The Primary Care Posttraumatic Stress Disorder (PC-PTSD) screen (Prins et al., 2003) is used by the Department of Defense to identify military members who are at increased risk of PTSD. This screen has been offered to all returning deployers since 2005. However, validation studies of PC-PTSD scores from military samples have seldom employed a significant number of female subjects and no published studies have examined it for gender bias. Ruling out bias is important because routine under-identification of PTSD risk in any group could result in hindered access to needed assessment and/or care. With the current proportion of military females historically high (Women’s Research & Education Institute, 2007), it is imperative that the PC-PTSD be analyzed to ensure measurement equivalence across gender. Using a large sample of male and female veterans returning from deployment, the validity of the PC-PTSD scores was first examined by conducting a differential item functioning (DIF) analysis across male and female subgroups. Then, using a clinical diagnosis as the criterion, both logistic regression and diagnostic likelihood ratio methods were employed to assess for differential predictive validity by gender. Finally, confirmatory factor analysis (CFA) was used to examine convergent and divergent validity in a two-factor model containing both PC-PTSD and depression screen responses. Results revealed no statistically significant gender-related DIF or differential prediction of PTSD by PC-PTSD scores. Good convergent and divergent validity were also observed in the CFA analysis. The results generally supported the continued use of the PC-PTSD with both male and female military veterans returning from deployment. Limitations of the study and recommendations for future research were discussed.

This study had three purposes: (1) to identify differential item functioning (DIF) on the PPVT-III (Forms A & B) using a partial correlation method, (2) to find a consistent pattern in items identified as underestimating ability in each ethnic minority group, and (3) to compare findings from an expert judgment method and a partial correlation method. Hispanic, African American, and white subjects for the study were provided by American Guidance Service (AGS) from the standardization sample of the PPVT-III; English language learners (ELL) of Mexican descent were recruited from school districts in Central and South Texas. Content raters were all self-selected volunteers, each had advanced degrees, a career in education, and no special expertise of ELL or ethnic minorities. Two groups of teachers participated as judges for this study. The "expert" group was selected because of their special knowledge of ELL students of Mexican descent. The control group was all regular education teachers with limited exposure to ELL. Using the partial correlation method, DIF was detected within each group comparison. In all cases except with the ELL on form A of the PPVT-III, there were no significant differences in numbers of items found to have significant positive correlations versus significant negative correlations. On form A, the ELL group comparison indicated more items with negative correlation than positive correlation [χ2 (1) = 5.538; p=.019]. Among the items flagged as underestimating ability of the ELL group, no consistent trend could be detected. Also, it was found that none of the expert judges could adequately predict those items that would underestimate ability for the ELL group, despite expertise. Discussion includes possible consequences of item placement and recommendations regarding further research and use of the PPVT-III.

Bacteria are immensely diverse and hold key-positions in essentially all biogeochemical cycles. In freshwater ecosystems, bacteria degrade and mineralize organic compounds, linking the pool of dissolved organic matter to higher trophic levels. Aware of the global biodiversity loss, ecologists have started identifying the relationship of diversity and ecosystem functioning. Central to this is the question if species can functionally replace other species, hence being functionally redundant. Functional redundancy might allow communities to maintain functioning when diversity is lost. Due to their large numbers and great diversity, bacterial communities have been suspected to harbor large amounts of redundancy. The central aim of this thesis is to investigate the coupling of diversity and ecosystem functioning of bacterial communities and to understand how environmental perturbation affects this relationship. I manipulated the diversity of complex communities by a dilution technique, and measured the performance of bacterioplankton and biofilm-forming communities at different diversities. Reduction of bacterial diversity differently affected different functions, and that the presence or absence of certain species might be causing this pattern. However, for ecosystems to function, the interplay of multiple functions, i.e. multifunctionality, has to be sustained over long periods of time. In bacterial biofilm communities reduced diversity affected multifunctionality, as reflected by extracellular enzyme activities. A continuous cultivation system was used to address the importance of diversity for resistance and resilience upon environmental perturbation. The analysis of co-occurrence of bacterial taxa showed that the communities form a dense network before the perturbation and that these patterns are disturbed by the environmental perturbation. The final chapter of the thesis presents experimental evidence for the positive effects of temporal and spatial refuges for bacterial communities and the functions they provide. Overall, I found several indications for a lower amount of functional redundancy as previously assumed and it becomes apparent from this thesis that a multifunctional perspective and the consideration of environmental heterogeneity is pivotal.

This thesis examines whether childhood family configuration influences performance on cognitive functions and health in adulthood and old age. All studies examined participants in the Betula Prospective Cohort Study aged 35 to 85 years (Nilsson et al., 1997). Study Ι established whether there are reliable effects of sibship size and birth order in a large sample of participants in adulthood and old age. The results showed that the effects previously demonstrated in children and adolescents (e.g., Belmont & Marolla, 1973; Mercy & Steelman, 1982) have a long-lasting effect and can be demonstrated in an adult sample. These studies concluded that intelligence and executive functioning decreased as the sibship size increased. Birth order, in contrast, had only influenced executive functions and working memory: earlier born siblings performed at a higher level than later born siblings. Study ΙΙ examined whether the effects of sibship size and birth order can be replicated and extended to episodic memory and whether the effects of family configuration are stable over a five-year interval. The results showed that early born siblings and siblings belonging to a smaller sibship size performed at a higher level and that these effects on both recall and recognition were stable over a five-year interval. Study ΙΙΙ explored whether childhood family configuration influences chronic adult diseases (myocardial infarction and circulatory disorders, stroke, and hypertension). The overall results showed that being born in a large sibship is a risk factor for stroke, myocardial infarction /circulatory disorders, and hypertension in old age. The results also suggest that being born early in a sibship is a predictor of stroke.

The goal of the study was to understand the nature of the relationship among self construal, family functioning and sibling number in terms of gender. Five hundred twenthy-nine high school students participated in the study. Participants were selected from seven general public high schools in Ankara. Data was gathered via Personal Information Questionnaire, Autonomous-Related Self in the Family Scale (Kagit&ccedil / ibagi, 2007a) and Family Assessment Device (Epstein, Balwin &amp / Bishop 1983). Results of the study indicated that, for both genders, relational selfconstruals had significant correlations with healthy family functioning. It was also evidenced that autonomous self-construal scores of males were significantly higher than females and related self construal scores of females were significantly higher than males. Furthermore the family functioning dimensions that families tend to be v healthy or unhealthy were displayed. All findings were dicussed in line with the relevant literature.

Objective. The overall aim of this thesis was to evaluate the biopsychosocial consequences after stroke and test the validity of the ICF Core Sets for Stroke during one year post-stroke. Material and Methods. Studies I, II and III were based on data from a prospective cohort study with 120 stroke survivors who were recruited at admission to stroke units in western Sweden and were followed-up at six weeks, three months and one year after stroke event. Repeated assessments were done through face-to-face interviews consisting of a battery of questions based on the Stroke ICF Core Set (59 categories of Body Functions, 59 of Activities and Participation and 37 of Environmental Factors) and several questionnaires (EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self administered Comorbidity Questionnaire (SCQ), information on health care and social services utilization and spouse support). Study IV was based on data from the multi-center cross-sectional validation study of the Stroke ICF Core Set with 757 stroke survivors from China, Germany, Italy and Sweden. Results. Study I: A total of 28 of 59 ICF categories of Body Functions and a total of 41 of 59 categories of Activities and Participation were significant problems for stroke survivors at six weeks and three months. These categories showed a good discriminative ability to distinguish between independent (≤ 2 on modified Ranking Scale (mRS)) and dependent (> 2 on mRS) stroke survivors. Study II: Most stroke survivors felt satisfied with their stroke care and rehabilitation during three months post-stroke. Frequently perceived environmental facilitators could be documented with eleven of 37 ICF categories of Environmental Factors. Only physical geography, such as hills, was a common perceived barrier. Study III: Independent factors of health-related quality of life (HRQoL) varied over time. Almost all variance in HRQoL was explained by categories within Body Functions and within Activities and Participation during the first three months, while at one year only half of the variance could be explained by categories within either Body Functions or Environmental Factors. Problems with personal and energy functions, as well as limited recreational activities, were recurringly associated with poorer HRQoL. Study IV: It was possible to integrate ICF categories of Body Functions and Structures, Activities and Participation into a cross-cultural measurement with good reliability providing summary scores of the overall functioning of stroke survivors. However, the five-point ICF qualifier scale was not consistently applicable. Conclusions. The results of the present thesis showed that the ICF,particularly the ICF Core Set for Stroke, was a valid and practical tool for documenting the multi-faceted biopsychosocial problems and consequences after stroke structured with one common terminology throughout the long chain of care and rehabilitation. The opportunity to integrate ICF categories of Body Functions and Structures, Activities and Participation into a measurement provides new possibilities for monitoring, following-up and comparing overall functioning after stroke. / Syfte. Avhandlingen i sin helhet syftade till att fastställa de mångfaldiga biopsykosociala konsekvenserna under ett års tid efter stroke med hjälp av ICF och att testa validiteten av det nyetablerade Stroke ICF Core Set med avsikt att mäta funktionstillstånd efter stroke. Material och metod. I studie I, II och III ingår data från en ett års prospektiv kohortstudie med 120 personer med stroke som vårdades på strokeenheter i Västsverige och somföljdes upp efter sex veckor, tre månader och efter ett år. Datainsamlingen genomfördes med intervjuer som bestod av ett batteri av frågor grundat påStroke ICF Core Set, EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self-administered Comorbidity Questionnaire (SCQ), och information om insatser från hälso- och sjukvård, socialtjänst och familj. I studie I analyserades de 59 ICFkategorierna gällande Kroppsfunktioner och de 59 kategorier gällande Aktivitet och Delaktighet deskriptivt vid sex veckor och tre månader efter stroke. Därutöver prövades core sets förmåga att skilja mellan personer som var antingen beroende eller oberoende av hjälp efter stroke. Hur deltagarna uppfattade omgivningsfaktorernas betydelse analyserades deskriptivt utifrån de 37 ICF kategorierna från Omgivningsfaktorer i studie II vid sex veckoroch tre månader liksom skillnaderna mellan deltagarna som var hemma redan vid sex veckor och deltagarna som kom hem senare men inom tre månader. I studie III identifierades faktorerna av generell hälso-relaterad livskvalitet (EQ-5D visuell analog skala) med hänsyn till den biopsykosociala mångfaldigheten av hälsan och huruvida faktorerna ändrades under ett år efter stroke. Till detta användes korrelation- och regressionsanalys och de 155 ICF kategorier gällande Kroppsfunktioner, Aktivitet och Delaktighet samt Omgivningsfaktorer. Den pyskometriska analysen i studie IV baserades på datamaterial från WHO:s internationella multicentertvärsnittsstudie för validering av Stroke ICF Core Sets där 757 personer med stroke från Kina, Tyskland, Italien och Sverige ingår. Möjligheten att integrera 15 ICF kategorier från Brief ICF Core Set for Stroke (6 kroppsfunktioner, 2 strukturer, 7 aktiviteter och delaktighet) med dess 5-stegsbedömningsskala (från 0 till 4, inget, lätt, måttligt, stort och totalt problem) undersöktes både nationsspecifikt men också tvärkulturellt med Raschanalys. Resultat. Studie I. Signifikanta problem kunde dokumenteras med 28 ICF kategorierfrån komponenten Kroppsfunktion och med 41 ICF kategorier frånkomponenten Aktivitet och Delaktighet. Det fanns inga skillnader mellan 6veckor och 3 månader. Kategorierna hade en god förmåga att skilja mellan personer som var antingen oberoende eller beroende av hjälp efter stroke. Personer som var beroende av hjälp hade kontinuerlig mera problem inom området som gällde framförallt förflyttning, personlig vård och urinering men även kommunikation. Studie II. Deltagarna uppfattade elva omgivningsfaktorer som underlättande vid sex veckor och vid tre månader (framförallt familj, vänner och hälso- ochsjukvårdspersonal men också hjälpmedel, medicin och hälso- och sjukvårdsservice) och endast en faktor (fysisk geografi, dvs. backe, grusvägar, etc.) som hindrande. Vid tre månader uppfattades de sistnämnda faktorerna vanligare som hindrande än vid sex veckor. Vården på strokeenheten upplevdes något bättre jämfört med den senare tillkomna servicen från primär- och kommunvård. Studie III. Medan kroppsfunktioner och aktiviteter och delaktighet kunde förklara nästan all varians av självupplevd hälsa under de första tre månaderna (R2=0.80 - 0.93), så kunde bara hälften av variationen förklaras antingen med kroppsfunktioner eller med omgivningsfaktorer (R2=0.51). Problem med fritidsaktiviteter, personlighet, mental uttröttbarhet ochgångförmåga var återkommande problem som var relaterat till sämre självupplevd hälsa under året efter insjuknandet. Studie IV. Efter justeringar som innebar en minskning av bedömningsskalan till mellan två till tre svarsalternativ för vissa kategorier och en borttagning av några kategorier som inte passade in i Raschmodellen visade de resterande ICF kategorierna en bra täckning av personernas funktionstillstånd efter stroke och en god reliabilitet för att mäta funktionstillstånd. I den tvärkulturella analysen fanns det fyra kategorier sominte hade samma betydelse i de olika länderna. Därför utformades nationsspecifika kategorier. Det slutliga tvärkulturella instrumentet omfattar 20 ICF kategorier. Därmed blir det möjligt att integrera olika ICF kategorier till ett instrument och summera bedömningsvärden av de olika kategorierna till ett helhetsvärde för funktionstillstånd som underlättar uppföljning av och jämförelse mellan personer med stroke men även jämförelse mellan olika nationer. Slutsats. Studierna visar att ICF, och särskilt det specifika Stroke ICF Core Set, är ett valid och praktiskt verktyg för att strukturerat kunna dokumentera de mångfaldiga problemen och konsekvenserna efter stroke enhetlig genom hela förloppet av vårdkedjan. Strokesjukvården i Sverige upplevs som välfungerande men en god förbättringspotential finns framförallt i senare skede när primär- och kommunvård ta över ansvaret för personernas vård och rehabilitering. För dokumentation av funktionstillstånd av den typiska äldre patienten med stroke kan de 166 ICF kategorierna reduceras till 92. Faktorer som påverkar hälsorelaterad livskvalitet varierar under tiden efter insjuknandet där kroppsfunktioner och aktiviteter och delaktighet är starkt relaterade under de första tre månaderna. Vid ett år efter insjuknandet har omgivningens betydelse ökat för hälsorelaterad livskvalitet. Tidig hänsyn inte bara till gångförmåga men också till problem med personlighet och temperament, mental uttröttbarhet och återgång till fritidsaktiviteter borde kunna förbättra personernas livskvalitet efter stroke. Att konstruera ett tvärkulturellt instrument i syfte att mäta funktionstillstånd efter stroke genom integrering av ICF kategorier som omfattar kroppsfunktioner, strukturer, och aktiviteter och delaktighet är möjligt. Därmed öppnas nya potentialer för att kunna följa upp och jämföra funktionstillstånd efter stroke inte enbart på individ- och nationell nivå men även på populations- och internationell nivå. Den 5-stegs bedömningsskala (ICF qualifier) är dock inte psykometrisk användbart och fortsatt forskning behövs.

Det finns mycket forskning kring hur individer med Parkinson har möjlighet att förbättra sina fysiologiska funktioner genom träning. Det finns dock få studier som beskriver upplevelser av träningen. Syftet med denna studie var att beskriva upplevelser av sjukgymnastledd gruppträning hos individer med Parkinson och undersöka hur resultatet överensstämde med domänerna i Internationella klassifikationen av funktionstillstånd, funktionshinder och hälsa (ICF). En kvalitativ deskriptiv innehållsanalys tillämpades. Fem deltagare medverkade i studien. En intervjuguide sammanställdes, intervjuerna transkriberades och tolkades. Slutligen sammanställdes resultatet i en tabell med kategorier, subkategorier och koder. Ytterligare en tabell utformades för att redovisa resultatet enligt ICF:s domäner. Det framkom i studien att en sjukdomsspecifik grupp möjliggjorde en trygghet och en social samhörighet. Vidare placerades majoriteten av resultatet inom ICF:s domäner aktivitet/delaktighet samt omgivningsfaktorer, vilket belyste att de psykosociala faktorerna föreföll prägla deltagarnas uppfattningar i större omfattning än de fysiska.

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.

Trauma research has been predominantly focused on the study of the negative psychological sequelae of traumatic experience. Recently, however, increased empirical attention has been paid to the potential for positive changes, or posttraumatic growth, derived from survivors’ struggle with trauma. There is evidence accumulating in support of this phenomenon following various types of traumatic events. Using an online, cross-sectional design, the present study examined posttraumatic growth among 143 survivors of interpersonal violence. Furthermore, the relationship between posttraumatic growth and the severity of psychological distress symptoms, as well as between growth and hope was explored. Results indicated that the severity of depressive symptoms was negatively related to growth, while the severity of posttraumatic stress disorder symptoms and hope were found to positively predict growth. Associations between posttraumatic growth and demographic and interpersonal violence characteristics did not emerge. The potential implications of these findings and directions for future research are discussed.

Knowledge of the literature pertaining to patterns of performance in normal individuals is essential if we are to understand intraindividual variability in neurocognitive test performance in neuropsychiatric disorders. Twenty-five healthy individuals with a high-level of education were evaluated on a short neuropsychological battery which spanned several cognitive domains. ---Results indicated that cognitive abilities are not equally distributed within a sample of healthy, high-level functioning individuals. This may be of interest to neuropsychologists who might base clinical inference about the presence of cerebral dysfunction, at least in part, on marked variation in a patient’s level of cognitive test performance. The practice of deductive reasoning in clinical neuropsychology may be prone to false-positive conclusions about cognitive functioning in neuropsychiatric disorders where base-rates of cognitive impairments are low and pre-existing educational achievements are high.