental psychopathology symptoms, and family functioning) of comorbid depressive symptoms in young anxious children. Method: Sixty-eight children, aged 6 to 10 years (M = 9.06, SD = 1.10), and caregivers completed measures assessing child depressive symptoms. Furthermore, children completed self reports of anxiety symptoms, feelings ratings, and family functioning, while caregivers completed self reports of psychopathology symptoms and family functioning. Predictors of child depressive symptoms were examined separately for girls and boys. Results: In females, hierarchical regression analyses revealed that, after controlling for anxiety, higher sadness and lower positive feelings accounted for 30% of variance in child-reported depressive symptoms. Further analyses indicated that child-reported overall family dysfunction moderated the relationship between positive feelings and depressive symptoms, such that high family dysfunction increased the risk of depressive symptoms in females with low positive emotions. In males, hierarchical regression analyses revealed that, after controlling for anxiety, higher negative/hostile feelings and child-reported overall family dysfunction accounted for 19% of variance in child-reported depressive symptoms. Further analyses of family functioning in males revealed that child-reported family cohesion and conflict were negatively and positively correlated, respectively, with depressive symptoms. Family dysfunction did not moderate the relationship between feelings ratings and depressive symptoms. The only significant predictor of caregiver-reported child depressive symptoms, for males only, was caregiver self-reported overall psychopathology symptoms. Further analyses indicated that, for males, caregiver depression and hostility symptoms correlated positively with caregiver-reported child depressive symptoms. Conclusions: Different patterns of emotion and family functioning predicted self-reported depressive symptoms in males and females. Self and caregiver reports of child depressive symptoms were not related, with only caregivers’ psychopathology symptoms predicting their reports of child depressive symptoms. Results suggest the importance of assessing child-reported feelings and family dysfunction, and parental symptomatology, of clinically anxious children. To prevent future depressive disorders in these children, different targets of intervention for males and females may be warranted.

Semantic web based decision support systems represent domain knowledge using ontologies that capture the domain concepts, their relationships and instances. Typically, decision support systems use a single knowledge model—i.e. a single ontology—which at times restricts the knowledge coverage to only select aspects of the domain knowledge. The integration of multiple knowledge models—i.e. multiple ontologies—provides a holistic knowledge model that encompasses multiple perspectives, orientations and instances. The challenge is the execution-time merging of multiple ontologies whilst maintaining knowledge consistency and procedural validity. Knowledge morphing aims at the intelligent merging of multiple computerized knowledge artifacts—represented as distinct ontological models—in order to create a holistic and networked knowledge model. In our research, we have investigated and developed a knowledge morphing framework—termed as OntoMorph—that supports ontology merging through: (1) Ontology Reconciliation whereby we harmonize multiple ontologies in terms of their vocabularies, knowledge coverage, and description granularities; (2) Ontology Merging where multiple reconciled ontologies are merged into a single merged ontology. To achieve ontology merging, we have formalized a set of semantically-defined merging criteria that determine ontology merge points, and describe the associated process-specific and knowledge consistency constraints that need to be satisfied to ensure consistent ontology merging; and (3) Ontology Execution whereby we have developed logic-based execution engines for both execution-time ontology merging and the execution of the merged ontology to infer knowledge-based recommendations. We have utilized OWL reasoning services, for efficient and decidable reasoning, to execute an OWL ontology. We have applied the OntoMorph framework for clinical decision support, more specifically to achieve the dynamic merging of multiple clinical practice guidelines in order to handle comorbid situations where a patient may have multiple diseases and hence multiple clinical guidelines are to be simultaneously operationalized. We have demonstrated the execution time merging of ontologically-modelled clinical guidelines, such that the decision support recommendations are derived from multiple, yet merged, clinical guidelines such that the inferred recommendations are clinically consistent. The thesis contributes new methods for ontology reconciliation, merging and execution, and presents a solution for execution-time merging of multiple clinical guidelines.

Introduction: Studies show that women living in Sweden treated for coeliac disease have lower subjective health than other women. After showing signs of remission, adults who have coeliac disease and follow a gluten-free diet, are expected to handle the treatment without any further planned follow-up by health care. Aim: The overall aim of this thesis was to study aspects of living with coeliac disease in adults in the years beyond the diagnosis. Methods: Quantitative methods were used in Studies I, II and III. A qualitative content analysis was performed in Study IV. Results: The results show that women with coeliac disease have a lower level of well-being than men with coeliac disease. The women who have coeliac disease reported a high rate of gastrointestinal symptoms, although they followed a gluten-free diet, and they visited health care services more frequently than women who did not have coeliac disease. A low rate of gastrointestinal symptoms, a positive self-image and few comorbidity emerged as factors that positively affected well-being. Worries also seemed to be a companion of women diagnosed with coeliac disease in adulthood, typically evident when socializing with others. Conclusion: This thesis may provide evidence questioning the validity of declaring all women with coeliac disease showing a normalized intestinal mucosa to be in remission, and thus leaving them to self-management. Clinical implications: Health care professionals need to be aware of that the transition to a gluten-free life may vary for individuals. It does not seem enough to follow a gluten-free diet to reach a state of good well-being for all women. A major task for health care providers is therefore to support women with CD in reaching better subjective treatment outcomes. The results may also contribute to that health care system develops routines in order to optimise the care and treatment of these patients.

Thesis (Ph.D.)--University of Wollongong, 2007. / Typescript. Includes bibliographical references: leaf 267-323.