No description available.

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.

This study was designed to follow up a chance observation in patients with an admission white blood cell (WBC) count showing an absolute lymphocytosis and relative neutropenia that changed to a lymphopenia and neutrophilia within 24 hours. As 15 of the 20 patients were admitted following trauma, we examined this association further by reviewing charts of 69 patients who had sustained stab wounds to the chest and abdomen. A prospective study involving 40 patients in the Intensive Care Unit was also undertaken because of the related hypothesis that the Adult Respiratory Distress Syndrome (ARDS) is associated with sequestration of complement activated polymorphonuclear leukocytes (PMN) by the lung. These studies show that trauma is frequently associated with a lymphocytosis and relative neutropenia. In cases where ARDS did develop, the onset of respiratory failure was associated with a profound fall in the circulating PMN count. To test the hypothesis that these leukocyte changes were due to catecholamine release and sequestration of PMN within the pulmonary micro-vasculature, we studied the effects of epinephrine infusion, lowered cardiac output and complement activation on WBC uptake and release from the dog lung. The data show that pulmonary blood flow has a marked effect on the uptake and release of WBC by the lung but has no effect on differential counts. Epinephrine infusion increases circulating WBC counts but also does not alter differential counts. In contrast, activation of the complement cascade alters differential values by causing preferential sequestration of PMN. We conclude that trauma is frequently associated with a lymphocytosis and relative neutropenia and speculate that this phenomenon is due to a combination of catecholamine release and sequestration of PMN within pulmonary and systemic microvasculatures. The findings that a profound fall in PMN counts occurs prior to the onset of ARDS and after activation of the complement pathway with cobra venom factor support the hypothesis that complement activated PMN play a role in the pathogenesis of ARDS. These data also suggest that prospective leukocyte counts may be a useful predictor with respect to determining which patients will develop this syndrome. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

Workplace stress has been found to be a causal agent of psychological distress consequences in employees. Chronic stressors have been well researched, in particular, role conflict, role ambiguity, and work overload have been extensively studied. A meta-analysis was conducted in order to aggregate past research to gain a better understanding of the impact these stressors have on the psychological distress consequences of depression, tension/anxiety, somatic complaints, and generalized feelings of stress. Only role ambiguity was found to be a significant contributor to psychological distress, in particular to feelings of depression and stress. In general, however, effect sizes for all three stressors were moderate to large. While chronic stressors have been well researched, acute stressors have been widely overlooked. Since research in this area is limited, the Daily Work Hassles Survey was developed and validated in order to analyze the role daily hassles play in the workplace. The survey yielded two factors, Interpersonal Hassles and Task Hassles. The former of which was found to be significantly related to the distress consequences of depression, tension/anxiety, somatic complaints, and general feelings of stress. The ultimate goal of this project was to compare chronic and acute stressors. Results from the daily hassles study were contrasted to the results of the aforementioned meta-analysis. It was found that the chronic stressors of role ambiguity, role conflict, and overload are significantly greater predictors of selected distress consequences than the acute factors of Interpersonal Hassles and Task Hassles. However, when somatic complaints was employed as the dependent variable, no significant differences were found between chronic and acute stressors.

The current review aims to unravel what is known regarding the neural substrates of empathicdistress and compassion fatigue. Empathic distress is a self-oriented feeling of anxietyexperienced in response to the suffering of another. It has been related to, and theorized to bea precursor of, compassion fatigue. This is a form of caregiver burnout received by secondaryexposure to trauma. In the current thesis, Scopus, Web of Science and PsycINFO weresearched identifying 301 articles that were subsequently screened. In the end, five studieswere included that measured either empathic distress or compassion fatigue in relation tobrain structure or function. Findings are largely inconsistent but areas involved in theory ofmind and that are important for the self-other distinction are discussed. A need for moreresearch is identified, together with a desire for conceptual clarification between compassionfatigue and burnout.

This thesis explores three important issues in financial distress and corporate bankruptcy: bankruptcy venue choice and creditor recovery, the efficiency of Chapter 11 corporate bankruptcy and distressed exchanges, and the bankruptcy ripple effect on peer firms’ investment policy. / Dissertation / Doctor of Philosophy (PhD) / This thesis explores three important issues in financial distress and corporate bankruptcy: bankruptcy venue choice and creditor recovery, the efficiency of Chapter 11 corporate bankruptcy and distressed exchanges, and the bankruptcy ripple effect on peer firms’ investment policy.

Nurses experience stress, fear and anger while they are trying to reconcile their ideals/ goals about health care with its inadequacies and abuses (Jameton, 1984:5), while at the same time trying to stay true to their convictions (Lindh et al., 2010:552). Moral distress is experienced when nurses cannot adhere to these goals (Corley, 2002:637). Conflicting moral principles, stress-provoking and contradicting demands weaken the nurse’s sense of control, power and autonomy (Lützen et al., 2010:213). The current descriptions of moral distress inadequately define the concept, and this might lead to the inconsistent use of the term moral distress. Therefore, conceptual clarity is needed. Current available instruments measure antecedents and situations causing moral distress. Therefore, an instrument measuring the attributes of moral distress is urgently needed. Such an instrument might be used in a variety of clinical departments because it is not based on department-specific situations but on the attributes of moral distress. Moral distress has a great impact on the nurse, patient care and the organization. This research used Benson and Clark’s (1982) method of instrument development as a theoretical framework. It is the aim of this study to develop and validate an instrument to measure moral distress in the clinical health care context of the professional nurse. In order to attain this aim the following objectives were set: To conduct an integrative literature review to identify antecedents, consequences, attributes and empirical indicators of moral distress; to conduct interviews to explore professional nurses’ experience of moral distress; to develop an instrument to measure moral distress in professional nurses; to validate the instrument. A qualitative and quantitative research design with explorative, descriptive and contextual strategies was used. The research process was divided into phases. During Phase One, an integrative literature review was conducted and the population included all available national and international data on moral distress in nurses/ nursing and sampling included all-inclusive sampling. Data analysis was performed through descriptive synthesis.Phase Onealso included semi-structured interviews and the population included professional nurses working in hospitals and clinics in the North-West Province. The sampling method applied was purposive sampling. Tesch’s method was used as data analysis method. During Phase Two, a content validation was conducted and the population included experts in the field of moral distress and instrument validation, and purposive sampling was applied. Data collection was done through the instrument that was developedand data analysis was the content validity index. Phase Twoalso included a qualitative evaluation which was conducted and the population consisted of professional nurses working in hospitals and clinics in the North-West Province and purposive sampling was applied. Data was collected through the developed instrument and a focus group session. Data analysis was conducted through aconsensus discussion. During Phase Three, a pilot study was conducted and the population was professional nurses working ina hospital with different departments and clinics in the Free State Province. All-inclusive sampling was applied and the instrument that was developed was used as data collection. Data analysis included: Descriptive statistics, factor analysis (exploratory, confirmatory and Bartlett’s test of spherity), Cronbach’s alpha coefficient, correlations and ANOVA. According to the results from the face-, content-, exploratory and confirmatory, discriminant- as well as divergent validity, the instrument has been shown to be valid. The Cronbach’s alpha for the Moral Distress Instrument was deemed reliable. Finally, the research was evaluated and limitations were identified. Recommendations for nursing education, -practice, research and policy were formulated. / PhD (Nursing), North-West University, Potchefstroom Campus, 2014

Nurses experience stress, fear and anger while they are trying to reconcile their ideals/ goals about health care with its inadequacies and abuses (Jameton, 1984:5), while at the same time trying to stay true to their convictions (Lindh et al., 2010:552). Moral distress is experienced when nurses cannot adhere to these goals (Corley, 2002:637). Conflicting moral principles, stress-provoking and contradicting demands weaken the nurse’s sense of control, power and autonomy (Lützen et al., 2010:213). The current descriptions of moral distress inadequately define the concept, and this might lead to the inconsistent use of the term moral distress. Therefore, conceptual clarity is needed. Current available instruments measure antecedents and situations causing moral distress. Therefore, an instrument measuring the attributes of moral distress is urgently needed. Such an instrument might be used in a variety of clinical departments because it is not based on department-specific situations but on the attributes of moral distress. Moral distress has a great impact on the nurse, patient care and the organization. This research used Benson and Clark’s (1982) method of instrument development as a theoretical framework. It is the aim of this study to develop and validate an instrument to measure moral distress in the clinical health care context of the professional nurse. In order to attain this aim the following objectives were set: To conduct an integrative literature review to identify antecedents, consequences, attributes and empirical indicators of moral distress; to conduct interviews to explore professional nurses’ experience of moral distress; to develop an instrument to measure moral distress in professional nurses; to validate the instrument. A qualitative and quantitative research design with explorative, descriptive and contextual strategies was used. The research process was divided into phases. During Phase One, an integrative literature review was conducted and the population included all available national and international data on moral distress in nurses/ nursing and sampling included all-inclusive sampling. Data analysis was performed through descriptive synthesis.Phase Onealso included semi-structured interviews and the population included professional nurses working in hospitals and clinics in the North-West Province. The sampling method applied was purposive sampling. Tesch’s method was used as data analysis method. During Phase Two, a content validation was conducted and the population included experts in the field of moral distress and instrument validation, and purposive sampling was applied. Data collection was done through the instrument that was developedand data analysis was the content validity index. Phase Twoalso included a qualitative evaluation which was conducted and the population consisted of professional nurses working in hospitals and clinics in the North-West Province and purposive sampling was applied. Data was collected through the developed instrument and a focus group session. Data analysis was conducted through aconsensus discussion. During Phase Three, a pilot study was conducted and the population was professional nurses working ina hospital with different departments and clinics in the Free State Province. All-inclusive sampling was applied and the instrument that was developed was used as data collection. Data analysis included: Descriptive statistics, factor analysis (exploratory, confirmatory and Bartlett’s test of spherity), Cronbach’s alpha coefficient, correlations and ANOVA. According to the results from the face-, content-, exploratory and confirmatory, discriminant- as well as divergent validity, the instrument has been shown to be valid. The Cronbach’s alpha for the Moral Distress Instrument was deemed reliable. Finally, the research was evaluated and limitations were identified. Recommendations for nursing education, -practice, research and policy were formulated. / PhD (Nursing), North-West University, Potchefstroom Campus, 2014

Malgré des études prolifiques sur le bien-être et la détresse psychologique, peu d'études ont testé la relation entre ces domaines de la santé mentale. De plus, il y a peu de modèles de la santé mentale qui ont été validés auprès des personnes âgées. II est essentiel de comprendre la notion de santé mentale des personnes agées étant donné le nombre important que represents cette population. Obiectifs : L'objectif de cette étude était de tester un modèle de mesure de la santé mentale chez les Canadiennes et Canadiens agés. Une validation de construit a été realisée pour les échelles de mesures du bien-être et la détresse psychologique et l'hypothèse d'indépendance des deux dimensions a été examinée. Le modèle a été testé selon le sexe et l'âge. Méthodoloqie : Les données proviennent de L'Enquête sur la santé dans les collectivités canadiennes - Cycle 1.2 - Santé mentale et Bien-être de Statistique Canada (2002). Cette étude épidemiologique transversale a été realisée auprès de 37 000 canadiens vivant dans la communauté dont 8 000 personnes de 65 ans et plus. Les échelles de mesures incluent l'Echelle de mesure des manifestations de bien-être psychologique de Masse et al. et le K10, une mesure de détresse psychologique developpée par Kessler et al. Les modèles d'équations structurales ont été testés à l'aide de la version 8.71 de LISREL. Résultats : Le modèle 2-facteur était valide pour les hommes et les femmes ages de 55 - 74 et 75 et plus. Ses résultats sont en accord avec la littérature. L'échele du bien être besoin plus d'études de validation. Des échantillons plus grands des personnes âgées ont nécessaires pour valider l'étude étant donne les méthodes utilités.

South Asian people are less likely to have their mental health needs recognised and experience inequality in access to services, compared to the White British population in the UK. Attempts through government policy to improve equality in mental health care and outcomes have had limited success. The aim of this study was to explore access to and experiences of services among people of South Asian origin living in the UK who were experiencing distress. An anonymous survey was distributed in GP surgeries and online, collecting a community sample of 103 adults who self-identified as South Asian. The survey contained questionnaires measuring distress, quality of life, acculturation and access to and experience of services for mental health. Between 33% and 50% of the sample was above the threshold for distress, depending on the measure used, while 40% reported a low quality of life. Those who were unemployed had greater levels of distress. Half of the sample had sought help for emotional problems in the past, with the majority seeking help in the NHS. Greater acculturation was associated with reduced distress and a higher quality of life. Seeking help from services was predicted by experiencing distress, being female and having a physical health problem. Clinical implications for mental health service delivery as well as the need for further research relating to the recognition of mental health problems in primary care are discussed.