The aim: To examinate depressive symptoms among heart failure patients. Another aim was to examinate the differences in depressive symptoms between gender and between heart failure patients and the population. METHOD: The self-assassment formula MADRS was answered by twenty patients with heart failure at the University hospital in Uppsala. MAIN RESULT: Among the participants 31,3 % showed diffrent levels of depressive symptoms. Mild depression was more common in women. Moderate depression was exclusively shown among the female participants, while severe depression only was shown in one man. The result suggested that heart failure patients have more depressive symptoms than the population. CONCLUSION: A large proportion of the patients with heart failure showed signs of depressive symptoms. This was particulary shown in the women. The results suggest that heart failure patients exhibit more depressive symptoms than the population.

Depressive symptoms are common in patients with heart failure (HF) and adversely affect mortality, morbidity, and health-related quality of life. Cognitive therapy (CT) has been proposed as a non-pharmacological treatment for depressive symptoms in patients with HF. However, there is currently little evidence to support use of CT in patients with HF. The purpose of this dissertation was to develop and test a brief, nurse-delivered CT intervention for the treatment of depressive symptoms in patients with HF. Prior to testing the intervention, preliminary work was conducted resulting in four manuscripts: 1) a review of the evidence for CT in treating depressive symptoms in patients with cardiovascular conditions, 2) a description of living with depressive symptoms in patients with HF and strategies that could be used to manage these symptoms, 3) a review of measures of negative thinking and the identification of a measure of negative thinking that can be used in patients with HF, and 4) an evaluation of the psychometric properties of this measure. Based on information from these manuscripts, a randomized, controlled pilot study was conducted to test the effects of a brief CT intervention on outcomes of hospitalized patients with HF who report depressive symptoms. Forty-two hospitalized patients with HF with mild-moderate depressive symptoms were randomized to a brief CT intervention focused on reducing negative thoughts with thought-stopping and affirmations, or to usual care control. Both groups experienced improvements in depressive symptoms, health-related quality of life, and negative thinking at one week and three months. However, the intervention group experienced longer cardiac event-free survival and fewer cardiovascular hospitalizations and emergency department visits at three months when compared to the control group. This dissertation has fulfilled an important gap in the evidence base for depression treatment in patients with HF by demonstrating that a nurse-delivered, brief CT intervention may improve cardiac event-free survival in patients with HF. This brief CT intervention is replicable, practical, can be delivered by acute care nurses, and may improve clinical outcomes in patients with HF. Additional research is needed to determine the effects of the intervention on long-term outcomes in patients with HF.

Adolescence heralds a unique period of vulnerability to depressive symptoms. The current study examined relational victimization, targeting adolescents’ interpersonal relationships, as a unique predictor of depressive symptoms in a broad age range of adolescents. Past research shows that interpersonal resources—particularly emotional support—are negatively related to depression. In this study, the moderating effects of emotional support from mothers, fathers, and peers on the association between relational victimization and depressive symptoms were investigated. As expected, high levels of maternal and peer emotional support buffered the association between relational victimization and depressive symptoms. Emotional support from fathers did not moderate this relationship. Findings also suggest that while support from peers is protective against concurrent depressive symptoms, it can be detrimental to adolescent’s mental health over time. In contrast, maternal emotional support buffers future depressive symptoms associated with past experiences of relational victimization.

Among several difficulties associated with immigration, acculturation process has been recognized as one of the main stressors and one of the major risk factors associated in the incidence of mental disorders. The strategies adopted by individuals to deal with the acculturation process appear to be predictive of different mental health outcomes. This exploratory study investigated the relationship between acculturation strategies and the occurrence of symptoms of depression in the context of the Brazilian immigrant community living in the Greater Toronto Area. The results demonstrated that Separation and Assimilation were the predominant strategies for this sample and that acculturation strategies failed to serve as significant predictors of depression scores. However, participants with Separation as their predominant acculturation strategy exhibited higher depressive symptom endorsement. The significance of these findings in the context of previous research as well as its implications for future research and critical multicultural practice in mental health are discussed.

Thesis (Ph.D.)--Indiana University, 2008. / Title from screen (viewed on August 27, 2009). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Tamilyn Bakas, Joan Kessner Austin, Susan M. Perkins, Susan J. Pressler, Linda S. Williams. Includes vita. Includes bibliographical references (leaves 219-236).

Adolescence heralds a unique period of vulnerability to depressive symptoms. The current study examined relational victimization, targeting adolescents’ interpersonal relationships, as a unique predictor of depressive symptoms in a broad age range of adolescents. Past research shows that interpersonal resources—particularly emotional support—are negatively related to depression. In this study, the moderating effects of emotional support from mothers, fathers, and peers on the association between relational victimization and depressive symptoms were investigated. As expected, high levels of maternal and peer emotional support buffered the association between relational victimization and depressive symptoms. Emotional support from fathers did not moderate this relationship. Findings also suggest that while support from peers is protective against concurrent depressive symptoms, it can be detrimental to adolescent’s mental health over time. In contrast, maternal emotional support buffers future depressive symptoms associated with past experiences of relational victimization.

Made available in DSpace on 2016-08-03T16:34:34Z (GMT). No. of bitstreams: 1 Mara Regina Manoeiro Cabral.pdf: 359442 bytes, checksum: 71806cf12d45f097b9353e05b1e08b11 (MD5) Previous issue date: 2006-08-15 / Fibromyalgia is a syndrome of unknown aetiology with diffuse, widespread and chronicle pain. The diagnosis of the fibromyalgia should be made in agreement with the American College of Rheumatology (ACR) 1990 criteria. The patient should present diffuse pain for more than three months and feel the touch of the physician in at least 11 of 18 sensitive points, called "tending points" that characterizes the syndrome. Most of the patients with it are women, and the pick of age incidence in the occasion of the diagnosis is between 40 and 50 years. The chronic pain promotes a quality impact in the people s life; reducing his/her self-esteem, isolating them of the social relationship and allowing them loose the control of their thoughts and feelings. Depressive symptoms can be the result of the organic dysfunction, associa- ted with the limited conditions of daily activities. The objective of this study is to investigate the presence of depressive symptoms and to analyze the impact of the same ones about on the quality of the patients life with SF. Thirty women, in service from October to November of 2005, were selected with diagnosis of SF and answe- red two questionnaires: Inventory of Depression of Beck, to investigate the presence of depressive symptoms and SF-36 - Medical Outcome Survey Short Form -36, to evaluate the life quality.The statistical results obtained by the program SPS show that the depressive symptoms are responsible for the quality impact in these people's life, mainly in the following aspects: physical, social, mental health, vitality and general health. The analysis of the data suggests that the depressive symptoms can influence in the women life quality with fibromyalgia negatively, because it increases the sensation of physical incapacity, reduces the quality of the social relationships and increases the pessimism, the fatigue and the discouragement / Fibromialgia é uma síndrome de etiologia desconhecida com dor difusa, generalizada e crônica. O diagnóstico da fibromialgia deve ser feito de acordo com o critério do American College of Rheumatology (ACR) 1990. O paciente deve apresentar dor difusa por mais de três meses e relatar dor à palpação em pelo menos 11 de 18 pontos sensíveis, chamados de tender points , caracaterizando assim a síndrome. A maioria dos pacientes acometidos são mulheres, e o pico de incidência etária na ocasião do diagnóstico está entre 40 e 50 anos. A dor crônica promove um impacto na qualidade de vida dessas pessoas, diminuindo sua auto-estima, isolando-as do convívio social e fazendo com que percam o controle dos seus pensamentos e sentimentos. Sintomas depressivos podem ser o resultado da disfunção orgânica, associada às condições de limitação das atividades diárias.Este estudo tem como objetivo investigar a presença dos sintomas depressivos e analisar o impacto dos mesmos sobre a qualidade de vida das pacientes com SF. Foram selecionadas 30 mulheres com diagnóstico de SF, em atendimento no período de outubro a novembro de 2005, as quais responderam a dois questionários: Inventário de Depressão de Beck, para investigar a presença de sinto- mas depressivos e o SF-36 Medical Outcome Survey Short Form -36, para avaliar a qualidade de vida. Os resultados obtidos na estatística pelo programa SPS demons- tram que os sintomas depressivos são responsáveis pelo impacto na qualidade de vida dessas pessoas, principalmente nos domínios: aspectos físicos, aspectos sociais, saú- de mental, vitalidade e saúde geral. A análise dos dados sugere que os sintomas depressivos podem influenciar negativamente a qualidade de vida das mulheres fibromiálgicas, pois aumenta a sensação de incapacidade física, diminui a qualidade das relações sociais, aumenta o pessimismo, a fadiga e o desânimo

abstract: This dissertation used the risk and resilience framework to examine the associations between perceived racial discrimination, family racial socialization, nativity status, and psychological distress. Regression analyses were conducted to test the links between perceived racial discrimination and psychological distress and the moderation on these associations by family racial socialization and nativity status. Results suggest, for U.S.-born adolescents, cultural socialization strengthened the relation between subtle racial discrimination and anxiety symptoms. In addition, promotion of mistrust buffered the relations of both subtle and blatant racial discrimination on depressive symptoms. For foreign-born adolescents, promotion of mistrust exacerbated the association between blatant racial discrimination and depressive symptoms. Overall, the findings revealed the detrimental effects of perceived racial discrimination on the mental health of Asian American adolescents, how some family racial socialization strategies strengthen or weaken the relation between perceived racial discrimination and psychological distress, and the different ways foreign-born and U.S-born adolescents may interpret racial discrimination and experience family racial socialization. / Dissertation/Thesis / Ph.D. Family and Human Development 2012

Este trabalho investigou a manifestação de sintomas depressivos e eventos de vida estressantes em crianças e adolescentes, através de três estudos. No primeiro estudo, verificaram-se os sintomas depressivos, a freqüência e o impacto de eventos adversos de forma transversal, em 257 jovens, de ambos os sexos, de 7 a 16 anos, sendo que 130 residiam em abrigos de proteção governamentais e não governamentais e 127 moravam com suas famílias na região metropolitana de Porto Alegre. Foram utilizados o Inventário de Depressão Infantil (CDI) e o Inventário de Eventos Estressores na Infância e Adolescência (IEEIA) para avaliar depressão e eventos estressores, respectivamente. Os resultados apontaram médias mais altas de sintomas depressivos e de ocorrência de eventos estressores no grupo institucionalizado. No segundo estudo, foi explorada a estrutura fatorial de uma adaptação do CDI, a partir de um banco de dados composto por 951 crianças e adolescentes, de 7 a 17 anos. Os dados apontaram que o instrumento apresenta características psicométricas adequadas e foi possível estabelecer normas percentílicas por sexo e faixa etária. No último estudo, longitudinal, buscou-se identificar um modelo de preditores de sintomas depressivos em participantes institucionalizados (N=127), através de uma análise de regressão linear múltipla. O modelo preditivo englobou o escore inicial de sintomas, seguido pelos eventos “Ter problemas com professores”, “Sentir-se rejeitado pelos colegas e amigos” e “Um dos pais ter que morar longe”. Destaca-se a importância de prevenir a ocorrência de eventos estressores na escola e família, bem como promover intervenções junto às crianças e adolescentes institucionalizados. / The present study verified the depressive symptoms manifestation as well as the stressful events in children and adolescents through three studies. In the first study, the depressive symptoms and the frequency and impact of adverse events were verified. A total of 257 youths of both genders, age 7-16 took part in this study. Among those, 130 lived at government and non-government protection youth shelters and 127 lived with their families in the metropolitan region of Porto Alegre. The Children's Depression Inventory (CDI) and the Stressful Events in Childhood and Adolescence Inventory (IEEIA) were used to assess depression and stressful events respectively. The results showed a significant higher mean score among institutionalized children and adolescents for both depressive symptoms and frequency of stressful events mentioned. In the second study, the factorial structure of the Children’s Depression Inventory (CDI) for 951 children and adolescents, between 7 and 17 years was explored. Data pointed out good psychometric properties and it was possible to present norms in percentiles by gender and age group. Finally, the last study aimed at identifying, with a longitudinal design, a model of predictors of depressive symptoms in the institutionalized sample (N=127) through the regression linear multiple analysis. The predictive model included the initial depressive score, followed by the stressful events “to have problem with teacher”, “feelings of peer rejection” and “one of parents ought to live so far”. It is highlighted the importance of preventing events related mainly to the school and familiar conflicts, as well as promoting interventions with vulnerable families.

Introdução: Alterações de parâmetros clinico-funcionais e parâmetros biomecânicos da marcha, são características marcantes na Doença de Parkinson (DP). Tais alterações são incapacitantes para a realização das atividades de vida diária (AVDS), pois representam um alto risco de quedas e comprometem a qualidade de vida (QV) desta população. Embora o exercício físico seja preconizado com um modelo de intervenção terapêutica eficaz para minimizar os sintomas da doença, pouco se sabe sobre os efeitos da caminhada nórdica sobre sintomas motores e não motores em pacientes com DP. Objetivo: o objetivo do presente estudo foi avaliar e comparar os efeitos de um programa de treinamento de caminhada nórdica e de caminhada livre sobre parâmetros clínico-funcionais e biomecânicos da marcha de pessoas com DP. Desenho Experimental: ensaio clínico controlado randomizado (ECR). Local da Pesquisa: Escola de Educação Física da Universidade Federal do Rio Grande do Sul e Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brasil. Métodos: Participaram deste estudo 33 voluntários, com idade acima de 50 anos, de ambos os sexos, com diagnóstico clínico de DP idiopática, com o estadiamento entre 1 a 4 na escala Hoehn e Yahr (H&Y). Voluntários com DP receberam dois tipos de intervenções: treinamento de caminhada nórdica (CN, N = 16) e caminhada livre (CL, N = 17), durante seis semanas. Com o intuito de avaliar os efeitos do treinamento, avaliações foram realizadas: Baseline: avaliação inicial pré-treinamento + préfamiliarização (T1); avaliação pós-familiarização + pré-treinamento (T2); avaliação pós-treinamento (T3). Desfechos do estudo A: Sintomas motores: estadiamento e gravidade da DP, equilíbrio (EEB), mobilidade funcional da caminhada, velocidade autosselecionada da caminhada (VAS), e índice de reabilitação (IR). Sintomas não motores: função cognitiva, sintomas depressivos e qualidade de vida. Desfechos do estudo B: Parâmetros cinemáticos (espaço-temporais e estabilidade dinâmica da caminhada) e parâmetros neuromusculares (amplitude do sinal eletromiográfico, limiar inicial e final de ativação, duração de ativação e índice de co-contração dos músculos: vasto lateral (VL), bíceps femural (BF), tibial anterior (TA) e gastrocnêmio medial (GM)). Análise Estatística: Os dados de descrição da amostra, no baseline, foram comparados aplicando-se ANOVA one-way. Os desfechos foram analisados utilizando as Equações de Estimativas Generalizadas (GEE), para a comparação entre os grupos (CN e CL) e os momentos (T1, T2 e T3). Utilizou-se um post-hoc de Bonferroni, para identificar as diferenças entre os efeitos e interações. Os dados foram apresentados em “model-based adjusted means”, e foram analisados com o software Statistical Package for the Social Sciense (SPSS) v.20.0. Adotou-se um nível de significância de α=0,05. Resultados: A intervenção proposta no presente estudo proporcionou um efeito benéfico significativo após o período de treinamento, para todos os domínios da CIF (função e estrutura corporal, atividade e relações sociais e ambientais). No estudo A, para os desfechos dos sintomas motores, houve uma redução da UPDRS III (p < 0,001), aumento nos escores da EEB (p < 0,035), incremento da mobilidade funcional da caminhada por meio da redução do TUGVAS (p < 0,001), TUGVR (p < 0,001), VAS (p < 0,001) e IR (p < 0,001), bem como para os desfechos dos sintomas não motores: aumento na função cognitiva (p < 0,046), redução dos sintomas depressivos (p < 0,001), e aumento para os domínios de QV geral (p < 0,001), físico (p < 0,037), psicológico (p < 0,019), participação social (p < 0,007) e intimidade (p < 0,033), independente do grupo de treinamento. O grupo da CN apresentou melhora, estatisticamente significativa, no domínio autonomia (p < 0,001), quando comparado ao grupo da CL. No estudo B, para os desfechos cinemáticos, houve uma redução do tempo de contato tempo de contato (TC), tempo de balanço (TB), comprimento (CP) e frequência de passada (FP) para a CN quando comparada a CL (p < 0,05). Em relação aos parâmetros neuromusculares, houve um aumento na amplitude do sinal EMG do VL e BF, redução do limiar final de ativação (offset) do VL e GM (p < 0,05), redução da ativação do VL e BF (p< 0,05) e índice de co-contração do TA e GM (p < 0,05), enquanto que o grupo da CL apresentou melhoras significativas somente na amplitude do GM quando comparado ao grupo da CN. Conclusão: Conclui-se que os programas de treinamento de CN e CL, promoveram melhora sem diferença entre os grupos, em todos os domínios da funcionalidade propostos pela CIF (estrutura e função corporal, atividade e relação social, e meio ambiente), após a intervenção proposta. Entretanto, o uso de bastões através da técnica da CN em comparação ao treinamento de caminhada sem bastões (CL), mostrou vantagens na mobilidade funcional e parâmetros neuromusculares pontuais (índice de co-contração de membros inferiores, offset dos músculos TA e GM) ao mesmo tempo em que melhorou aspectos clínico-funcionais, fundamentais para a saúde e QV dos indivíduos com DP. / Introduction: Changes in clinical, functional and biomechanical parameters of gait are remarkable features in Parkinson's disease (PD). Such changes are disabling for the performance of daily living activities (DLAs) as they represent a high risk of falls and impair quality of life (QL) in this population. Although exercise is recommended as an effective model of therapeutic intervention, to minimize the symptoms of this disease, little is known about the effects of Nordic walking on motor and non-motor symptoms in patients with PD. Purpose: The aim of this study was to evaluate and compare the effects of a Nordic and free walking training program on clinical, functional and biomechanical parameters of gait, in people with PD. Experimental Design: Randomized controlled clinical trial (RCT). Study Site: Physical Education School of the Federal University of Rio Grande do Sul and the Clinical Hospital of Porto Alegre, in Porto Alegre, Rio Grande do Sul, Brazil. Methods: The sample comprised 33 participants, aged above 50 years, of both sexes, with a clinical diagnosis of idiopathic PD, with the staging of 1-4 in the Hoehn and Yahr scale (H&Y). The participants received two types of intervention: Nordic walking training program (NW, n = 16) and free walking training program (FW, n = 17), during six weeks. Aiming to evaluate the effects of the training program, the participants underwent the tests in the following period: pre-training + prefamiliarization (T1); post-familiarization + pre-training (T2); post-training (T3). Outcomes of Study A: Motor symptoms: Staging and severity of PD, balance, walking functional mobility, self selected walking velocity, and rehabilitation index. Non-Motor symptoms: Cognitive function, depressive symptoms and QL. Outcomes of Study B: Kinematic parameters (spatiotemporal and dynamic stability of walking) and neuromuscular parameters (amplitude of the EMG signal, initial and final activation threshold, activation time and co-contraction index, of the following muscles: Vastus Lateralis (VL), Biceps Femoris (BF), Tibialis Anterior (TA), Gastrocnemius Medialis (GM). Statistical Analysis: Sample characteristics, at baseline, were compared by applying the One Way ANOVA. Outcomes were analyzed using the Generalized Estimates Equations (GEE), to compare groups (NW and FW) and moments (T1, T2 and T3). The Bonferroni post-hoc was used to identify differences between effects and interactions. Data were presented in a “model-based adjusted means”, and analyzed using the Statistical Package for Social Sciences (SPSS, v.20.0) software. A significance level of α=0.05, was adopted. Results: The intervention proposed in this study provided a significant beneficial effect after the training period, for all ICF domains (body function and structure, activity, and social and environmental relations). Regarding study A, for motor symptoms outcomes, there was a reduction in UPDRS III (p < 0,001), increase in EEB scores (p < 0,035), increase in walking functional mobility through TUGVAS reduction (p < 0,001), as well as TUGVR (p < 0,001), VAS (p < 0,001) e IR (p < 0,001) reduction. For non-motor symptoms outcomes, there was an increase in cognitive function (p < 0,046), reduction of the depressive symptoms (p < 0,001), and increase in the overall QL domain (p < 0,001), as well as in the physical (p < 0,037), psychological (p < 0,019), social participation (p < 0,007) and intimacy (p < 0,033) domains, independent of the training group. The NW group showed significant improvement in the autonomy domain (p < 0,001), when compared to the FW group. Regarding study B, for kinematic outcomes, there was a reduction in contact time (CT), swing time (ST), stride length (SL) and stride frequency (FP), for NW when compared to FN (p <0.05 ). Regarding the neuromuscular parameters, an increase in the amplitude of the VL and BF EMG signal, reduction of the final activation threshold (offset) of the VL and GM (p <0.05), reduction in the activation of the VL and BF (p <0.05) and reduction in the co-contraction index of the TA and GM (p <0.05), were found for the NW group, whereas the FW group showed statistically significant improvements only on the amplitude of GM when compared to the CN group. Conclusion: The NW and FW training programs provided improvement, without difference between groups, in all functionality domains proposed by ICF (body function and structure, activity and social relationships, and environment), after the intervention. However, the use of sticks in the technique of NW compared to the free walking without the sticks (FW training), showed advantages in functional mobility and neuromuscular specific parameters (index of co-contraction of lower limbs, offset of muscles TA and GM), improving, as well, clinical and functional aspects, that are imperative to health and QL of individuals with PD.