Background Suicidal behavior is an important global health problem affecting also significant others. Both genetic and environmental influences play an important role in the development of suicidal behavior. There is a need of interventions for family and friends after a suicide attempt. The aim of this thesis was to assess the impact of family history of suicide (FHS) and early life adversity (ELA) on severity of suicidal behavior and on level of interpersonal problems in suicide attempters. Furthermore it aimed to evaluate a DBT-based skills training program, Family Connections (FC), for relatives and friends of suicide attempters. Methods Studies I and II included 181 suicide attempters. FHS was assessed with the Karolinska Self-Harm History Interview or in patient records. ELA was assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to interpersonal violence in childhood. Suicide intent was measured with the Freeman scale. Interpersonal problems were assessed with the Inventory of Interpersonal Problems (IIP). Study III, a pilot study evaluating the effect of FC for family members of suicide attempters, included 13 participants who completed the program with pre- and post-questionnaires. The experience of burden was assessed with the Burden Assessment Scale (BAS), general wellbeing with Brief Symptom Inventory (BSI) and level of depression was assessed with Beck Depression Inventory (BDI). The Swedish scale Questions About Family Members (QAFM) was used to explore the quality of the participants’ relationship with the patient and the Quality of Life Inventory (QOLI) was used to measure satisfaction with life situation. Study IV included 132 family members, and investigated the feasibility and preliminary efficacy of FC in psychiatric care. Participants were assessed pre- and post-intervention with the following self-report questionnaires: BAS, QAFM and Five Facet Mindfulness Questionnaire. Results Male suicide attempters with FHS made more serious and well planned suicide attempts and had higher suicide risk. FHS and exposure to interpersonal violence as a child were independent predictors of suicide in male suicide attempters. Regarding interpersonal problems, suicide attempters with FHS had significantly more often an intrusive personal style, indicating that they might have an impaired ability to create stable, long-lasting relationships. In the pilot study the participants reported a significant reduction in burden, an improved psychic health and an improvement in the relationship with the patient after completing FC. In the fourth study, FC showed to be feasible and effectively implemented in a psychiatric outpatient services clinic. Regarding burden, results were in line with the pilot study, with a significant reduction in all subscales in BAS. Conclusions High-risk patients call for a consideration of both ELA and FHS in clinical suicide risk assessment. In suicide attempters at biological risk, suicide might be prevented with the early recognition of environmental risks. Further, the interpersonal problems associated with FHS may cause difficulties for suicide attempters to accept or benefit from treatment, and caregivers should take into account the characteristics of the suicide attempter´s interpersonal functioning. The results from the pilot study provide support for the need and importance of an educational program addressed specifically to family members of suicide attempters. Preliminary results support the feasibility and potential value of an implementation of FC in psychiatric open care clinics.

This thesis is a family history of Silas Molema and his three children from the late 1880s to the late 1920s. The Molemas were a family of devout Methodists and educated chiefs in Mafikeng north of British Bechuanaland (part of the Cape colony in 1895) but they held extensive landholdings across the border in the Bechuanaland Protectorate. The thesis explores education, landholding and political office as strategies through which the Molemas attempted to maintain their position of class, status and power. Chiefs perceived formal annexation by Britain in 1885 also as opportunity to pursue greater self-determination, preserve the institutions of chiefly rule, and sustain respectable livelihoods. These aspirations had come to be experienced and understood as sechuana, which was a fluid reconstruction of tradition that helped Molemas and other Bechuana notables straddle incongruous cultural spheres along a racially and ethnically diverse colonial frontier. The thesis argues that nationhood was a key identification through which Molemas and other educated Bechuana saw themselves, and considers why they imagined their nation within the British Empire. The thesis also points to the various historical transformations and private entanglements that enmeshed various conceptions of nationhood into the everyday experience of the family as an emotive and socialising institution. These sentiments of nationhood profoundly shaped this family’s self-understanding, and mediated the choices children made about work, marriage and other significant relationships. The challenge to transfer inherited privilege across generations shaped identities, intersected with the reconfiguration of the local political economy, and impinged upon structural transformations in southern Africa.

This is a compilation of 3 abstracts for the three manuscripts included in this dissertation. I. Meta-Analysis: Racial Disparities in Prostate Cancer Survival: Prostate cancer is the second leading cause of cancer-related mortality in men. Previous studies have drawn inconsistent conclusions on racial differences in prostate cancer survival. This meta-analysis was conducted to investigate the relationship between race and survival from prostate cancer. A systematic review of published articles from 1968 to 2007 assessing survival from prostate cancer among African American and White men was conducted. The search yielded 20 eligible published manuscripts. Analysis of unadjusted studies showed African American men have an increased risk of all-cause mortality (Hazard ratio (HR) = 1.47, 95% confidence interval (CI): 1.31, 1.65, P < 0.001). However, examination of adjusted studies showed no difference (HR = 1.07, 95% CI: 0.94, 1.22, P = 0.308). No statistically significant difference was observed in prostate cancer-specific survival in both analyses using unadjusted (HR = 1.11, 95% CI: 0.94, 1.31, P = 0.209) and adjusted studies (HR = 1.15, 95% CI: 0.95, 1.41, P = 0.157). There was evidence of heterogeneity that was unexplained by factors analyzed in overall survival but explained by stage in prostate cancer-specific survival. This meta-analysis concludes that there are no racial differences in the overall and prostate cancer-specific survival between African American and White men. II. Case-Control study: Association between Family History of Cancers and Prostate Cancer: Family history of prostate cancer is an established risk factor for prostate cancer. However, the relationship between family history of cancers other than prostate cancer and prostate cancer risk is inconclusive. This study sought to examine the association between family history of cancers and prostate cancer. A case-control study was conducted in which cases and controls were randomly selected from a large urology clinic in Central Virginia. Cases were 600 histologically confirmed prostate cancer patients who were diagnosed between January 2000 and December 2005, and controls were 686 patients who visited the clinic during the same period and diagnosed with urological illnesses other than cancers and prostate-related problems. Data on family history of cancers, lifestyle and demographic factors were collected. Unconditional logistic regression analysis was used to estimate the odds ratios and the corresponding 95% confidence intervals after adjustment for potential confounding factors. Multiple comparisons adjustments were made using Bonferroni adjustment. Men with family history of any cancer in first-degree relatives including parents (OR=2.42, 95% CI: 1.53, 3.84) and parents only (OR=1.90, 95% CI: 1.23, 2.94) were at increased risk of developing prostate cancer compared to men with no such family history of cancer. Significant increased risk was also observed with family history of prostate cancer in first-degree relatives (OR=2.68, 95% CI: 1.53, 4.69) and parents only (OR=3.26, 95% CI: 1.71, 6.24) compared to men with no family history of prostate cancer. Even after adjustments for multiple comparisons, the significance persisted both in first-degree relatives (OR=2.68, 95% CI: 1.16, 6.21) and parents alone (OR=3.26, 95% CI: 1.24, 8.63). No association was found with family history of other cancers including breast, colon, lung, skin, digestive tract, stomach, liver, pancreas, female cancers, urogenital, urinary bladder, brain, blood and lymph node and other cancers and risk of prostate cancer. This study demonstrated an increased prostate cancer risk for men with a family history of any cancer or prostate cancer in first-degree relatives including parents and parents alone. Health care providers need to be aware of the potential risk of family history of cancers on prostate cancer. III. Case-Control study: Association between Obesity and Prostate Cancer: Obesity is a major public health problem in the United States. Several studies have investigated the association between obesity and prostate cancer risk. However the impact of early-adult obesity on prostate cancer is not well studied. This study proposes to investigate the relationship between prostate cancer and early-onset obesity and current obesity. A case-control study was conducted to investigate the relationship between obesity and prostate cancer in a large urology clinic population in Central Virginia. Cases included histologically confirmed prostate cancer patients of all stages and grades diagnosed from January 2000 to December 2005. Controls were patients who were diagnosed with urological illness other than cancers and prostate-related problems. Self-reported data was collected on anthropometric, lifestyle and demographic factors through a mail survey. Unconditional logistic regression analysis was conducted to investigate the association between prostate cancer and early-onset obesity (BMI at age 18) and current obesity. Odds ratios and corresponding 95% confidence intervals were calculated after accounting for significant interaction terms and adjusting for potential confounding variables. This study showed statistically significant association between BMI at age 18 and prostate cancer risk in the multivariate analysis when BMI was evaluated as a continuous variable. There was a 7% decrease in the odds of prostate cancer risk for every 1 kg/m(2) increment in BMI at age 18 (OR=0.93, 95% CI: 0.87, 0.98). Analysis of BMI at age 18 as a categorical variable also showed reduced risk though statistically non-significant. Obese men (OR=0.62, 95% CI: 0.12, 3.08) and overweight men (OR=0.60, 95% CI: 0.35, 1.05) had a non-significant decreased risk of developing prostate cancer compared to normal weight men at age 18. Examination of current BMI showed a non-statistically significant decreased risk of prostate cancer when examined as a continuous variable. However, there was significant interaction between current BMI treated categorically and age. This study concludes that there is decreased prostate cancer risk associated with increasing BMI at age 18. Future large prospective studies are needed to better understand the association between early-onset obesity and risk of prostate cancer and explore the biological factors associated especially in the early ages. This document was created in Microsoft Word 2003.

Orientador: Ana Maria Fonseca de Almeida / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-09-11T21:17:22Z (GMT). No. of bitstreams: 1 Peternella_AdrianaCarnielliDeLima_M.pdf: 1199993 bytes, checksum: f6a898a6b5bf7fe3a5957402a7c84847 (MD5) Previous issue date: 2010 / Resumo: O que os jovens julgam como bom trabalho ou mau trabalho, trabalho desejável ou trabalho indesejável? Como constroem esses julgamentos? Esta pesquisa documentou as percepções de um grupo de jovens oriundos de grupos populares e estudou o processo de socialização a que estavam submetidos para tentar responder a essas perguntas. Para tanto, foram realizadas duas rodadas de entrevistas com nove jovens e seus pais quando esses tinham idade entre doze e quatorze anos. Os resultados mostram que os julgamentos são construídos em relação com a história da família, especialmente com a história de trabalho dos adultos mais próximos, e com as percepções dominantes no círculo de amizades formado principalmente no próprio bairro onde moram. A pesquisa mostrou também que essas percepções estão fortemente relacionadas com os investimentos realizados na escola e com a decisão de adiantar ou atrasar a entrada no mercado de trabalho / Abstract: What do young judge good or bad, desirable or undesirable jobs? How do the build their judgment concept? In order to answer these questions, this research documented the perceptions of a group of teenagers originated from low social classes and studied the socialization process which they were submitted. Two rounds of interviews were done with young and their parents when the teenagers were twelve and fourteen. The results shows that the judgments of the young are build based on family history, especially on labor history of closest adults, and on dominant perceptions inside the friendship circle formed by other teenagers in their neighborhood. This research shows also that these perceptions are closely related with school investments and with decision of postpone or advance the entry in the job marked / Mestrado / Educação, Conhecimento, Linguagem e Arte / Mestre em Educação

The purpose of this study was to evaluate whether the Applied Ancestry program meets its objectives of assisting at-risk youth with regard to character development. The sample consisted of 40 youth (12-17 yrs) enrolled in the Anasazi Foundation Outdoor Behavioral Healthcare program. These teens were randomly assigned to either the control (n = 22) or treatment (n = 18) group. To measure the impact of Applied Ancestry on character development the VIA Signature Strengths Survey, developed by the VIA Institute, was used. A pre-post test comparison found no difference between the two groups, however the overall negative changes in survey scores for the entire sample (N = 40) were found to be statistically significant. The negative change in scores was attributed, in large part, to participants' self-concept at the time they took the survey, with lack of humility being a key factor in pre test scores.

Type 2 diabetes mellitus (T2DM) is a disease that affects the body's ability to metabolize glucose effectively. The disease is predicted to be prevalent in over 300 million people by the year 2030. African Americans (AA) have the highest prevalence rates in the United States. Lifestyle modification and awareness of risk factors, including family history, are important aspects for prevention of developing T2DM. The purpose of this study was to understand if a family history of T2DM played an influential role in individuals making positive health behavior changes for T2DM prevention. The phenomenological study was grounded in the health belief model. Participants selected for this study were at least 18 years of age, self-identified as AA, self-reported a family history of T2DM, and were not diagnosed with the disease themselves. Transcriptions of 20 face-to-face interviews were stored and organized via a qualitative research software NVivo Version 12 for Mac and later analyzed for data outcome. Participants demonstrated a strong awareness of T2DM with an accurate definition of T2DM and explanation of signs, symptoms, and prevention. Participants recognized family history as a risk factor in only 55% of the responses. However, family history played a major role in prevention in the lives of the participants. The participants reflected on personal barriers to health behavior changes and were encouraged to incorporate better life choices in their own lives. This research offers communities, healthcare providers, and stakeholders a better understanding of the importance of family history as a risk factor to T2DM as programs are developed to mitigate health disparities in the AA community.

Family history (FH) is a risk factor for many diseases. Disease guidelines often include family history as important in assessing chronic disease risks, but the empirical evidence base to inform the routine use of family history in primary care in practice appears largely lacking. An environmental scan of how family history is represented in prevention guidelines for five conditions showed that, while family history is often included in guidelines, there is variation in the definition used, recommendation given and evidence cited. A dataset on cardiovascular health in women was analyzed to examine whether family history offers useful discrimination value above standard risk factors. Regression results showed that family history is an independent risk predictor for coronary heart disease which improves discrimination beyond classical clinical factors. However, the absolute amount of discriminatory ability alone or with other factors is moderate at best, raising issues regarding clinical utility.

Family history (FH) is a risk factor for many diseases. Disease guidelines often include family history as important in assessing chronic disease risks, but the empirical evidence base to inform the routine use of family history in primary care in practice appears largely lacking. An environmental scan of how family history is represented in prevention guidelines for five conditions showed that, while family history is often included in guidelines, there is variation in the definition used, recommendation given and evidence cited. A dataset on cardiovascular health in women was analyzed to examine whether family history offers useful discrimination value above standard risk factors. Regression results showed that family history is an independent risk predictor for coronary heart disease which improves discrimination beyond classical clinical factors. However, the absolute amount of discriminatory ability alone or with other factors is moderate at best, raising issues regarding clinical utility.

Cytochrome P450¡]CYP¡^2J2, the single member of human cytochromes P450 II J subfamily, plays an important role in the biosynthesis of biologically active cis-epoxyeicosatrienoic acids. An allelic variant named CYP 2J2*7, a relatively frequent G¡÷T substitution at position-50 relative to the transcription start site, which interrupts a critical Sp1 binding site, results in both decreased promoter activity in vitro and reduced circulating levels of CYP2J2 epoxygenase metabolites. Epoxyeicosatrienoic acid (EETs) are endogenously produced and incorporated into membrane phospholipids in the pancreas. Low concentrations of 5,6-EETs stimulate insulin secretion, whereas 8,9-, 11,12-, and 14,15-EETs stimulate glucagon secretion from the pancreas. Peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily. EETs increased PPAR-£\ and PPAR-£^ transcription activity. PPAR-£\ and PPAR-£^ play a key role in the regulation of adipogenesis, lipid metabolism, insulin sensitivity and inflammation. Thus, genetic abnormalities in the function or expression of CYP2J2, the pathogenetic of enzymes may play a role in diabetes. The present study investigates whether CYP 2J2*7 gene polymorphism can be associated with type 2 diabetes in a Chinese population. We studied 2,073 Chinese type 2 diabetes patients and 704 control subjects without. CYP 2J2*7 gene polymorphism was determined by PCR-RFLP and real-time PCR. In both study groups, the genotype frequency distributions of this polymorphism were in Hardy-Weinberg equilibrium. The CYP2J2*7 genotype distribution or allele frequencies were not different between type 2 diabetes and control subjects. Diabetics with young age of onset¡]¡Ø35 years old¡^ had a higher frequency of T variant than that of the age of onset of greater than 35 years old and controls ( GG / GT + TT = 84.2% / 15.8% vs. 90.3% / 9.7% vs. 91.3% / 8.7%¡Fp = 0.018¡Ap = 0.027 ). CYP2J2*7 genotype had a statistically significant association with age of onset ( p for trend = 0.042 ). The HOMA-IR and HOMA-£] values were significantly higher in diabetic patients with young age of onset compared to those of late onset diabetics and controls. CYP2J2*7 polymorphism was associated with HOMA-IR and HOMA-£] in diabetics with young age of onset and controls, subjects and T variants had significant higher value of HOMA-IR and HOMA-£]¡]early onset diabetics¡GGG / GT + TT = 8.9 ¡Ó 6.1 / 6.4 ¡Ó 3.8, p=0.045¡Fcontrols¡GGG / GT + TT = 2.6 ¡Ó 1.1 / 2.1 ¡Ó 0.8, p = 0.007¡^.These findings suggest that CYP 2J2*7 polymorphism may play a role in the pathogenesis of young onset type 2 diabetes and family diabetic history.

Premenstrual dysphoric disorder (PMDD) is a severe dysphoric form of premenstrual syndrome (PMS) that is included as a diagnosis for further study in the DSM-IV (APA, 2000). A primary aim of the present study was to characterize the co-occurrence of PMDD and major depression, in a sample that spans the entire range of depressive severity. The range included non-depressed controls, women meeting criteria for dysthymia, and women meeting criteria for current Major Depressive Disorder (MDD). Co-occurrence of MDD and PMDD were only statistically significant when considering Lifetime MDD. Resting frontal electroencephalographic (EEG) asymmetry has been hypothesized to tap a diathesis toward depression or other emotion-related psychopathology. Another primary aim was to assess Frontal EEG asymmetry in college women who meet criteria for Pre-Menstrual Dysphoric Disorder (n = 25) and 25 matched controls. Participants were assessed four times in a two week period. Women reporting low premenstrual dysphoric symptomatology exhibited greater relative left frontal activity at rest than did women high in premenstrual dysphoric symptomatology. These results are consistent with a diathesis-stress model for premenstrual dysphoric symptomatology. A secondary aim was to assess whether individuals with PMDD or menstrual related mood variability, but no current diagnosis of depression, have an increased family history of depression. Promising evidence of a relationship between family history of MDD and a likelihood of PMDD was discovered. A trend was found for Spectrum PMDD women: a higher rate of Family History of MDD (36%) than non PMDD women (19.6%). Ideally, resting frontal electroencephalographic (EEG) asymmetry could help us learn more about the etiology of depression and hormonal-related depression specifically, and test whether they may share etiological factors.